Sodium Valproate and Pelvic Mesh

Lord Hunt of Kings Heath Excerpts

Monday 25th March 2024 Lords Chamber

[Lord Markham (Con)]

The 2025 date is the timetable that the Patient Safety Commissioner recommended in terms of financial redress. The point that the noble Baroness makes, quite rightly, is about the non-financial aspect: if you are suffering pain from it all, you want to be treated as quickly as possible. That is why we have set up these nine specialist centres to allow exactly that sort of redress to occur.

[Lord Hunt of Kings Heath (Lab)]

My Lords, can I remind the noble Lord that, of course, it was not a matter of months since this first recommendation came? The noble Baroness, Lady Cumberlege, recommended a redress scheme some years ago. Why was it rejected in the first place, and why are we waiting many more months, as the Minister said, when, as the Patient Safety Commissioner has said, the intention is

“an initial, fixed sum in recognition of the avoidable harm they have suffered as a result of system-wide healthcare and regulatory failures”?

Why are the Government being so slow to respond?

[Lord Markham (Con)]

That is precisely what I put to Minister Caulfield this morning. She commissioned the review because her feeling was that the period from when my noble friend’s initial report came in until when Maria Caulfield was in post was too long. So it was absolutely she who commissioned it last year, and it is absolutely she who very much said that she is determined that there should be a substantive reply from us in the next few months.

Sexual and Reproductive Healthcare

Lord Hunt of Kings Heath Excerpts

Tuesday 19th March 2024 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I congratulate the noble Baroness on her contribution and fully endorse what she has to say. We clearly have a crisis in sexual and reproductive healthcare.

I refer the Minister to evidence given to the Commons Women and Equalities Committee only in January by Dr Claire Dewsnap, president of the British Association for Sexual Health and HIV. She said that

“a lot of the presentations in clinics and potentially in other settings like primary and secondary care, are things that we have not seen for 50 or 60 years”.

In the same session, Dame Rachel de Souza highlighted that in the past, schoolchildren could go to the school nurse with sexual health issues but there has been a 35% cut in school nurses over the last 10 years. This issue of access means that it is significantly harder for young people to access sexual health services, particularly in rural areas. According to Dr Dewsnap, because of budget cuts only 10% of sexual health services offer a drop-in facility. That makes it far less likely that young people and children will seek the support they need.

A further, highly effective resource that has been totally cut is the Sexwise website. This highly valued sexual health resource for professionals and the general public was developed by the FPA in 2017 on behalf of Public Health England and handed to PHE to run in 2019. But, alarmingly, the Minister’s department ended the contract to deliver maintenance support for the website from 4 March this year. Twice, the department has refused an offer from the FPA to take it over, and the reasons given are clearly spurious. The first rejection was based on Crown copyright considerations of the Sexwise brand—a ridiculous argument. The second rejection, after the FPA clarified that the Crown could keep ownership of the brand, was, quite frankly, nonsensical.

The basic need for what Sexwise gave, which was accurate and free-to-access sexual and reproductive health information, has not gone away. I hope the Minister will instruct the DHSC either to put Sexwise out to a public tender—we are talking about tens of thousands of pounds of cost—or to accept the generous offer from the FPA to run it on the department’s behalf. I am afraid that the Sexwise saga just reflects the Government’s attitude towards public health, perhaps apart from smoking.

I would like the Minister to reflect on the effective dismantling of the Office for Health Improvement and Disparities. It took over the funding of the public health grant when Public Health England was disestablished in 2021, which in turn, of course, replaced the Health Protection Agency following the Health and Social Care Act 2012. It has now been authoritatively reported in the Health Service Journal that unannounced changes to the office have led to its fragmentation and decimation.

So over 12 years we have seen, through a number of iterations, the Government essentially move from having a large, mainly independent public health agency to a disparate group of people spread thinly across a number of directorates in the Department of Health. At what cost? I have seen reports that OHID has been reduced by about 60% in staffing terms, with a loss of several senior and experienced officials and the downgrading of many functions, including sexual health. Can the Minister tell me how many qualified public health specialists have left OHID and how many remain within his department? It is a far cry from the triumphal tone of the announcement launching the office, followed by the September 2021 statement by the then Health Secretary, Sajid Javid, who said he wanted OHID to work on preventing poor mental and physical health, addressing health inequalities and improving access to health services, and to work with partners within and outside government to respond to wider health determinants. That ended well, didn’t it?

