Pharmacies: Funding

Lord Mawhinney Excerpts

Wednesday 2nd March 2016 Lords Chamber

[Baroness Greengross (CB)]

My Lords—

[Lord Mawhinney (Con)]

My Lords—

[Lord Clement-Jones (LD)]

My Lords—

--- Later in debate ---

[Lord Prior of Brampton]

I think the noble Lord has misunderstood what I said. Interestingly, 40% of all community pharmacies are in clusters of more than three within 10 minutes’ walk. There has been a proliferation in the numbers of community pharmacies at a time when we want a deeper integration of community pharmacy with primary care in particular.

[Lord Mawhinney]

My Lords, talking about the services which pharmacies provide, when do the Government plan seriously to regulate and inspect pharmacies with a view to making sure that their patient record-keeping and consultation facilities for patients are appropriate to the high standards of patient confidentiality which we insist on in every other aspect of the NHS?

[Lord Prior of Brampton]

The noble Lord raises an important point which I regret I cannot answer. I will have to write to him on that matter. However, for community pharmacy to play the important role in primary care that we expect it to do, it will have to have access to integrated patient records. The confidentiality that surrounds those records is very important.

National Health Service

Lord Mawhinney Excerpts

Thursday 14th January 2016 Lords Chamber

[Lord Mawhinney (Con)]

My Lords, the wording of our debate in part says,

“the ability of the National Health Service to meet present … demands”.

I think we all agree that when it meets present demands, it does so in an exemplary way. The problem is that it does not meet all demands and the failure to meet demands is increasing. I picked four important points at random and was interested that, at least in part, they overlap those inadequacies to which the noble Lord, Lord Turnberg, drew attention.

There is very little integration between health and social services. We are sad about that at the community level but is it realistic to expect that to happen if, at the government level, there is not integration between health and social services? Perhaps the time has come to reverse the decision to separate them that was made some years ago. Thousands of people urgently need hospital treatment who cannot get it because beds are blocked by frail, elderly, blameless people who cannot otherwise be cared for. That is a failure in demand.

All around us, GP surgeries are closing, some of them permanently. I think 20 closed permanently in the county of Northamptonshire just last year. No one knows how many are being shut on a short-term basis because we cannot get the GPs to keep them open. It is a failure of demand when two or three weeks elapse before you can see your GP and when your chances of dying are 16% greater if you happen to be admitted to hospital over the weekend.

One of the problems with the NHS is that it is embedded in politics. That is not a new phenomenon: it was true when I was on the Front Bench doing my thing 25 years ago; it remains the case. Any chance to change the structure for the future has to deal with that political problem. Maybe a royal commission is the way forward, or something smaller, independent, with public consultation could lead the way. I can think of no place better than your Lordships’ House, which is full of expertise, common sense and vision, to lead the way to make it possible to engage the politicians who now lead us, on both sides of the House, to look at the possibility of a better future.

Southern Health NHS Foundation Trust

Lord Mawhinney Excerpts

Thursday 10th December 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Lord makes an interesting point. We have a much more transparent system than we used to. Surely it is better that we know about what is going wrong within the NHS rather than that we cover it up as it was in the past.

[Lord Mawhinney (Con)]

My Lords, after all the investigations, inquiries and reviews relating to the terrible events at Mid Staffordshire NHS Foundation Trust, your Lordships’ House was told that no one was to blame. Is it the Minister’s initial instinct that after these shocking new facts have been analysed, reviewed, examined and so on, the House will again be told that no one was to blame?

[Lord Prior of Brampton]

My Lords, I do not think anyone was told that no one was to blame as a result of the investigation into Mid Staffs. There were failures at all levels within the NHS with the regulation, the professions and the management of that particular trust. I believe that transparency is the right way to deal with the systemic problems that we have in many of our hospitals.

National Health Service: Sustainability

Lord Mawhinney Excerpts

Thursday 9th July 2015 Lords Chamber

[Lord Mawhinney (Con)]

My Lords, I, too, congratulate the noble Lord, Lord Patel. I very much appreciated his kind personal comment at the beginning of his speech.

This debate is about the sustainability of the NHS, not its desirability. If you talk about its sustainability, hard words about the NHS are likely to follow. Those who issue hard words might conceivably be charged as not being as supportive of the NHS as they ought to be, so I want to make two personal statements before I start. First, for the majority of this year I have been in the intimate care of the NHS. I owe my life to Steven Tsui and to the doctors, nurses and technical staff who have looked after me so well over the past few months. Anyone who has been through what I have has to be an NHS fan. Secondly, for the record, apart from the years when I lived and worked in the United States, I have never had any private health insurance; I have been an NHS man all my life.

