NHS: Targets

Lord Bishop of Carlisle Excerpts

Thursday 6th February 2020 Lords Chamber

[The Lord Bishop of Carlisle]

My Lords, this is a very timely debate. I am most grateful to the noble Lord, Lord Hunt of Kings Heath, for securing it. I also look forward very much to the maiden speech of the noble Baroness, Lady Wilcox. We have already heard many statistics with regard to NHS targets and shall no doubt hear many more. But there seems to be general agreement that one of the biggest problems facing the NHS is what many now call a crisis in social care, which has been highlighted by this debate and emphasised by the noble Baroness, Lady Pinnock, and to which I will address this contribution.

The crisis consists of several factors—most already mentioned, so I will not repeat them—that lead to delays in discharge, the cancellation of elective operations due to lack of beds and an increase in A&E admissions, including elderly people whose health has suffered as a result of a lack of adequate care. All this is of course immensely costly in time, money and misery, as well as immensely disruptive for an NHS desperately trying to meet its targets. Given that the laudable aims of the NHS long-term plan will never be realised unless we sort out social care, what needs to be done?

I suggest that in the first place we remind ourselves just why this is so important. It is not only because it is vital for an effective NHS but primarily because the hallmark of a civilised society is the way in which it treats its vulnerable members. Recognising the intrinsic value and dignity of every member of our society, we want to offer care and respect to all, and aspire to the best by enhancing rather than just maintaining people’s lives. That will involve three fundamental changes. First, and most important, is the proper integration of health and social care. This was one of the main recommendations of the ad hoc Select Committee on the Long-term Sustainability of the NHS, mentioned by the noble Lord, Lord Hunt, of which I had the privilege to be a member. Although we now have a Department of Health and Social Care, there is still a very long way to go. The root of today’s problem was the separation of health and social care and their means of funding, even though they are linked aspects of health and well-being. Secondly, we need proper training, care and status of care workers. We need a professional, motivated and committed workforce who enjoy high esteem, which is not always the case at present. We also need to acknowledge the immense and invaluable contribution of unpaid carers.

Thirdly, social care in this country needs adequate funding. Noble Lords will have seen the seven key principles for that offered by the Health for Care coalition in our briefing note from the NHS Confederation. The need is estimated at an extra £8 billion per annum, which obviously has to come from somewhere. That somewhere is presumably our pockets. Of course, that is one reason why this subject is so politically sensitive. It is also one of the many reasons why we so urgently need the sort of cross-party consensus to which this Government have declared their commitment.

I support calls that have been made for a Select Committee or cross-party group of some kind to be established immediately to produce specific long-term proposals—that expression, “long-term”, has been used several times already in this debate—to break the current deadlock. There are plenty of previous reports on which to draw and although this might look like yet another delay to the long-awaited Green Paper, if it results in decisions and actions, that brief delay will be well worth it. Without it, the situation will only get worse to the detriment of all concerned. As we have already been eloquently reminded, a well-funded and good-quality social care sector is fundamental to a well-performing NHS.

Nursing and Midwifery

Lord Bishop of Carlisle Excerpts

Thursday 30th January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

We are of course conscious that we need to support midwives, especially as we look to raise standards in midwifery. Specific plans are being developed by the Chief Nursing Officer, Ruth May, which will ensure that all parts of the nursing profession, including midwives, will be focused on. These will be brought forward shortly.

[The Lord Bishop of Carlisle]

My Lords, given Florence Nightingale’s genius for exploring and combining very disparate fields of study and practice, including the worlds of healthcare and faith, will Her Majesty’s Government and the Minister join me in commending the work of parish nurses, who now bring health and healing to more than 100 communities around the country, complementing the work of both the NHS and social care agencies?