My noble friend Lady Merron anticipated this in her regret Motion of 9 November 2021. As she put it, it is hard to see how the UK Health Security Agency or the OHID could be “independent or effective”. They were not set up in statute and were created

“without parliamentary scrutiny or approval”.—[Official Report, 9/11/21; col. 1675.]

As we can see, it is very easy then virtually to dismantle OHID without any public or parliamentary scrutiny whatever. Hunter, Littlejohns and Weale, in a forthcoming BMJ opinion column, will argue:

“Set up in haste with no consultation, OHID lacks any of the … independence PHE had, being an opaque body scattered through the Department of Health and Social Care. Given its low profile and lack of a clear mission, it comes as no surprise that, despite denials from the government, it has been virtually eviscerated”.


Or, as Dave West from the HSJ has put it,

“the latest restructure, as well as being damaging to a functioning national public health system, suggests any idea of greater push and support from the centre for independent for ICSs’ long-term agenda—of population health, prevention inequalities—remains for the birds. Hopes of tougher preventative action on alcohol or sugar, for example, equally so”.

That has to be on a par with the Government’s tepid approach to public health measures, smoking aside. The shamefully postponed implementation of the obesity strategy is but one example, and it is in this context, of course, that we see the problems arising in sexual health. How else can we explain the LGA’s analysis that, between 2015 and 2024, the public health grant received by local authorities has been reduced in real terms by £880 million, which has resulted in a reduction in councils’ ability to spend on STI testing, contraception and treatment? As David Hunter and his colleagues argue, revitalising public health in the UK requires changes, including a cross-government approach to tackle the social determinants of health alongside restoring the funding cuts to public health funding. Will the Minister effect that change, including restoring the real-terms value of the public health grant, the cut to which has so decimated sexual health services in the way described by the noble Baroness, Lady Barker?

Prioritising Early Childhood: Academy of Medical Sciences Report

Lord Hunt of Kings Heath Excerpts

Monday 11th March 2024 Lords Chamber

Asked by

[Lord Hunt of Kings Heath]

To ask His Majesty’s Government what assessment they have made of the report of the Academy of Medical Sciences Prioritising early childhood to promote the nation’s health, wellbeing and prosperity, published on 5 February, particularly regarding children under 5.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The Government welcome the report. We have taken significant action to improve children’s health in the early years. This includes reducing sugar in children’s food, supporting healthy diets for families from lower-income households through schemes such as Healthy Start, and investing record amounts into children’s and young people’s mental health services and around £300 million in the family hubs and Start for Life programmes. We are also improving children’s oral health through our dentistry recovery plan.

--- Later in debate ---

[Lord Hunt of Kings Heath (Lab)]

My Lords, I pay tribute to my noble friend Lord McAvoy, who was an incredible parliamentary servant in both Houses over many years.

I thank the Minister, but he will be aware that we have a frightening number of people of working age who are not able to work because of long-term illness. The implication of the academy report is that we are storing up huge problems for the future. As one example, 20% of under-fives are obese or overweight. If the Government are so keen to take action, why have they postponed the implementation of their obesity strategy, which would start to take action against unhealthy food and encourage young people towards more exercise and a healthier lifestyle?

[Lord Markham (Con)]

First, I add condolences from myself and this side of the House for Lord McAvoy.

Secondly, I am grateful for the direction of the report. I think that we all agree that early investment in childhood, and in young people, is vital. That is what our vision for the first 1,001 critical days is all about. A lot of the things in the report are helpful. I must admit that I did not recognise that particular stat, because rather than it being one in five children suffering from obesity at age five, the latest report—and it is an extensive study—shows that it is less than one in 10. It is the lowest number since 2006-07. So, in the area of obesity, we can show that our plans are working. I say again: we have the lowest level of obesity among reception age children since 2006-07.

