Premature Deaths: Heart and Circulatory Conditions

Earl Attlee Excerpts

Tuesday 6th February 2024 Lords Chamber

[Lord Markham (Con)]

First, I am happy to commit on the data front, because data and giving results always shine a light and will always help in these situations. On outreach to all these communities, the noble Lord might be aware that, on top of the pharmacies and leisure centres, we have been incentivising GPs. As an example, being in the right age group I have numerous texts and messages from my GP about getting those check-ups done. It is those sorts of measures that we are trying to use.

[Earl Attlee (Con)]

My Lords, is the Minister aware that many of us strongly support his efforts to deter youngsters from starting to smoke because of the adverse effect it has on the circulatory system?

[Lord Markham (Con)]

Yes. I thank my noble friend. Prevention is absolutely key, as is tackling things such as smoking—the smoke-free legislation will do this for a new generation—obesity, and high levels of sugar and fat in foods. These are all key parts of our armoury.

Childhood Obesity

Earl Attlee Excerpts

Monday 15th July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness presents a sensitive and sophisticated point: the whole point of the obesity message is that children should be eating a healthy, balanced diet and exercising in an appropriate way.

[Earl Attlee (Con)]

My Lords, does the Minister agree that obesity will break the NHS model if we do not do something about it?

[Baroness Blackwood of North Oxford]

I absolutely agree with my noble friend. Obesity is a crisis that will not only create misery for those who will then experience increased risk of tooth decay and of diseases such as cancers, diabetes and other severe illnesses, but it will also create significant unsustainability within our health service, which we are able to prevent. Since we know the tools that we have to prevent it, we should all be working together to make sure we do.

Antimicrobial Resistance

Earl Attlee Excerpts

Thursday 25th October 2018 Lords Chamber

[Lord O’Shaughnessy]

I agree with the noble Baroness about the grave long-term threat AMR poses, but it also poses a threat in the short term. Estimates vary, but between 2,500 and 5,000 people a year in England die because of AMR. In relation to the seriousness with which the UK takes it, I mentioned the new strategy which will be published shortly. I should point out two things that have been a success. First, the UK has taken a very important global leadership role in making AMR a priority for the G20. Secondly, as a consequence of our action plan, we have seen reductions in the prescribing of antibiotics at GP level. That means that we are starting to drill down on the overprescribing and inappropriate prescribing which is driving AMR.

[Earl Attlee (Con)]

My Lords, is it correct that last-resort antibiotics are being fed to pigs in order that they can be weaned at an earlier stage?

[Lord O’Shaughnessy]

I do not know specifically about pigs, although in my briefing there was a quote from Pig World, which is not a periodical I read very often. Antibiotic use in the veterinary environment has gone down by 40%. It is one of the big successes of the strategy.

General Practitioners: Appointments

Earl Attlee Excerpts

Thursday 17th March 2016 Grand Committee

Asked by

[Earl Attlee]

To ask Her Majesty’s Government what assessment they have made of how quickly an economically active patient should be able to secure an appointment with their GP and how that compares with other professions.

[Earl Attlee (Con)]

My Lords, the Committee will recall the fabulous opening ceremony for the 2012 Olympics held in London and its NHS component. Interestingly, some young indigenous Brits take for granted our fabulous health service, free at the point of delivery. They do not really appreciate how clever we have been as a nation, but hard-working immigrants from other countries certainly do. We have much to be proud of and I salute the efforts of all those involved. Our European partners have a variety of health systems that appear to work for them. However, you have only to look at the political challenges with the health system in the United States to see the problems that we have avoided and to understand that their healthcare costs are considerably higher than ours. There is no doubt that the NHS is very good if you are seriously ill, which is one reason why I am not the slightest bit interested in private healthcare. However, we would be deluding ourselves if we denied that we have some serious difficulties with the NHS; the most obvious are A&E and ambulance services, but I want to concentrate on GP services, although they are related.

