National Health Service (Dental Charges) (Amendment) Regulations 2023

Lord Hunt of Kings Heath Excerpts

Monday 5th June 2023 Lords Chamber

Moved by

[Lord Hunt of Kings Heath]

That this House regrets that the increase of 8.5 per cent to patient charges under the National Health Service (Dental Charges) (Amendment) Regulations 2023 (SI 2023/367) (1) will be a considerable burden on NHS patients, and (2) will not help to improve access for NHS patients, including children and young people.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I know how eagerly noble Lords have anticipated our debate this evening. I should declare at the beginning my presidency of the Fluoridation Society and patronage of the National Water Fluoridation Alliance, so I can guarantee the House that I am not going to mention fluoridation again during tonight’s debate.

This is a critical time for NHS dentistry. The massive hike in charges of 8.5% in this SI seems to be a deliberate policy of discouraging patients who need care the most. Of course, it comes at a time when access to dentists has become increasingly difficult, with reports of patients resorting to DIY dentistry because they cannot get access to an NHS dentist. In August last year, the BBC reported that, based on a survey of 7,000 NHS practices, nine in 10 were not accepting new adult patients for treatment. The problem, of course, predates the pandemic, when enough dentistry was commissioned for only around half the population in England, and in many parts of the country access to NHS dental services was already very poor. It has now got worse.

Of course, the increasing cost burden on patients has been paired with a crisis of access. The General Dental Council found that the proportion of adults receiving dental care under the NHS fell from approximately half in 2013 to just over a third in 2021. The proportion of those over 15 years old receiving free NHS dental treatment fell from 31% in 2012 to 22% in 2017. According to the most recent GP Patient Survey, conducted in 2022, 12.9% of those surveyed said they had failed to get an NHS dental appointment in the last two years.

These access problems are obviously also linked to workforce challenges. In June 2022, the House of Commons Health and Social Care Committee reported that the headcount of primary care dentists in England providing NHS treatment or otherwise conducting NHS activity in 2020-21 was at its lowest level since 2013-14. The report said that although the GDC register has the largest number of dentists in its history, the number of dentists doing NHS work is decreasing. The BDA has told me that official data it secured shows that

“just 23,577 dentists performed NHS work in the 2022/23 financial year, down 695 on the previous year, and over 1,100 down on numbers pre-pandemic”,

which

“brings figures to levels not seen since 2012”.

The noble Lord referred to the NHS workforce plan in Oral Questions today. We certainly need a coherent long-term workforce plan for all dental professions, underpinned by data, starting with the regulator, the GDC, which counts dentists registered by full-time equivalent and not headcount. The basic fact is that we do not have enough dentists in this country willing to perform NHS treatments. At the moment, the shortfall can really only be met with overseas recruitment.

On that, I understand that the GDC has just announced that it is tripling the number of places on the first part of its overseas recruitment examination. However, there is no mention of part 2, which is the practical part of the process after candidates have passed part 1. Completely missing at the moment is anything being done to ease the blockages involved in getting an NHS number. Without that, newly registered dentists can work in the private sector immediately but not the NHS, making access to NHS dentistry even more problematic as private practices are more accessible to overseas recruits.

Dentistry has been subject to cuts unparalleled in the NHS. In real terms, net government spend on dentistry in England was cut by over a quarter between 2010 and 2020. The Prime Minister keeps making references to the £3 billion spent on dentistry, presumably implying that that is a growth figure. In fact, the budget was over £3 billion in 2015. In May 2022, the noble Lord, Lord Kamall, the Minister’s predecessor, told the House:

“The Government are working with NHS England and the British Dental Association to reform the current NHS dental system and to improve access for patients, tackling the challenges of the pandemic”—[Official Report, 24/5/22; col. 754.]


He also referred to an extra £50 million for additional activity and patient appointments. However, this is clearly not sufficient and a drop in the ocean. Actually, we have the remarkable situation whereby, as I understand it, we also have a likely £400 million underspend in the dental budget in the financial year just finished.