Anaesthesia Associates and Physician Associates Order 2024

Lord Hunt of Kings Heath Excerpts

Monday 26th February 2024 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I was a member of the GMC until the end of January, so at the council meetings I was involved in a number of discussions about the responsibilities of the GMC in the lead-up to this order being laid. Unsurprisingly, I strongly support it.

I listened to the noble Baronesses, Lady Bennett, Lady Brinton and Lady Finlay, and clearly they raised issues that the Minister will need to respond to. However, the combination of statutory regulation by the GMC and a proper governance framework within each employment body seems the most appropriate course for us to take. Therefore, I say to the noble Baroness, Lady Bennett, that passing the order is the best way to secure the safety of patients, which is why I hope the House will give it resounding support tonight.

My second point comes back to the noble Baroness, Lady Bennett, on democratic accountability and legitimacy. The Minister mentioned that a combination of the Health Act 1999 and the Health and Care Act 2022 has brought this order before us. Since I took the 1999 Act through this House, I feel some responsibility to stand up for what it essentially aims to do. The whole problem of regulation of the professions in the health service is that it has never had the priority it deserves from the Government. The Law Commission reported in 2014, and here we are 10 years later, just about getting round to the first tranche of orders that we need to modernise the regulation of our health professions.

If you rely on primary legislation to make this kind of change, nothing will ever change. It is slow enough with secondary legislation, but with primary legislation it becomes almost impossible to get sensible change made. All the regulatory bodies are utterly frustrated that they have very old-fashioned processes and procedures, because they do not have the discretion needed to make changes that would be to both the public’s and the professions’ benefit. Therefore, I am glad we have this order and I hope we can follow it through.

My third point is about the noble Baronesses saying that they do not like the campaign of what is essentially vilification that has been going on over the last few months against the physician and anaesthetist associates. I wish they had paid a little more tribute to the members of those professions and the fantastic work they do. I have met physician and anaesthetist associates, and they are going through a torrid experience. They have been subjected to a nasty campaign and, even in their own employing body, there have been reports of bullying at work and they have been subjected to rude and antagonistic comments from colleagues.

What is the context in which we are to judge this litany of mistakes that they have made? They seem to be isolated examples and, to my knowledge, there is no comparative data on errors by consultants, principal GPs or postgraduate medical trainees. I would not like to see a list of all their mistakes. What would happen if we asked people to report mistakes made by F1 medics each August? The BMA is playing with fire in the campaign it has adopted of putting these poor professionals, who are doing their best, in this frame. I protest about this and the general lack of medical leadership from the profession when it should have been defending the associates. The way it has run away from this issue has been a disgrace. It will find that its lack of leadership and strength will bite it in future. I have not been impressed by the way in which employing authorities have dealt with this either; they have left individual AAs and PAs to withstand the pressure and bullying without the support they need.

The Minister needs to reflect on some of the points raised. First, in addition to declaring his confidence in physician and anaesthesia associates, he needs to set out a long-term plan for their contribution to the NHS, ensuring that the voices of those professions are heard. The Government’s ambitions on the numbers of AAs and PAs seem very modest. Why? Does he think we need to revisit that? Secondly, he needs to make it clear to NHS England and to employing authorities that bullying and intimidation of any healthcare professional in their employment must not be tolerated.

Thirdly, in response to the noble Baronesses, Lady Brinton and Lady Finlay, the Minister needs to ensure that each employing body adopts an appropriate local governance framework to deal with some of the issues that they have legitimately raised. Fourthly, we need research on the clinical outcomes of physician and anaesthesia associates and, frankly, comparative data with other health professionals. That is the only way to deal with the toxicity of these lists of mistakes that have been circulated. Finally—here I agree with the noble Baronesses, Lady Finlay and Lady Brinton—there clearly needs to be a plan of communication to the public to explain the role of the associates and the contribution they can make in future.

The order is important. Some legitimate issues have been raised, but equally we need to defend the associates, uphold the work they do and give them confidence about the future.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interest as a NED of the NHS Executive. I support this order, for many of the reasons that the noble Lord, Lord Hunt, has just explained, but stress that I am extremely unhappy about the division between the reports from various medics and the associates that are planned. One of the big problems is that we do not value junior doctors enough. The phrase we use is inappropriate. I have been married for 43 years to a doctor who has been called a house officer, a senior house officer, a registrar and a senior registrar—those things would now be referred to as a junior doctor. I want to put that on record.