I recently had to move house from one parish to an adjacent parish, but which was in a different GP catchment area. My original surgery was co-located with a rather good convenience store and the nearest ATM to my house. The surgery met all my requirements, I never had any difficulty in securing an appointment when I needed one, and the practice premises were purpose-built and relatively new. My new surgery’s building is old and small and there was local evidence that appointments could be a problem, probably due to increasing demand from a growing and also ageing population. Your Lordships will not be surprised to hear that I did not want to register at that new, nearest surgery but I was told that I had to. I am sorry to say that my worst fears were realised. The administration of the surgery was relatively poor from the start. Clearly not all practices operate to the same standard—though I hope that my noble friend Lord Bridgeman will describe to the Committee how a good practice works.

Worse still, several weeks ago now, I developed some slightly worrying symptoms. However, my judgment was—correctly—that I was not an urgent case and I was not prepared to claim otherwise. Unfortunately I could not secure an appointment at all. Given that men are notoriously bad at presenting with unpleasant symptoms, how can it possibly be right to deny a patient an appointment with the doctor? The fact is that people who are fit, well and working ask to see the doctor only when absolutely necessary. All they need is a bit of maintenance from time to time to keep being productive and generating the money needed to fund the NHS.

Before suggesting to the Committee what is going on, I want to make it clear that I fully appreciate that GPs have to deal with a wide range of patients, many of whom have serious conditions or are even terminally ill. I feel that practices fall into the trap of believing that they are providing a service to a certain standard and that patients should be grateful for what they get. Surgeries do not regard themselves as being competitive, which means that there is no mechanism for them to individually determine the appropriate level of service, although no doubt they try hard. It also means that they cannot determine what services to offer or how to provide them.

Take the appointments issue. Suppose I rang my solicitor’s office and said that I had had a fairly worrying meeting with another businessman who claimed that I was infringing his patent. I do not think that the solicitor’s office would say, “Well, we have no appointments available for the next two weeks. Try again next Monday, but make sure you ring early because the available slots go quickly”. I suggest that any professional services outfit with that sort of ethos would not stay in business very long. I have to tell the Committee that that is exactly what I experienced with my new GP surgery and I doubt that this is unusual. This is why my Question compares GPs to other professions.

Or take blood tests. GPs no longer seem to take blood samples. A separate appointment has to be made, either with the practice nurse or with a local hospital. This is fine if one is retired, but if one is working it is another appointment to be made which conflicts with economic activity. It also tends to lower productivity, which we know is a general UK problem. I have not been to an A&E department for many years, but it seems to me that the majority of walk-in patients could equally well be dealt with by a GP surgery, and far more quickly than the four-hour target, which is itself an admission of total failure. At present, GP surgeries do not market themselves for that business because they do not need to.

Surely, a practice in a competitive environment would say, “Why wait at least four hours in an A&E department for a minor injury when, if you were registered with us, you could be on your way within an hour?”. I am not suggesting for a moment having mini-A&E centres. Serious injuries and life-threatening conditions are clearly a matter for a large A&E department with the appropriate range of facilities.

Since the time when I was forced to change my GP the rules have changed, I am pleased to say, and with certain, sensible caveats one can register with whichever surgery one wants. I am pleased about this but there is still no evidence of any commercial competitive pressures between GP surgeries. I hope the Minister can tell the Committee what, if anything, he is doing to introduce competition between GP surgeries. Does he see this as being important, so that economic output is not lost due to a GP service that does not suit busy working people, especially if they work a long way from home? Does he agree that GPs should be doing more to relieve the unnecessary load on A&E departments?

South London Healthcare NHS Trust

Earl Attlee Excerpts

Thursday 31st January 2013 Lords Chamber

[Lord Wills]

I am very grateful—

[Earl Attlee]

My Lords, the Minister answers a question. If the noble Lord wants to ask a supplementary question, he can at the appropriate point.

Life Sciences

Earl Attlee Excerpts

Tuesday 6th December 2011 Lords Chamber

[Earl Howe]

My Lords, if I may I shall pass over that final remark. I am not sure that it is strictly relevant to the Statement. I was happy to hear from the noble Baroness of her support for the initiatives that we have taken and of her welcome for the measures. She said that the coalition Government had lost momentum in this area. From my perspective as a Research Minister, that is not the case. The Office for Life Sciences was an initiative of the previous Government that we eagerly continued. I pay tribute to the noble Lord, Lord Drayson, for his work in establishing the bridge between BIS and my own Department of Health. That relationship remains very active.

