Health: Obstetrics and Gynaecology

Baroness Walmsley Excerpts

Monday 17th July 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is quite right to highlight the appalling tragedies involved. As she said, over 500 families could have had different outcomes if the care they had received had been different. That is worth dwelling on because every one of these incidents is a human tragedy. She highlights midwives. There are over 2,000 more midwives in the National Health Service and 6,500 in training. There has been a big increase in the number of births in recent years, so the number has had to rise. Of course, I would be delighted to meet her to discuss the training and to make sure that it is the very best available so as to avoid and, as the Secretary of State has said, to reduce the number of maternity incidences in future years.

[Baroness Walmsley (LD)]

My Lords, does the Minister agree that it is good practice to involve parents in the reviews of what went wrong during their baby’s birth? Why were only 28% of parents involved in the reviews of what went wrong? Surely it is totally unacceptable that 25% of parents were not even told that a review was taking place.

[Lord O'Shaughnessy]

I agree that parents should be involved in such reviews—as those who are ultimately most affected by these tragedies, they absolutely should be involved. It is fair to reflect that issues around maternity deaths, brain injuries and so on have been going on for a very long time, and in certain trusts there have been acute instances of tragedy. That is why, as I said, the Secretary of State is determined to halve the number of deaths and incidents. We have had a number of reports, not only the one we are discussing today but also that of my noble friend Lady Cumberlege, Better Births, in an attempt to improve the way that services are delivered.

Adult Social Care Services

Baroness Walmsley Excerpts

Thursday 6th July 2017 Lords Chamber

[Lord O'Shaughnessy]

I shall respond to the several questions that the noble Baroness asked. She is right that the CQC made that warning last year, and that is precisely why the Government have chosen to put in additional money—£2 billion extra was announced in the spring Budget—to support the social care system and provide real-term increases in funding.

It is worth pointing out that today’s report shows that 79% of care settings received a good or outstanding rating, compared with 72% last year. There are obviously differences in the kinds of settings that were inspected; nevertheless, it shows an increase in the number of good or outstanding settings.

I completely agree with the noble Baroness’s point about patient safety. I think that the phrase “the Mum test” is both accurate and evocative. Clearly, nobody wants to choose care settings that do not pass that, and any care that is inadequate is unacceptable. However, the reason we have that information about unacceptable care settings is that this Government, in coalition with the Liberal Democrats, introduced a very tough inspection regime in 2014. I believe that today’s report shows that four out of five settings that were judged inadequate on the first inspection had improved on reinspection, so the inspection regime is itself a critical part of dealing with the issue that she rightly points to.

The noble Baroness highlighted the number of beds and staffing. Around 165,000 more staff are working in the care sector, but of course care is moving more from residential homes to domiciliary settings, so the nature of care is changing there. However, more staff are going into the service and they are now being paid the national living wage.

Finally, it is fair to say that no Government have a completely unblemished record in getting to grips with the problem of funding care. The Labour Government had Green Papers, royal commissions, the Wanless review and so on; we have had other investigations. However, to go back to the beginning, the point is that we cannot wait any longer—we need to get on with this—and that is why I set out in the Queen’s Speech debate last week that the consultation that we will publish at the end of this year will look not just at an open question but at very specific proposals around floors and caps, and I hope that we will be able to build a consensus on the need to move forward.

[Baroness Walmsley (LD)]

My Lords, quality improvement is really urgent given that, as the noble Baroness, Lady Wheeler, said, one in four settings was found by the CQC either to be unsafe or to require improvements in safety. Safety is fundamental when you are looking for a setting for one of your loved ones. Given that, according to the CQC, the rate of improvement is slowing down in some settings and in others has deteriorated, does the Minister agree that a shortage of well-trained staff is at the root of this problem?

While we wait for the Green Paper, will the Government respond to the CQC’s second warning that social care is at a tipping point and inject some urgent cash into it? Many authorities, which really understand these issues, told us last autumn, when the extra money was announced, that it was really only half of what social care required to keep it at the same level, let alone improve, so some extra cash is urgently needed.