[Baroness Blackwood of North Oxford]

I absolutely agree with the right reverend Prelate on this issue. He will know that the long-term plan is committed to supporting and developing community care. Parish nurses are a key part of that, but so is the development of social prescribing, which we have committed to rolling out. I know that parish nurses work hand in hand with this programme, so I am pleased to agree with the points that the right reverend Prelate has made. We will also want to think carefully about how we can support the work that he is doing.

Asthma

Lord Bishop of Carlisle Excerpts

Wednesday 3rd July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Lord is asking me to step in and comment on matters that are slightly outside my brief. However, I am pleased that we have brought in the clean air strategy, which is a significant step forward. He is also asking me to commit the Mayor of London rather than leadership candidates to a policy area. We do need to move further and faster on air pollution; that is what I expect to see in the prevention Green Paper which will be published shortly.

[The Lord Bishop of Carlisle]

My Lords, given the recent report of an upsurge in acute asthma attacks among schoolchildren at the start of each school year, and given that—as we have already heard—there are three deaths per day from asthma in the UK, many of them preventable, what plans do Her Majesty’s Government have for encouraging better health education regarding the seriousness of this disease?

[Baroness Blackwood of North Oxford]

As ever, the right reverend Prelate is insightful on this matter. Children going into school with identified respiratory illnesses should have care plans to assist the school in caring for them. Asthma UK has indicated that many children are slipping through the net and remaining on long-term oral steroids in primary care. This results in repeated trips to A&E with no referral to specialist centres. We are working with NHS Improvement and others to ensure that we support them with training in the use of medication and improving the use of smart inhalers, which can track the management of their care and reduce referrals to secondary care.

Lung Health

Lord Bishop of Carlisle Excerpts

Monday 1st July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right: COPD is the second most common lung disease in the UK. It is disturbing that around a third of people, in their first hospital admission for COPD, had not been previously diagnosed. NHS RightCare is developing a COPD pathway, which is being rolled out nationally through clinical commissioning groups, to identify the core components of an optimal service for people with COPD to ensure earlier diagnosis and better management, so that they do not experience the concerns that she has identified.

[The Lord Bishop of Carlisle]

My Lords, further to the Minister’s helpful comments about air quality, can she tell us to what extent Her Majesty’s Government are monitoring the existence of microparticles of plastic in the air, especially in our cities, and the impact they are having on lung health?

[Baroness Blackwood of North Oxford]

The right reverend Prelate raises an extremely important point on air health. While we have long-term commitments in the clean air strategy, and the other measures that have been put forward in the Green Paper and net-zero commitments, NICE has published guidance on the effect of air pollution on people with chronic respiratory and cardiovascular conditions. We also have the Committee on the Medical Effects of Air Pollutants, which advises the Government on many matters, including those the right reverend Prelate raised.

NHS Long-term Plan

Lord Bishop of Carlisle Excerpts

Monday 1st July 2019 Lords Chamber

[The Lord Bishop of Carlisle]

My Lords, as a former member of the Long-Term Sustainability of the NHS Committee, I welcome the long-term plan and the Government’s response to it. I am especially glad that mental health issues will achieve financial parity with physical health issues. Does the Minister agree that research into and attention to the causes of these ever-increasing issues is as important as more spending on their treatment?

[Baroness Blackwood of North Oxford]

As ever, the right reverend Prelate is insightful in his question. He is right that although we have made a lot of progress in improving services, we were coming from a low base. One of the challenges is not understanding why there is such an increase in the challenges we face. This is why the NIHR has dramatically increased the amount of funding it provides to mental health research, and why other important organisations, such as the Wellcome Trust, are prioritising mental health research as a matter of urgency.

Diesel Emissions

Lord Bishop of Carlisle Excerpts

Wednesday 5th December 2018 Lords Chamber

[Lord O’Shaughnessy]

The important issue is that, whoever holds the post, the Mayor of London has the power to take action. It is notable that that has not been reinstated by a Labour Mayor of London, so maybe there was something in that decision in the first place.