We then come to the issue of charges. In their Statement in March, the Government argued that this increase was necessary in order to continue to fund dental provision. They argued that the larger increase was necessary because dental patient charges had been frozen since December 2020. One contrasts that with the large underspending figure in the current dental budget. I simply do not see why the underspend figure could not be used to incentivise dentists to provide more NHS treatments. I understand that in the north-east there is a concept that follows the dental access centres, which we as a Government opened up and incentivised dentists to provide more NHS treatment. Some more imaginative leadership from the Government on this could use the money in a more effective way. We should not underestimate the real challenges for patients in finding access to a dentist where they are not eligible for financial support but do not have the resources to go private. For some people, this is a hugely disturbing and worrying challenge.

The BDA has said that the hike in charges

“won’t put a single penny into a struggling service”

or improve patient access to quality dental care. In essence, patients are being asked to pay more so that the Government can put less into the dental budget. We are talking about a huge differentiation between what happens in England and in the rest of the UK. A band 1 treatment, a check-up, will now cost £25.80 in England but just £14.70 in Wales. A band 3 treatment such as dentures will now cost £306.80 in England and just £203 in Wales. It is important to have some cohesion across the NHS in the United Kingdom and the differential in charges is really worrying.

The Government have described charges—no doubt the Minister will do so in his speech—as a patient’s contribution towards the cost of NHS care. However, it is clear that they are being used as a substitute for state investment, increasing as a proportion of total spend within a flat budget, thereby enabling Ministers to cut back government contributions. One wonders where this is all going to lead. Is this a signal that what the Government are doing is gradually withdrawing from any responsibility for NHS dentistry, leaving many members of the public desperately short of the ability to access a dentist?

The fact is that the UK now spends the lowest share of its health budget on dentistry of any European nation, according to OECD figures published in 2019. That is unsustainable and the dentistry service requires greater investment and leadership. I hope that this debate will provide some evidence to the Minister that the Government need to get a grip. I beg to move.

--- Later in debate ---

[Lord Markham (Con)]

I will try to unpack that point a bit more. A dentist can say, “Okay, I can provide so many UDAs over the course of the year”, and they will be contracted to do that. But there is then the situation whereby some of them—I am not saying all of them—having that banked in and knowing that they have the money to afford it, might go out to try to sell private healthcare, underpinned by that money. At the end of the year, if they have not delivered all the UDAs, then, in effect, the only reason that they have not delivered it is because they substituted that for private care work, resulting in that underspend, which we do not want.

That is what the changes we talked about in May were about: removing the UDAs from those persistent underdeliverers, for want of a better word, and having the capacity to give them to those who are persistent deliverers, so that we can increase their amounts by 110%. This is very much about taking away from those who are not delivering and giving to those who can, and also having money in the bank for some of the more creative ideas that Minister O’Brien is very focused on, and that we look forward to delivering. I can say, hand on heart, that is not about banking underspend; this is about making sure that we can redistribute it. These price increases—which, again, are half the rate of inflation—are for funding a dentistry plan through which we want to improve access; that is fundamental to all of this.

I hope that noble Lords understand a bit more where we are coming from and understand that it is an 8.5% increase versus 17% inflation. We are looking to recycle that increase and put it into more access for those who are not receiving it at the moment. I hope that noble Lords will see this in a better light and that it is all about increasing access.

In conclusion, as the noble Lord, Lord Hunt, mentions, it is important that patients can access NHS dental care and that it is affordable. No price increase is easy but we hope it is seen that this is a proportionate increase at less than half the rate of inflation and only for those 50% of people who are in a better position to pay. Most of all, this is part of a package of measures, of which more will be announced shortly, about expanding access to NHS dentistry—because I completely agree with the noble Baroness, Lady Merron, that it is vital to the health of our children, particularly, but to all the people in England.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very grateful to the Minister and for him attempting to explain the mystery of the dental contract, which has defeated many Ministers over many years. Explaining it in the way he did lends support to those who think we need a fundamental rethink about the way we remunerate dentists. I took part in some of the discussions with the profession which led up to the last contract and before that there was the contract in the 1990s. Essentially, it seems to me, each time there is a revenue envelope agreed with the Treasury on how much can be afforded for a new contract. The profession will always exceed performance in general because it is always based on a payment for a procedure, although efforts have been made to bring in incentives to treat the oral health of a person as a whole, more like the way in which GPs are remunerated. But at the end of the day, we still await a change in contractual arrangements which will provide the right incentives.

