The NHS

Lord Bhattacharyya Excerpts

Thursday 5th July 2018 Lords Chamber

[Lord Bhattacharyya (Lab)]

My Lords, I thank my noble friend, Lord Darzi, for securing this debate, which has demonstrated how important our National Health Service is to the lives of so many in this House. I was very proud of the IPPR report—I was a long-standing trustee of the IPPR. I am an engineer; I am not a doctor. I design cars. However, I am married to a midwife, as well as the proud father of both a dietician and a recently qualified junior doctor; I have taken a great interest in this area. On that note, I should draw attention to my interests in the register.

This debate asks how the National Health Service can serve our nation in future. I want to raise two examples of how digital technology can improve our national health. Today the National Health Service is far from being a digital organisation. In fact, it is the world’s largest purchaser of fax machines. However, current digital resources can be used to improve future NHS services. In radiology, the NHS has held images and reports for a decade: millions of X-rays, scans and diagnoses. At the same time, radiologists face ever greater time pressure. Only seconds can be given to reviewing each new X-ray. This leads to outsourcing to expensive tele-radiology firms, which then make a lot of mistakes that cause a lot of errors.

We have an opportunity to build artificial intelligence systems that use the NHS’s historical data to identify which new X-rays radiologists should examine first. It is a form of digital triage. At my place we are developing such a system for chest X-rays. In future, the same principles could be applied to CT scans and MRIs.

Data anonymisation is essential, but, as my very good friend Dame Julie Moore of Queen Elizabeth Hospital in Birmingham, with which we are co-operating, said, no patients have refused consent to her trust collecting outpatient data.

Another way we can improve the use of current data by the NHS is with patients who have multiple chronic conditions. These cases are so complex that the causes of worsening symptoms may not be apparent even to experienced healthcare professionals. Furthermore, when multiple treatments are prescribed the patient can be overwhelmed. These patients do not need to present to a GP or an A&E as often as they do. A digital care planning programme could intelligently understand how treatments interact, prompt patients to medicate correctly and allow healthcare professionals to monitor patients remotely. Such technology and devices are available now. This would reduce the pressure on front-line NHS providers and provide better care to patients at home or in social care.

We desperately need to support innovation if the NHS is to succeed for the next 70 years. Sadly, as the Science and Technology Committee report on life sciences has said, the structure of the NHS stifles innovation. Innovation is a topic I am familiar with. We have been innovating in British manufacturing industry for a long time. We need to transform the way the NHS applies new technologies. To achieve this we need strong leadership on innovation in the National Health Service. Innovation is simply essential and is very easy to use. However it is important that we have the skills base to use it.

National Health Service

Lord Bhattacharyya Excerpts

Thursday 14th January 2016 Lords Chamber

[Lord Bhattacharyya (Lab)]

My Lords, I thank my noble friend Lord Turnberg for securing this debate and declare my interest as an engineer and chairman of the Warwick Manufacturing Group at the University of Warwick. I also run the Institute of Digital Healthcare jointly with the medical school.

Two years ago, I was treated for pneumonia at the Queen Elizabeth Hospital Birmingham, a fantastic new hospital led by an outstanding former nurse, Dame Julie Moore. The care I received was immaculate, and I understood then why the NHS is sometimes called our other national religion. However, I see it as our national science. After all, it is the subject of many experiments and is constantly being tested.

One current test is higher care standards, which requires more medical staff on wards. As a result, agency staff costs have soared. Monitor expects the bill to be over £4 billion this year, blaming a fundamental mismatch between supply and demand for medical staff. A lot of companies have made very good profit exploiting this, and it is rather ironic that Ministers are now proposing a cap on rising bills as the answer. The truth is that, whether in energy or agencies, price caps are a short-term fix. The solution is to increase supply.

Several medical schools, including Warwick, offer four-year medical degrees for graduate entrants. Such graduates do very well both academically and in their career. Warwick graduates are currently second only to Cambridge medics in gaining specialty training places. Shorter courses also mean qualified students can contribute to the NHS earlier. Four-year graduate entry degrees broaden access, attract quality applicants and give faster returns on public spending. It would be ludicrous to close such programmes. Yet medical schools could be forced to do so, as EU legislation demands that medical qualification takes five years. Currently, the fifth year for graduate entrants is the first-year foundation programme. During this time, graduates are provisionally supervised under the GMC before full registration as an independent practitioner is granted.