[The Lord Bishop of Carlisle]

My Lords, does the Minister agree that, while electric cars are being developed, trees, plants, shrubs and especially hedges can make a very useful contribution to the absorption of harmful emissions, as well as having a therapeutic value for those who grow them and those who enjoy them? Can he tell us of any plans the Government may have to encourage the greening of our towns and cities?

[Lord O’Shaughnessy]

The right reverend Prelate makes an excellent point, with which I completely concur. We are making good progress in increasing the number of ultra-low emission cars. There is a huge amount that we can do to green our cities. I know that this is a priority of both the Ministry of Housing, Communities and Local Government and Defra. They will have specific details, and I will write to him with an answer.

Organ Donation (Deemed Consent) Bill

Lord Bishop of Carlisle Excerpts

2nd reading (Hansard): House of Lords
Friday 23rd November 2018 Lords Chamber

[The Lord Bishop of Carlisle]

My Lords, the Church of England is wholly committed to both the principle and the practice of organ donation, believing as it does that giving oneself and one’s possessions voluntarily for the well-being of others and without compulsion is a Christian duty and that organ donation is a striking example of that. Like many other noble Lords, I am personally glad to have my name on the organ donor register. I was closely involved with the so-called fleshandblood churches campaign, which we ran in partnership with the NHS from 2012 onwards and added thousands of potential donors to the list. We therefore have absolutely no wish to be remotely churlish about this Private Member’s Bill which is so very clearly well intentioned, and with whose overall objectives we are in complete agreement. We are most grateful to the noble Lord, Lord Hunt, for bringing it forward.

However, I cannot let this moment pass without mentioning three caveats which have all been raised elsewhere and by other noble Lords but which bear repeating and need to be borne firmly in mind as the Bill proceeds. First, “deemed consent” is not some sort of magic wand—as the noble Lord, Lord Ribeiro, referred to it—that will automatically increase the number of effective donations. More important by some distance, as we have been reminded, is the raising of awareness, the encouragement of conversations about this subject in families and a new willingness to talk about death. This was stated by the Bill’s author as one of its principal aims, but I do not see the Bill achieving that aim in itself. As some have observed, it could have the opposite effect. This would be highly unfortunate since, as we know, for understandable reasons, grieving relatives are often a stumbling block to donation, even when it was manifestly the deceased person’s wish.

My second hesitation is that our present system, which is referred to as a hard opt-in but is really a soft opt-in, reflects a very careful balance between individuals, relatives and the state, with a presumption that the state does not have a right to dictate either to individuals or their families how their bodies should be used. An opt-out system represents, whether it means to or not, a major shift in the state’s relationship with its citizens. The noble Lord, Lord Lansley, touched on this. As the Catholic Bishops’ Conference of England and Wales observed, an opt-in system emphasises the positive ethos of donation as a free gift with informed consent. Despite the assurance from the noble Lord, Lord Hunt, that the Bill is still very much about giving, this suggests that we need an overwhelming case that numbers of lives saved or enhanced would be significantly increased. That overwhelming case would have to be made before a change of this kind is introduced.

That brings me to my third caveat. There is at present, I suggest, no overwhelming case. The evidence, such as we have, is rather ambivalent. I fully acknowledge the February 2018 BMJ article cited in our Library briefing, which says that Wales has seen more registered donors and fewer family refusals than any other part of the UK since the introduction of the opt-out system in 2015—the noble Baroness, Lady Finlay, and the noble Lord, Lord Ribeiro, referred to the very high consent rate in Wales. However, at the same time, as the same briefing records, the Welsh Government indicate that, as yet, opt out has had no impact on the number of actual organ donors in Wales. It is three years on: perhaps we do need to wait 10 years, as the noble Lord, Lord Ribeiro, suggested, because at the moment the evidence is not clear.