I am grateful to my noble friend for her support. She is right to say that at the heart of this is needing to know the Government’s aspiration for NHS dentistry. The Minister said that dentistry is an important part of the NHS, that he recognises the access challenges faced by the public and that we can await further announcements. I welcome that and hope that we can reset NHS dentistry on a much more positive route for the future.

In relation to charges, the contrast between the difficulty so many patients are having in getting access on the one hand and the 8.5% increase on the other is very difficult to understand and to support. Many of the people who rely on the NHS but do not get benefit support from the state are really caught by high inflation in general and dentistry charges is one more burden they have to face. That ultimately is what makes the proposal before us really rather worrying.

I hope this is an opportunity to reset our whole concept of NHS dentistry. I am very grateful to noble Lords who have supported the debate tonight and beg leave to withdraw my Motion.

Motion withdrawn.

NHS GP Surgeries: Purchase by US Companies

Lord Hunt of Kings Heath Excerpts

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

The noble Lord is absolutely correct that it is all about supply and the quality of that supply. That is why, again, I am pleased to say that we have a record number of GPs in training. We can learn from innovative measures. I have been looking at an advanced draft of the workforce plan. The number of doctors in the most advanced medical systems in the world—those of Japan and the US—is lower per head of population than here, but the number of nurses is higher. They have altered their staff mix to get the optimum performance, and we should be open to these innovative approaches to get the best output.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Lord referred to the workforce plan. Can he assure me that, when published, it will be fully funded?

[Lord Markham (Con)]

This is absolutely the work that the Treasury is doing at the moment. Noble Lords have asked, many a time, when it is coming out. I think people will understand that part of the delay is making sure that, when the plan does come out, it really does work.

Branded Health Service Medicines (Costs) (Amendment) Regulations 2023

Lord Hunt of Kings Heath Excerpts

Thursday 25th May 2023 Lords Chamber

Moved by

[Lord Hunt of Kings Heath]

That this House regrets that the Branded Health Service Medicines (Costs) (Amendment) Regulations 2023 propose a 27.5 per cent claw back rate which significantly exceeds that required by comparable countries, and which risks seriously damaging future investment in the research and development (R&D) of new drugs in the United Kingdom for the NHS, investment in the life sciences more generally, and the manufacture of branded medicines and their availability to the NHS; further regrets the short and insufficient consultation period for these measures of just 39 days over the Christmas period; and notes with concern that the UK’s share of global pharmaceutical R&D has fallen by over one-third between 2012 and 2020, and that the UK’s medicine production volumes, clinical trial delivery, and global share of new medicine launches have also all declined in recent years. (SI 2023/239)

Relevant document: 34th Report from the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument)

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very glad to introduce this debate, and thankful to noble Lords who have stayed to take part in it. Underpinning this debate is a major concern about the current state of the UK economy, beset as it is with low growth, low productivity, workforce shortages, regional inequality and a dilapidated infrastructure; yet we have no industrial strategy. The Government have raised corporation tax; it is little wonder that Sir James Dyson recently accused the Government of having a “stupid” and “short-sighted” approach to the economy and business in the UK. Indeed, as Theresa May’s former chief of staff, Nick Timothy, put it on 8 May, there is an alarming decline in manufacturing as a percentage of GDP.

We ought, at least, to welcome the Prime Minister’s launch of the Government’s plan to create the UK’s place and cement it as a science and technology superpower by 2030. My concern is that the Minister and his colleagues in the Department of Health and Social Care are doing everything they can to inhibit that ambition. The life sciences industry is one of the most successful and important pillars of the UK economy, contributing more than £94.2 billion a year and 200,000 jobs in this country. Two-thirds of this is generated by the biopharmaceutical sector. The industry’s pipeline of new medicines is equally impressive.

We are at great risk of seeing this economic success falter under the watch of the Government, as companies are reducing their level of investment because of the imposition of a massive clawback that equates to one-quarter of sales revenue. We are already seeing very worrying trends in investment levels. From 2012 to 2020, the UK’s share of global pharmaceutical R&D spend decreased by more than a third. Since 2018, the UK has been falling down the global rankings across all phases of industry clinical trials. UK manufacturing production volumes have fallen by 29% since 2009. We all know that the NHS is far too slow to adopt new innovation and new medicines.