I start by setting a context. When the NHS started, in its first year it employed 144,000 employees. On 30 September 2014 the UK employment total was 1.6 million. The first NHS budget was £437 million, which in today’s money is about £9 billion. This year, as the noble Lord, Lord Patel, reminded us, we are going to spend around £116 billion. In the first year we spent 3.5% of our GDP on it; as we have been reminded, this year we are going to spend around 9%. That trajectory is not sustainable.

I turn to money. The recent King’s Fund report said that,

“financial problems are now endemic among NHS providers, with even the most prestigious and well-run hospitals forecasting deficits”,

this year. Are we relaxed about that? More than 25% of trusts are in deficit, some in deep deficit, and most of the rest of them are heading in that direction. In the seven years between 2006-07 and 2012-13, over and above the normal financial arrangements, the department slipped about £1.8 billion worth of cash to hospitals in addition, just to keep them going. There is one hospital in this country that in the last few years was in receipt of £1 million per week over and above its normal financial arrangements, just to keep going. I am told that one of the London teaching hospitals is £200 million in debt. Monitor predicts that by 2021 the NHS will be £30 billion in debt—and if there is one thing you can say about that figure, it is that it will be an underestimate when we get to 2021.

I turn from money to service. I had the honour of being a member of the Select Committee on Public Services and Demographic Change. We said in 2013 that,

“the current healthcare system is not delivering good enough healthcare for older people”.

I noticed the president of the Royal College of Emergency Medicine saying recently that the treatment of patients at A&Es is “inhumane”. I noticed the Alzheimer’s Society saying that GPs are reluctant to diagnose patients with dementia because they feel there is nothing that the NHS can do. And it is a disgrace that if you go into hospital at weekends, you are 15% more likely to die than if you go in during the week.

We have had a lot of nice things said about the NHS Five Year Forward View. I shall read one sentence from it:

“The traditional divide between primary care, community services, and hospitals”,

increases the barrier to the type of care that people need. None of that even hints at sustainability.

The NHS is not only a sort of religion, it is a political football. If I were a Labour Member, I would be really pleased that we had started it. As a Conservative, I am really pleased that we have looked after it for more years than anyone else. Both sides have played their part in keeping this political football moving backwards and forwards, but it is time to blow the whistle—it is time to stop. I want to be the third ex-Health Minister, and there may be more yet to speak, who says that it is time for an independent review. It is time for an independent national commission to recommend how we should move from unsustainability to sustainability. Will the Minister’s department undertake to put pressure on the rest of the Government to set up a royal commission, or would it prefer that an independent commission was set up, independently generated?

Health Funding

Lord Mawhinney Excerpts

Thursday 9th July 2015 Lords Chamber

[Lord Prior of Brampton]

I agree fully with the noble Lord. Early prevention is crucial, not just for diabetes but for a whole range of mental health issues as well, and prevention will remain a critical part of the five-year forward view.

[Lord Mawhinney (Con)]

My Lords, will my noble friend make arrangements for someone to survey local supermarket shelves and record the number of items for sale that have either no added sugar or are sugar free? Will he then arrange for a similar survey to be conducted among the major supermarkets in the United States? After which, will he explain to us what government policy will be applied to try to get us even in the same vicinity as the sugar reductions that are available to American purchasers?

[Lord Prior of Brampton]

My noble friend raises a very interesting point. I will certainly bring it to the attention of Public Health England and, depending on its reaction, I will be happy to come back to the House and give the noble Lord the answer to his question.

NHS: Ambulance Response Times

Lord Mawhinney Excerpts

Monday 21st July 2014 Lords Chamber

[Earl Howe]

The noble Lord is right. Ambulance trusts are experiencing high demand and we realise that a handful of services have experienced difficulty. Broadly, we are taking action in the short term and in the medium to long term. In the short term, we are supporting trusts with operational resilience plans so that they are better equipped to manage peaks in demand and we are providing clinical commissioning groups with additional funding, as I mentioned in my original Answer. Over the longer term, the NHS England review led by Sir Bruce Keogh is considering whole-system change, incorporating ambulance services.

With regard to the east of England, I met the East of England Ambulance Service NHS Trust’s chief executive, Dr Anthony Marsh, on 8 July to discuss performance since his appointment in January, and he assured me that the trust is now in recovery stage. Having seen his detailed proposals, I accept that judgment.