I note the comments of the highly regarded Nuffield Council on Bioethics, which is concerned that making a legislative change based on poor evidence risks undermining public trust in the organ donation system. Indeed, as we have been reminded, especially by the noble Lord, Lord Ribeiro, examples from countries such as Spain indicate that improvements to transplant protocols and procedures are more important than a change to the consent system. That is why the Church of England would prefer to build on the current opt-in model to increase the number of organ donors and transplants. However, we accept fully the head of steam, as it were, behind the Bill and will certainly not oppose it. None the less, we ask that in the almost certain event of its successful passage three very important considerations are taken into account.

The first—we have heard a great deal about this already—is that there should be very good communication, not least in schools and in BAME communities, where, as we have heard, the need for donors and transplants is often greatest. We heard some statistics on this from the noble Lord, Lord Patel. The second is that adequate resources should be made available for the implementation of this new system, including specialist nurses for organ donation. That has been mentioned by almost all noble Lords who have spoken. The third is that more effective use should be made of potential donors, in ways highlighted by the transplant pathway. Only then do we believe that the pressing need for more organ donations will be met.

The NHS

Lord Bishop of Carlisle Excerpts

Thursday 5th July 2018 Lords Chamber

[The Lord Bishop of Carlisle]

My Lords, I too am most grateful to the noble Lord, Lord Darzi, for securing this timely debate. On the one hand, I am grateful because it is an opportunity to recall and be thankful for the establishment of the NHS in 1948 as one part of a comprehensive vision of social welfare—which, incidentally, owed much to the insight and energy of Archbishop William Temple and other Christian thinkers and activists. Temple and Beveridge were close friends, and much of the post-World War II vision that led to the creation of the welfare state by Bevan and others emerged from church-led consultations.

On the other hand, I am grateful for the clear emphasis in this debate on integration. Our word “health” comes from an Old English word meaning “wholeness”, and the Old Norse version of that word meant “holy” or “sacred”. From the start, when churches and monasteries founded our first hospitals, healthcare has been understood holistically. There is a real sense in which our National Health Service should include caring for all aspects of well-being in all our people. Certainly, in the Select Committee report on the long-term sustainability of the NHS the word “integration” appeared several times.

In the brief time available, I will suggest two aspects of healthcare that fall into the community care category, and which, like mental health and social care, urgently need integrating with other parts of the NHS. The first and most obvious is public health. Here I declare an interest as an associate of the Faculty of Public Health. Other noble Lords have raised this and I am sure others will. I will not, therefore, dwell on it, but from a purely financial point of view money spent on prevention bears obvious dividends: it is never wasted. From a well-being angle, furthermore, prevention has always been better than cure and always will be, especially in relation to our consumption of food and alcohol and our commitment to taking exercise.

The second aspect is spiritual well-being. The World Health Organization understands spirituality as,

“an integrating component, holding together the physical, psychological and social components of a person’s life”.

It is often perceived as concerned with meaning and purpose. For those nearing the end of life, this is commonly associated with a need for forgiveness, reconciliation and affirmation of worth.

Delivery of spiritual care is the responsibility of all professionals in the multidisciplinary healthcare team. This debate, however, provides the opportunity to affirm the vital role of healthcare chaplains, who minister to the spiritual needs of those from all religions and none.

Underlying all this is a significant question of responsibility. Who is responsible for making all this integration happen? We ourselves have an obvious responsibility, as every citizen does, when it comes to prevention but with regard to the integration of physical and mental health with social and community care, do we look primarily to NHS England, regional STPs, local trusts or Parliament to take a lead? I would be most grateful for the Minister’s view on this. There is also the question of consultation. The foundation of the NHS followed a comprehensive and inclusive debate in UK society. Are there any plans for a similar process of inclusive debate, in which all voices are heard and all concerns addressed, as we look forward to the next 70 years of our invaluable National Health Service?