[Lord O'Shaughnessy]

I reiterate the point I made to the noble Baroness, Lady Wheeler. I completely agree that safety is paramount: it is the beginning of any good care setting. As I said, the new regime highlights issues of safety where they exist so that operators and commissioners, whether that is local authorities or whoever, can demand turnaround in those services. As I said, the response to that has been demonstrated.

I mentioned that more staff are, of course, getting the national living wage, which will continue to attract people to the sector. The noble Baroness is quite right about skills, which is why we have the skills for care programme.

It is also worth pointing out that one thing the CQC report did show, as indeed you would hope it would, is that 79% of settings provided either good or outstanding care. There is no doubting the motivations of the people who work in this sector, and we all pay tribute to them. It is about making sure that there are enough of them and that they are properly skilled. That is precisely why we have put additional money into social funding, to enable real-term increases over the next three years to address the fact that we have an ageing and growing population.

NHS: Working Conditions

Baroness Walmsley Excerpts

Wednesday 5th July 2017 Lords Chamber

[Lord O'Shaughnessy]

I join the noble Lord in paying tribute to the commitment and selflessness of NHS staff. I am of course aware of the report that he talked about. That is why we need to increase the numbers of both nurses and doctors in training, which has happened. On pay, I think we all know that everybody has had to make sacrifices as we get the public finances in order. That is well understood. My right honourable friend the Secretary of State is shortly meeting the leaders of the Royal College of Nursing, for example, but of course any decisions on pay will be made as a consequence of the reports from the independent pay review bodies.

[Baroness Walmsley (LD)]

My Lords, in the 2016 NHS staff survey, 47% of staff who responded said that staffing levels were insufficient for them to be able to do their job properly. One in five GP training places were unfilled, mental health and community nurse numbers fell by 13%, and district nurse numbers fell by 42%. Given that workload is the major reason given for staff leaving the service, how do the Government plan to increase the number of patients treated in primary care and in the community as opposed to in acute settings in hospital, as recommended by a number of authoritative reports, including that of the Select Committee of your Lordships’ House?

[Lord O'Shaughnessy]

I can only reiterate that I recognise the pressures on the workforce. That is why we are recruiting more GPs and nurses. There are more than 50,000 in training, and we are aiming to get 5,000 more GPs into the NHS over the next few years. On the noble Baroness’s point about moving treatment out of hospitals and into the community, that is one of the core drivers of the STP process, which is about reorganising care so that it happens sooner and, ideally, in a preventive way rather than after the fact.

Queen’s Speech

Baroness Walmsley Excerpts

Thursday 29th June 2017 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, this has been a fascinating debate with powerful contributions from many noble Lords. It was admirably kicked off by the passionate speech from the noble Baroness, Lady Sherlock, on poverty, public services and a fair welfare state.

Noble Lords have heard from 10 of my colleagues on these Benches whose speeches have ranged far and wide. My noble friend Lord Storey absolutely demolished the Government’s claims that they are protecting school budgets in real terms. My noble friend Lord Kirkwood talked about the importance of exploiting the talents of the whole of the UK. I hope he is right that we are becoming a kinder country. My noble friends Lady Bonham-Carter and Lord Clement-Jones talked about the creative industries and the importance of starting in schools. I often think of your Lordships’ House as being a bit like a school. However, it is clear to me that we in this place understand the importance of arts and culture because we have created so many APPGs on those subjects to enrich our own lives, not least of which, of course, is the famous parliament choir, which reaches its 17th birthday this year. So why should we deprive children of that enrichment?

My noble friend Lord Lee talked about tourism and the important contribution that it can make in helping young offenders. My noble friend Lady Benjamin talked about school gardening. As a keen gardener and somebody who established a school garden herself 40 years ago, I could not agree with her more.

My noble friend Lady Jolly talked about the effect of recent judgments on charities and about defence. My noble friend Lord Rennard asked for a new smoking strategy. My noble friend Lady Brinton talked about social care, and my noble friend Lord Addington spoke about disabilities. I was very interested in all those valuable contributions.