I also support what the two noble Baronesses have said, which is that we need a distinguishing factor for a qualified doctor, be that “MD” or whatever else is selected by the medical profession. I am a nurse, and I am proud of being a nurse. We have nursing associates, but I know that I am a registered nurse and I know that I have a doctorate, but I would never refer to myself as a doctor in the clinical area. These issues are difficult to deal with because we need to value people’s different experience and training.

I was appointed by a previous Secretary of State to chair the grandfathering of the paramedics on to the new register, when it came into being, and look at the success that that has been.

--- Later in debate ---

[Lord Patel (CB)]

My Lords, I begin with a slight disagreement with the noble Lord, Lord Harris. I take his point about how dental professionals, not just dentists, are regulated by the GDC, but I agree with the comment from the noble Lord, Lord Lansley, about the impression it would give if other professions apart from doctors were regulated by the General Medical Council. Hitherto, the GMC has regulated only doctors, so it would have to be clear in the register how these people were differentiated. I am afraid that the solution of having a prefix on a register would not mean anything to patients.

In the past, if you walked around a hospital, it was easy to know who was a doctor, as they mostly wore white coats; who were the nurses, because they wore different uniforms, including the matron’s uniform, which was a different colour; and who was a trainee nurse, because they wore a pink uniform, which is why junior doctors referred to them as “pinkies”. Physiotherapists wore yet another colour of uniform. However, nowadays everyone wears suits or jackets or jerseys, so you cannot distinguish from that which profession is looking after you.

I take the point that the noble Lord, Lord Winston, made, that for all of us who have done surgery, a qualified, competent anaesthetist is our friend. But sometimes—as he and I have no doubt done—we operate on pretty vulnerable patients for whom the surgery is necessary but they are not a safe bet for anaesthesia, unless by an extremely competent anaesthetist. But I interpret the anaesthesia associate as someone who does not induce anaesthesia but only maintains anaesthetic under strict supervision by a qualified anaesthetist. And that is quite distinct from what a physician associate might do, because they might be involved in different ways in assisting the physician. The point made by the noble Lord, Lord Winston, is important because it is an example that shows up the importance of the scope of the practice of physician associates and anaesthesia associates.

It does not help—and this debate is an example of why so much concern has been expressed—when the NHS health careers website says, in relation to physician associates, that they will be trained in

“taking medical histories … performing physical examinations … diagnosing illnesses … seeing patients with long-term chronic conditions … performing diagnostic and therapeutic procedures … analysing test results … developing management plans”—

which I presume means patient management plans. If you see that, you can see why there are concerns and confusion over what their responsibilities will be and the limitation of the scope of their practice.

I absolutely appreciate the need for physician associates —I keep calling them assistants—and anaesthesia associates and the need for regulation, but I think this crosses the Rubicon since it is the General Medical Council that will regulate this. It is important that what it defines as the scope of the practice is understandable to patients and professionals clearly.

The noble Lord, Lord Hunt of Kings Heath, commented that he took the legislation through this House in 1999, and that Act will subsequently be the vehicle for SIs to be used for future regulation. I am sorry that some of us were not here at the time because some of us might have opposed it. An Act from nearly 25 years ago cannot be the one that continues to be used. If we are going to have further reforms of the regulation of doctors and nurses—where we are talking about 1.5 million health professionals, not 3,000 physician associates or anaesthesia associates—I hope we are not going to have an SI to do that, because there are lots of issues of regulation.

[Lord Hunt of Kings Heath (Lab)]

My Lords, to be fair, I said that that Act had been subsequently amended by the Health and Care Act 2022. If you do not have flexibility through regulation, you will never get anything done in relation to modernising health regulation. Governments simply do not find time in primary legislation to update regulation.