We recognised from the outset that a strong research base was vital for our future as a global knowledge economy. I refer both to basic research—curiosity-driven research—and research applied to the challenges that face business and public services. Despite enormous pressure on public spending, the BIS science budget of £4.6 billion a year has been protected; and in my own department the research and development budget is increasing year by year over the period of the spending review. In the current year it is just over £1 billion. That shows our commitment to the sector.

The noble Baroness asked several questions. The first concerned the use of patient data. There are very clear information governance rules that will protect the confidentiality of patients. We are not changing the rules. They will apply to whatever sector a researcher may come from: the public sector, a charity or the private sector. The rules are the same. All approved research is conducted to strict ethical standards. It is subject to robust regulation. Before any data are given out about a patient, the following conditions must be met. There must be confirmation that the data requested will support the health question being researched. There must be approval from an ethics committee to ensure that the research is ethically valid, including a check on the data requested. There must be information governance checks and approvals to ensure that the recipient can receive and process the data legally to conduct their research. There must be confirmation that the data are anonymised. No data will be disclosed to a researcher unless all the conditions are met.

The NHS gives out data in anonymised form. Before they are given out, they will be checked to ensure that reidentification is not possible. The main exception is where a patient gives consent for identifiable data to be disclosed. Except in that instance, companies or other researchers who receive data in anonymised form will not be able to identify the patient. The data will be checked before they are disclosed to any company, and legal contracts for the use of the data will require all recipients to comply with strict controls on using data lawfully. The companies will be subject to spot checks.

The noble Baroness asked whether patients would be able to opt out. The answer is yes. Patients will be able to opt out of their personal electronic health record being used for research purposes in an identifiable form. Patients should tell the NHS that that is their wish. The GP will record this in the patient’s record. We have tested technical ways of delivering this and of enabling researchers to identify patients who might be able to contribute to a research project without physically searching through records. Our pilot projects have been very successful.

The noble Baroness asked how all of us can be sure that our patient data are secure. Both the clinical practice research datalink and the NHS Information Centre will hold data securely. They are governed by strict access protocols to ensure that the data are processed lawfully, including when information is disclosed to researchers. Services are subject to the highest levels of independent audit and to regular checks. The data are held in a secure data centre not connected to the internet and are managed to the highest standards of information governance. I hope that that reassures the noble Baroness.

She also mentioned the European Court of Justice ruling on human embryonic stem cell patenting. As she knows, the UK is a world leader in the research and development of stem cell therapies, and the Government will continue to support and fund this work. The judgment of the court applies only to human embryonic stem cell lines, not to other stem cell sources such as adult or induced pluripotent stem cells that are used in stem cell research and regenerative medicine. The judgment does not impact on the regulation of embryos and embryonic stem cells in the UK. However, it is a landmark judgment and we will work with BIS and the Intellectual Property Office to further explore the options on how to address the issues from the ruling. The noble Baroness will understand that the ruling is recent and it is important that we consider the implications very carefully.

[Earl Attlee]

My Lords, we have plenty of time but perhaps I may remind the House of the need to avoid the trap of making a detailed speech rather than asking a short question.

--- Later in debate ---

[Lord Willis of Knaresborough]

My Lords—

[Earl Attlee]

My Lords, we have not yet heard from a Conservative speaker.

[Lord Brooke of Sutton Mandeville]

My Lords, first, I congratulate my noble friend on having omitted a reference in his Statement to a valley of death fund. Secondly, having picked up the reference to big pharma in this welcome Statement, I called to mind the historic and dramatic decision of the late Austin Bide of Glaxo to increase the planning horizon for research in that company from five years to 25 years. The Statement makes clear the acceleration that we shall see in drug development. Can my noble friend hazard any estimate of what effect today’s announcement will have on the planning horizon of research, in the manner of the late Mr Bide’s remarkable extension?

Southern Cross Care Homes

Earl Attlee Excerpts

Tuesday 12th July 2011 Lords Chamber

[Earl Howe]

My Lords, I am grateful to the noble Baroness for her comments and questions. She asked a number of the latter. I hope I can answer most of them. It is important to appreciate that this is a managed process. The announcement that the Government made last month of a four-month restructuring window still applies, and we are at the first major stage of that process. Therefore, anxieties about the welfare of residents are misplaced because this is not a case of the collapse of Southern Cross. It is still very much a managed and solvent restructuring that is going on.