[Lord Mawhinney (Con)]

My Lords, in his original Answer, my noble friend said that a majority of ambulances arrived in less than eight minutes. That majority could be 99% or 51%. Will my noble friend tell your Lordships slightly more precisely what the percentage is?

[Earl Howe]

My noble friend makes an important point. The standard for arriving in the most urgent cases is that the ambulance should do so in 75% of cases or more. In recent months, performance across the country has been slightly below that standard.

National Health Service: Hospital Beds

Lord Mawhinney Excerpts

Wednesday 11th June 2014 Lords Chamber

[Lord Mawhinney (Con)]

My Lords, does my noble friend recall that the previous Government did not run their NHS policy on the basis of the number of beds in the NHS, and rightly so? Will he continue robustly to reject the arguments of those who, using beds as a criterion, are so out of date with modern medicine delivery?

[Earl Howe]

My noble friend has encapsulated the point very well. One cannot correlate bed numbers as a stark statistic with the quality of care that a health system delivers. Our system is dependent not just on acute settings but on care in the community, and that is where the focus should rightly lie at the moment.

Mental Health: Young People

Lord Mawhinney Excerpts

Monday 7th April 2014 Lords Chamber

[Earl Howe]

Children with the conditions mentioned by the noble Baroness are most certainly eligible for CYP IAPT, not least cognitive behavioural therapy for emotional disorders, which include anxiety and depressive disorders. The programme covers services available to 54% of England’s population aged nought to 19—our target is 60%—and that is successfully giving children and young people improved access to the best evidenced care. NHS England is planning for a countrywide extension of the programme and the Government’s aim is that all of England should be involved by 2018.

[Lord Mawhinney (Con)]

My Lords, regarding my noble friend’s statement that £54 million has been made available over four years, although there will be plenty in the department and some in the NHS who know of this project, can he tell your Lordships’ House how information around the services paid for by this project are brought to the attention of young people themselves and their parents?

[Earl Howe]

My noble friend clearly has a close insight into this area because he is spot on in asking that question. CYP IAPT is rather different from the adult IAPT programme. It is a programme that aims to ensure that those working with CAMHS work much more closely with children and young people and with their parents and their families. The services have to enable children and their parents to have a say in designing the service that they receive, and they must also introduce and use regular outcome measures that help the child or young person and their parents and therapist to understand how well the child is doing. Therefore, involving the parents is absolutely integral.

Drug Companies: Medical Trials

Lord Mawhinney Excerpts

Monday 24th February 2014 Lords Chamber

[Earl Howe]

Certainly, my Lords, any advice that comes from NICE on the clinical effectiveness of a drug should be adhered to by commissioners. It is not, however, mandatory that that happens. Commissioners have discretion in that area.

[Lord Mawhinney (Con)]

I compliment my noble friend on the full and comprehensive Answer that he gave to the Question, and on the reassurance that it contained. Do he and his colleagues think that perhaps the issue here is not the legal framework but the issue of transparency and ease of access to information? If they think that that has some merit, would they be willing to consider having a simplified summary of the legal position on the department’s website for easy access for those who are interested?

[Earl Howe]

I absolutely agree with my noble friend. The Government are committed to transparency in the area of clinical trials. Transparency is important for patients, the public, researchers and the NHS, and it can be achieved through ensuring trial registration and outcome publication, as well as making data available through the appropriate channels. I think that the new EU regulation will be extremely helpful in promoting transparency, and the availability of summaries of all trials and clinical study reports will be a part of that regulation. However, I take my noble friend’s point about a simple guide for the public and I will gladly consider it.

NHS: Black and Minority Ethnic Nursing Directors

Lord Mawhinney Excerpts

Monday 10th February 2014 Lords Chamber

[Earl Howe]

My Lords, I fully agree with the noble Lord about the importance of this issue. A strong focus on equality and diversity is essential to create services and workplaces that are equitable and where everyone feels that they count. The position at present is highly unsatisfactory. The Chief Nursing Officer has personally assured me that this is a priority for her, and she is working closely with BME nurse leaders to address how to support BME nurses to prepare themselves for promotion. Forty-six million pounds has been invested at the NHS Leadership Academy in schemes on leadership development being led by the Chief Nursing Officer. At last year’s BME nursing conference, she made a public commitment to renew efforts to develop BME nurses more effectively, and that will include monitoring.

[Lord Mawhinney (Con)]

My Lords, what figure, set by the Government or Public Health England, would constitute a success for the strategy that my noble friend has just outlined?