Mental Capacity (Amendment) Bill
Lord O'Shaughnessy Excerpts(5 years, 9 months ago)
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Lord O'Shaughnessy
That it be an instruction to the Committee of the Whole House to which the Mental Capacity (Amendment) Bill has been committed that they consider the bill in the following order:
Clause 1, Schedule 1, Clauses 2 to 4, Schedule 2, Clause 5, Title.
General Practitioners: Indemnity Scheme
Lord O'Shaughnessy Excerpts(5 years, 10 months ago)
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Lord Sharkey
To ask Her Majesty’s Government what plans they have to introduce a state-backed indemnity scheme for general practitioners in England.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O’Shaughnessy) (Con)
My Lords, in October 2017, the Secretary of State for Health and Social Care announced his intention to develop a state-backed indemnity scheme for general practice in England. The state-backed scheme is being designed to provide more stable, affordable cover for GPs and patients. We are working with stakeholders to design the scheme and are committed to implementing it from April 2019.
Lord Sharkey (LD)
Will the proposed scheme cover all GP-related healthcare staff who provide services for the NHS and, if not, who will be excluded? Will the scheme cover historical liabilities, as was the case when the NHS clinical negligence scheme for trusts was introduced? What additional costs will the new scheme generate for the NHS?
Lord O’Shaughnessy
The scheme is intended to cover primary medical care services, which will also include integrated urgent care services and NHS primary care provided in secure environments. The scheme will certainly cover future liabilities, and cover for historic liabilities will depend on discussions with stakeholders and achieving value for money. As for the cost, this is a complex negotiation with multiple partners, and we are not in a positon to give costs at this point without prejudicing commercial interests. Suffice it to say, one intention of the scheme is to provide better value for money than those currently in existence.
Baroness Thornton (Lab)
My Lords, the average GP paid indemnity costs that rose by 50% in a six-year period. That has had a knock-on effect of discouraging doctors from going into primary care and has been a factor in many leaving. It seems to me therefore that this is a matter of urgency, and so I am very pleased to hear that the scheme will be introduced in April next year. However, GPs are sorting out their indemnity insurance right now—they do it over the summer. What advice are the Minister and the Government giving GPs now to help them decide what the costs are? Given the shortage of GPs in this country, anything that the Secretary of State can do to encourage GPs into primary care would be a good thing.
Lord O’Shaughnessy
I agree with the noble Baroness’s final point. Indeed, one reason for sorting out this scheme is that we know it is a barrier to people joining the profession and, unfortunately, encourages them to leave it. There is of course an urgency, but nevertheless it is a complex discussion with commercial partners. I can tell her that we are talking to GPs themselves and their representative organisations to make sure they understand what is at stake, what we intend to do and that we intend to introduce the new scheme in April.
Baroness Jolly (LD)
My Lords, on 1 June, a DHSC spokesperson said:
“We are continuing to work closely with key stakeholders in the development of the scheme from April 2019”—
as the Minister said. The spokesperson went on:
“We will provide a further update in the near future”.
GPs need reassurance that this will not be kicked into the long grass. What is the department’s understanding of the “near future”—is it six weeks, six months or a year?
Lord O’Shaughnessy
That is a very existential question. The point is that we need to introduce the scheme by April and are absolutely committed to that. There are some very big decisions to be made on the scheme design now. We have a new Secretary of State who is getting up to speed on these issues as we speak. Our intention is to make those decisions to confirm the design of the scheme and to be able to tell GPs and other stakeholders publicly as soon as possible. We are committed to the April 2019 deadline.
Lord Suri (Con)
My Lords, is such a scheme currently available to general practitioners in any other part of the United Kingdom?
Lord O’Shaughnessy
I can tell my noble friend that the scheme we are designing is for England, the jurisdiction that the department looks after. However, the Welsh Government have announced their intention to have a state-backed scheme and we are speaking to the devolved Administrations in Scotland and Northern Ireland to make sure that we act together in this regard.
Lord Patel (CB)
My Lords, when the scheme is introduced, what plans are there to reduce the level of litigation in primary care, considering that the majority of primary care practitioners are independent contractors, and those who are not are employed by GP principals and not by the National Health Service?
Lord O’Shaughnessy
The noble Lord is right to highlight this issue. It is important to state that the rising cost of indemnity is not driven by a poor or worsening safety record but by the volume of activity and the rising cost of the average claim. Not only do we need to make sure that we reduce those costs, for example, by introducing a fixed recoverable cost scheme, we also need to reduce the number of safety issues so that there are fewer claims to bring in the first place.
Lord Watts (Lab)
My Lords, is it not the case that the costs are rising because GPs do not have sufficient time to see their patients? It is all linked to the shortage of GPs, which means that they have to see more patients for shorter periods.
Baroness McIntosh of Pickering (Con)
My Lords, I declare the work that I do with dispensing doctors. A particular barrier to retaining and recruiting GPs in rural areas is the pension provisions, which is the case for all professions. Will my noble friend make representations to the authorities that be in this regard as that would be a major step forward for those now coming into the profession in their 30s and 40s?
Lord O’Shaughnessy
My noble friend makes an excellent point and I will certainly do so. There is an attempt not just to recruit many more GPs into service but to recruit them into hard-to-reach areas, such as rural areas, through a targeted recruitment campaign. I am sure that that is one of the areas that we will want to look at.
Lord Hunt of Kings Heath (Lab)
My Lords, is it intended that locums will be covered by the scheme?
Lord O’Shaughnessy
My understanding is that the scheme is for all providers of primary medical care services under GMS, PMS and APMS contracts.
Lord Kakkar (CB)
My Lords, I declare my interests as in the register. In reducing the problem of clinical negligence, it is vital to ensure that general practitioners are able to learn from the entirety of their clinical practice. As has been heard, many work in single-handed practices. How do Her Majesty’s Government propose to ensure that there is proper learning across the primary care system to reduce errors once mistakes have been made?
Lord O’Shaughnessy
The noble Lord is quite right. I point him in the direction of the learning from deaths programme, which is attempting to do exactly that.
Mental Capacity (Amendment) Bill [HL]
Lord O'Shaughnessy ExcerptsMonday 16th July 2018
(5 years, 10 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)
My Lords, treating people with respect and dignity, no matter what their disability or condition, are touchstones of our civilised society. Those are virtues that we all seek to promote, but sometimes, even with the best intentions, they do not always materialise. For that reason, the Government have now introduced legislation to reform and improve the current deprivation of liberty safeguards system. It is fitting that we do so in the month when we celebrate the 70th anniversary of the NHS, an institution founded on those and other virtues, which have sustained it as one of the most successful and respected health and care systems in the world.
Deprivation of liberty safeguards seek to empower and protect vulnerable people in our society by ensuring that any deprivation of the liberty of people who lack capacity is always in their best interests. It is a step that is never taken lightly and always with the intent to prevent harm to the individual. Even in cases where a person who lacks capacity is unable to make decisions, there is an express duty for all involved to consider their views and wishes as far as they can be determined. Despite the existence and undeniable necessity of these protections in our society, the deprivation of liberty safeguards system as it stands today is overly technical and legalistic, placing significant burdens on people and their families. It too often fails to achieve positive outcomes for those at the heart of this process, and we too often hear that individuals, families and their carers are experiencing a process that feels “done to them” rather than with their full consent and engagement. People’s voices, and those who care for them, are not being heard; this needs to change.