The UK is falling behind comparable countries as an early-launch market. Companies are making decisions to delay, or even not to launch, in the UK. These can be clinically important medicines that address many of the NHS’s priorities. Compared to leading countries in Europe—Italy, Spain, Germany and France—we have experienced the largest decline in our global share of new medicine launches between 2016 and 2021. This is the background to the statutory instrument that we are debating today.

I believe and hope this debate can influence the negotiations that have just started with the industry over the next phase of the voluntary scheme, otherwise known as VPAS—various noble Lords used to know it as PPRS. Under these regulations, companies in the statutory scheme will be required to pay to the Secretary of State 27.5% of their 2023 net sales income received for the supply of those medicines to the NHS.

The Government’s argument is that continued high sales growth in 2022 has led to an increase in the payment percentages in the VPAS scheme from 15% in 2022 to 26.5% in 2023, which is higher than was projected at the time of the 2022 statutory scheme consultation. As a result, the Government have ratcheted up the statutory scheme required payment rate. My argument is that both the voluntary and statutory schemes—companies have to be in one or the other, and can switch between them—are becoming a major impediment to future investment in the UK. The proposed rate of 27.5% will place the UK as a global outlier. In countries that operate similar clawback arrangements, current rates include 12% in Germany, 7.5% in Spain and 9% in Ireland, and all those countries spend more on medicines per head than we do. How on earth can the Government’s stated aim to grow the life sciences industry, as set out in the Life Sciences Vision and just recently articulated by the Chancellor, be delivered if industries expect to pay twice the level here that they do in Germany?

--- Later in debate ---

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very grateful to the Minister. I think he has responded in a positive way, which is gratifying and, I hope, sets the foundation for a proper negotiation with the industry to get a jointly owned voluntary scheme which will incentivise global pharma to invest in the UK.

For me, two or three themes come from this. First, the noble Lord, Lord Lansley, talked about the curiosity of a fixed drugs budget, and I found it curious when the Minister said we need value for money on medicines in order to have resources for front-line services. But medicines are a front-line service. Why is it a good thing to increase the number of doctors and nurses and buy more medical equipment, but it is suddenly shock-horror to spend more on medicines? What would we do without medicines? It is curious. I have never understood why the Department of Health has such a downer on the medicines budget, when it has just said—and I declare an interest as a member of the GMC—that it wants to see a massive expansion in medical school places. Why is the medicines budget regarded as such a negative factor? It defies all understanding; of all the great advances we have made in healthcare, how many have been made through new medicines? And I have to say that new medicines are rather easier to get than extra staff.

[Lord Markham (Con)]

May I just clarify? I completely agree that medicines are of course valuable. My comments were not about not spending money on medicines but about getting value for what we spend on medicines—not the quantity, not the quality, but the price that we are paying. I think that all noble Lords would agree that we want to make sure that we are getting the best value on pricing.

[Lord Hunt of Kings Heath (Lab)]

I fully accept that, but the sentiment that comes through is something that is shared throughout the National Health Service: that drugs expenditure, per se, is something to be held down. That is why, even though we have NICE, and bilateral negotiations—as the noble Lord, Lord Lansley, said—between NHS England and pharma companies in relation to specific drugs, at local level you have formularies and all sorts of mechanisms designed to ration medicines to patients. It is a curiosity about our whole approach. I agree with the Minister that one needs to start with a health budget. If we have—and I hope we do—new medicines coming on in relation to, say, Alzheimer’s, we will need to spend extra money in order to invest in them.

My second point—also made by the noble Lords, Lord Warner and Lord Allan, and my noble friend Lady Wheeler—is that it is very important that this is seen as a cross-government approach. If this is seen simply an issue for the Department of Health and NHS England in terms of the NHS budget, we will never get the kind of agreement that we need. If the Prime Minister is true to his word in terms of trying to reset the relationship—as the Minister implied—that is very welcome indeed.

This has been a very useful debate and I am very grateful to the Minister and other noble Lords. I beg leave to withdraw my Motion.

Motion withdrawn.

