Sugar Tax
Baroness Walmsley Excerpts(8 years, 9 months ago)
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Lord Prior of Brampton
My Lords, the Government are considering a whole range of options for tackling the scourge of obesity in young people, which include portion control, reformulation, advertising and many others. One issue they are considering is a sugar tax, but we will announce the results of that strategy in the very near future.
Baroness Walmsley (LD)
My Lords, does the Minister agree that the key to weight management is correcting energy imbalance? Will the Government therefore consider forcing manufacturers of junk foods to put on their labels the number of hours of vigorous exercise that are equivalent to the contents of the packet?
Lord Prior of Brampton
My Lords, as the noble Baroness will know, there are plans for later this year to have compulsory labelling of sugar content on packaging. However, I am not aware that there are any plans to have pictures of well-known athletes on the packaging as well.
NHS: Trust Finances
Baroness Walmsley Excerpts(8 years, 9 months ago)
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Lord Prior of Brampton
My Lords, the noble Lord asked a number of questions. Starting in reverse order, the Five Year Forward View was signed by not just the NHS Commissioning Board but also all the ALBs. Of course the £22 billion is a huge stretch. No one denies that and it requires a transformation in the way in which healthcare is delivered in this country. In terms of efficiency savings, the requirement for next year is 2%. We expect that to continue at around 2% to 3% over the five-year period.
I come to the noble Lord’s other questions. There is not a direct conflict between safe staffing levels, efficiency and financial balance. In good hospitals, the three go together. Of course I accept that there have been tensions and it is not surprising, looking back on it, that the reaction to what happened at Mid Staffs led to a number of hospitals increasing staffing levels very rapidly. I remember talking to the noble Lord when he was chairman of a trust—as I was at the time, or I might have been at the CQC—and of course I understand those pressures. All boards of all hospitals must live with those pressures and come to the right balance. I accept that the newly reinvigorated CQC has added to some of the pressures on hospitals to increase the level of staffing.
On the King’s Fund, I have not seen the report that the noble Lord mentioned and that reference to the “financial meltdown”. We expect to break even across the NHS this year. There is £3.8 billion extra spend going into the NHS next year and we hope that when all the plans have come in from the hospital trusts we will be in reasonable shape.
The noble Lord referred to the letter sent out, which I think was leaked in the Guardian, which led to this Urgent Question. I did not see the actual letter before it went out, but there is nothing in it that comes as a big surprise.
Baroness Walmsley (LD)
My Lords, a good example of NHS trusts doing what the Government have asked them to do and working together to deliver care more efficiently is the Uniting Care Partnership in Cambridgeshire and Peterborough, which collapsed after only eight months. We are told that the three NHS entities involved in the contract will continue to deliver care under the new model without disruption. If this is able to be done, why was so much money wasted in the bidding process? Could not they have worked together anyway? How much did the whole process cost and how much was paid to their advisers, the Strategic Projects Team, which did not seem to realise that the contract at the agreed price was simply undeliverable? Is not it clear that the CCG simply did not have enough money to deliver those services?
Lord Prior of Brampton
I think that the noble Baroness’s party was in government when that contract was negotiated, although it seems a bit churlish to remind her of that. The fact is that, as we move to these new ways in which to deliver care, risk is going to have to be taken. Some of the new ways in which we do it are not going to work. In this case, it clearly did not work. It was a very big project—£800 million in total value, I believe, over five years, for older people in Cambridgeshire. It was a highly complex contract and, tragically, it has not worked out. I shall have to come back to the noble Baroness if I can about how much it cost in fees.
National Health Service: Nurses
Baroness Walmsley Excerpts(8 years, 10 months ago)
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Lord Prior of Brampton
My Lords, I completely agree with my noble friend’s sentiments. She will be pleased to know that from August of this year, Health Education England will be funding 1,000 new nursing associates, who will not be taking a degree but will effectively do a nurse apprenticeship, although they will be able to switch over to doing a degree later in their career if they so choose.
