NHS: Junior Doctors’ Pay

Lord Bishop of Chester Excerpts

Wednesday 27th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, it is not a question of hospitals closing at weekends because of inadequate staffing; it is a question of whether hospitals are able to offer high-quality care throughout the weekend. Some hospitals can but some cannot. We have seen, for example, the reorganisation of stroke care in London. Providing high-quality seven-day services for stroke care can have a significant impact on the quality of patient care. This seven-day issue is not just about junior doctors by any means; it is a question of having diagnostics, senior doctors and a whole range of other specialties on duty over the weekend.

[The Lord Bishop of Chester]

My Lords, I, too, declare that I have a daughter who is a junior doctor. She is in her fourth year since qualification. To get to the level of remuneration that the noble Lord mentioned—from £23,000—junior doctors have to work jolly long and unsocial hours. But my specific question is: what is the comparator with other developed western countries for the remuneration of our younger doctors?

[Lord Prior of Brampton]

My Lords, I cannot answer that question as fully as I would like but I shall certainly write to the right reverend Prelate on that. I think that from 2004 to 2007 British doctors were extremely well remunerated by any international comparison but that, over time, that has eroded. But I will write to the right reverend Prelate with those comparisons.

General Practitioners

Lord Bishop of Chester Excerpts

Monday 22nd June 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness is quite right. After five years as a medical student, they then do two foundation years before making the choice whether to become a GP or to go into specialist medicine. That is a crucial time to persuade young doctors that there is a good, long-term career in general practice. Health Education England and NHS England are putting huge resources into persuading young doctors at that stage in their career that there is a good future in general practice. I say to the noble Baroness that there is no doubt at all in my mind that, if we run the clock forward five years, more care will be delivered in primary practice and in the community than in acute hospitals.

[The Lord Bishop of Chester]

My Lords, I declare inside information, in that my daughter is a trainee GP. I asked her about these issues last night. In Cheshire and Wirral there are vacant training places with no GP trainees to take them. On asking her why people did not want to go into general practice, she said that it is the growing burden of bureaucracy and administration. What do the Government plan to do about that?

[Lord Prior of Brampton]

The right reverend Prelate is right. Many GPs are concerned about the level of bureaucracy in their practices. As he probably knows, we have reduced the number of QOF indicators by a third—that is, by 40—from a staggering 120. This is a big concern. NHS England is looking at other ways in which we can reduce the bureaucracy. If the right reverend Prelate’s daughter has any ideas, perhaps she will be kind enough to give me them.

Children and Families Bill

Lord Bishop of Chester Excerpts

Wednesday 20th November 2013 Grand Committee

[The Lord Bishop of Chester]

My Lords, I will speak very briefly. Over the years I have been attracted by most vices, but never to smoking, so in the circumstances it is easy to speak against it. I will add that it is not just a domestic issue. The noble Lord says that he has an interest in BAT. What astonishes me is the way in which the growing awareness in this country of the dangers of smoking seems to be so slowly taken up in the developing world. We have a moral need, not only in relation to our own children but to the developing world, to make clear the dangers of smoking. It really is a global issue. It behoves particularly the wealthier countries—not least if the interests of big business are engaged, as undoubtedly they are, or those of the Exchequer—to give a proper lead. I think these amendments do just that.

[Baroness Howarth of Breckland (CB)]

My Lords, I want to speak briefly because the health arguments have mainly been made. I want to make two rather different points. I support both of these amendments. I have a long-standing reputation for campaigning in this area. I find it interesting that the industry has suggested, from time to time, that packaging makes no difference. If it makes no difference, why is it so important? Let us get on and take it off the shelves. We have all the evidence to show that children are attracted to packaging and we all know our own instincts. I have never smoked, but both my parents died from smoking related diseases. My mother was addicted and said that I should stop anyone else I could from smoking.