I shall focus my remarks today on an issue that is usually top of the list with voters in a general election. In the last election, health and social care started off as second in line to Brexit, but concerns about Tory social care policy quickly became the turning point. As it happens, I had managed to talk my way in among the Tory faithful when Theresa May did her notorious U-turn in our village hall about 100 yards from my house, so I heard first hand the announcement of the U-turn on a cap on social care payments and the vigorous denial that it was anything of the sort. As it happens, I heard Jeremy Hunt, only four days earlier at the Alzheimer’s Society conference, firmly denying the need for a cap. It was indeed a U-turn and a wobbly Monday for Mrs May.

Other measures, such as including the value of the patient’s home when they apply for help with domiciliary care costs, would put the incentive in exactly the wrong place and discriminate against dementia patients, who often need long-term care. Dementia is a disease. So is heart disease, but you do not have to sell your home for that. I call on the Minister to ensure that the Green Paper announced in the gracious Speech addresses the incentives as well as the funding and quality of the provision of social care.

It amazes me that a Government can publish a gracious Speech with so little about a public service that is in multiple crises. There is a crisis of public confidence, illustrated by a recent BMA survey that showed that for the first time more people were dissatisfied with the NHS than were satisfied with it. There is also a staffing crisis, with vacancies reaching record numbers, despite the Government’s recruitment of more doctors and nurses. A recent BMA survey found that around two-thirds of hospital doctors have experienced rota gaps in the past 12 months and that 48% of GPs reported vacancies in their practices. Clearly, with rising demand, what the Government are doing is not enough.

Your Lordships’ Select Committee report on the Long-Term Sustainability of the NHS and Adult Social Care, mentioned by the noble Lords, Lord Ribeiro and Lord Warner, among others, was very critical of the limited powers of Health Education England and the lack of leadership in the Department of Health, resulting in poor planning to provide the workforce needed to keep patients safe in the long term. The committee referred to,

“the absence of any comprehensive national long-term strategy”.

It recommended that Health Education England’s powers be substantially strengthened and criticised cuts to its funding. This is not just a matter of clinical staff. Denmark has three times as many trained radiologists per head as the UK. Such technicians are needed for cancer diagnosis and treatment and are just one example of where we fall behind other developed countries.

The NHS has always relied on international doctors to fill gaps in the medical workforce. Over the next five years, the general population is expected to rise by 3%, while the number of patients aged over 65 is expected to rise by 12% and those aged over 85 by 18%. Given that the medical needs of these patients will grow ever more complex, the demand for doctors and nurses from overseas will continue. Following our withdrawal from the EU, any future immigration system must be flexible enough to allow EU staff to fill the gaps in the health and care services, as well as in university and research sectors and in public health. So will the Government make special arrangements for the health and care workers whom we so badly need?

The Government have announced legislation for an independent health service safety investigation board, but will the Minister accept that the greatest danger to patients is a shortage of properly trained staff with high morale? Until the pay cap of 1% per year for public sector workers is removed and the service is properly funded, the results of investigations by the new body will be a foregone conclusion.

There is also a financial crisis in health and social care. The Public Accounts Committee report on financial sustainability showed that the financial performance of NHS bodies had “worsened considerably”. NHS trusts’ deficits reached £2.5 billion in 2015-16. Two-thirds of trusts were in deficit that year, up from 44% the previous year. Some 40% of mental health trusts saw their budgets actually cut. No wonder the Select Committee concluded that health and social care are underfunded and require a stable and predictable fix, not the short-term sticking plaster referred to by the noble Baroness, Lady Pitkeathley.

I see no attempt to address this in the gracious Speech. Instead, the Government’s response is the capped expenditure process, which is not transparent and in some places risks patients’ lives. I have read that cancer surgery has been cancelled in order for one trust to stay within its financial targets. In another place, £900,000 for mental health was diverted to other services in order to stay within financial targets. This makes a mockery of the commitment in the gracious Speech to ensure parity of esteem for mental health. While there is a need for the NHS to get a financial grip, there is a danger to patients if cuts are arbitrary.