Baroness Walmsley (LD)
My Lords, given that hospital trusts are recruiting 5,600 nurses from outside the EU every year, that is surely much more of a pull factor than anything the Government might do with benefits. Given the fact that trainee nurses have to work on a clinical placement outside term time in which they add value to the NHS and take on responsibility, why are they not paid?
Lord Prior of Brampton
My Lords, I do not entirely follow the noble Baroness’s question. All I can say is that we are all pleased that we are able to attract nurses from overseas, but that cannot be the right long-term policy for this country. We must train our own nurses and not rely upon recruiting nurses from overseas.
Failures of the 111 Helpline
Baroness Walmsley Excerpts(8 years, 10 months ago)
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Lord Prior of Brampton
My Lords, I echo the tribute that the noble Lord paid to the Mead family and their recognition that we can only learn from these terrible tragedies. The fact that they are prepared to make available the report to other parts of the NHS will help in that learning process. I, or one of the other Ministers concerned, will certainly undertake to meet the UK Sepsis Trust.
The noble Lord raised the issue of the 111 service. It is worth making the point that, in this case, the call handler took the call and referred it to a GP who was part of the out-of-hours service. The GP then spoke directly to William’s mother and decided on what the right course of action was. However, I take on board exactly what the noble Lord said about training and the mix between clinicians and non-clinicians in 111 call centres. It will become a better service when the out-of-hours service and the 111 service are integrated.
One point that came out of the report was that had there been an electronic patient record indicating the evidence of the time that William had spent with GPs in the preceding six weeks, the GP who took the call might possibly have come to a different decision. This was a tragic case of all the holes in the Swiss cheese lining up to cause this awful tragedy. Therefore, I take on board what the noble Lord said about 111 and will pursue that with NHS England.
Baroness Walmsley (LD)
My Lords, I share the concerns of the noble Lord, Lord Hunt, about 111, but does this not go much wider? On the issue of medical and public education about sepsis, what are Public Health England and Health Education England going to do about this? We cannot rely on the BBC1 programme “Trust Me, I’m a Doctor”, which this week has certainly increased my understanding of the symptoms of sepsis. But that needs to be spread to the wider public. I recommend that people go on iPlayer and watch that programme if they want to know about this. Does this not also indicate that this very conscientious and determined mother was not listened to? She knew her child was behaving abnormally and all the people who talked to her—from GPs through to everyone else—just did not listen.
Lord Prior of Brampton
My Lords, the facts of this case demonstrate that a lot of things went wrong. That is the real tragedy of it. Had one of those things not gone wrong, the tragedy may not have happened. The noble Baroness referred in particular to medical education but it is wider than that. As I said, a whole stream of things went wrong and we must learn from that.
Health: Hormone Pregnancy Tests
Baroness Walmsley Excerpts(8 years, 10 months ago)
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Lord Prior of Brampton
My Lords, this issue goes back to the 1950s, so trawling back over that period may not be that helpful. What is helpful is that we learn lessons from the past so that the existing regulatory system can learn from those errors. I am, however, very happy to meet the noble Lord and others who are interested to discuss this further, if they wish to do so.
Baroness Walmsley (LD)
My Lords, given that many of the survivors of Primodos, the drug in question here, were not told that they were taking part in a clinical trial, will the noble Lord assure us that today nobody would take part in a clinical trial without their knowledge?
Lord Prior of Brampton
My Lords, I understand that to be the case but I will double-check and, if it is not, I will of course write to the noble Baroness.
Health and Social Care: State Pension
Baroness Walmsley Excerpts(8 years, 10 months ago)
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Lord Prior of Brampton
The right reverend Prelate is right to remind the House of the report by the Commonwealth Fund which indicated that the National Health Service is the most efficient and overall the best healthcare system in the world. He also referred to prevention. The childhood obesity prevention strategy is due to be announced by the Government in the next couple of months. We have made huge progress on reducing smoking and in other areas of prevention, but I agree with the right reverend Prelate that prevention is a critical part of our long-term approach to healthcare.