My other point is on the smoking in cars amendment. Having said that the medical arguments are substantially made, which the Minister knows whatever the position he has to take on this, there is also a clear safety issue about smoking with children in cars. Anyone who has driven with two arguing children strapped in the back of their car—because children argue in the backs of cars, and if yours do not, then they are remarkable—will know how distracting it is and how you have to absolutely keep your concentration up. So I have always found it strange that we do not stop people being distracted by fiddling into a bag or a pocket for a packet of cigarettes, finding something to light up with and taking their eye off the road—we have all seen it—while they light a cigarette. They then have a cigarette in one hand while they are driving their children in their cars. This is an added reason for ensuring that people cannot smoke with children in cars. You might say that where there are two people one of them may smoke, but there is the medical reason and this additional safety reason. I have no idea whether there are any statistics on accidents because people have been smoking in cars, but when you think of the legislation we have to stop people using mobiles, which in some ways are much more automatic, I cannot understand why we do not have similar legislation to protect children, not only for the medical issues in relation to their health but also for sheer practical safety reasons.

Care Bill [HL]

Lord Bishop of Chester Excerpts

Wednesday 12th June 2013 Lords Chamber

[Lord Patel]

I disagree with my noble, respected and even revered friend Lord Walton of Detchant. He fundamentally fails to understand this amendment. It does not remove the research functions of the Human Fertilisation and Embryology Authority. I have spoken strongly in the past about embryo research, including cell nuclear transfer and mitochondrial research. It is the authority that has held up for so long the progress in mitochondrial research. We should have been doing something about it at least 18 months ago. This amendment does not remove that function, nor does it remove the functions of the Human Tissue Authority, but by amalgamating these functions we can better promote research. The authority and functions of the Human Fertilisation and Embryology Authority—and now we are entering into a science debate, which is not the purpose of the Bill—stop once it gives a licence to do specific research on an embryo. Once the embryonic stem cells are created it has no authority over how those cells are used. Once the cells are used to create a tissue for research it does not have any authority, but the Human Tissue Authority may do. By amalgamating the two you are co-ordinating this research function and maybe improving it. I hope that my noble and revered friend accepts that explanation.

[The Lord Bishop of Chester]

My Lords, having listened to these distinguished doctors taking different points of view on this subject, I fear that I might lower the tone of the debate. However, I think that my money is with the noble Lord, Lord Walton of Detchant. There is a world of difference morally between research carried out on tissue taken from a dead body and research taking place on living tissue which has the potential to be a human being in one way or another. People will argue about when life begins and those arguments can be very sensitive and very divisive. That is why there is separate legislation on research and on therapeutic techniques involving eggs fertilised outside the womb. Whether one likes it or not, if you put together the Human Tissue Authority and the HFEA you will create an impression that you are just dealing with dead matter or whatever, just a lump of cells. That is the impression that will certainly be given psychologically, even if in practice one could construct the unified authority in a way that had the two legs.

It may well be that one needs to revisit this area. The noble Lord, Lord Winston, speaks with such authority that I am very reluctant to take a different view. However, he seemed almost to be arguing for greater regulation rather than no regulation. I would be very reluctant to see a free market in implanting more than two embryos into women in this country, for example. The 14-day rule, which may be an irritant to researchers, was fought over and discussed at great length. To those of us who have quite a few reservations in this area, that is at least a line in the sand. I think that this area needs to be considered on its own merits and, notwithstanding the arguments quite rightly put by the noble Lord, Lord Patel, I am with the noble Lord, Lord Walton.

[Lord Patel]

Stem cells are not dead cells: they are immortal cell lines, such as the HeLa cells on which scientists have been doing research for decades. These cells were taken in 1951 from a woman called Henrietta Lacks—that is why they are called HeLa cells—and they are still alive. Most cancer research is done, and many drugs produced, using HeLa cells. They are immortal, living cells.

[The Lord Bishop of Chester]

My Lords, as St Paul once said, I speak as a fool. However, is there not a difference between stem cells that are alive in that sense and a fertilised egg that is alive in a different sense?

[Lord Walton of Detchant]

I intended to say, but did not, that the two different bodies’ areas of authority collide when you deal with stem cells, because they are derived from embryo research but then become cells that are used for tissue research and transplantation and so on. That is where they collide. That does not necessarily mean that it is crucial to merge the two authorities.