There is also a mental health crisis, despite the marvellous work of my colleague in the other House, Norman Lamb. Last year it was revealed that there had been a 47% increase in detentions under the Mental Health Act compared with 10 years ago. In response, as the noble Baroness, Lady Sherlock, mentioned, the Prime Minister promised to rip up the 1983 Act and introduce new law. However, the gracious Speech instead committed to a review of existing legislation. Actually, I think that that is just as well, as many in the sector call for the Government to exercise caution. The noble Baroness, Lady Browning, was right to ask for pre-legislative scrutiny. The Royal College of Psychiatrists warns against the assumption that the rise in detentions is caused by flaws in the law. Instead, it blames lack of early intervention and of community services. I join the right reverend Prelate the Bishop of Peterborough in asking the Government to ensure that the funding for mental health services reaches them and is not diverted to other services. Timely access to preventive care, a whole-system approach and sufficient funding will do more than any legislative change ever could.

We also need more skilled staff. There has been a 10% drop in trainees for psychiatric specialisms since 2014. Some 41% of trainee psychiatrists come from abroad—the highest proportion of all the medical specialties—and that would be impacted by the £2,000 international skills charge which the Government intend to impose. If the Government are serious about mental health, they should scrap that tomorrow.

In some places, there is also a crisis of standards, according to the CQC, and there is certainly a crisis of health inequality between rich and poor. If you look at all these crises, you have to conclude that there has never been a better time for a cross-party health and care commission, as proposed by Norman Lamb MP, to engage with all interested parties to find sustainable solutions. He has already taken a cross-party initiative supported by nearly 20 MPs from other parties, and I understand that a further initiative is imminent. When opposing parties are able to agree on something like this, surely Governments should act.

Another important proposal from the Select Committee was about public health. It criticised the cuts as being short-sighted. I agreed with it when it said that prevention of preventable disease is the only hope for the NHS, but it accepted that with patient rights come patient responsibilities. But people need help and services in order to look after their own health. I did not expect legislation for this in the Speech but there is a role for health education; cultural, arts and sports facilities; food labelling; and drug, alcohol and smoking cessation services; and these need to be encouraged, not cut, during this two-year Parliament.

I was about to ask for the Secretary of State for Health to reverse the injustice of not providing abortions for women from Northern Ireland on the National Health Service. I was pleased to learn during the course of this debate in your Lordships’ House that the announcement has been made that this will be done. However, I regret that it took the threat of a defeat in another place for the Government to see that they need to do the right thing.

Finally, the Government’s hard Brexit approach cost them the big majority they were seeking. A Brexit that protects the economy is vital for funding the public services we have been debating today. However, the Government’s approach reminds me of “The Wizard of Oz”. Dorothy is happily skipping along the yellow brick road along with her three friends. I will leave your Lordships to decide which one has no heart, which has no brain, and which is the scarecrow. However, off they go, expecting to find a great wizard behind the curtain at the end of the road. But instead of a little man with a megaphone, as in the film, they will find 27 well-prepared EU officials, determined that the UK will not get as good a deal as we have now. How will the Government deal with this while protecting our public services?

Brexit: Nursing Staff

Baroness Walmsley Excerpts

Tuesday 27th June 2017 Lords Chamber

[Lord O’Shaughnessy]

I am afraid the noble Lord is mistaking cause for correlation in this instance, and let me explain why we think that is the case. The General Pharmaceutical Council introduced language testing in November 2016; it had experienced no significant drop-off in applications from EEA member countries after Brexit but before that point and a big downturn in applications after that point. So it is language testing; it also happened with the GMC as well when it introduced language testing. I know this is something that the noble Lord supports—he said as much in a debate on this very issue in 2015—because it is an issue of safety. That is why language testing has been introduced. I would like to say, however, that of course we value the work of EU staff who come here, and, indeed, all nursing staff. As the Prime Minister set out yesterday, we want them to stay and have offered a generous package to allow them to do so, and there are more EU nurses here than there ever have been.