Baroness Walmsley (LD)
My Lords, the Minister talks about the support for the five-year forward view, but is he aware that more than 80% of finance leads within the health service do not believe that the five-year forward view can achieve the savings that it says it can? It just cannot be done without extra resources. Surely, particularly with the state of affairs in social care, where the Government’s extra money is being back-loaded, not front-loaded, we need to take an overall holistic look at health and social care and how much we should be spending as a country and how we are prepared to raise that money fairly.
Lord Prior of Brampton
My Lords, I think that the same question is being asked in slightly different terms by many different noble Lords. I cannot really add to what I said before. We are supporting the NHS’s plan. By the end of this Parliament we will be putting another £3.5 billion into social care through the social care precept and an extra £1.5 billion into the better care fund. We believe that we have a plan for social care and healthcare over the course of this Parliament.
Health: Cancer
Baroness Walmsley Excerpts(8 years, 10 months ago)
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Baroness Walmsley
To ask Her Majesty’s Government what assessment they have made of the factors contributing to cancer survival rates in the United Kingdom.
Baroness Walmsley (LD)
My Lords, my reason for asking for this debate is to highlight the fact that, despite much good work, cancer patients in the UK have poorer survival chances than those in comparable countries. We rank 20th out of 24 developed countries for cancer survival in breast, cervical and colorectal cancers. For a Government that seek a world-class health service, this is not good enough. I want to look at the reasons and ask what the Government plan to do about it, in particular the implementation of the five-year cancer strategy.
Anyone who has had a diagnosis of cancer will know the naked fear that the news generates. At that moment, it is hard to remember the great strides we have made in cancer survival, with half of all cancer patients now surviving for 10 years or more compared with a quarter 40 years ago. Some cancers such as breast cancer have seen remarkable improvements in survival rates, particularly because of the excellent screening programme, for which I am most grateful. But others such as pancreatic cancer have seen very little improvement. Some cancers related to lifestyle or environmental factors, such as skin cancers or the various bowel cancers, have become more common. But many more people are living with cancer for a long time and we need to consider how we look after their needs.
So what needs to change? We need to invest in prevention through information and help for people to reduce their risk and earlier, more accurate diagnosis. We need better training and resources to enable GPs to refer quickly and a realistic approach to consultant utilisation and shortages, along with that of specialist nurses. We need better data collection and transparency and earlier access to innovative treatments. To show public support, I hope that all noble Lords will celebrate World Cancer Day on 4 February by sporting a unity band to celebrate survival, show solidarity with those in treatment and remember loved ones.
Let us look at some figures. According to Public Health England, four in 10 cancers are preventable. Cancer cases are increasing, partly it is believed because we are living longer and partly due to lifestyle, so more people are living with cancer. One in two people will develop cancer at some point in their lives. But according to Eurocare-5, the UK’s survival performance rates are below the European average. According to the Lancet in 2011, Norway, Canada, Sweden and Australia do a lot better than us, while recent studies have shown that the gap is not being closed. As we do better, other countries are doing even better. That is why we need excellent data and accountability. Experts tell us that the one-year survival rate is a very good indicator of success or failure, so it is important that this information is collected efficiently and made available transparently.
This week, we have had some very worrying headlines. Cancer services have missed key targets. The six-week target for diagnostic tests to be done was missed and it is now two years since it was last met. One of the key cancer targets, the 62-day target for treatment to start from urgent GP referral, was missed. Those missed targets mean that nearly 2,000 people—not targets—had to wait longer than they should have. Wales was the worst, with only 71.9% of patients starting treatment within that time in Swansea and 62.9% in Cardiff and Vale. In Wales overall, the target has not been met since 2008. In England, just under 8,000 people with suspected cancer did not see a consultant within two weeks of an urgent referral by their GP and 536 patients had to wait more than a month to have their first treatment for cancer. We need to be cautious about targets. There is no point in setting higher and tighter targets for tests if hospitals do not have enough consultants to deal with the patients diagnosed as positive.