Health and Social Care Bill

Lord Bishop of Chester Excerpts

Monday 14th November 2011 Lords Chamber

[Baroness Barker]

My Lords, for over 25 years I have worked either in or as a consultant to voluntary organisations. Consequently, my eyes lit up at the sight of an amendment that said VAT and charities. In my time, I have sat with wet towels around my head trying to figure out this, one of the most complicated subjects. I have attended seminar after seminar with the Inland Revenue at which people with bigger brains than me have come away with their heads reeling from trying to understand the issue of VAT and charities. It is infinitely more complicated for charities than it is for the private or public sectors. That is not new. As various people have said, this issue has been running for some considerable time.

I want to correct two impressions that might have been given inadvertently in the debate. First, there is the impression that there is a view in the charitable sector on this issue. There is not, because the issue effects different organisations disproportionately. While there may well be a consensus among hospices that it would be advantageous for them to make such a change, it may not be and indeed is not for other, smaller charities. That is the first thing.

Secondly, we have this new generation of social enterprises. These organisations are not charities but businesses. They are intended to be big players in the provision of services. The noble Lord, Lord Patel, has been clever here in not asking for the Government to take a particular step. He simply asks for a report on a subject that will fascinate some of us quite deeply. Were the Government to take on board the point that the noble Lord makes, apart from looking at a whole range of different charities—not just hospices—would they also consider the effect on social enterprises? I do not think that it is possible to come up with a set of legal proposals that relate simply to health and social care. By definition, they would have to go across the whole of public services. I hope that the noble Lord, Lord Patel, would accept that an exercise of this kind should do that.

Finally, be careful in the questions that you ask of HMRC. As someone who advised charities, I was always brought up never to ask a question of HMRC unless I was pretty confident that I would get back the answer that I wanted. This may be an answer that the hospices want but I would wish to be pretty clear that it worked for charities across the board. I simply finish by saying that if this subject were straightforward, it would have been sorted out a long time ago—but it is not and that is why it has not been.

[The Lord Bishop of Chester]

I am very grateful to the noble Baroness, Lady Barker, for what she just said about the complexity of the question. However, I would like to go back to what the noble Baroness, Lady Pitkeathley, said about what charities do well. Particularly important is their face-to-face concern with the whole needs of whole persons rather than the abstract application of principles. I would add two things that some charities offer that intersect with other bits of our social agenda at the moment. One is the passion of those volunteers who work particularly for local, small charities. A lot of energy is sapped by precisely the issue that we are discussing this afternoon. If we are concerned for what might be called in the most general way the big society, how you engage people in maximum participation at a local level in concerns and charities—particularly small ones, which are very close to the action—is extraordinarily important, it seems to me. Passion and localism are two aspects of this that must not be forgotten.

[Lord Cormack]

My Lords, I thought that the noble Lord, Lord Patel of Bradford, moved an absolutely model probing amendment, and the complexity of the issue was very well illustrated by the brief contribution of the noble Baroness, Lady Barker. I came not to take part in this debate but to listen, but I just want to say, as someone who represented a constituency in Parliament for 40 years, that I saw the enormously valuable work that so many charities did, particularly hospices and organisations that provide support, such as the Macmillan nurses and, as the noble Lord, Lord Noon, mentioned, the Marie Curie nurses, who do a very similar job.

As we have this seminal opportunity to get it right, I hope that my noble friend the Minister, for whom I have enormous respect and regard, will be able to respond to this exemplary probing amendment in his customary exemplary way by indicating that the Government are indeed taking these matters exceptionally seriously. I hope that the Government are anxious to ensure, when this Bill emerges from Committee and goes to Report, that the Minister will have some remedies to meet the extremely important and pertinent points raised by the noble Lord, Lord Patel, when he moved this amendment and others who have supported him in this brief but, I think, important debate.

Health and Social Care Bill

Lord Bishop of Chester Excerpts

Wednesday 9th November 2011 Lords Chamber

[Baroness Cumberlege]

That sounds very suggestive, my Lords.