What is more, report after report has provided strong evidence of the strain the system is under and of unacceptable inefficiencies. It is costly and cumbersome, and in its current state is unable to process all the necessary applications to protect human rights. Last year, reports showed that more than 108,000 people were awaiting a deprivation of liberty safeguards application; again, this needs to change.
Many noble Lords have worked hard on this issue for years, and I would like to take the opportunity to thank them for continuing to shine a light on a system in urgent need of reform. In 2014, a House of Lords Select Committee published a detailed report which concluded that deprivation of liberty safeguards were “not fit for purpose”. Again in 2017, the chair of the National Mental Capacity Forum, the noble Baroness, Lady Finlay, for whose tireless commitment I am especially grateful—and I am delighted to see that her train got her here in time—reported that the current system was overly complex, excessively bureaucratic and costly. More recently, the Independent Review of the Mental Health Act: Interim Report, led by Professor Sir Simon Wessely, stressed the need for,
“an appropriate calibration between resources spent on delivery of care and those spent on safeguards surrounding the delivery of that care”.
We have listened and, following a Government commission, in March 2017 the Law Commission published a review of the deprivation of liberty safeguards and Mental Capacity Act. Over three years, the Law Commission sought views from a breadth of stakeholders, exposing the system’s struggles as well as looking at the process from a user’s perspective. The evidence, analysis and recommendations, drawn from across the system, have provided further impetus for reform. In March this year, the Government published their response to the report, accepting in principle the Law Commission’s model. Since the publication of the Law Commission’s review, the Government have continued to work closely with stakeholders and we have listened carefully to them to build on that model, streamlining it to focus on the crucial protections that this Bill seeks to mandate.
The Bill will reform the process so that it is less burdensome on people, carers, families and local authorities. Not only will it ease financial burdens throughout the system, creating significant savings of more than £200 million a year which will mainly fall to local authorities, but according to the Law Commission, it will also relieve local authorities of the significant legal liability burden of more than £408 million by removing the backlog of deprivation of liberty safeguards applications. It will introduce a simpler process with increased engagement with families and other carers, and afford swifter access to justice. It will ensure that any restrictions are proportionate and help to support cared-for persons to live as freely as they can by protecting their liberty. It will allow the NHS rather than local authorities to authorise the deprivation of liberty arrangements for its own patients, enabling a more streamlined and clearly accountable process in which the NHS has a clear role in helping to afford people their rights.
The Bill will make sure that consideration of restrictions on people’s liberties will be part of their overall care planning and considered from the earliest stages, rather than a bolt-on afterthought as under the current system. The Bill will also eliminate repeat assessments and authorisations when someone moves between a care home, hospital and ambulance as part of their treatment. In the words of Law Commissioner Nicholas Paines QC:
“This new legislation … will go a long way towards addressing the flaws of the current system and better protect the most vulnerable in our society”.
The president of the Association of Directors of Adult Social Services, Glen Garrod, has also indicated support for the Bill, observing that:
“Once enacted, it is hoped that this law will help ensure the protection of liberty of all people who lack mental capacity more effectively and efficiently than under the present Deprivation of Liberty Safeguards”.
Finally, before beginning debate on the Bill, I want to recount the seminal case study that underlines the importance of the legislation before us. It illustrates the role that this law plays in our society when protecting and empowering people. It illustrates the need to put individuals, carers and family members at the heart of a system, and reminds us that the framework fundamentally exists to ensure that vulnerable people are cared for and looked after. A man—HL—came to live with Mr and Mrs E, his carers, under a resettlement scheme from Bournewood Hospital, where he had lived for 32 years. HL’s carers found it rewarding to see him benefit from living in a family setting. Gradually, he became more confident and progressed beyond all expectations. HL would attend a day centre once a week, to which he travelled with the centre’s transport.
However, on one occasion, the usual driver did not collect him from home. Rather than taking him straight to the day centre as normal, the driver took a different route. HL became increasingly agitated. The next thing Mr and Mrs E knew was that HL had been taken back into hospital and detained there. As HL cannot speak, he was unable to object. Mr and Mrs E were not allowed to visit him, apparently in case he wanted to leave with them. When HL returned after various legal proceedings he was “in a terrible state”, in the words of his carers. Eventually, a legal case brought to the European Court of Human Rights found that HL was being deprived of his liberty without the necessary legal safeguards. This ruling triggered the introduction of deprivation of liberty safeguards in 2009. The story emphasises the importance of this system and that a rights and person-centred approach is needed to deliver better public services for everyone. Up to 2 million people in our society have impaired capacity, so many of us in this Chamber will have had direct experience of it among our family and friends. It is essential that the system affords the necessary protections for the most vulnerable people.
To conclude, we have an opportunity to transform the deprivation of liberty safeguards process, improve access to human rights, support families, carers and individuals and reduce pressures on the health and care system. We have an opportunity to bring about change and I look forward to working with noble Lords to make sure that we use this opportunity to improve the welfare of some of society’s most vulnerable people. I beg to move.
Mental Capacity (Amendment) Bill [HL]
Lord O'Shaughnessy ExcerptsMonday 16th July 2018
(5 years, 10 months ago)
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Lord O'Shaughnessy
My Lords, I thank all noble Lords for an incisive, illuminating, at times technically complex but always wise debate, which has been a credit to the House. I will attempt to answer as many questions as I can. I will not try to cover all of them as we actually would be here all night, but I will have time to explore the major categories of issues. I hope noble Lords will indulge me as I do that.
I welcome my noble friend Lady Barran and congratulate her on a very passionate and moving speech. It is clear that she has already been a force for good in the world and we look forward to her bringing her singular qualities to the stage which she now fills with such great authority. I hope noble Lords also noticed the attendance for the first part of the debate of my honourable friend the Minister for Care, Caroline Dinenage, who obviously takes a close interest in this. She was at the briefing and we are working closely together to try to get the right Bill through this process.
I think the general tone of the debate was that there is a strong desire to reform the DoLS system and to end, as the noble and learned Lord, Lord Brown of Eaton-under-Heywood, pointed out, the lawlessness and the highly unsatisfactory current situation. My noble friend Lady Barran brought this to life. The truth is that the current system has overwhelmed local authorities and others. As the noble and learned Lord, Lord Brown, pointed out, Cheshire West has extended the definition to whom this should apply, such that the backlog of cases is now extraordinary. The only consequence of that is a denial of access to justice. The challenge we have in the Bill is to make sure that we do not have access to justice just in theory but that it actually happens, and it cannot happen if more than 100,000 people are getting it in theory but not in practice.
As somebody who was new to this before preparing for the Bill, the situation almost sounds too good to be true. We are going to extend the number of people who have access to safeguards but we are also going to stop the system being overwhelmed and save money. This is achievable because it is about introducing a proportionate system that reflects the needs and wishes of the people whom it is there to protect, rather than having a maximalist approach that in theory applies to everyone but in reality does not and is sometimes random in its application, which is clearly unacceptable.