What is the Government’s answer? The independent cancer strategy, which reported last July, made six key recommendations: a radical upgrade in prevention and public health, including national plans on reducing smoking and obesity; earlier diagnosis with 95% of patients referred by a GP being diagnosed or given the all-clear within four weeks; patient experience on a par with clinical effectiveness and safety through access to test results and a clinical nurse specialist or other key worker; transformation in support for people living with and beyond cancer, and appropriate end-of-life care; investment to deliver a modern high-quality service, including upgrading radiotherapy machines, reviewing the Cancer Drugs Fund and better molecular diagnostics for more personal treatment; and a big effort to address the shortage in the cancer workforce. It also called for overhauled processes for commissioning, accountability and provision with a regional network of care alliances and a national cancer team to oversee delivery of the strategy.
The Government have accepted the recommendations and the latest NHS five-year mandate asks for: early diagnosis to be a priority; more work to tackle smoking, alcohol and physical inactivity; reduced impact of ill-health and disability; and support for research and innovation to enable new treatments to reach patients more quickly. So there was a recognition of the role of speedy diagnosis in improving cancer survival rates, but nothing about better training or diagnostic tools for GPs. Molecular diagnostics have made enormous strides in recent years for monitoring the effectiveness of treatments as well as diagnosing the disease and enabling more effective personalised treatments. The strategy asks for a national commissioning framework for this. Will the Minister ensure that that happens? It is vital for equal access for patients, particularly for rare cancers.
The mandate recognised the need for prevention, but then we had cuts in public health budgets. When will the Government accept the common sense and economic benefit of prevention and put their money where their mouth is, and save money and lives at the same time? The mandate mentions support for research and innovative new treatments, but many in the service are not convinced that appropriate pathways exist. The mere existence of the accelerated access review recognises that the UK is very poor at getting innovative new treatments to patients, and that needs to change.
In the first year, among other things, the Government are reviewing the operating model of the Cancer Drugs Fund within its existing budget. This is currently being consulted on, but patients, clinicians and pharma companies have serious concerns that the outcome will not achieve what it should. Does the Minister agree that any new methodology should guarantee increased access to innovative medicines, as proposed in the cancer strategy? We do not want the UK to become a “late-launch market”, meaning that UK patients would have poor access to innovative drugs compared to others worldwide.
Nothing should be done to deter pharma companies from doing R&D and clinical trials in the UK, since this both adds to total UK life sciences and covers the costs of treating patients which would otherwise be borne by the NHS. Indeed, we need an about-turn in relation to research. Every patient, every doctor and every health worker could be involved in medical research, but there are currently threats to the collection of data. I would encourage all patients, with suitable assurances, to allow their anonymised data to be used for medical research to save future lives. Without complete data, the researchers are working blindfold and we cannot hold CCGs, hospitals and the Government to account.
NICE must look again at its methodology for evaluating cancer drugs, especially those focused on rare cancers. But there are no proposals for NICE to change the criteria or thresholds and no recognition of unmet need, such as for cancers with very poor prognoses, such as pancreatic cancer.
It is instructive to look at some specific cancers to see where the problems lie. Despite being the 10th most common cancer, pancreatic cancer is the fifth biggest killer. Yet it only gets a tiny research spend. Survival rates are shockingly low. Only 4% survive five years from diagnosis and this has not improved in 40 years, indicating a desperate need for earlier diagnosis and more research. Around four in five patients are diagnosed at a very advanced stage and may have made up to seven visits to their GP with symptoms. All that suggests a need for better GP training and better access to diagnostic tools so that patients can have surgery before it is no longer an option. Other specialties such as skin cancer have a shortage of consultants and the ones there are spend far too much of their time seeing patients whose GP could have diagnosed the lesion as benign if they had had better training. This is another area where public awareness of symptoms needs to improve.
I have not been able to cover all the ground in 10 minutes, but I hope that other speakers will. I thank all those who are about to take part in this debate and hope that the Minister can answer the many questions that will be raised.
Health: Red Cell Folate
Baroness Walmsley Excerpts(8 years, 10 months ago)
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Baroness Walmsley (LD)
My Lords, is the Minister aware that, as I was told this morning by three neural disease specialists, the danger of overmedication with folic acid by fortification is absolutely minuscule—you cannot measure it? In addition, they suggested to me that it is vital that we reduce the number of babies with neural tube defects because, due to our success in the past in reducing the numbers, the specialists and services for such babies are very thin on the ground. We really need to do something about this now.