[Baroness Walmsley (LD)]

My Lords, the Department of Health’s own modelling predicts that there will be a shortage of 40,000 nurses by 2026. My own local hospital has 60 nurse vacancies, and I am sure other noble Lords have similar examples. What do the Government propose to do to avoid the NHS becoming unsafe because of these nursing shortages, given that some nurses are already being asked to stay on at the end of 12-hour shifts in order to fill gaps in the roster?

[Lord O’Shaughnessy]

I thank the noble Baroness for giving us the opportunity to talk about the fact that we have increased the number of nurses and health visitors by nearly 5,000 since 2010. She is quite right to say that we need more of them; we have a growing and ageing population and higher expectations of what the NHS should be delivering. It is for that reason that we have a number of things in action: we have 52,000 nurses in training; we have a return to practice programme, which has already prepared 2,000 nurses to come back into the profession; and we are introducing nursing apprenticeships and nursing associates. We are not complacent about this issue—we know it is important—but there are a number of programmes in train to fill the gap that she has identified.

NHS: Shared Business Services

Baroness Walmsley Excerpts

Tuesday 27th June 2017 Lords Chamber

[Lord O'Shaughnessy]

I will answer the noble Lord’s four questions. The first was on taking advice from officials. I think the noble Lord would probably be alarmed if the Secretary of State was not taking advice from officials. That should be welcomed. It is clearly the case that he was thinking on his own, because he took the decision to follow that advice in the first instance in March, but was of the view by July that enough was known and that it was important to update Parliament before recess.

The second question was about the timing of the Statement. The noble Lord will remember that summer 2016 was a reasonably busy period after the EU referendum. The main point here is that the Statement was made before recess and was not held back until the autumn. As regards NHS Shared Business Services and the consequences for it, those consequences have been severe: it no longer has this contract and will, as my right honourable friend confirmed in another place just now, pay its share of the costs.

Finally, as my right honourable friend said, it could appear that there was a potential for conflict of interest, but in his view there was not one, because at all times—as confirmed in the NAO report—patient safety was the driving force behind the actions of the department and NHS England. It will always be the case, whatever arrangements the department has with an ALB—whether a standard agency, a joint company or whatever it is—that patient safety must come first. That was confirmed in the NAO report today.

[Baroness Walmsley (LD)]

My Lords, as I understand it, that Statement on the last day of term before the Summer Recess last year was one of 30—which implies to me that the Government consider the last day of term to be a very good day to hide bad news.

The Minister suggests that the company, or its shareholders, will have to pay its share of the costs of investigating this scandal. Can he assure us that the NHS will not be out of pocket, particularly in the light of the fact that the loss is not just financial? A lot of doctors and various officials, in both the department and trusts, have had to spend a great deal of their time looking into this—and, of course, time is money. Will this scandal actually cause the Government to be a little more cautious in future when they claim that putting health services out to private companies always gives better value to the taxpayer and the NHS?

[Lord O'Shaughnessy]

The noble Baroness will know that I was not in post at the end of last summer, so I cannot explain why there were the number of Statements that there were. I know that Governments of perhaps different hues have also tended to put out Written Statements, so I do not think any political party is entirely innocent in this regard. The point is that the information was made available to Parliament.

On the point about cost settlement, there are interested parties here and the costs need to be settled once we have got to the bottom of exactly what has happened and once those inquiries and indeed the investigations into the potential for patient harm have been settled. I underline that as yet no instances of patient harm have been discovered.

Finally, the point about privatisation is quite an important one. The noble Baroness will know that the private sector is involved in the delivery of all parts of the NHS. Breach of contract, which is what this is, and the covering up of mistakes happen in all parts of the health service—public, private, shared and all the rest of it. It is not a case of “private sector bad, public sector good”: we know that from instances like Mid Staffs and so on. The core point is that we need very strong data security standards, and that is why the Government will be responding in due course to the Caldicott review and the review of these issues by the CQC.

Health: Electronic Patient Records

Baroness Walmsley Excerpts

Thursday 27th April 2017 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, given the continued revelations of data security breaches, along with the absence of a response to last year’s report from Dame Fiona Caldicott, how do the Government intend to avoid a repeat of the fiasco several years ago over care.data? Does the Minister agree that it is vital that patients are given confidence in the security of their data so that they do not withdraw from allowing their data to be used for vital medical research?