[Lord Patel (CB)]

I hope they do find time, because that allows for better scrutiny and better ability to amend, which we always claim to be our key role—to scrutinise and amend. It is a major piece of legislation to go through using SIs, and it is inappropriate to do so. Maybe we must consider how else we could do it in a way that maintains flexibility.

Moving on from that, as the noble Lord, Lord Harris, already mentioned, if this legislation is going to be the template for future legislation to regulate all health professionals, some issues will need to be discussed. This order does not require that health is considered as a category in the regulation of physician and anaesthesia associates. The statistics show that, when the GMC or, I presume, any other regulator investigates, it is a very stressful situation for the person involved. Some statistics suggest that one in three considers suicide; they are depressed by it. If the category of health is removed as a consideration when a person is investigated, as this order does, it is a backwards step. I need to ask the Minister why health has been removed as a consideration. If this is the template, I presume that this will also apply to other regulations in the future.

NHS Dentistry

Lord Hunt of Kings Heath Excerpts

Monday 19th February 2024 Lords Chamber

[Lord Markham (Con)]

The noble Lord is correct in talking about the supply challenges. That is what the long-term workforce plan is all about, and why we are committing to a 40% increase in training places by 2030. The other issue that he rightly raises is the balance between the cost-effectiveness of providing private versus national health dentistry. The problem is that it is often seen as more lucrative for a dentist to go down the private sector route. That is why we are trying to rebalance that and have introduced an increase in the minimum charge to £28 for a unit of dental activity, and £50 for a new patient, to try to bring services back more in favour of the NHS.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I declare my interests as president of the British Fluoridation Society. The Academy of Medical Sciences reported very recently that nearly a quarter of five year-olds have tooth decay. Unless we deal with this there will be many more queues and great difficulties with access. The Minister will know that shortly there will be a consultation in the north-east to introduce fluoride. Surely the current situation demands that we extend this throughout the country.

[Lord Markham (Con)]

Yes, the noble Lord is correct that there is very good evidence of the effectiveness of water fluoridation, and the report as recently as 2022 showed there are no side-effects. The north-east will increase the number of recipients by about 1.6 million people, and there is a process that that needs to go through but I totally agree that we should expand it as far as we can.

Pharmacy First

Lord Hunt of Kings Heath Excerpts

Tuesday 6th February 2024 Lords Chamber

[Lord Markham (Con)]

My noble friend is absolutely correct to bring that up, and that is why it is quite specific on “simple” UTIs. The devil is in the detail, but the reason behind saying simple UTIs is that so the capacity is there, and you can have a referral to a GP.

In this space I speak from personal experience with my partner. It is much harder these days to get antibiotics for UTIs. We know that this is generally a good thing in terms of antimicrobial resistance, but in many cases, as my wife often says, she knows when she has a UTI—and boy does she need those antibiotics.

Some of the things I have started to see in terms of technology, which is relevant to the question of complexity, include point-of-care devices in surgeries or pharmacies that can detect a UTI very quickly, so that you then know you can give a prescription for antibiotics. That is what we see in terms of the direction of travel.

[Lord Hunt of Kings Heath (Lab)]

My Lords, when I had responsibility for community pharmacy more than 20 years ago, one of the schemes we instituted was incentivisation for private consulting rooms and spaces. I wholly endorse what my noble friend Lady Merron said about the importance of this, and the noble Baroness’s intervention reinforces this. It sounds as if most community pharmacies have some kind of private area, but they are not always as good, secure or private as they ought to be. So I very much hope that the incentive that I hear the noble Lord has built into the scheme will actually lead to ensuring that patients have confidentiality, which is really important here.

On the cap, I understand the need for probity and making sure that there are no perverse incentives to overcount, but it would be a bit of a disaster if, nine months into the financial year, a very good community pharmacy ran out of its allocated funding. What would happen? Will integrated care boards at the local level have some discretion to come in at that point to ensure that that service can continue?

On integrated care boards, some clinical commissioning groups were very poor at getting community pharmacy around the table. It always amazed me that, in their winter planning, they seemed to forget the need to have community pharmacies as equal partners. Can the Minister assure me that, when this programme is taken forward, integrated care boards will be clearly told that they are expected to treat community pharmacies as important partners in this and in planning for winter, which, as the noble Lord knows, continues for much of the year?