Pharmacies: Medicines at Home

Lord Hunt of Kings Heath Excerpts

Wednesday 17th May 2023 Lords Chamber

[Lord Markham (Con)]

Yes.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister referred to the Royal Pharmaceutical Society guidelines, but those were issued in 2013—some 10 years ago. If it was so important, why has it taken Boots and Lloyds Pharmacy so long to phase them out? Surely, the Minister recognises, as his noble friend said, that there must be automated ways of delivering blister packs safely, thereby helping very vulnerable people to take the right medicine?

[Lord Markham (Con)]

As noble Lords are aware, I hold the technology brief, so, if there are automated ways, I am absolutely all for them. As I learned while researching this Question, this is a complicated area, given the number of permutations of pills that can be there in each circumstance. I have not seen those solutions, but I will look into them.

Childbirth: Black Women

Lord Hunt of Kings Heath Excerpts

Wednesday 3rd May 2023 Lords Chamber

[Lord Markham (Con)]

First, through its local maternity and neonatal systems, every ICB is responsible for publishing an equity and equality plan. It will then be the job of both the CQC and the maternity surveillance system to measure them against that plan and make sure it is being kept up. Every area is different, but each needs a plan to address this issue.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister mentioned the Maternity Disparities Taskforce meeting on 18 April. Can he explain why the Select Committee was able to report that the task force had not met for nine months preceding the writing of its report? It does not look like the task force is putting much energy into this. Can he also say whether the work that is now being undertaken will take into account the fact that black women are regularly underrepresented in research and data, which leads to them being neglected in policy-making?

Long Covid

Lord Hunt of Kings Heath Excerpts

Tuesday 25th April 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Earl for his question and for raising this subject generally; it is of key importance to all of us. In the area of long Covid, we are still learning. The reality is that there are a lot of situations where, thankfully, long Covid might end after 12, 14 or 16 weeks. For those reasons, it is not appropriate to define it as a long-term disability in legislative terms at this stage. At the same time, clearly, if people are suffering from conditions that mean they are unable to work for a length of time, they are absolutely able to get personal independence payments and the other payments that are due to them.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister will be aware that there is real concern about the rising number of inactive people of working age, due mainly to long-term sickness. I accept what he said about the time limits, but to what extent is he concerned that our failure to tackle long Covid appropriately will add to that labour market inactivity?

[Lord Markham (Con)]

I take issue with the statement of failure to deal with it. We pioneered this space. We set up 90 specialist adult centres and 14 specialist centres for kids. We have invested £314 million and 80% of people are seen within eight weeks of being referred. That shows that we are taking this seriously. The noble Lord is absolutely right that we want to ensure that we get as many people into work as possible. In the case of long Covid, we are definitely doing that.

Diphtheria

Lord Hunt of Kings Heath Excerpts

Tuesday 18th April 2023 Lords Chamber

[Lord Markham (Con)]

To be honest, I think the most effective method is to have the screening when people enter. Refugees come in from across the world so, to concentrate resources, it is best done on entry. The record speaks for itself; an 88% take-up rate is very high, comparable to that of the general UK population. I think we have got it right.

[Lord Hunt of Kings Heath (Lab)]

My Lords, coming back to the original Question, does the Minister accept that during the Covid pandemic the role that directors of public health played locally was critical to ensuring a co-ordinated and effective response? Does he agree that it is a great pity that the Home Office seems to have refused to engage with the Association of Directors of Public Health on this? Will he assure the House that the Home Office will start to engage with this organisation?

[Lord Markham (Con)]

I am probably best placed to speak about how we engage with the Home Office, which we have been doing pretty successfully. I agree with the noble Lord about the role that those public health directors played during Covid and will play going forward. UKHSA is very much committed to doing that as well. As I said, our record on interactions with the Home Office speaks for itself—it is pretty good.

Stroke Rehabilitation and Community Services

Lord Hunt of Kings Heath Excerpts

Wednesday 22nd March 2023 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend and agree. When I was looking at the waiting lists of those in need of physiotherapy, I was delighted to see that 80% of people were waiting less than 18 weeks. A plan is being put in place for musculoskeletal priority patients, so that they do not have to wait any more than two weeks. The urgency of putting these things in place quickly is recognised.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister talked about the national integrated service. He will be aware that rehabilitation services are very patchy and that, over the last four or five years, the amount of time that professionals have spent with individuals has got less. Will this new integrated care service bring us up to higher standards and see consistent standards throughout the country?