Chronic Lymphocytic Leukaemia: Ibrutinib

Lord Bishop of Carlisle Excerpts

Thursday 7th June 2018 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Lord for his question. There are two important issues here. First, on this treatment as a first-line treatment, the evidence that was put into NICE by the company itself did not propose its use as a first-line treatment, which is why it has been proposed as a second-line treatment. It is important to distinguish there. However, clearly there is this apparent discrepancy between the NICE guidelines and NHS England. I have, obviously, investigated this, subsequent to the meeting with my noble friend and sufferers. NHS England’s view is that its commissioning guidelines are consistent with the commissioning when the drug was in the cancer drugs fund, and the full NICE guidance, but I also know that that is not satisfactory to some of the patients suffering from this illness who have been in remission for three years. That is precisely what I want to get to the bottom of next week.

[The Lord Bishop of Carlisle]

My Lords, I am most grateful to the Minister for meeting some of the patients suffering from this terrible disease. Can he tell us whether anyone directly affected by blood cancer was consulted before the initial decision was made by NHS England to restrict access to Ibrutinib? Can he assure the House that NICE guidelines will not often be varied—and then only after consultation with patients?

[Lord O'Shaughnessy]

I thank the right reverend Prelate for that question. As he will know, NICE consults widely with patient groups and others in making its decisions. I am not clear at this stage whether NHS England met patient groups and others in designing its clinical commissioning guidelines, which is of course what I shall investigate next week.

NHS: Cancer Treatments

Lord Bishop of Carlisle Excerpts

Thursday 25th January 2018 Lords Chamber

[The Lord Bishop of Carlisle]

My Lords, it is a great privilege to speak in this debate. I begin by observing that although, as we have heard, we currently have one of the worst cancer survival rates in Europe, the overall 10-year survival rate for all cancers in the UK has improved from 25% a few decades ago to 50% today. The laudable and ambitious goal of our cancer strategy is to make that 75% within the next decade, thereby not only catching up with but surpassing international, and especially European, averages. Cancer Research UK, among other agencies, is currently researching possible therapeutic interventions, many of them innovative, in a range of more than 200 different types of cancer, and that is something to celebrate. However, I suggest that three vital conditions need to be met if those aspirations are to be achieved.

The first, as others have mentioned, is proper funding for research as well as for the highest-quality treatment available for all cancer patients. This is obviously a major challenge for an NHS which is strapped for cash and for a country which faces so many massive, competing demands for its resources. In the previous debate today, I and others referred to the recent report of the Lords Select Committee on The Long-term Sustainability of the NHS and Adult Social Care. I beg your Lordships’ indulgence to do so again now, as that report, which I hope we will soon be able to debate, directly addresses this issue.

The second condition is prioritising planning, especially of the workforce. Health Education England’s cancer workforce plan talks about training 300 more endoscopists and 200 more radiographers, and about every patient having access to a cancer nurse specialist by 2021. That is most encouraging but it has to be seen in the context of a significant shortage of staff trained to perform tests necessary for diagnosing cancer and alarming forecasts about future vacancies. For instance, 28% of radiographers are due to leave by 2021. The APPG on cancer concludes that NHS England will struggle to achieve the objectives set out in the cancer strategy unless corrective action is taken immediately—and that includes taking the NHS out of party politics in order to encourage long-term plans.

The final condition is putting patient outcomes ahead of process target performance. This is essential for identifying treatments for inclusion within the NHS. It also applies to the release of funding, both for early diagnosis and support for life after treatment. Several cancer care alliances have had their funding delayed because of their lack of progress against the 62-day wait standard, and some genomic diagnostic testing is in danger of being withdrawn even though that may mean that thousands of cancer patients may have to endure what, for them, would be unnecessary and debilitating chemotherapy. Good patient outcomes include not only increased life expectancy through cure or slowing down the disease but the prospect of improved palliative care.

I welcome this short debate on innovative cancer treatments and, like everyone else, I am grateful to the noble and courageous Baroness, Lady Jowell, for securing it. I hope that its outcome will be another step forward for cancer patients everywhere.