As many noble Lords have pointed out, the system that we need to create must be patient-led. It needs to have proper oversight and to deliver that access to justice which we have discussed. Clearly, if, as the noble Baroness, Lady Finlay, pointed out, only one in 20 have benefited from the current system, it is highly inefficient. As many noble Lords also pointed out, there is a huge urgency here.
Many noble Lords pointed out the benefits of the new system. I will come to some of the challenges but, ultimately, this is about making sure that caring organisations take a more active role in the assessment of deprivation of liberty. Where they do so and integrate it into their care planning, we will provide a proper system of oversight and support for individuals deprived of their liberty in general but, specifically, for those who object, or whose families who care for them object. That is ultimately what we are trying to do and it is the intention of the Bill.
Several noble Lords, including the noble Baronesses, Lady Jolly, Lady Greengross and Lady Thornton, asked about our consultations to date. There have been very wide consultations but this debate has shown that there is much work to be done over the summer, not just with noble Lords but with stakeholder groups, to ensure that we are not only explaining the consequences of what is proposed—I think there are still some misunderstandings about that—but able to demonstrate the benefits and, critically, learn how we can further improve what is proposed.
I turn to some of the issues raised. Several noble Lords including the noble Lord, Lord Touhig, the noble Baronesses, Lady Barker, Lady Finlay, Lady Greengross and Lady Tyler, the noble and learned Lord, Lord Brown, and the noble Baroness, Lady Murphy, talked about the absence of a statutory definition. I can tell the House that we are aware of that and are listening particularly to the recommendations of the Joint Committee. However, the debate demonstrated some disagreement over the right way forward. There are various options, such as definitions in the Bill or through a code of practice, but we clearly need to get to an answer in order to proceed.
We have talked about wanting a system that has the person’s wishes and best interests at the heart of the process. That was raised by the noble Lord, Lord Touhig, and endorsed by the noble Baronesses, Lady Barker, Lady Finlay, Lady Greengross, Lady Meacher, Lady Browning and Lady Hollins. It is absolutely right for us to be clear that there is no watering down of the interests of the individual concerned through this process. As the noble Baronesses, Lady Barker and Lady Finlay, pointed out, capacities can fluctuate; as the noble Baronesses, Lady Browning and Lady Hollins, pointed out, they can also be varied—strong in one area and weak in another. Any system needs to take account of that and I can tell the House that it is absolutely not our intention to water down the role of a person’s expressed wishes. The best interest test still applies absolutely in the care setting, but the necessary and proportionate test is to account for those cases where a person may wish to do something regarding their liberties which is contrary to their best interests for their individual care. Striking that balance and making sure that there is proper oversight, with proper advice for people who are unable to enunciate their own wishes, is at the core of getting the Bill right.
As noble Lords have also pointed out, getting the Bill right is actually about getting a statutory code of practice right. It is out of date and there is a degree of urgency about improving it. I will return to that in a moment but, in talking about the statutory definition, I will finish on the power of attorney and the role of families. They still have primacy under the Mental Capacity Act, the principles underpinning which still apply. It will not be possible to deprive a person of liberty when the attorney acting on their behalf has stated that their best interests are served otherwise. I want to make that clear but it is something that we will need to explore and explain better. Attorneys will be part of the group that is to be consulted, and the Bill creates an explicit requirement for further consultation with families. Family members can also act as appropriate persons, so I think there is a greater strengthening of the role of those acting on behalf of a person deprived of their liberty in the process of scrutinising that and making sure that it is done appropriately.
Baroness Barker
If this matter is unclear to some of us who can claim to be fairly well informed on it, clearly, there has been a communication problem. Might I suggest to the noble Lord that it would be enormously helpful—as it has been in similar situations—to have a copy of the Act, as amended by the Bill, for us and interested parties to look at? Believe me, it makes the whole business a great deal clearer and easier to understand.
Lord O'Shaughnessy
That is an excellent suggestion. I should be clear: any confusion comes from a failure to communicate on our behalf, rather than there being any suggestion that noble Lords who are extremely expert on this do not understand what is proposed. There is a need to explain better exactly how all this will work in practice.
Obviously, the system depends on the quality and independence of the reviews, assessments and authorisations that take place; that issue was particularly raised by the noble Lord, Lord Touhig, and the noble Baroness, Lady Hollins. There were also questions asked by the noble Baronesses, Lady Tyler, Lady Murphy, Lady Jolly and Lady Thornton, about the capacity of those carrying out assessments in local authority care homes, the NHS and so on to do them properly and in a way compliant with the law. I agree with noble Lords that in the coming weeks we will need to set out much more clearly how that independence support and those assessments will be staffed and provided, making sure that there are sufficient resources and proper training. I am reassured that training in the implications of the Mental Capacity Act is part of medical training, and that there are Health Education England resources for that. Clearly, all that will need to evolve as we go through this process and the Act itself is amended.
The noble Baronesses, Lady Barker, Lady Greengross, Lady Tyler and Lady Murphy, and the noble and learned Lord, Lord Brown, asked about the interaction with mental health legislation and whether we should have delayed publication. The noble Baroness, Lady Tyler, described a tension between the two Acts. We are conscious of the interface—that is the term used—but there is an urgency to reform the system, notwithstanding its interaction with the Mental Health Act. We do not yet have a timescale on completion of the review and any subsequent legislation that might be required. There has been lots of talk about the work to reform—the committee, the Law Commission, the Joint Committee and so on—and we need to get on with this, cognisant all the time that subsequent changes may need to be made once we have the outcome of the Mental Health Act review. It is not in my gift to promise time for legislation in the future but we are cognisant of the need to make sure that our interface works, once we have the review itself completed.
Several noble Lords asked why the Bill does less than the Law Commission. We could spend a lot of time going through that, but I do not propose that we do so at this point. We can achieve non-legislatively several of the Law Commission’s proposals; it is made up of lawyers, so they prefer law but there are other ways of doing things. One of the key issues raised is the Bill’s not applying to 16 and 17 year-olds. There is clearly an important interplay here with the education, health and care plan process, but I have listened to noble Lords on the subject today and shall reflect on whether we can do something about it.
The code of practice was raised by the noble Baronesses, Lady Finlay and Lady Greengross, and my noble friends Lady Barran and Lady Browning. Getting it up and running quickly is critical. Detailed work is going on, and we need to be very specific in it to provide reassurance about how it will work. Unfortunately, I do not have a timetable yet for its production, but I will endeavour to get hold of one. We need to make sure that its implementation is properly resourced. The CQC will continue to inspect its implementation, so there will still be that quality oversight.
A few other issues were raised. Many noble Lords referred to “unsound mind” being an unhelpful and, frankly, out-of-date phrase. I do not disagree. The concern here is the interaction with the jurisprudence and the ECHR itself. If we were to move on that—I make no commitment at this point—we would need to think it through very clearly, but I would like to explore it.