Lord Prior of Brampton
My Lords, the danger of overmedication with folic acid is small, I accept that. It is not non-existent but it is small. Just so that the House knows the numbers, the number of babies aborted because of neural tube defects is about 400 a year; the number who are born with neural tube defects, alive or not alive, is about 60 a year. It is a very serious issue and one that the Government are taking extremely seriously, but we have to weigh that against the other issues of medicating the entire population.
National Health Service
Baroness Walmsley Excerpts(8 years, 10 months ago)
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Baroness Walmsley (LD)
My Lords, we are on the last lap. I thank the noble Lord, Lord Turnberg, for telling us about the enlightened approach of Salford Royal Hospital. It has obviously made great progress since I worked in Manchester and it was known as the “No Hope Hospital”.
It is no coincidence that the London Olympics highlighted the NHS in its very creative opening ceremony. We are all very proud of it, particularly the staff, but it would be stating the obvious to say that it has numerous problems. At a time when it faces unprecedented increases in demand, the NHS has been given its most challenging funding envelope ever. The future of the health service is in jeopardy unless we do something radical. As the noble Lord, Lord Rea, said, it cannot get out of this hole by itself.
That is why my right honourable friend and former Health Minister Norman Lamb introduced a Private Member’s Bill in another place a week ago. He called for the establishment of an independent commission to examine the future of the NHS and social care system, to take evidence and to report its conclusions to Parliament. I pay tribute to those on the Conservative Benches who have called for something similar, but I think that a royal commission may take too long and that something quicker is required.
Norman Lamb was supported by two former Secretaries of State for Health, Members from all parties and the chief executives of more than 40 organisations in the sector. I join with his call today in this debate, along with many of your Lordships. When you get agreement from so many from all sides of health and social care, it is clear that you are reflecting a real need. The purpose of the commission would be to consult widely to find solutions to the massive challenges that face the health and care services, and to establish a sustainable—a crucial word—new settlement which takes into account present and future demands.
In order to calculate future demand, we need no crystal ball—we have a lot of evidence to help us. We know that since the Second World War demand has gone up by about 4% every year. For example, thanks to successful new diagnostics, treatments, drugs and surgical procedures, half of people diagnosed with cancer now survive the disease for 10 years or more compared with only a quarter 40 years ago. Other chronic conditions are also now managed better than ever. We should celebrate all this while being realistic about what it means.
We have heard about the predicted gap of £30 billion in NHS funding by 2020 unless something is done. The Government have committed to providing only £8 billion of this and expect the NHS to find the other £22 billion through efficiencies and new models of care. However, experts involved in the process are unconvinced that this can be done.
The King’s Fund’s Quarterly Monitoring Report, published in October 2015, included a survey of NHS finance directors’ views on their ability to achieve 2% to 3% productivity gains per year, which would be needed to achieve that saving. The vast majority were sceptical to say the least. Eighty-four per cent of NHS trust finance directors and 88% of CCG finance leads felt that there was a “high” or “very high” risk of failing to achieve the target. Here are a few respondent comments:
“I feel strongly that the low-hanging fruit has been taken. The modus operandi needs to change fundamentally”.
“When plans are not credible then it is impossible to enthuse people”.
“Increased national pressures/tying of hands … make it difficult to achieve big savings”.
“The £22 billion challenge requires productivity gains significantly over what has been achieved over the past few years”.
“Unless there is a national debate about what the NHS can provide then there is no way that the NHS can deliver within the financial envelope”.
Jim Mackey, chief executive of the hospital regulator, NHS Improvement, put it in colourful language—and I quote him verbatim—saying that the efficiency targets set by the Government are,
“unachievable and, frankly, bloody stupid”.
That is what he said, my Lords.
