Cancer: Older People

Lord Lansley Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Merron (Lab)]

I thank my noble friend for her confidence, and I will do my best. Decisions on screening, including the age ranges at which they operate, are made by the UK National Screening Committee. They have an upper and a lower age limit, which are based on evidence and kept under review. Current evidence does not support making changes to these ages. For breast screening, for example, self-referral is available for those over the age of 71 and for bowel screening it is available for those over 75. I confirm to her that this is all evidence-based, and we always keep an eye on the continuing evidence.

[Lord Lansley (Con)]

My Lords, I declare an interest in that I am a happy statistic of having survived more than five years after cancer treatment. But I know that I am not alone and that many others of the near 2 million cancer survivors have chronic conditions resulting either from cancer or from its treatment. Will the cancer strategy recognise and offer support to the many cancer survivors who have continuing chronic conditions resulting from their cancer?

[Baroness Merron (Lab)]

I am glad that the noble Lord is, as he describes himself, a happy statistic. We are all grateful for that. I certainly share the view that there are a number of ongoing chronic conditions and impacts on other aspects, such as people’s mental health. The cancer strategy needs to look at this in its development, and I am grateful to him for highlighting it.

NHS: Independent Investigation

Lord Lansley Excerpts

Tuesday 8th October 2024 Lords Chamber

[Baroness Merron (Lab)]

I am sorry to hear of the circumstance that the noble Baroness raises. I agree with her about the pressure on GPs who, of course, are working harder than ever. We know, not just through the Darzi report but through much evidence, that discharge into the community has to take place at the right time and with the right support, and that is not the case at present. I will certainly take up the specific thing the noble Baroness asks for and look into it in far greater detail, because this is clearly a practice, as she described, that is not supporting patients or GPs but working against them.

[Lord Lansley (Con)]

A wholly different report could have been written based on the underpinning evidence. To that extent, the report may call itself independent but it was not objective. If the Minister subscribes to some of the hyperbolic criticisms of the 2012 Act, can she then explain how the NHS in Labour-run Wales—where the 2012 Act had no effect whatever—performed worse on almost every measure of performance? She said that output was what matters. Can she therefore confirm that productivity in the NHS rose after 2010, relative to the preceding period, up until the pandemic? Can she actually agree that it is outcomes that matter most? Will she say that the Government will maintain the progress that needs to be made in making the NHS accountable to the NHS outcomes framework that we established a decade ago?

Finally, to revert to what my noble friend and the noble Lord, Lord Scriven, rightly asked about, in the last decade the 10-year plan has been something that the NHS owned. There was the five-year forward view in 2014 and the 10-year plan in 2019, and now in 2024 the NHS should own the refresh of the 10-year plan, but I do not think that is going to be the case. Can the Minister explain why the Government are taking that earned autonomy away from the NHS?

[Baroness Merron (Lab)]

I do not recognise the description of taking autonomy away; I appreciate that that is the noble Lord’s opinion. The National Health Service is so key to not just our health and well-being but the economic health of this country. In my opinion, it is something of a backbone of the country. It is right that the Government have made this an absolute priority and have commissioned a very honest report—I hear his criticisms of the report; they are not ones that I share—and that the Government are held accountable. That does not mean taking away autonomy from the NHS. I accept the noble Lord’s point that it is outcomes that matter, and perhaps I should have put that better because by output I mean things not just being done but actually being effective. I thank him for that point.

On frameworks and meeting obligations, one of the points made not just in the Darzi report but elsewhere is on how many of the standards are not being met. We will return to a number of the standards to ensure that people can feel that they know what they are going to get and within what timeframe, and that that will be absolutely possible. We are interested only in what works. We are not interested in scoring points; we are interested in improving the health and well-being of the nation, and I hope noble Lords will want to join with that.

Covid-19 Inquiry

Lord Lansley Excerpts

Tuesday 3rd September 2024 Lords Chamber

[Lord Lansley (Con)]

My Lords, I am very pleased to contribute to this debate and to follow the noble Baroness, Lady Thornton. One should never underestimate the importance of the Official Opposition in securing the role of good government. I am slightly hoping that the noble Baroness, Lady Merron, will recall that I was the shadow Secretary of State for Health when she was Minister of State for Public Health during the swine flu pandemic. I give credit to her and to the then Secretary of State, Andy Burnham—and indeed to Alan Johnson previously—because they were always very open. She will know that it was one of the things I was very interested in before the 2010 election. I asked specifically for an evaluation by the Health Protection Agency of the containment phase of the response to the swine flu pandemic. Although people might imagine that we did not do this, we were looking carefully at what the potential for containment of an influenza epidemic looked like and how we might do more in that respect.

I should declare an interest: I was Secretary of State between 2010 and 2012. In that context I was, strictly speaking, the author of the 2011 pandemic influenza preparedness plan. I am not going to go on at length about it, but I have my personal criticisms of the way the inquiry has been conducted, which I hope can be remedied in part by the government response which the Minister said will be coming in the months ahead. It is very important for the Government to ensure that any flaws in the inquiry report are themselves challenged, because the inquiry may have been prone to groupthink as well, by imagining that there were certain conclusions that it was bound to reach and then aiming for them.