The noble Baronesses, Lady Barker and Lady Jolly, asked about legal aid. I can confirm that it is, and will still be, available on a means-tested basis. The noble Baroness, Lady Meacher, and my noble friend Lady Browning asked about advance consent—an issue that the Law Commission also raised. Again, there is an important distinction to be made here between an advance decision to refuse treatment, which will continue to be respected and is untouched, and advance consent to a future deprivation of liberty. Although that was in the Law Commission report, officials engaged in the process indicated that this did not receive support from families. There was a concern that you could sign yourself up to being deprived of your liberty at some point in the future, so it did not garner support. Perhaps it was the wrong subset or sample of people; nevertheless, we need to consider the best way forward on that.
Finally, the noble Baroness, Lady Thornton, asked about the equality impact assessment. I do not have an answer at this stage about why it was not carried out but I will endeavour to get one.
To conclude, I hope that I have been able to summarise the main issues and topics. Clearly, there are some very big questions that still need to be answered, but I return to the point that my noble friend Lady Browning made, which is that we need to solve the problems this time. We cannot introduce another Bill or piece of legislation that just creates a problem three years down the line. It is not just about the Bournewood gap; it is about making sure that we avoid, and do not create, any other gaps. The words “nightmare” and “disaster” have been used to describe the current system, and that is why we need to act now, but clearly we need to act in such a way that we do not create another problem further down the line.
It has been clear from this debate that there is still much work to be done to provide the right kind of reforms that we all want to see. Looking at the Chief Whip, I am sure that we will have adequate time in Committee to make sure that the Bill is in the best possible shape. We saw a nod of the head from the chief, so that is good. This debate has demonstrated—the noble Baroness, Lady Thornton, said as much—that there is no group of people better qualified to improve this legislation and make sure that we get the right reforms. I look forward to engaging with noble Lords and others throughout the coming months to make sure that we can achieve that and deliver a Bill that provides for people deprived of their liberty the fair and proportionate access to justice that we all want to see.
Adult Social Care
Lord O'Shaughnessy Excerpts(5 years, 10 months ago)
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Lord Warner
To ask Her Majesty’s Government when their Green Paper on the future funding of adult social care will be published; and whether the Green Paper will draw on the experience of other countries.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O’Shaughnessy) (Con)
My Lords, as recently announced by the previous Secretary of State for Health and Social Care, the Government will publish a Green Paper in autumn 2018 setting out proposals for social care reform alongside the NHS plan. In developing the Green Paper, the Government are drawing on best practice of what works abroad to create a sustainable social care system.
Lord Warner (CB)
I thank the Minister for his Answer. Is he aware, however, that according to a report in May by the Health Foundation and the King’s Fund, adult social care funding needs to increase by between £5 billion and £8 billion by 2020-21? Can he reassure those service providers who are leaving the publicly funded adult social care system in droves that the Government’s financial cavalry will arrive by Christmas?
Lord O’Shaughnessy
The noble Lord is quite right that there is a need for more money in the social care system. That is why, in addition to the funding set out in the spending review, the Government have put £9.4 billion over three years into the system in the short term. The point he makes, which is right, is about the long-term sustainability of the settlement. I would point him to the seven principles underpinning the Green Paper, which my right honourable friend set out. One of those is a sustainable funding model—a model which, as we have said, cannot put pressure on the NHS. That means that we need to find the money to ensure that it can subsist.
Lord Turnberg (Lab)
My Lords, the noble Lord is well aware that we need more money for social care, and that integrated care is vital. He may also be aware that Salford has successfully integrated health and social care. I am sorry to keep banging on about Salford, but it is where I spent many happy years working. It has done it very successfully, and Sir David Dalton has led it wisely. What lessons are being learned centrally, not just from abroad but from the UK and similar experiments?
Lord O’Shaughnessy
The noble Lord speaks with great wisdom and he is absolutely right to highlight Salford, as he always does, because it is the root of the integrated care service being put in place in Greater Manchester with unique devolution powers, and we want to see that model rolled out across the country. Of course, the point of that is to ensure a better interface between the National Health Service and social care, so that one of the problems that bedevils us at the moment—delayed transfers of care—does not get in the way of proper care.
Baroness Howarth of Breckland (CB)
My Lords, it is good to be back, but very depressing to find that some of the things that were happening when I left are very much the same as I return—in particular, in respect of the Green Paper. The world may be changing radically in other ways, but I find that we have yet another Green Paper to add to the pile of other reports on adult social care.
I briefly pay tribute to the health service, particularly in Norfolk, which has saved my life and put me partly back on my feet. When I came out of the health service and had to use social care, however, I found myself spending thousands of pounds of my savings on carers. Many others, like me, find themselves uncertain about what the future will bring when they come to the end of their savings because we do not have the answer in the Green Paper. I am asking the Government not only to look very carefully at the issue of people who need carers, but to tell us the timeframe so that people are not left in a state of uncertainty about what the future will bring.
Lord O’Shaughnessy
I am very pleased to welcome the noble Baroness back to the House, and am glad to see that she is on the mend. She highlights a critical point about certainty, which she makes movingly from a personal insight. It does not matter what age someone is; there is a great deal of uncertainty about what the system will look like when they retire—whether that is in five or 50 years. Providing that security and certainty is one of the principles underpinning the reform. It will be in the Green Paper. I know that successive Governments have had Green Papers, but we need to seize the chance of a long-term plan for the NHS and a Green Paper coming together to try to make it work.
Baroness Eaton (Con)
My Lords, I declare my interest as recorded in the register. The recent Local Government Association survey of council leaders and social care cabinet members found that 96% believe that there is a major national funding problem in social care. I think we all agree that we urgently need a long-term funding solution for social care. With that in mind, will the Minister commit to working with the Local Government Association, as it consults on its own social care proposals, and seek to start a debate on how best to fund the care we want to see for adults of all ages? Will he update the House on whether the Government’s Green Paper will commit to new funding for social care?
Lord O’Shaughnessy
I absolutely agree with my noble friend. I know that she speaks from great experience. We have some good working practices now, through the better care fund, between health commissioners and local government, which is an essential part in making sure we have a sustainable system.
Baroness Wheeler (Lab)
Will the Minister reassure the House that the Green Paper will address the parity of esteem between mental and physical health in terms of eligibility for social care support at home? Although there is serious concern that many people suffering debilitating mental illness, particularly depression, are not receiving the basic social care support they need, it is very difficult to assess the national scale of the problem because of the very poor data on how the current eligibility criteria are applied in mental health support. How is this key issue being addressed?
Lord O’Shaughnessy
I reassure the noble Baroness that it will be addressed. When we have the consultation, there will be more opportunity to explore that.
Baroness Brinton (LD)
In addition to looking at funding mechanisms from abroad, will the Green Paper look at some innovative solutions, such as the projects in Holland where students live in sheltered accommodation with the elderly, improving the quality of life for the elderly and financial support for students, which is much cheaper for the state?
Lord O’Shaughnessy
That sounds like an excellent idea, and I would be delighted to consider it, as well as any other ideas that the noble Baroness has.
Baroness Pitkeathley (Lab)
I welcome the Green Paper but it is only a Green Paper. Does the Minister have any assessment of how long it will be before legislative changes can be brought in to make new initiatives a reality?