[Lord Markham (Con)]

I thank the noble Lord and will answer his questions in reverse. On getting the ICBs around the table, I absolutely agree. This is seen as a key part of those initiatives and handling those pressures. Generally, going back to privacy, I would expect to see, as ever with these things, some pharmacies that become very good and set up really nice areas, with a lot of expertise. I am sure they will push ahead. I am making this up, to be honest—this is not policy—but I would not be surprised if it started off with a base level of ones that can do only the seven, with others that are more skilled and show that they can manage more things, such as hypertension. There will be some very successful ones. On the cap, it would be perverse if those really successful ones suddenly hit the buffers, so to speak. As I understand it, the cap looks at this much more in terms of a global presence. In the department as a whole and the Treasury, we are going into this with a budget in mind and with the appropriate safeguards. But, going back to the value for money question, overspending is actually probably good news because it shows that it is working.

National Health Service: Key Targets

Lord Hunt of Kings Heath Excerpts

Tuesday 16th January 2024 Lords Chamber

[Lord Markham (Con)]

Funnily enough, I had this conversation in terms of productivity just today. The virtual wards—the 11,000 extra beds we have put in—are actually making a real impact on that, because of course it is much better that people can be treated in their own home, knowing they have the comfort of these virtual displays and treatment to look after them. We have 11,000 extra beds, with 72% utilisation, and, yes, it is really working.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister keeps talking about progress being made, but if he looks at, say, the four-hour A&E target, he knows that the latest figures show that the NHS reached only 69% in December. In 2010, his party inherited a performance of 98.3%. What does he think that says about his party’s stewardship of the NHS?

[Lord Markham (Con)]

I can talk about what we are doing now, which is showing real progress. But I have to say that the saying “People who live in glass houses shouldn’t throw stones” comes to mind, because, looking at those same targets, I notice that the Labour-run NHS in Wales never reached the four-hour A&E target; the last time it hit the 62-day cancer target was in August 2010, 14 years ago; and the last time it hit the hospital treatment target was in August 2010. I say politely that the noble Lord might want to get his own house in order first.

NHS Winter Update

Lord Hunt of Kings Heath Excerpts

Thursday 11th January 2024 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness for those points. Absolutely, I will need to come back on some of the detail on the virtual wards and how they are being used. One thing I will say about them, though, from my knowledge, is that the ability of people to communicate on a regular basis is one of the key advantages. On the point she makes about palliative care and the ability to have 24/7 communication, the beauty of the virtual wards is that they have that inbuilt, for want of a better word—they have that advantage. As noble Lords know, I am always eager to learn from practices all around the world, so I will very happily meet people and learn from them.

On retention, absolutely, we all know that the supply of doctors and medics is the key thing that we need, so I personally feel that we need to look at every avenue to make sure that we can maximise that supply. Again, it is something that I will inquire into as a result of that, and maybe when we have our meeting we can discuss that further.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I too thank the Minister for the Statement and his response, but it takes the biscuit in terms of the Government really seeking to exploit the plight of the NHS by putting so much emphasis on the industrial action being taken. As the noble Lord has said, even before Covid the Government were way off meeting any of the core targets. In 2010, they inherited a health service that was running very well and met all the targets. They threw away that inheritance. When Covid hit, the health services were already running so hot that there was just no headroom at all to cope with the pressure that then came, with—my noble friend is right—hugely dangerous occupancy rates. There was simply no headroom.

Looking at the funding, from 1948 to 2019-20 the NHS received funding of 3.6% real annual growth, on average, per annum. The coalition Government slashed it to 1.1%. The May and Cameron Governments gave it 1.7%. Only with the Covid expansion were resources over that 3.6% average. It is no wonder that the health service is tackling such a momentous challenge. We need to hear from the Government some real plans to get investment back in the health service, to give it the kind of headroom it needs to start meeting the targets that are so important—would the Minister agree?

[Lord Markham (Con)]

I happily agree that we are investing record sums. The latest figures show that we are investing around about 11% of GDP in the National Health Service. I believe the figure in 2010 was somewhere in the 7% to 8% range—I am speaking from memory and so I will correct that if it is not quite right, but that is the sort of massive expansion we have seen. If I take one area as an example, the cancer workforce has trebled since 2010.