[Lord Markham (Con)]

During the pandemic this was one of the areas that probably did not get enough time, for all the good reasons that we understand. Therefore, I am pleased to see that these pathways are being set out so that we can get back to the standards that we need. I believe this is something that we will see happening now.

Adult Social Care

Lord Hunt of Kings Heath Excerpts

Monday 20th February 2023 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, if the Government are moving in the right direction, why have they yet again delayed the implementation of the Dilnot report? Why have they taken no notice of the report from the Select Committee chaired by the noble Lord, Lord Forsyth, in 2019, which clearly gave the Government the route forward to deal with this perennial problem?

[Lord Forsyth of Drumlean (Con)]

Answer.

Health and Social Care Information Centre (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023

Lord Hunt of Kings Heath Excerpts

Wednesday 25th January 2023 Lords Chamber

Moved by

[Lord Hunt of Kings Heath]

At end insert “but that this House regrets that (1) the consultation on the statutory guidance that will direct NHS England’s handling of the medical data under these Regulations is being conducted in a rushed and piecemeal manner, and (2) the results of that consultation are not available alongside the Regulations to reassure the House that patient data will be used properly”

[Lord Hunt of Kings Heath (Lab)]

My Lords, let me say at once that I support the digital transformation of the NHS and the use of information to enhance patient outcomes. I want to see the NHS move faster in a digital world, but it is essential that there are safeguards in place to protect the integrity and confidentiality of patient data. I say that as I look back into the history of NHS data, where we confronted a number of occasions when this did not happen. That is why this is such an important debate. I am grateful to the Minister for the assurances he has already given in his opening speech, and through him I thank his officials for the way in which they have been prepared to engage with us over the past few months, which has been very helpful.

I remain of the view that it was a mistake to bring NHS Digital, or the Health and Social Care Information Centre as it was formerly known, into NHS England, and feel that there are some inevitable tensions and conflicts in so doing. I think the review that led to this overlooked the issue of the integrity of patient information and public confidence when it suggested that the two functions should be brought together. That was legislated for; here we are now, examining some of the details.

The noble Lord has already referred to the Select Committee’s disappointment about the way in which it considered this had been done in a rushed and piecemeal manner. I have no doubt the House will want to take account of the Minister’s response. It is a pity that the full statutory guidance is not available as we debate these regulations. I think, as a matter of principle, it would have been much more sensible if that had occurred.

The core issue is that in the passage of the Bill, and a number of noble Lords who are here took part in that debate, the Government gave assurances that governance arrangements would protect NHS England from marking its own homework, with independent oversight of governance decisions under the new arrangements. The noble Lord, Lord Kamall, the then Minister, said that

“I can assure your Lordships that the proposed transfer of functions from NHS Digital to NHS England would not in any way weaken the safeguards. Indeed, when I spoke to the person responsible in the department, who the noble Lords met, he was very clear that in fact we want to strengthen the safeguards and take them further.”—[Official Report, 5/4/22; cols. 2005-06.]

Having said that, when one comes to look at the arrangements, there are still some questions and doubts that we would like to put forward tonight. I pay tribute to medConfidential, which has raised questions on how some types of data will be handled under the new regime and whether, in pursuit of efficiencies, NHS England’s handling of the data will be less transparent and subject to fewer checks and balances. I think that expresses the issue and the potential tension in a nutshell.

This was reinforced by the comments of the National Data Guardian, to whom I pay tribute for her strong involvement in these matters. In December, Dr Nicola Byrne expressed concern that, in the statutory instrument before us, there is no recognition of the need to have independent oversight. She noted that provisions to obtain independent advice from specialists and experts to advise on and scrutinise NHS England’s exercise of its data functions, which were originally included in a previous draft of the SI, had been removed. She reminded the Government that the commitments to putting the current, non-statutory provisions safeguards regarding oversight into regulations had been made by officials to the House of Commons Science and Technology Committee. I understand from the briefing we received last night that the advice received by the Minister’s officials was that it is not possible, due to the nature of the statutory instrument and the original primary legislation. It is, though, a pity.