Lord O’Shaughnessy
I do not have that information, but it will be set out in the Green Paper.
Hepatitis C
Lord O'Shaughnessy Excerpts(5 years, 10 months ago)
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Baroness Randerson
To ask Her Majesty’s Government what plans, if any, they have to publish a strategy for the elimination of hepatitis C.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O’Shaughnessy)
My Lords, the Government are committed to meeting the World Health Organization’s target of eliminating hepatitis C as a major public health threat. While there are currently no plans to publish a strategy, my department is working closely with NHS England and Public Health England to deliver a highly ambitious, whole-system approach that would achieve elimination in 2025—five years ahead of the WHO target.
Baroness Randerson (LD)
I thank the Minister for his positive approach. I declare an interest as co-chair of the All-Party Group on Liver Health. In our recent inquiry, we demonstrated that hepatitis C specialists do not believe that the NHS is geared up to achieve the Government’s ambition, which the Minister has just outlined. Some 40% to 50% of those with hepatitis C remain undiagnosed. Do the Government intend to introduce a national campaign to raise public awareness of hepatitis C, thus encouraging more people to seek treatment?
Lord O'Shaughnessy
First, I applaud the noble Baroness for her work on this. We know that hepatitis C is a truly horrible disease that affects some of the most vulnerable people in our society, which is why we want to eliminate it. In terms of the NHS being geared up, we are on track to treat 70,000 people by 2020. We need to keep finding people, and, of course, they become harder and harder to find. She is quite right about the need to raise awareness. We are doing other things as well, such as reaching into hard-to-reach communities. To give one example, there is now a 100% opt-out testing offer for people entering the prison estate, which is one of the areas where hepatitis C tends to be transmitted. There is clearly a need to do more, but we are looking at how to reach those hard-to-reach communities.
Baroness Wheeler (Lab)
Can the Minister say a bit more about the steps the Government are taking to support the delivery of hepatitis C treatment in community settings, such as GP clinics, pharmacies, homeless shelters, substance misuse clinics and sexual health clinics? The King’s Fund estimates that spending on tackling drug misuse in adults has been cut by more than £22 million compared with last year, and funding for sexual health clinics by £30 million over the same period. How will the 2025 target for elimination of hepatitis C be met if vital education and work in these services, and the work they do in reducing reinfection rates, are not available?
Lord O'Shaughnessy
The first thing I would say to the noble Baroness is that, in terms of sexual health clinics, local authorities are mandated to commission comprehensive testing services. Clearly, however, testing needs to happen in many more areas. We have introduced testing in pharmacies, for example, for hepatitis C. That has proved very effective in identifying it in people who take drugs, as well as offering other opportunities to test particularly high-risk communities. Another example is that there has been an increased screening of the south Asian population, where there is a much higher prevalence. It is about using the opportunities of community health services and taking testing into those communities, so that we can deliver on our target.
Lord Patel (CB)
My Lords, direct-acting antivirals are the greatest advance that has occurred in trying to eliminate hepatitis C infection—it is effective in 95% of those who carry the infection. So a policy that does not treat everybody who is known to have the hepatitis C virus is wrong. Secondly, if we are to eliminate it, we need to identify those who carry the virus but are not diagnosed. Strategies focusing only on the prison population will not do that. Thirdly, we need to reduce the risk in the at-risk population by educating them. Unless we have a strategy across these three areas, we will not eliminate hepatitis C by 2025.
Lord O'Shaughnessy
I agree with the noble Lord that we need a whole-system approach, but I do not think that we necessarily need to condense that into a document. There are lots and lots of things going on, some of which I have talked about. Of course, the WHO target is about the elimination of hepatitis C as a public health risk; it is not about elimination completely. As he said, it is very difficult to find everybody who has not yet been diagnosed. The main thing is that it is reduced as a health risk: it does not kill people anymore and cannot be transmitted. That is what we are on track to do by 2025.
Baroness Afshar (CB)
What are the Government specifically doing for minority women who do not come out, whose community is unlikely to report any kind of illness, and who do not have the skills to access what is available?
Lord O'Shaughnessy
I would need to write to the noble Baroness specifically about minority women. I do know that there are specific programmes taking place in towns and cities across the country to support minority groups where there is a high prevalence, and I mentioned the south Asian group, which has increased screening and diagnosis. It has reduced mortality, which has been affected. Clearly, that is something we need to do more of.
Lord Rennard (LD)
My Lords, does the Minister accept that NHS England may in the past have been too restrictive in its use of the relevant drugs? How might improved procurement policies result in greater use of those drugs, including more innovative products, as well as providing better value for the NHS in reducing the prevalence of hepatitis C?
Lord O'Shaughnessy
The noble Lord asked an excellent question. It is very rare to come across diseases you can cure; that is one of the exciting potentials here. Unfortunately, the drugs were expensive when they came out and we did not come up with a way of paying for them over a number of years as we should have done. Happily, through competitive tendering, prices have dropped. The NHS is spending over £200 million a year. We have just engaged in a very complex procurement which I hope will yield some fantastic results. We are using that procurement process to drive down prices and to help find the people who need this treatment.
NHS: Brexit-related Risks
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)
Nearly there.
My Lords, patient safety is our priority in the exit negotiations, and maintaining continuity of supply of medical products is a key part of ensuring that patients continue to receive safe, high-quality care from day one after we leave the European Union. Extensive work has been undertaken to understand the implications of our EU exit on the NHS, considering a range of negotiation outcomes, including exit without a withdrawal agreement. This has included a focus on continued access to medical supplies.
Lord Bassam of Brighton (Lab)
My Lords, I congratulate the noble Lord on his stamina this morning—more Fleetwood Mac than Iron Maiden. Given that the Government seem a long way off getting any sort of Brexit deal on goods and services, will the Minister tell the House whether there is a plan B to ensure that the NHS has continuity of medical supplies, and will he explain how he expects the interface of the medicines approval regime and the international regulation of medicines to work post Brexit? Will he also guarantee comparable levels of patient safety after we leave the EU?
Lord O'Shaughnessy
I am glad that the noble Lord’s train got him here in time for him to ask his Question. First, I do not share his pessimism about the outcome. We will publish the White Paper on our proposals next week and we expect it to get a warm welcome—and not just in this House. Nevertheless, it would be wrong if we were not working on contingency options. I think that the public would be surprised if we were not planning for every scenario. That is precisely what we are doing at the moment, and of course, as we do that, patient safety is our number one priority. We need to make sure that the supply of medicines and medical devices can come in to the country and be used by NHS patients, come what may.
Lord Purvis of Tweed (LD)
My Lords, I declare an interest as the son of an ambulance driver who drove ambulances for the NHS for nearly half of its existence. Some 45 million packs of patients’ medicines are exported from the UK every year, and 37 million are imported into the UK every month. Merck, GSK and AstraZeneca have all forecast that if we leave the customs union, it could take five to 10 years for any technological solutions to replace the system we have at the moment. They are now considering stockpiling, given the levels of extra documentation and checks that will be required. This will place an increased burden on the NHS. Would not the best thing for the NHS be if the Cabinet tomorrow agreed that we will continue as part of the European Medicines Agency and the customs union? Given that the Minister has been on his feet so much this morning, the simple answer “yes” will suffice.