However, after the Greenaway review, the Government proposed merging degree graduation and full registration. This would unintentionally make four-year courses impossible, as removing the year under provisional registration would leave graduate entry courses short of the EU demand for five years’ training. To resolve this, graduate entrants could continue to do their first foundation year under provisional registration, and I understand the GMC may favour such a solution. We must innovate to attract outstanding medical students, then get them working as soon as we can. To achieve this, I urge the Government to pledge that future graduate entrants will retain the option of a four-year medical degree.

Residential Care: Cost Cap

Lord Bhattacharyya Excerpts

Thursday 10th December 2015 Lords Chamber

[Lord Bhattacharyya (Lab)]

My Lords, I also thank my noble friend Lady Wheeler for securing this debate. When two years ago the Government committed themselves to capping the cost of care, the Health Secretary said that the policy would create,

“certainty, fairness and peace of mind”.—[Official Report, Commons, 11/2/13; col. 592.]

Both the summer postponement of the cap and our debate today demonstrate that those pledges are just a distant hope. True, the challenges the Government faced were vast. Social care was an unreformed, unsustainable system. For some, social care meant losing all their savings. For others, it meant inadequate homes, or worse. A growing number were denied support altogether.

The Care Act was a serious attempt to address these issues. It was not perfect but it put a limit on financial risk and set clear guidelines. However, five years after Dilnot, we find that 400,000 fewer people now receive social care and 1 million more elderly people have unmet needs. Care home providers warn of bed reductions and home closures. The only place where the cost of care has been capped seems to be the spending review. After all, we know that the cost of care is growing for those in need. The threshold at which you must pay the full cost of your care has now been frozen for five years. This care creep means that more and more pensioners are losing the right to any help with social care every year. Those who still qualify for some support have seen their bills increase by almost 50% since 2010.

We know that pressure is growing for carers. Since the turn of the century, 1 million more people have become unpaid carers. The number of carers doing 20 hours of unpaid work each week is up by over a third. The LSE estimates that a third of a million carers have left the workforce altogether.

We know that the burden of care is falling on our health service. Cancellations of urgent operations in the NHS have almost doubled in just two years. The reason? Patients cannot leave hospital if there is no care at home. Just last week NICE told hospitals to appoint a discharge co-ordinator to try to get patients out of NHS beds. That is money being spent in the NHS to deal with the care cuts.

We have heard the Government’s response to these growing stresses in the system. They say that councils can increase taxes, which is welcome, of course. However, you cannot fund national social care fairly with a system that allows Wokingham to raise twice as much per head as Birmingham. Next, the better care fund is being increased—but only in two years’ time. We shall wait and see. Finally, the care cap is being delayed, as many people have said, saving £6 billion. The truth is that the savings from delaying the cap will come from the assets of those in care. With no care cap, more family homes will become deferred payments for social care. Self-funders will still get no support for five years, even if eligible for help.

I accept that there are no easy answers. Many of these issues dogged the last Labour Government as well. Nor do I think you can build a strong social care system on the basis of unsustainable borrowing. Ultimately, if we want decent social care, we must pay for it. I will highlight two ways in which we could do so. First, it is bizarre that while we are making huge cuts to social care, we are increasing pensions via the triple lock. The Government’s actuaries say that the triple lock already costs an extra £6 billion a year. That is the same as the care cap. Politically, the triple lock may seem untouchable. But if those excess pension rises were used to fund social care, we would be changing only how we help our older citizens.

For a longer-term solution, we must examine the broader pensions and tax system. One consequence of delaying the care cap is that for the next five years anyone who withdraws their pension faces the risk that their nest-egg will be snatched to pay for social care. This could be the next pensions scandal. However, it also suggests an opportunity. The Government are reviewing the tax arrangements for pensions. If pension funds are to be truly flexible, surely we can encourage savers to use these savings to support their care needs. Why not make using your pension to pay for social care tax-free? To help create a save-for-care culture, we could offer younger people “care ISAs”. We could even cut tax-free allowances for the wealthy to fund incentives for people on lower incomes to save.

Finally, the Government have hinted that they might move to a “tax first, exempt later” pensions policy. This would give an immediate, if temporary, increase in tax revenue. It would make sense to use such a windfall to fund a transition to an integrated health and care service. I would be interested to hear from the Minister if such approaches are being considered in the pensions review. Clearly, finding money in an austere age requires creativity but, as my noble friend Lady Wheeler made so clear, social care desperately needs resources. Last year we agreed on the right ends; this year our ambition must be matched by means.