[Lord O'Shaughnessy]

The noble Baroness is quite right that the National Data Guardian produced her report last summer. There has been the intention to reply to that report but purdah has had an inevitable impact, unfortunately. She made points in that report about the simplified process for opting out but was also clear that vital uses can be made of suitably anonymised data which benefit patients directly, particularly through medical and clinical research, and about making sure that patients know about that so that they can choose to have their data shared. It is encouraging that at the moment, only around 2% of all patients have opted to have their summary care records not shared. This suggests that when it is explained properly and there are suitable safeguards, people are happy to share their data.

Education (Student Fees, Awards and Support)(Amendment) Regulations 2017

Baroness Walmsley Excerpts

Thursday 27th April 2017 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, this is a terrible time for the Government to undertake a highly risky revision of the funding of student nurses. We are already short of nurses, as the noble Lord, Lord Clark, told us, and of course midwives, and the imminent Brexit has already made that worse with, as we have heard, a 90% drop in the number of applications from EEA nurses. In addition, we are losing nurses due to overwork and poor morale.

The Government’s so-called consultation focused only on implementation rather than looking carefully at alternative ways of funding nurse training to ensure both fairness and a stable increased supply of nurses. The excellent speech by the noble Baroness, Lady Watkins of Tavistock, clearly demonstrates that there are many different ways of doing that, and I am not convinced that the Government have taken all those proposals into account. They ought to stop in their tracks and look at all those alternatives before going ahead with this regulation. We are still waiting for information about how or whether the practice placements will be funded, wherever that is—in the NHS or in the care services. As we have heard, nurses have to do 2,300 hours in a clinical placement. This requires considerable resource input from the hospitals or care placements, and most hospitals are already in deficit. Without proper resources there is no way that the system can accommodate 10,000 extra student nurses, even if, as we all hope, the Government are right and universities do offer that many additional places.

I understand where the noble Lord, Lord Willetts, is coming from. Clearly, the tuition fees and loans system has not put off students on most university courses. However, nurses are different from other students, so it is not a given that they would respond like students on other courses to the need to take out loans and pay fees. They are more predominantly from lower socioeconomic groups and have a higher proportion of mature students with family commitments. They spend nearly half their course time in supernumerary placements in hospitals and have a higher number of contact hours and weeks than other students. That makes it more difficult for them to get a part-time job to fund their living expenses, as other students can do. Indeed, because they are not highly paid, it has been calculated that the vast majority of them—I apologise to the noble Baroness, Lady Watkins—will not have paid off their student loans over 30 years, so they will be written off. It makes me sad to have to say that but it is a fact. Some even have other student loans from other courses that they have previously undertaken. So this strategy of the Government will not necessarily save much money in total but will simply shift the debt off the books, which I suppose was the objective of the exercise.

The Government have been very hasty. Instead of arbitrarily removing the bursaries we need a thoroughgoing investigation into the factors affecting nurse recruitment and retention, because the latter is a very important factor. It is no use filling up the bucket if there is a great big hole in the bottom—and in this case there is. Retention of student nurses to the end of their course is poor, and retention of nurses and midwives beyond the first two years after qualification is also poor. Therefore, not for the first time I ask the Minister whether he will ensure that attrition data is collected in a consistent way so that we can identify those settings that are good at keeping their students, nurses and midwives and those that are not. We can then learn from the best practice and spread it.

The impact of the Government’s plans on admissions, student numbers and quality and on the stability of the qualified workforce is yet unclear, and the Government have not said how they intend to monitor the impact on the workforce. Without a solid evidence base this policy should not go ahead. I therefore support the regret Motion in the name of the noble Lord, Lord Clark, and call on the Government to think again.