Lord Morris of Handsworth (Lab)
Will the Minister take the opportunity to recognise the contribution that the Windrush generation has made to the development and continuity of the National Health Service?
Lord O'Shaughnessy
I am very pleased to do so. The Windrush generation has made a fantastic contribution to our NHS and caring services.
Baroness Hollins (CB)
My Lords, I am glad that contingency plans are being made. The British public voted to leave the EU because of the promise of £350 million a week to save our NHS. We now hear, however, that Brexit could have catastrophic consequences for the NHS in areas such as staff recruitment and essential supplies and for the adequate resourcing of the NHS to the standard of our EU partners—a standard that we do not yet reach. Will the Minister admit that these promises were wrong and tell the British people that we may need to think again?
Lord O'Shaughnessy
It would be a big mistake for anybody to tell the British people that they voted the wrong way. I point out to the noble Baroness, however, that, whatever was on any side of the bus, as a result of the funding plan announced by the Prime Minister there will be £394 million a week more in real terms for the NHS by 2024. I am also pleased to say that there are more EU staff working in the NHS today than two years ago.
Lord Reid of Cardowan (Lab)
My Lords, the problems and challenges of Brexit will only add to the massive challenges which, in our enthusiasm for the birthday of the NHS, we sometimes underestimate. These include demographic change, an ageing population, new inventions and therapies, new pharmaceutical products and so on. Although I very much welcome extra money, this problem will not be solved just by extra money; it will require massive organisation, radical restructuring, and innovation in technology on a massive scale. That will not be achieved by one party on its own. Why, therefore, do the Government constantly refuse the recommendations of some noble Lords and committees in this House to establish a cross-party consensus on this and take party politics out of it to the maximum extent? That is the only way—accompanied by money—that we can save the NHS for the next 70 years.
Lord O'Shaughnessy
The noble Lord knows better than most the challenges of transforming the National Health Service, and is right about the big challenges that we face—although I think it is better to look at them as opportunities. He is also right that reform has to go hand in hand with extra money. We promised the extra money; we now need to see the reform. Every part of the health service—the department, the NHS, and others—needs to drive that through. On his point about consensus, I do not think there is anything stopping that consensus: the Government want consensus. We do not necessarily think that it needs to be in the form of a royal commission or a parliamentary commission. We want to work with all corners of this House and the other place to make sure that there is support for a broad plan for the NHS for the next 10 years.
Health and Social Care Act 2012
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Lord Hunt of Kings Heath
To ask Her Majesty’s Government, in the light of the Prime Minister’s criticism of the regulatory framework established under the Health and Social Care Act 2012, what plans they have, if any, to bring forward measures to amend or repeal that Act.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O’Shaughnessy) (Con)
My Lords, the Government have announced a five-year funding settlement, and we have asked the NHS to develop a 10-year plan to transform health and care. As my right honourable friend the Prime Minister said, as it develops its plan we will listen to the NHS about whether there are any barriers created by legislation. We will consider, after that, what changes may be needed.
Lord Hunt of Kings Heath (Lab)
My Lords, in her speech on 18 June the Prime Minister referred to chief executives of NHS organisations having to make so many reports to different regulators that they have no time to improve their own organisation, and to a typical clinical commissioning group having to agree 200 contracts with other parts of the NHS. Is not the answer to the first question from the noble Lord, Lord Hamilton, that the NHS, employing 1.3 million, is not hard to manage, but the fact is that the Government have bequeathed to it an organisational structure that is dysfunctional and costs billions of pounds? If he really wants to help the NHS, will the Minister not come forward with a Bill to repeal the Health and Care Act 2012?
Lord O'Shaughnessy
My Lords, since the 2012 Act was passed, there have been some significant improvements in NHS performance, not least in cancer outcomes, for example. There are also around 42,000 more staff since 2010. So improvements have clearly been able to happen within the legal framework set by Parliament in 2012. Nevertheless, we recognise that as the service is required to become more integrated and people across different care functions are required to work together, we need to look at the structure. There is already joint working, for example, between NHS England and NHS Improvement at the regional level. But if the NHS identifies any barriers, we will look at those.
Lord Cormack (Con)
My Lords, when we are looking at the structure, which is clearly important, can we also look at priorities within the National Health Service? I heard this morning that certain treatments and unnecessary medicines are to be ruled out. Can we have a comprehensive list of those? It is not right that dandruff shampoo should be on prescription. It is not right that we should be looking at funding the treatment of gaming machine addiction. Can we have a real look at the priorities?
Lord O'Shaughnessy
My noble friend makes a very important point, which is that as we move ahead, even with the funding settlement, it is essential that the NHS becomes more productive. That means looking at whether there are medicines or treatments that are no longer producing the outcomes it was suggested that they would and taking those out of service. It is very important to state that this has to be a clinically led process. We have already begun that with certain low-value prescriptions. NHS England is now leading that process—as I say, it is clinically led—to look at whether there are other treatments that could be discontinued.
Lord Alton of Liverpool (CB)
My Lords, what does the Minister make of the poll that showed that 66% of British people would be prepared to pay more for the provision of the National Health Service? What is his view on a hypothecated tax to meet those needs?
Lord O'Shaughnessy
I am sure that the Chancellor will have taken that view on board and he will reveal his decisions in the Budget.
Baroness Blackstone (Ind Lab)
My Lords, have the Government made any estimates of the cost of the extensive and in some cases overintrusive regulatory system? The Minister has rightly said that the Government are looking for savings in the NHS. Surely this is an area where savings can be made, as well as that of questionable surgical procedures.
Lord O'Shaughnessy
That is one of the areas we need to look at to make sure that there is proper regulatory reform. It does not necessarily require legislation, primary or secondary. There are actually fewer managers in the NHS today than in 2010. We have tried to transfer responsibility to clinical staff. But if the NHS identifies any barriers, we are committed to looking at them.
Baroness Brinton (LD)
My Lords, the Minister has referred to the NHS five-year plan, but does he agree that that plan is worthless without a clear proposal for social care funding in the future, including on how the NHS and social care can fully integrate?
Lord O'Shaughnessy
I absolutely agree with the noble Baroness that they have to go hand in glove. That is why the Green Paper has been delayed, so that it can co-ordinate properly with the NHS plan. It is also important to point out that the Prime Minister was very clear in her announcement that, as a result of the settlement on social care, there would be no further pressures on the NHS.
Lord Elton (Con)
As we are looking for savings in the National Health Service, perhaps my noble friend can explain why the National Health Service does not reclaim crutches, Zimmer frames, moon boots, et cetera. Even wheelchairs are found in the attics of deceased former patients. There must be quite a reserve in your Lordships’ attics, which would be very helpful.
Lord O'Shaughnessy
I could not possibly comment on the latter point. My noble friend makes an important point. Of course it is right to be judicious with the use of these kinds of products. However, they are sometimes damaged in use and are not always reliable, which is one reason they cannot always be reclaimed and reused.