What we are seeing more than ever is a record level of investment in the health service but also a record level of demand. I was hoping to show in the Statement how we are looking to tackle that. I will freely admit the challenges, and that it is early days, but I believe we are showing signs of getting on top of it. As I have said many times, I really think that technology will be its future, and there will be lots more we can talk about when we show the profound changes it is going to make.

Organ Donations

Lord Hunt of Kings Heath Excerpts

Tuesday 12th December 2023 Lords Chamber

Asked by

[Lord Hunt of Kings Heath]

To ask His Majesty’s Government what assessment they have made of the impact on organ donations of the Organ Donation (Deemed Consent) Act 2019.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very glad to have tabled this Question for Short Debate. I was honoured to take through the House my Bill, which became the Organ Donation (Deemed Consent) Act in 2019. In the year before the Bill became law, over 400 people died while waiting for a transplant and a further 755 people were removed from the transplant list as they were just too ill to receive a transplant. The Act aimed to increase the number of organ donations and save more lives.

The Policy Innovation Research Unit at the London School of Hygiene & Tropical Medicine is undertaking an evaluation for the Government on the implementation of the Act. It described the situation we have as a “soft opt-out” system, where it is presumed that people are happy to donate their organs after their death unless they have indicated otherwise or registered their decision to opt out. The principle behind the Act is simple: decisions not to donate should rest with individuals to make during their life, and families should not be able to make decisions on their behalf after they have died. The question is: has the Act made an impact?

My understanding is that there were just under 7,000 patients waiting for a transplant, with a further 3,800 temporarily suspended from the transplant list, at the end of March 2023. In 2022-23, 439 patients died while on the active list waiting for their transplants, compared with 429 in the previous year. A further 732 were removed from the transplant list, mostly as a result of deteriorating health and ineligibility.

NHS Blood and Transplant reported that:

“In 2022/23, there was a 2% increase in the number of deceased donors … and the total number of patients whose lives were potentially saved or improved by an organ transplant increased by 5%”.


Worryingly, its evaluation of opt-out legislation in England observed a consent rate of 61%, which was lower than the predicted post-legislative opt-out consent rate of 78%. We can conclude that, in England, while there has been a little progress, there is no evidence of significant change in consent rates in the initial years after implementation.

So what has gone wrong? I want to identify six issues. The first is whether the NHS is geared up to respond to higher deceased donor rates, if we can get them. The second is whether we have enough specialist nurses. They have the extremely difficult role to play of initiating discussions about potential organ donations with families, at a sensitive time. The family is still always involved in those discussions, but we know that investment in transplant co-ordinators is often cited as one of the key factors for Spain’s world-leading organ transplantation service. The third issue is whether we have a strong enough communications strategy. The Government committed £18 million to this but, in essence, Covid got in the way. It seems to have been left to patients themselves and the charities that support them, such as Kidney Care UK, to raise awareness of the Act.

The fourth issue is bureaucracy. While the Act covers some elements of deceased donation, it excludes less common organs, tissues and research. There are now multiple pieces of legislation and consent systems working in parallel, which provide a confused picture for those trying to operate the transplant service. The fifth issue is that there clearly needs to be a lot of work done to reverse the poor donor participation affecting patients with ethnically diverse backgrounds. Finally, we need to think further about the role of families. Although families no longer have a veto in law on organ giving, in practice they are still influential. This contrasts with other countries where opt-out systems are in place, where there tend to be fewer families vetoing the organ donations of their loved ones.

In advance of the evaluation that the Government commissioned, three reports have identified and looked at some of these issues. The first was that of the All-Party Parliamentary Group on Ethnicity Transplantation and Transfusion. Its recent report highlighted how the lack of donor participation affects patients with ethnically diverse backgrounds. It reports that a patient’s chance of surviving diseases such as blood cancer, and chronic conditions such as kidney disease, is heavily swayed by their ethnicity. On average, those of mixed heritage and from ethnic-minority communities wait longer for diagnosis and for the best donor to be found for their treatment. The APPG says that its key discovery is how hard it is to get sound data and what little progress has been made on this. The APPG thinks that our healthcare systems do not record ethnicity with the consistency or granularity necessary to be clear about the gaps in need and outcome of treatments.