[The Lord Bishop of Chester]

My Lords, perhaps the noble Lord, Lord Davies, was right to refer to besetting sins behind me.

[Lord Mawhinney]

Moving on, I remind my noble friend of the times we sat with a cup of coffee and a private secretary or two—just to make her feel better—and we wrestled over some fairly difficult and complex issues. Either she or I would say, “We need a bit more information about that”, the civil servant would say, “Yes, Minister”, and in due course, when diaries permitted, we would sit down again with a bit more information. That can be said to be good ministerial governance—or it could be said to be politically motivated delay when others in the health service knew better, and if only we had got out of the way they would have done what they wanted, but they would do what those in power at the time happened to want, ignoring the contrary views of those who did not happen to hold the management positions at that moment.

I want my noble friend to accept that I still hold her in as high regard as I did before this debate started, but we part company fairly fundamentally on the issue of the accountability on a spend of £128 billion a year. As I said in an earlier debate—I have expressed this privately to the Minister, and my noble friend had the grace to say that he understood—my difficulty is that if you are spending £128 billion of public money, the public whose money are spending are simply not going to say when big problems arise, “Well, that’s okay, we’ll listen to him or her because he or she is chairman of a quango”—even a quango as highly thought of as my noble friend no doubt hopes the national Commissioning Board will be.

There is no debate in this House about the fact that the Secretary of State must be held accountable by Parliament. My noble friend Lord Marks of Henley-on-Thames made the point, which has to be right, that the Secretary of State must also be held accountable by the courts. However, the Secretary of State also needs to be held accountable by the public and the patients, who have not had a huge showing in our debates thus far. I have concerns about this clause because I am not at all clear how the Secretary of State is going to satisfy X billion people by putting in £128 billion that he is accountable to them for if they are absolutely determined that they want him to be accountable to them.

To help the Minister when he takes this clause away and thinks about it, I say to the noble Lord, Lord Warner, that I was not convinced by the amendment. I am happy that he has made that part of his contribution to the review that my noble friend will conduct, but I hope that he does not press it to a vote because I for one would not be able to support it.

There are parts of the clause that the Minister really needs to look at, such as the phrasing in new Section 1C(a):

“any … person exercising functions … or providing services … is free to exercise those functions or provide those services in the manner that it considers most appropriate”.

From that, I am not clear—I do not necessarily want the Minister to tell me this today, but I ask him to think about this—at what point these actions start to become health service policy in their own right. We quote precedent in here. If someone takes an action because they think it is right in the circumstances, does that become a policy or a guideline? Where does the Secretary of State play any role in developing a policy for the NHS?

New Section 1C(b) goes on to say,

“unnecessary burdens are not imposed”.

I have to say to my noble friend that I do not understand what that means. Who decides whether it is a burden? Who decides whether the burden is unnecessary, and where can you challenge the decision whether a burden is a burden and when it becomes unnecessary? It is okay if you consider your action to be the most appropriate in the circumstances. My party occasionally gets criticised for being inclined to being a bit too individualistic, but you cannot run a health service in which everybody can make the decision that they think is most appropriate in the circumstances without a well defined political framework within which they would be expected to act.

I will tell my noble friend something that I have said to him in private but do not mind sharing in public. I spent 26 years at the other end of the Corridor. In all that time I never once voted against my party. Some in this House will see that as wimpish and craven, and some will see it as a fine expression of loyalty. Frankly, I do not mind how you see it. It is how I see it that is important to me.

I have not done a Committee stage of a Bill since I left the Cabinet in 1997, so I want Members of your Lordships’ House to understand that I am not having much fun in these Committee sittings. This is not something that comes naturally to me, and I have tried to reassure my noble friend that my participation in these debates is because of my commitment to the health service and my desire that it should be as excellent as possible. This is for the sake of my former constituents, who are patients. In that spirit, I hope my noble friend will take away Clauses 1 and 4 and think about them again.

Health and Social Care Bill

Lord Bishop of Chester Excerpts

Wednesday 2nd November 2011 Lords Chamber

[Baroness Murphy]

My Lords, I am particularly concerned about the area-based issue because, like many people, I have been banging on for years about the importance of coterminosity between health and social services. However, my experience over the years has been that that has not made much difference to the co-ordination of care between health and social care.