Lord Bradley (Lab)
My Lords, we should first congratulate and celebrate the establishment of the first NHS hospital at Park Hospital, now Trafford General Hospital, in Greater Manchester. But we should also have concern that the devolution deal for health and social care for Greater Manchester is being impeded because of the Health and Social Care Act. What changes would the Minister recommend to ensure that the ambitions of the devolution deal to integrate health and social care and physical and mental health are progressed as rapidly as possible?
Lord O'Shaughnessy
I join the noble Lord in congratulating Trafford General Hospital. I think that one of my colleagues is there today, unveiling a plaque. I am grateful to him also for raising the devo deal for Greater Manchester. It is a very important deal that goes further than any other in the area of health and social care. If it is the case that it is impeded by the Act—and I do not think that that is necessarily a given—I would say that the changes that need to be made ought to be promoted and proposed by Greater Manchester and by the clinicians themselves. That is exactly the sort of thing that the Prime Minister has asked for.
Baroness Meacher (CB)
My Lords, perhaps I may pursue the question asked by the noble Baroness, Lady Blackstone, to which the Minister responded, “Yes, we need to look at regulation”. The Minister knows that GPs are leaving the service at an unprecedented rate, and a large part of the reason for that is the regulatory burden. Will he make a commitment to undertake a full investigation of the regulatory burden on NHS staff, with the terms of reference being to reduce that burden?
Lord O'Shaughnessy
I agree with the noble Baroness about the importance of bolstering our GP workforce—that is one thing we are absolutely focused on. It is part of the five-year forward view and clearly of the long-term plan as well. I will identify one area where we are trying to make a big difference, which is indemnity insurance. We know that this has been a financial burden on GPs and we are looking at creating a state-funded scheme to provide reassurance. This is just one way in which GPs are looking for support from government.
NHS and Social Care Services: Parity of Esteem
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Baroness Wheeler
To ask Her Majesty’s Government what action they will take to ensure that their strategy for National Health Service and social care services recognises the importance of parity of esteem, including pay and professional standing, for staff across hospital, community and social care settings.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy)
My Lords, having the right number and quality of clinical and non-clinical staff is essential to realising our ambitions for the NHS, community and social care. Last week we agreed an Agenda for Change multi-year pay and contract deal, while the introduction of the national living wage has boosted pay for the social care workforce. Later this year, we will publish a 10-year integrated health and care workforce strategy informed by our recent consultations.
Baroness Wheeler (Lab)
I thank the Minister for his response. It is right today to pay tribute fully to the work and dedication of staff across the whole of health and social care. But for the future, both the NAO and our own Long-term Sustainability of the NHS Committee strongly criticised the absence of any long-term joint strategy to secure the well-trained and committed workforce that we need for a fully integrated service. The Minister told the House on 18 June that he is considering the implications of the very recent and welcome NHS staff three-year pay increase for the independent care sector. He recognised the need for the latter to be able to compete on a “level playing field”. Does he acknowledge that for the social care sector in particular that means aiming to level-up pay and professional standing between social care and the NHS, and accepting that parity of esteem is one of the key drivers to building integrated services for both patients and service users?
Lord O'Shaughnessy
I join the noble Baroness in paying tribute to staff, not just across the NHS of course but across all the caring professions. We published the draft strategy and will publish a joint strategy for the health and care workforce precisely for the reasons that she set out. We need to make sure that there is joined-up care across all sectors. That means that we need extra funding—a sustainable funding solution—for the social care sector. We have put in an extra £9 billion over the course of this spending review since 2015 to provide a short-term solution. The Green Paper is about providing a long-term solution. Some of the principles in the Green Paper emphasise the importance of this integration, delivering quality and integration, a valued workforce and sustainable funding. Those are the conditions necessary for what she wants to achieve.
Lord Laming (CB)
The Minister will know that in the social care field there are now numerous independent providers. What mechanism is there to ensure parity across the whole sector, including all aspects of social care?
Lord O'Shaughnessy
The noble Lord is right to point out that there are differences between the two workforces: clearly the NHS has a largely publicly employed workforce and social care has a largely privately employed one, so there will inevitably be some differences in form. We need to make sure that those workforces work together and are as attractive as one another, which is why finding a sustainable funding solution is so important so that those private contractors have the ability to pay what is necessary to attract the right staff.
Lord Clark of Windermere (Lab)
My Lords, the NHS proves that, with determined leadership, democracy can deliver long-lasting benefits to society. Will the Minister join me in paying tribute to those parliamentarians—in spite of them all being Labour—who, over 70 years ago, time and again traipsed through the Lobbies to bring about the National Health Service?
Lord O'Shaughnessy
Well, they say that success has many parents and we should pay tribute to the Liberal MP William Beveridge, the Conservative Health Minister Henry Willink, and the Labour Health Minister Nye Bevan in the founding of the NHS. It is important to point out that the Conservative Party has been in power for 43 of the NHS’s 70 years and it has thrived under our leadership.
Lord Hamilton of Epsom (Con)
Will my noble friend confirm that when Nye Bevan established the NHS he said that the demand was going to be strictly limited?
Lord O’Shaughnessy
Limiting demand is one of the challenges that we face to make sure that we are able to deliver a health service, but the NHS has proven to be highly effective not just in dealing with acute disease but now in supporting people with chronic disease, which is the greatest health challenge that we face.
Baroness Brinton (LD)
My Lords, what advice would the Minister give to the management of organisations throughout the NHS and social care services about maintaining morale, retaining staff, promoting professional development and rewarding good work when there is often little increase in funding from local authorities, which themselves face continuing cuts in their grant from central government?
Lord O’Shaughnessy
I recognise that staff work under a great deal of pressure and there are two ways we can help alleviate it. One is obviously to have social care and NHS staff work more closely together, and that is a stated ambition that we all want to achieve. The other is making sure that there are more resources, both to pay people better and to make sure that there are more people. That is what we are focused on delivering.
The Earl of Listowel (CB)
My Lords, is the Minister concerned to hear that, when speaking recently to a mental health nurse, I was told that she had received only four of her monthly supervision sessions in the last eight months? Does he agree that to ensure high-quality care across health and social care, all professionals and carers need their entitlement of regular supervision? Will he discuss with his colleagues in the education department whether there might be clinical supervision in some schools, to allow the mental health of children in schools to improve?
Lord O’Shaughnessy
I am concerned to hear the story that the noble Earl has raised: I am sure that he will write to me with specific details. We know that at the moment only 25% of people with a mental health problem are seen. That needs to rise. We want to get that up to 33%, but clearly that is not enough. To do that we need more staff at every level. We have committed to training another 21,000 mental health workers to provide exactly the kind of leadership and support that he describes.
Baroness Andrews (Lab)
Is the noble Lord aware that on 4 July 1948, on the eve of the creation of the National Health Service, Aneurin Bevan also said that the NHS was the highest expression of moral leadership? Does he agree that we now need an equally high expression of political moral leadership? The fundamental of that is to tell the truth about the funding challenges facing the NHS, whether they are in manpower or in innovation and drugs. Does he agree, therefore, with the Prime Minister that there will be a Brexit dividend? How much is it going to be and where is it likely to be accounted?