Given that the recently announced increases in funding will be swallowed up mostly by paying for the £2.2 billion of deficits in NHS and foundation trusts, increases in payments to pension funds, apprenticeship levies and the new minimum wage, it is pretty clear that this extra money will do nothing to address future increases in demand. Meanwhile, social care funding has been cut in real terms and faces a funding gap of £6 billion by 2020 according to the Health Foundation, but this does not take into account the effect of the new minimum wage in a sector where so many workers are on the minimum wage. The LGA estimates that this will add a further £1 billion to the gap. Now Ministers have decided to stop the £1 billion payment-for-performance element of the better care fund and, instead, have mandated local targets for the reduction of delayed transfers of care. So the Government give with one hand and take away with the other.
Did the Chancellor provide the answer to these problems in the autumn spending review? I think not. The new provision for councils to raise a 2% social care precept would provide only an extra £1.7 billion by 2020 if every single council did it. In poor areas the ability to raise significant extra funds in this way is in inverse proportion to the need—not a very clever solution.
The increase in the better care fund will not come until 2019. Sadly, this will mean that the better-off will be able to pay for good care and the poor will get either no care at all or a substandard package—the best their poor stretched local authority can manage—adding further to our appalling health inequalities. The inevitable pressure that these cuts to social care will put on the NHS is obvious and has been clearly outlined by Simon Stevens, the head of NHS England. So current and projected NHS funding does not allow the service any chance of fulfilling the mandate, mentioned by the noble Lord, Lord Lansley, put upon it for the next five years by the Government themselves. Beyond 2020, it will just get worse if nothing is done, and our precious NHS will no longer be the envy of the world. Mention of the mandate reminds me to endorse the call of my noble friend Lady Tyler and the noble Lord, Lord Bradley, on mental health. We need to find new answers.
All Governments pledge themselves to protect the NHS, yet our spending as a proportion of GDP is low, as we have heard, compared to that of other developed countries. According to the Office for Budget Responsibility, it will decline further by 2020. The position of social care is even more dramatic.
What is the point of growing our economy if we do not spend the money on the things that most of the population would like it spent on—and what they vote for? Given what we know about rising demand, it makes no sense at all. The consequences of the Government’s failure to address this are very serious and completely contrary to what they say they want according to the latest mandate. Standards will not rise, new technologies will be unaffordable and services will not be able to address our health inequalities—an absolutely top priority in my book.
The silly thing is that nobody really believes in the ability of the system to fill the gap through efficiency savings and new models of working, desirable though they may be. Money is so tight at the moment that many parts of the system are struggling with crisis management, let alone improvements. To make things worse, there are numerous financial disincentives. For example, where is the incentive for acute hospitals to work with local services to keep patients out of hospital when they rely on the payments for activity when they come in?
The social care system is living on borrowed time. Eligibility criteria are getting tighter every day. Will the Government face this crisis head-on, take politics out of it and support my right honourable friend’s call for a commission to bring together all the evidence, the brains and the expertise available?
I think it boils down to five simple questions. How much should we be spending as a country and how should it be raised? How can we spend it better and have all services reach the standard of the best? How can we end the artificial divide and conflicting incentives between health and social care? How can we minimise future demand by avoiding preventable diseases? How can we reduce health inequalities? It is time for a new Beveridge commission.
Sugar Tax
Baroness Walmsley Excerpts(8 years, 10 months ago)
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Lord Prior of Brampton
My Lords, I think that the noble Lord is right; indeed, the Prime Minister has called this the new smoking. Obesity is as important to public health as smoking has been in the past. We have to build a much stronger case among the public at large before we can start to introduce the full range of tax and other measures that we have had for cigarettes and alcohol.
Baroness Walmsley (LD)
My Lords, has the Minister tried the Sugar Smart app on his mobile phone, which can be found on the Change4Life website? I tried the app this morning—it is very clever; it reads a barcode and tells you how much sugar is in a product. Unfortunately, however, I tried it on five sugary products and it did not have any of them in its database. Has this very good idea been under resourced?
Lord Prior of Brampton
My Lords, fortunately I, too, tried the Sugar Smart app this morning. Interestingly, 600,000 people have downloaded that app and the PHE Change4Life programme has had considerable success in raising awareness of the amount of sugar that you consume when you buy a product in the supermarket.