In relation to the membership of the Data Advisory Group, the National Data Guardian referred to the arguments put forward by the department for having NHS England representatives on the group present in their capacity as senior individuals with responsibility for data access. I think they are not full members, but they will be present. The department’s argument is that that will support more efficient discussions regarding applications for data access. I can see that, clearly, officials may need to make presentations. I think it is a bit of grey area when they are members, albeit not full members, of the actual group. The National Data Guardian reiterated that moving from a completely independent group to a hybrid model could affect public trust, particularly when advice is given and decisions are made on the internal uses of data.

We need to be clear why NHS Digital had an entirely independent oversight group. It was for very good reasons; it was put in place following the 2014 Partridge review which was conducted due to concerns about the way that patient data had been shared with insurance companies. There was a huge furore at the time. It was interesting that one of the resulting proposals after Partridge was the disbanding of an oversight group which involved staff members for a new independent oversight group. A public consultation in 2015 found support for this change. This is now being reversed. My fear is that something may go wrong with patient data and the department will come back and say, “Actually, we should make this an independent function”.

We have dealt with the issue of timing, and tonight the Minister has given an assurance that the outcome of the internal review into how well the transfer has gone will be made public—that will be very welcome. I will go just one step further and say that I hope the Minister may be prepared to brief parliamentarians on this at the same time.

The noble Lord also answered a question about social care that was asked in our briefing. I think he said there would be a person from a social care field on the group, which is definitely welcome. I suggest that discussions take place with the Local Government Association and the Association of Directors of Adult Social Services to make sure that they are fully involved and supportive of this happening.

So I remain of the view, as I have made clear, that it has been a mistake to bring NHS Digital into the NHS executive. Whatever the structure, one has to build in rigorous safeguards. The key here is the integrity and confidentiality of patient data. It is pretty clear that if the NHS is to be at all sustainable, it has to embrace the digital revolution and it has a long way to go. So I am right behind the Minister in what I know he is personally seeking to do. It is just that if anything that goes wrong with patient confidentiality, the whole thing can fall down. That is why this is so important. I very much look to the noble Lord and NHS England officials to ensure that we recognise that the integrity of personal patient information is important. I beg to move.

[Baroness Brinton (LD)]

My Lords, I echo the thanks of the noble Lord, Lord Hunt of Kings Heath, for the helpful and detailed discussions that the Minister, his predecessors and officials have had with the small group of us who have been worried about this issue, even before the Health and Care Bill started its passage through your Lordships’ House. Although some of us were more expert than others, and I was definitely not one of the expert members of the group, I care greatly about the digital revolution and ensuring that patient data is kept confidential.

The noble Lord, Lord Hunt, said that he supports improving and transforming data in the NHS. That cannot come soon enough. I have said before in this House, and it is still true probably a decade on from when I first said it here, that for my monthly blood tests I have to print out, photocopy and send copies to my hospital consultant because the hospital that I go to and the hospital that processes my blood tests do not use the same data system. That is ridiculous. It needs to change.

It is a real problem, as the noble Lord, Lord Hunt, set out, that the consultation and draft statutory guidance have been rushed through. I want to set that in the same context as that to which he referred, about perhaps going at a slightly slower pace while wanting the revolution to start. That might have been helpful. Omitting organisations such as the BMA from seeing the original statutory guidance raises the question: who else has not seen it? The question is almost impossible to answer. However, the detail of how this is going to work in practice inside the NHS will be the business of all clinical and administrative staff at all levels. It is vital that it works.