Lord O’Shaughnessy
I agree with the noble Baroness about the need for leadership and I think the Prime Minister has shown that leadership. Despite the many challenges that we face at the moment as a country and have done for many years, she has committed to a five-year funding settlement worth more than £20 billion extra in real terms by 2023-24. That is an admission that there are funding challenges, not just in the NHS and social care, and of course one of the ways that that will be funded will be through our not paying subscriptions to the European Union any more.
NHS: Equitable Access
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Baroness Thornton
To ask Her Majesty’s Government what steps they will take to ensure that National Health Service patients have equitable access to the benefits of (1) artificial intelligence, (2) genomic medicine, (3) new drugs, and (4) innovative treatments.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)
My Lords, the NHS was founded on the principle of universal access and we are committed to making sure that that remains. To achieve this we are establishing a genomic medicine service to provide equitable access to testing across the NHS. We have commissioned the Topol review so that our staff can maximise patient benefits from technological advances and we are accelerating access to innovation across the country by expanding the role of academic health science networks.
Baroness Thornton
I thank the Minister for his detailed Answer. My Question concerns the future in the next 70 years. One of the key barriers to ensuring that NHS patients have equitable access to genomic medicine, new drugs and innovative treatment is the pressure on the workforce and lack of protected time for the workforce to develop research and to translate new research into practice. Some 25% of medics do research in their own time. This suggests a welcome hunger for innovation, but only 0.1% of NHS money is set aside for the adoption and spread of innovation. That seems modest. With the new funding agreement and the 10-year plan in preparation, will the Government support and enable our research base and ensure the continuation of clinical trials across the EU post Brexit?
Lord O'Shaughnessy
I thank the noble Baroness for her Question and join the whole House in wishing many happy returns to the NHS on its 70th birthday. She asked an extremely good question: how do we make sure that the NHS is equipped for the future and that everybody can benefit from the technological advances we are seeing take place? I point her in the direction of three issues. First, the National Institute for Health Research has more than £1 billion of funding and supports the translation of research into new technology every day. It is based in the NHS and uses NHS staff. I have also recently commissioned the department to look at the money spent on innovation, which we think is around £750 million in total, to make sure that it supports the uptake of effective medicines and treatments better than it does today, and to make sure that staff have time. Finally, in response to her last question, as we set out during the passage of the withdrawal Act, we will align ourselves to the clinical trials regulation as much as possible, whatever the outcome of Brexit.
Baroness Walmsley (LD)
My Lords, as a member of the Parliament choir I am a bit tempted to start singing, but I will resist. Given the remarkable success of the various vaccination programmes during the 70-year history of the NHS, will the Minister say when preventive measures for two modern-day diseases will be made equitably and nationally available? I refer to pre-exposure prophylaxis for HIV, which has already been shown by the trials to be remarkably effective, and vaccination against human papillomavirus, which should be made available for teenage boys as well as teenage girls to ensure full protection.
Lord O'Shaughnessy
I am sorry that the noble Baroness has not started singing; I am sure that we would have all joined in. As she rightly said, the NHS carried out the first major public vaccination programme in the world. We have always led the world in vaccination programmes. As she said, prophylaxis has been deemed to be successful; I will need to write to her on the specifics of the rollout. On the HPV vaccine and its availability for boys, we are still waiting for the final recommendations of the joint committee on vaccinations. We will act on those as soon as we get them.
Baroness Lane-Fox of Soho (CB)
My Lords, despite starting a chain of karaoke bars, I will also not sing. The noble Baroness, Lady Thornton, is right to talk about the advances but there are also some fundamentals to improving patient care. Two years ago, I made some recommendations to the Secretary of State about basic digital skills for NHS staff and free wi-fi in hospitals, which we decided would be the most important building blocks to dramatically improve things for those working in the NHS and people in the system. Can the Minister update us on the progress of those recommendations?
Lord O’Shaughnessy
The noble Baroness made some fantastic recommendations, which we have adopted. I mentioned the Topol review of skills, which will make sure that clinical skills are there to adopt technology. It is expected that all GP practices and secondary care trusts will offer free wi-fi by the end of this year.
Lord Forsyth of Drumlean (Con)
My Lords, the Question is on the availability of new drugs equitably across the NHS. Is my noble friend satisfied with the independence of NICE, given that ibrutinib is not available to patients in England after a round of chemotherapy of more than three years, but is available to patients throughout the rest of the United Kingdom?
Lord O’Shaughnessy
I am more than satisfied with the independence of NICE. I am grateful to my noble friend for raising this issue, which we have talked about both in and outside the Chamber. NHS England is currently considering further evidence on the prescribing of that drug for that group of patients, after I asked it to do so.
Lord Morris of Aberavon (Lab)
My Lords, what progress is being made by the National Health Service on even national delivery of modern technologies, such as flash monitoring systems, for diabetic patients? I declare an interest for a member of my family.
Lord O’Shaughnessy
The noble Lord picks a very good example of a technology that is transforming diabetic care, as he knows. A few months ago, I was pleased to be able to approve it for prescription in the NHS; it is now available across the country where clinicians think it is the appropriate course of treatment.
Lord Hamilton of Epsom (Con)
My Lords, is my noble friend concerned that the NHS, employing 1.3 million people, is too large to manage?
The Lord Bishop of Oxford
My Lords, the Question also asked about artificial intelligence. Can the Minister comment on the steps being taken to improve data transfer across different NHS trusts, and standardisation? Are steps being taken to ensure the ethical release of data for research purposes?
Lord O’Shaughnessy
I thank the right reverend Prelate for asking two very good questions. We recently announced the first local health and care records, covering around 40% of the population. Sometimes, you can pitch up in one part of the NHS and they cannot access all your patient and care data; this measure will make sure that that does not happen. Patients want this; it is essential for good direct care.
The right reverend Prelate is quite right about the ethical considerations. We will publish a code of conduct on the proper use of AI in the NHS later this year. We are working with the new Centre for Data Ethics to make sure that this happens.
Lord McColl of Dulwich (Con)
My Lords, there are 4 million type 2 diabetics in this country. Does the Minister agree that they could be cured quite easily if they ate fewer calories?
Lord O'Shaughnessy
Changes in eating habits certainly help, as do changes in exercise. Our obesity strategy tries to make sure that those good habits are ingrained from an early age.
Lord St John of Bletso (CB)
My Lords, will the Minister elaborate on how the forthcoming NHS digital innovation hubs, combined with the Data Saves Lives campaign, can deliver a fairer distribution of excellence in the regions with the greatest health and social care needs?
Lord O'Shaughnessy
One thing that has become apparent to me in 18 months of being a Minister is that the data in the NHS about patients and their needs, diseases and care is a unique asset. We have to ensure that patients trust the way that the NHS uses that data, which is why we have created things such as the national data opt-out, cybersecurity and so forth. If we can bring that public trust, that data can be used for research through these digital innovation hubs to develop new treatments and make sure that they are available for NHS patients first.