The noble Baroness asked me about the landlords. It is not for the Government to liaise with all the landlords directly but they are all represented on the restructuring committee, working to develop a plan for the future. Local authorities and the CQC will link as necessary with all the landlords as they take through their plans for the future management of homes. I am advised that the CQC understands that the Southern Cross landlords’ committee wants the handover of care home properties to take place at the end of September. The CQC is co-ordinating its activities to ensure that regulation does not prevent the handover across England. I hope that reassures the noble Baroness that nothing is going to happen tomorrow. It is very much part of a planned and structured process.

The noble Baroness asked about care homes that were in debt. Many companies, in all sectors, may have some degree of debt, quite obviously—this is a normal part of business, not necessarily a concern. We are clear that Southern Cross’s particular business model—not owning but leasing nearly all its properties—is a unique model and that is what has given rise to its particular problems.

The noble Baroness asked about the consequences of the landlords taking back their properties. The department is very clear that it expects all parties to maintain service continuity and quality of care while the restructuring process is ongoing. Our principal concern, as I have said, is for the safety and well-being of the residents. CQC will pay particular attention to any care homes where there is a concern that quality may be at risk or inadequate. It does have the resources to do this. It has indicated that there is not a problem in that sense. CQC has regular dialogue with Southern Cross at corporate level in addition to the attention it gives to individual services. We have emphasised to CQC the importance of ensuring that Southern Cross homes continue to comply with regulations and safety and quality requirements. Of course, we expect CQC to take the necessary action if it finds, for example, that staff reductions are affecting safety and quality of services.

The noble Baroness asked about government money for Southern Cross. Southern Cross is not asking for a bailout. It is looking to resolve its problems and it is for the company, its landlords and those with an interest in the business to put in place a plan that stabilises ownership and operation of the care homes. That process is happening and we must let it continue.

A number of providers that will acquire Southern Cross homes are already registered with the CQC as care providers in their own right, such as Four Seasons. There are established processes in place to allow these providers to extend their current registration to take on additional care homes. That process, assuming that it occurs, is relatively straightforward. Providers who are not known to or registered with the CQC will require a full application that will be subject to full scrutiny and a determination of fitness to provide the service. This cannot be a case of companies registered overseas suddenly becoming care home operators—that will not happen. Any new operator must demonstrate that they are fit and proper people to conduct this type of business and prove that to the CQC. Each landlord will be required to ensure that it has arrangements with a reputable and capable operator which can meet the CQC’s requirements. This is what the companies are now resolving as restructuring discussions continue.

It is also important to emphasise that while the CQC is committed to ensuring continuity of care, it will not lower the regulatory bar or reduce the rigour of registration. CQC’s principal concern is the safety of service users and it will not compromise on the standards that are required. At the same time, we expect that local authorities will ensure that any transfer or new arrangement to provide care for residents takes place smoothly and with continuity of care for service users assured. We are talking to the Association of Directors of Adult Social Services, the Local Government Association and, of course, the CQC, as I have mentioned, to ensure that robust local arrangements are in place.

Finally, the noble Baroness asked about the staff and their legal position. This is not a matter that the department can comment on directly, but staff are protected by the relevant employment law. I understand that Southern Cross has undertaken in a letter to care staff that they will be transferred under their existing terms to new operators under TUPE. That is our understanding of the position.

[Earl Attlee]

My Lords, perhaps I may remind the House of the benefits of short questions which will enable my noble friend the Minister to answer as many questions as possible.

--- Later in debate ---

[Lord Campbell-Savours]

My Lords—

[Earl Attlee]

My Lords, I am very sorry, but we are out of time.