NHS and Adult Social Care

Baroness Walmsley Excerpts

Wednesday 5th April 2017 Lords Chamber

[Lord O'Shaughnessy]

Those were the words just repeated by the noble Lord. The so-called “death tax” was a percentage levy on all estates, regardless of the use of social care systems. The proposals that the coalition Government came forward with—the Dilnot proposals—were about capping amounts and therefore were much more responsive to the amounts being spent. The Chancellor has recently recommitted us to not looking at that proposal but we will, through the Green Paper, seek to put the social care system on a sustainable basis and, of course, seek consensus wherever we can.

[Baroness Walmsley (LD)]

My Lords, does the Minister recognise the logic of the committee’s criticism of the cuts to public health funding? Will he go back and commit himself to promoting the prevention agenda and good health agenda, not just in his own department but across government, because so many other departments have an effect on the health of the nation?

[Lord O'Shaughnessy]

The noble Baroness is quite right about the importance of public health. It is worth pointing out that it is not just an issue of money. This country was the first in Europe to act on cigarette packaging, to introduce a soft drinks industry levy and to develop a childhood obesity plan. As we have talked about previously, if you look at the risky behaviours displayed by young people, you will see good evidence that this approach is working.

Health Service Medical Supplies (Costs) Bill

Baroness Walmsley Excerpts

Wednesday 5th April 2017 Lords Chamber

[Lord Warner (CB)]

My Lords, the amendment removes the requirement on the Government in the original amendment passed by this House to have “full regard” to the considerations relating to life sciences and access to NICE-approved medicines and treatments. Instead, it requires the Government to “take account of” those considerations in discharging its responsibilities under the Act. This responds to the Government’s concerns that the original wording was too inflexible to respond to all the situations with which they might be confronted in controlling the price of medicines and medical supplies. I suggest that the revised wording gives them the flexibility they seek while retaining some requirement to pause to consider the impact and implications of a price cut to NHS-purchased medicines and medical supplies on the UK’s important life sciences sector and on patient access to NICE-approved medicines.

We passed the original amendment and placed it at the front of the Bill because of our central concern that the legislation seemed overpreoccupied with driving down the price of drugs and medical supplies to the NHS and was in serious danger of losing sight of the importance of the life sciences sector to UK plc, despite the Minister’s protestations—and, together with that, the related issue of ensuring that patients have speedy access to the most cost-effective therapies.

Delaying patients’ and NHS access to new proven therapies will only drive life sciences away from the UK at a time when pharmaceutical investment here is already on a downward trajectory, and at the very time when we need this investment to be increasing under the Government’s own industrial strategy post Brexit, as the Minister has rightly said. But the money is going down from big pharma investing in this country and the Bill has not helped reverse that trend. Delaying patients’ and NHS access to new proven therapies will only make things worse.

The danger of this Bill passing without a pausing mechanism of the kind I am suggesting is that the Act will become yet another example of the short-termism that is criticised in this House’s Select Committee report on NHS sustainability, published today. I recommend that noble Lords read that report about the short-term focus of much of the action taking place in the NHS today. I declare an interest as a member of that Committee.

The Bill has made the ABPI and the pharmaceutical industry worried that it signals the end of the voluntary PPRS system for settling the price of research-based medicines in this country. Only this week the ABHI published a report on a strategy for a thriving med-tech industry outside the EU, calling for the NICE technology appraisal programme to be expanded to assist NHS take-up of new technology. Little did it know that it was this very week, as the Minister recognised, that the Government, through the agency of NHS England, had introduced a new “budget impact test” for NICE-assessed products. That is yet another hurdle to be jumped by British science and research and before NHS patients can benefit.

I have been probing this new system which in plain English is a new affordability test grafted on to the NICE appraisal process following discussions between NHS England and NICE, under, I suggest, a good deal of pressure from the Department of Health. I tabled a Question on this on 14 March, to which the Minister answered on 28 March. I still have concerns about that Answer, which I am pursuing through further Questions. But I want briefly to share those concerns with the House because they are relevant to why we should send the Bill back to the Commons with a new amendment.