I want to raise a point about the new arrangements. I understand that we are trying to move away from the old RAWP funding formulation, which has always been deeply unsatisfactory and open to political manipulation, to the funding of real groups of patient populations on a risk-assessment base. To achieve that, there is no doubt in my mind that you must have real people on real lists, whether or not that clinical commissioning group has a responsibility to provide for a population within the group. You must be able to work towards a funding solution for those clinical commissioning groups that reflects real need and moves away from the old area-based populations.

I think that that may be the response I would give the noble Baroness, Lady Finlay. I did not really understand the brief amendments in this group that were not specifically related to this question so I address my issues to that.

[The Lord Bishop of Chester]

My Lords, I completely support the amendment in the name of the noble Baroness, Lady Finlay, but wonder whether what she wants could be achieved—it might be a small step in the right direction in relation to legislation generally—by simply removing from the Bill the words “provided to individuals”. The term “individuals” has a jarring effect. “Provided to people” might sound a bit better, but “individuals” has a slightly impersonal feel, especially as we are concerned as a Committee and as a House about the “national” character of the National Health Service. References to individuals jar in that regard as well. Simply requiring improvement in the provision of services might achieve what the noble Baroness seeks in her amendment.

[Baroness Cumberlege]

My Lords, I should like to ask a few questions about Amendment 10A. I thank the noble Baroness, Lady Finlay, for her introduction, but we do not yet have a precise definition of what she means by area-based populations. All sorts of different services have different catchment areas. At the beginning, the noble Baroness cited family planning services. She said that she felt that perhaps it was a bad example, and I think it probably is because there are so many different services that require different boundaries. I am for coterminosity as far as we can get it, because when I was a regional chairman, I saw that where you had coterminosity between the health service and local government, you could achieve a great deal. That worked well, but when one examined it carefully, it was not so much about the boundaries; it was about the relationships built between different people. That was what made the services work extremely well.

With regard to GP practices, GPs usually want people within their area, especially if they will have to do home visits. I have been in the situation—I am sure that many noble Lords have—where I had an emergency in London but my GP is 52 miles away. That can be coped with; you can still manage that, although it is quite awkward in some respects. My anxiety about allocating patients to different GPs—being neat and tidy and trying to get all the boundaries sorted—is that I do not know what it does for choice. Perhaps the noble Baroness will say something about that. What happens when people want to choose a different GP who is out of their area, which is what we want to do locally but are unable to because the boundaries have been so clearly fixed, I have to say, by the GPs themselves?

Disabled People: Dementia

Lord Bishop of Chester Excerpts

Monday 11th October 2010 Lords Chamber

[Earl Howe]

My Lords, my noble friend has hit on an extremely sensitive and important area. My answer to her is similar to the one I gave on a previous question: we must focus on outcomes. That is the main theme of the recently published implementation paper. This morning, I was speaking to a representative of the King’s Fund, which has done tremendous work in this area. This is one aspect of its work, of which I am sure we shall be hearing more.

[The Lord Bishop of Chester]

My Lords, what policy do the Government have for supporting the learning of British sign language?

[Earl Howe]

My Lords, the right reverend Prelate rightly calls attention to the needs of those with aural disability. The Government’s plans for audiology are in gestation at the moment. Unfortunately, it is too early for me to tell him, but I shall aim to write him a letter at the earliest opportunity.

First Aid

Lord Bishop of Chester Excerpts

Thursday 17th June 2010 Lords Chamber

[Earl Howe]

My Lords, I will gladly feed that suggestion in to the Chairman of Committees.

[The Lord Bishop of Chester]

My Lords, the noble Baroness has asked my question. However, I wonder whether mouth-to-mouth resuscitation might be excluded from such a course?

[Baroness Masham of Ilton]

My Lords, is the Minister aware that the St John’s guide on first aid and the five basics is free and can be carried round in somebody’s pocket? Should not all restaurants have it because people can choke very easily?