Public Bodies Bill [HL]

Earl Attlee Excerpts

Monday 28th March 2011 Lords Chamber

[Lord Hunt of Kings Heath]

My Lords, perhaps I may briefly support my noble friend in saying that I hope that the noble Earl will be able to give the assurance that he requires. The problem with Schedule 3 is that, on the face of it, it gives considerable power to Ministers to alter the constitutional arrangements of bodies and offices. I take that to mean that, if the Government were unhappy with the performance of the board of such an organisation, they could make drastic changes in its governance arrangements by bringing an order before Parliament. The problem is that that power could also be used to remove members of the board who may be causing some disagreeableness to the Government. That is a matter of concern. Clearly, if these public bodies are not able to exercise their functions in a robust and independent way, they are unlikely to do their job effectively. This relates to all the bodies listed but I think that the question that my noble friend has raised about Passenger Focus is a fair one to put to the noble Earl, Lord Attlee. I hope that, specifically in regard to this body, the noble Earl will say on the record from the Dispatch Box that the changes envisaged to governance et cetera will only be minor.

[Earl Attlee]

My Lords, this amendment would remove Passenger Focus from Schedule 3, preventing our current proposals to change the governance arrangements of the body. The noble Lord, Lord Whitty, asks why the body is still here in the Bill. He also mentioned other bodies, such as Citizens Advice. He will recognise that BIS is developing proposals for reforming the wider consumer landscape, but it is too soon to say how the reform of Passenger Focus will fit with that, as this is too long term.

The noble Lord expanded his point to Citizens Advice and trading standards organisations, if I may put it like that. We would not want to rule that out but the consideration of options is at too early a stage for any commitment to be given. As was made clear in Committee, the appearance of Passenger Focus in the Bill does not reflect the view that passengers’ interests are unimportant. We are very clear that passengers are the only reason that we run a public transport system in the first place. In addition, we fully accept the need for a powerful passenger advocate, which is reinforced by EU provisions that require us to have a properly independent complaints body to which passengers can turn. Passenger Focus has that role. This was reflected in the public bodies review, which concluded that Passenger Focus should be retained but substantially reformed to focus on the core role of protecting passengers, while reducing costs to taxpayers.

The noble Lord, Lord Hunt of Kings Heath, made the important point—if I might paraphrase him—that this is perhaps an opportunity to weaken the body in certain circumstances. The answer to that is simply no. We want to maintain an effective passenger advocate; that is the best way of ensuring that transport operators are held properly to account. The Government also value having a passenger advocate that has the confidence and expertise to be a critical friend to the Government and is prepared, where appropriate, to hold both the Government and transport operators to account. This is an opportunity to ensure that role is performed in a robust and cost-effective way.

A significant amount of work has already taken place to review the details of Passenger Focus’s work for next year within a significantly reduced budget. As part of this process, it is right that we should look at areas such as the size and composition of the Passenger Focus board. The noble Lord, Lord Whitty, asked how we would achieve the reduction in budget. An obvious area for reduction is research. We do not expect research to end altogether, but it is right to be sure that the current range of research is genuinely justifiable. We need to consider whether operators should do more to canvass the views of their customers, rather than expect the Government to pay for research.

As referred to in Committee, Schedule 3 can be used to implement changes to the composition of the Passenger Focus board. Indeed, we understand that Passenger Focus has for some time been considering streamlining the board’s operation. Although the details are still to be finalised, it makes sense that a scaling back of its activities should be accompanied by a smaller board that will also result in savings for the taxpayer. I understand that Passenger Focus is looking at reducing the size and cost of its board through a combination of measures, including not filling vacancies and changing the scale and scope of board meetings. The Government are working constructively with Passenger Focus to help it maintain its important functions within the constraints of a reduced budget.

We are also interested in exploring the continued funding of passenger representation in Scotland and Wales, where rail policy is largely a devolved matter. We are in contact with the devolved Administrations about how this may be taken forward. Some of Passenger Focus’s other specific Scottish and Welsh passenger activity, such as the current passenger link work, is expected to be restructured in a similar way to that in England.

I hope the noble Lord is persuaded that there are good reasons to have the ability to change the governance arrangements for Passenger Focus and that he will therefore feel able to withdraw his amendment on that basis.

Public Bodies Bill [HL]

Earl Attlee Excerpts

Wednesday 9th March 2011 Lords Chamber

[Lord Bradshaw]

My Lords, I support what the noble Lord, Lord Whitty, said. There is certainly scope for economy. I did not agree with the previous Government’s decision to transfer protection of bus and coach passengers to the Rail Passengers’ Council. However, the work of the council is concentrated mainly on issues such as punctuality. It has produced extremely good reports on things that irritate users such as huge queues at booking offices and the way in which ticket machines baffle many users and often do not work. These issues are important to people and I cannot think who will regulate them for less money. Transferring the functions to the Office of Rail Regulation, which is full of lawyers, will raise the cost of doing this work.