First, there is the very real issue of how big a part NICE-approved medicines actually played in the 20% rise in the drugs bill between 2010-11 and 2015-16 that the Government are so concerned about. Were these appraisals the villains or were there other explanations for that increase in the drugs bill? We do not know. Nor do we know whether the costs of these appraisals were actually offset by savings derived from the new treatments. The danger is that an unexplained rise in the NHS drugs bill can cause a panic reaction in the department, which will then use this new legislation to curb access to new drugs.

My second concern is over the actual legality of this new system and the damage being done by it to NICE’s reputation for independence. As I understand the 2013 regulations governing NICE functions, they impose a three-month period for NHS implementation of NICE-approved technology appraisals. It is only NICE that can extend the period of implementation, not the Secretary of State and not NHS England. So we are going to see a system being developed under which NICE is regularly put under pressure by the Department of Health or NHS England to extend the three-month implementation period.

I welcome any light that the Minister can throw on these concerns, but it is not just me or this House that he needs to satisfy—or even industry. He also has to convince patient interest groups such as Breast Cancer Now, Prostate Cancer UK and Diabetes UK, which are all very concerned about the budget impact test and what it means for patients’ speedy access to new proven therapies and their rights under the NHS constitution. I am not convinced that what the Minister has said this afternoon will convince them that they should not be suspicious of these changes.

The more events unfold, the more this looks like a piece of legislation originally designed legitimately to tackle a major NHS rip-off from a generic scam which was then rapidly expanded in scope to give the Government more powers to drive down NHS prices for medicines and medical supplies. From our earlier consideration at different stages of the Bill, I suggest that there has been a lack of proper consultation with many interested parties, and the measure provides powers whose exercise could well have some highly undesirable outcomes. The budget impact test could well illustrate what we might expect without some counter-influence; my Amendment A1 strives to do that but without over-restricting the Government’s legitimate freedom of action when there are outrageous increases in drug prices to the NHS. I beg to move.

[Baroness Walmsley (LD)]

My Lords, I support the noble Lord, Lord Warner, in his amendment. I thank the Minister for how he has worked with your Lordships’ House on all sides to improve this Bill; it is unfortunate that we remain with one point of disagreement. We certainly support the policy objective of the Bill in general and very much welcome the list of actions in the Minister’s introduction to promote research and drug development in this country. But in listening to his outline of his particular responsibilities, it occurred to me that no policy area is ever an island; they always impact on other things. The Minister’s responsibility to achieve best value for the NHS actually impacts on other responsibilities that he and his department have—in particular, in relation to this amendment, on the thriving life sciences sector, on which we all depend, and the access of patients to cutting-edge medicines.

Both those things are suffering from particular threats at the moment. One is Brexit, which I shall not go into now; we have discussed it on many occasions. The other is the recent £20 million affordability test that the Government are introducing. Although £20 million sounds like a very large amount of money, if it is applied to medicines where the population of those needing the medicines is very large, such as some of those mentioned by the noble Lord, Lord Warner—diabetes, breast cancer and other things—the individual cost to an individual patient does not need to be very high to be caught up by the affordability test. The Minister used the word “only”; he said that it would affect only one in five of medicines, but I think that that is an awful lot of medicines, and we should be very concerned about it. That is why we feel that it is important to press the Minister on this issue.

I congratulate the noble Lord, Lord Warner, on offering the Government a compromise, which I hope would avoid what the Minister is clearly worried about: being taken to judicial review by a pharmaceutical company about efforts to push down the price of a medicine. I draw the Minister’s attention to the word “sector” in paragraph (a) of the proposed new clause, which asks the Government to take account of the need to,

“promote and support a growing life sciences sector”.

The word “sector” makes it unlikely that any pharmaceutical company trying to take the Government to judicial review would succeed if the Government had, in all other respects, promoted a thriving life sciences sector in this country. It is highly unlikely that they would do so.

I therefore hope that the Minister will think again and not resist this amendment. It is essential, given the current threats to patients in this country—and very large populations of patients too, in particular those coming towards the end of life—to pharmaceuticals, to treatments and access to medicines. I therefore hope that the Minister will reconsider, and, if the noble Lord, Lord Warner, wishes to test the opinion of the House, he will have the support of these Benches.