The Minister will know that I have repeatedly raised concerns about patient data and how people were not consulted in the two previous patient data and care.data communications. Both had to be held back because there has been outrage from the public that they were not given the chance to understand how their data would be used. Earlier this week, the Mirror reported that Matt Hancock had talked about handing over private patient medical records and the Covid test results of millions of UK residents to US data company Palantir fairly early on in the pandemic. It had offered to hold its data in its Foundry system, clean it and send it back to the NHS. I spoke about this in the Procurement Bill because I am concerned about how data can be kept truly confidential. Regarding the GP data for planning and research, the NHS has already published its federated data platform details, which is called by the Mirror the Palantir procurement prospectus. Perhaps I may ask the Minister, as an example of transparency for the new NHS England digital processes set out, whether organisations such as Palantir that are handling data records will absolutely not be permitted to use that data—even anonymised or deidentified—outside the purposes of the NHS, other than for agreed research being used in what my noble friend Lord Clement-Jones would say, if he were able to be in his place today, was a safe haven, thereby ensuring that that patient data remains completely confidential. The Minister knows, because I have said it before, that the problem is that in the past it has been possible to identify patient data when it was pseudonymised. I want confirmation that deidentifying really means that individuals cannot be tracked down and, most importantly, that the data will not be used elsewhere or sold on.

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I have tried to answer most of the concerns. I will follow up in detail by writing. If we feel that there is anything that is still not secure enough, I am very happy to call a meeting so that we can go through it all. I thank noble Lords for their comments and for the spirit of the debate tonight. I again thank the noble Lord, Lord Hunt, for ensuring that we managed to cover those points, because we can all see the benefits of a common platform and the digital ability—the ability not to have to print out and fax or email your results—that could come. My letter bag is very full of loads of those sorts of cases, so we can all see the benefits, but at the same time maintaining public confidence is key. There is nothing that can ensure that a great utopian opportunity is a defeat snatched from the jaws of victory if the public do not have confidence in it. With that, I commend the Motion to the House.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very grateful to the Minister and other noble Lords who have spoken in this debate. I should say that I am particularly grateful to the noble Baroness, Lady Brinton, as she and I have been working on this for quite some time, along with the noble Lord, Lord Clement-Jones, who unfortunately could not be here tonight.

I very much take the substantive point. If you look at care.data, essentially the people running it were very careless in terms of the confidentiality of patient information. That set back the whole programme for a number of years, and that is the lesson that we need to remember. The noble Baroness, Lady Finlay, raised some very important points, including about Wales, on which the Minister has responded in terms of the agreement that has been reached with the Welsh Assembly Government, but her point about the security of local NHS data is very relevant to the way we are going forward.

On the issue of commercial companies, 20 years ago, I took through the legislation to allow the NHS or the Department of Health to agree with commercial companies a very legitimate use of patient information. We had in mind the research institutes and pharmaceutical companies, because we have such a rich information source in the NHS, and we wanted to do that to encourage new medicines and speed up their introduction to NHS patients. The problem is that as it has proceeded there has been a lack of transparency, and this wretched commercial incompetence has undermined confidence in what is happening. It is perfectly legitimate to seek to use this information, provided patient confidentiality is preserved, for the enhancement of our knowledge and understanding and future treatments. Clearly that is in everyone’s best interests.

On UTOPIA, mentioned by the noble Lord, Lord Allan, I could not help thinking of “Utopia, Limited”, the Gilbert and Sullivan opera. The alternative title is “The Flowers of Progress”. He went through the list: Avon FHSA, the Exeter system, NHS AI Lab, Connecting for Health. Such happy memories. The point that he raises is that the NHS and the Department of Health have a constant need and desire to restructure. We know this is displacement activity. Even now one hears that NHS England wants to reduce the number of regions and you think, “For goodness’ sake! Can you not understand that it’s completely hopeless thinking a restructure will have any impact whatever on the task in hand?”

This is the substantive point: we know that we are going to be back here debating an SI at some point which will take NHS Digital out of NHS England and establish a separate body. No one will take a bet on it, because we know it is going to happen, and I am afraid that this instability really detracts from the core purpose of what we are seeking to do. My noble friend Lady Merron raised some very pertinent points about the information, the lack of final guidance, the impact on staff and the big question about patients knowing whether their information is being used, which I believe from the advice I have received is possible. I hope that, as the work gets taken forward, this will be taken very seriously by NHS England. The Government will find that patients will have much greater confidence if they get that information, and that most of us will be absolutely supportive of why that information has been used.

Finally, I thank the Minister for his constructive response and the parliamentary briefing that he has offered on the 12-month review; I also think the information about Wales has been very helpful indeed. Having said that, we wish him and his officials the very best in taking this work forward, and I beg leave to withdraw my amendment.

Amendment to the Motion withdrawn.