I will say one further thing in defence of Passenger Focus. It has developed a system of statistical analysis by which it can take very little in the way of raw information and turn it into statistically robust results. I am all in favour of economy, but I am also in favour of having a body to look after the interests of passengers that is functional and that rests on a secure base. I and most passengers would regret anything that abolished this body.

[Earl Attlee]

My Lords, I was surprised when the noble Lord, Lord Whitty, did not move his amendment, so it is a great pleasure for me to respond to him. He and I have debated together over many years. He has accepted some of my amendments and taken others away. It is a great pleasure to continue our debate, albeit with our roles reversed.

The noble Lord’s amendment seeks to remove Passenger Focus from Schedule 5 to the Bill. The appearance in the Bill of Passenger Focus does not reflect the view that the interests of passengers are unimportant. We are clear that passengers are the only reason why we run a public transport system. This was reflected in the public bodies review, which concluded that Passenger Focus should be retained but substantially reformed to focus on the core role of protecting passengers, thereby allowing a reduction in the cost to the taxpayer.

Noble Lords may see this as a first step towards cutting the budget of Passenger Focus to the point where it is no longer capable of being an effective voice for passengers. I reassure them that this is not the case. We fully accept the need for a powerful and effective passenger advocate. This is reinforced by EU provisions that require us to have a properly independent complaints body to which rail passengers can turn. Passenger Focus plays that role.

The noble Lord, Lord Whitty, asked whether this was not simply an opportunity to weaken and abolish a body that has been critical of the Government in the past. The answer is no. We want to maintain an effective passenger advocate because that is the best way of ensuring that transport operators are held properly to account. This is an effective opportunity to ensure that that role is performed in a robust and cost-effective way.

The Government had originally listed Passenger Focus in Schedule 5 to enable possible changes to its functions. Further work and our discussions with Passenger Focus have clarified that we can significantly reduce the cost to the taxpayer without recourse to legislative change through Schedule 5. For example, efficiencies can be derived by reducing the scope of Passenger Focus’s research and survey work. My noble friend Lord Taylor has added his name to Amendment 98 on that basis to support the removal of Passenger Focus from Schedule 5, which we hope will be welcomed by the Committee. However, the governance changes that we intend require its inclusion in Schedule 3, so we cannot support Amendment 75, which the noble Lord, Lord Whitty, was unable to move on Monday. Amendment 160A, which would remove Passenger Focus from Schedule 7, is effectively redundant in the light of the Government’s decision to remove Schedule 7 from the Bill.

I hope that I have been able to reassure the Committee and the noble Lord that we are not planning to leave passengers without proper protection and I hope that the Committee will accept Amendment 98.

[Lord Whitty]

I am not sure that it is in order for me to reply, given that my noble friend moved the amendment. However, I am grateful for some of those reassurances about the future of Passenger Focus. It would be helpful if we could be told the nature of the changes in governance that the Government propose, but perhaps that is for another day. However, I think that the body’s removal from this schedule is important. The noble Earl was probably not in a position to reply to my other points, which concerned the broader landscape of consumer representation.

[Earl Attlee]

The noble Lord asked what reforms we plan under Schedule 3. That schedule can be used to implement changes to the make-up and composition of the Passenger Focus board. Although the details are still to be finalised, the intention is to streamline the board’s operation significantly, which will also result in significant cost reductions.

[Lord Whitty]

I thank the noble Earl. Of course, some of the make-up of the board reflects the structure of the railway industry and the structure of the company. I hope that we will not lose that geographical dimension in changing its composition. I accept what the noble Earl says in relation to Passenger Focus. Clearly, I am grateful for his support for the amendment, although I think that we will have to return to the wider issue of the consumer landscape as a whole either in this Bill or in some other context in this House.

Blood and Blood Products

Earl Attlee Excerpts

Monday 10th January 2011 Lords Chamber

[Lord Corbett of Castle Vale]

My Lords, can I ask—

[Earl Attlee]

My Lords, I am sorry but we are out of time.