Kidney Research UK echoed this in its 2018 report on the health inequalities of kidney disease, which found that people from ethnic-minority groups waited between 168 and 262 days longer for a kidney transplant than Caucasian kidney patients. I find that both remarkable and utterly unacceptable; think of the impact that must have on the life chances of those people waiting, on average, much longer for a transplant.

Coupled with that, Kidney Research UK pinpointed in a recent health economics report that demand for kidney transplantation could be as high as 12,000 per year by 2033. In the UK, the current levels are around 3,000—we have an awful long way to go there.

I will mention a final report produced last month by the Cystic Fibrosis Trust, which stated that organ utilisation is a key issue affecting transplant rates in the UK. It pointed out that in 2022-23 only 15% of donor lungs offered for transplantation were utilised. It also pointed to a February 2023 report by the Organ Utilisation Group—I believe Ministers have looked at it very carefully—which highlighted the unwarranted variation in practice between organ types and transplant units contributing to disparities in more general access.

I put the following questions to the Minister. First, is he satisfied that NHS Blood and Transplant and NHS trusts are putting sufficient priority into work on organ donation? Is NHS Blood and Transplant far too risk averse? Has it struggled to adapt to a soft opt-out programme? It looks to me as if it has continued to operate on the basis that the family needs to give consent. Secondly, does he think enough resources have been put into the programme? I particularly have in mind the specialist nurses who are the key professionals in the service in terms of relating to families, alongside transplant services themselves. Do we have continuous communications campaigns and, if not, should we not be prepared to invest some resource in stepping that up? Around that is the message of individual choice; is the choice to donate organs and tissues sufficiently clear to the public?

As patient support charities, including Kidney Care UK, are working across all regions to increase awareness and encourage those vital family conversations about organ donations, can we give those organisations more support?

Is the Minister satisfied that NHS Blood and Transplant is really grasping the opportunities that having an opt-out law can bring to increasing public awareness? During the progress of the Bill, I received huge support from its medical director. He came to briefings very enthusiastic about getting rates up, but I do not get that sense of enthusiasm from the organisation any more. Is it fully committed to taking advantage of the legislation?

Finally, are the Government cognisant of some of the issues that bureaucracy is causing?

I very much welcome this debate and look forward to hearing other contributions.

Adult Social Care: Staffing

Lord Hunt of Kings Heath Excerpts

Tuesday 12th December 2023 Lords Chamber

[Lord Markham (Con)]

We have tried to adopt a balanced approach here. While we all understand the necessity in the healthcare sector, I think most of us would agree that 750,000 net migration is a very high number. The balance we have struck is to protect this sector. Our figures generally show that we will be able to keep the recruitment coming. We are now moving on to part 2 of the reform, through the other things we are doing, particularly around qualifications—we know that people who are qualified are far more likely to stay in a social care setting. That is what the whole investment is about. It will be rolled out next year and will fund hundreds of thousands of places. I think it will make a real difference to the motivation, recruitment and retention of staff.

[Lord Hunt of Kings Heath (Lab)]

My Lords, to respond to the right reverend Prelate’s question, if I may, the Migration Advisory Committee has said that the reason we recruit so many people from overseas is poor terms and conditions in social care. The Government set the market for social care, through their poor funding of local authorities. When will they grasp the nettle and realise that we actually have to give care workers decent pay and conditions?

[Lord Markham (Con)]

It is absolutely understood that, to have a highly motivated workforce, you need to look at everything—pay and conditions, and training and motivation. We see that while, on average, staff turnover is almost 30%—which is way too high—about 20% of care home providers have a turnover of less than 10%. Why is that? It is because they are investing in their staff and they have a training programme. That is why we are trying to do a similar thing. The national care certificate that we are putting in place will take time; for it to be valuable, we will need to put the right things in order, including the digital platform to pay the 17,000 providers. These are all parts of the reform, which will make a difference.