My problem with the process is that, as a number of noble Lords have said, there is criticism of flaws in the 2011 preparedness plan. The inquiry did not ask me for evidence. It did not invite me to give oral evidence or ask me for written evidence. Notwithstanding that, it then chose to send me a rule 13 letter, making what were not specific individual criticisms but generalised criticisms of Secretaries of State over a period that included me. I then had three weeks in which to send it what were pages and pages of corrections, some of which it took on board, and others it did not. Although I will not go through them in detail, there are things the report says about the period running up to the 2011 pandemic influenza preparedness plan and the use of it which are absolutely wrong. It is not fair for it to say that we should have looked at other emerging infectious diseases in the same way that we looked at avian influenza.

I was responding, and I knew it, to the national risk register. It said that H5N1 was going to have a very high mortality rate when it was transmitted to humans, and therefore was immensely dangerous. If it were to mutate to the point at which it would be readily transmissible between people, we would be facing a pandemic on at least the scale of Spanish flu. I was very focused on that, because that is what the risk assessments told me to do. Let us not leave aside the central importance of looking at risk and understanding the various components of the risks that we face. To be fair, the national risk register and the risk assessments took account of other emerging infectious diseases—hence the establishment of NERVTAG.

We should be much more aware of the risk of the next pandemic—we may be in it. The scale of the impact of antimicrobial resistance on global population and mortality could potentially be worse than the Covid-19 pandemic. We know that many emerging infectious diseases are zoonoses, and we may see in them characteristics that we do not recognise from either influenza or coronaviruses; it may be something completely different, and the vectors of transmission may be completely different.

I do not want to go on about it at length, but I want to talk about the idea that, in 2011, we should have had a pandemic plan that looked at other potential pandemics. It would not have changed the outcome in 2020. Why? Because when you look at the 2011 pandemic preparedness plan, you find that many of the potential countermeasures were either not considered or the evidence base we were presented with and on which Ministers were working said that they would not work.

The evidence base said that respirators and face masks were right for preventing transmission by a person but that they were probably not going to be effective in the population as a whole. We may now conclude that that was wrong, but that was the advice we were given at the time. The advice given at the time was that school closure should have been a limited measure, devoted to specific high-impact areas and events. That may have been wrong, but it was the advice given at the time. The advice given at the time was that we stood no chance of containing a pandemic by controlling access to airports.

If somebody had come along, by some mystery, and told us in 2011 that we were going to be presented with a coronavirus pandemic of the scale that we subsequently encountered, many of the measures that we deployed—including lockdowns, which were not recommended in relation to pandemic influenza—would not have been recommended. The pandemic plan may have been a pandemic plan for some other virus, but it would not necessarily have been any different from that which was prepared for pandemic influenza.

Therefore, there are two key points when it comes to what our preparedness should look like. The first is understanding at the earliest possible moment what a new virus or infectious disease actually looks like. How is it transmitted and by what means? What is the incubation period? What are the clinical characteristics? In 2011, the idea that we could be presented with something with a long incubation period and asymptomatic transmission was not contemplated, and so the idea that in 2011 we would have understood this and prepared for it is fanciful.

The point that the inquiry looks at but does not really focus on is the second key part of preparedness: making the country resilient by making people and our public health system more resilient. I put in parentheses that the public health White Paper of December 2010, establishing Public Health England, did so on the basis that its budget would increase at the same rate as the NHS budget. In 2015, this was trashed by the Treasury. Unfortunately, I think Secretary of State Hunt let that happen. You can look at the evidence to the inquiry from Duncan Selbie, former chief executive of Public Health England, to see the serious adverse consequences that resulted from the £200 million cut in that year and in subsequent years to the public health budget.

Not only that, but we must understand that, around the world, some populations were more resilient because they were less unequal. Equality matters. The coalition Government had this as an explicit objective of our policy, and I personally very much subscribe to it. Our public health needs us to be much more equal and for disadvantage to be actively challenged. That is why I supported Michael Marmot in the latter part of his further inquiries.

I encourage the Minister, in the work that will be done in government, not simply to respond to this module —and, as the noble Baroness, Lady Thornton, rightly said, to later modules—with what the present Labour Administration think or thought at the time but to challenge some of the things that the inquiry says if it is conducting itself on a basis which is not a reasonable one for us to have worked on in the past. To make conclusions that are unjustified seems to be a bad way of reviewing the evidence and thinking for the future.

Finally, when the inquiry moves on to later stages, I hope it will return to the question of what was done in 2016 on Exercise Cygnus and after it. If we are going to do better in future, having plans is critical. As von Clausewitz would have said, having plans will never stand contact with reality but having no plan gets you nowhere. It is important to have plans and to expose those plans to serious scrutiny, including by Ministers, as well as officials, and to follow up on those plans.

Everything tells me that the 2011 preparedness plan was not the problem. The problem, as Sally Davies said in evidence to the inquiry, was that it was not reviewed, updated and properly looked at in 2016 as it should have been. After Exercise Cygnus, there should have been a new and additional preparedness plan related to what we had then understood to be different threats from MERS and SARS. That did not happen. The follow-up to Exercise Cygnus did not happen as it should have. Having these exercises, preparing the scenarios and following up on them is absolutely critical to our overall preparedness, as is reforming our ability to influence the public health of this country.