NHS: Brexit-related Risks

Lord O'Shaughnessy Excerpts

Thursday 5th July 2018 Lords Chamber

[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 O'Shaughnessy]

It might have to be a simple “no”.

[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.

Brexit: Reciprocal Healthcare (European Union Committee Report)

Lord O'Shaughnessy Excerpts

Tuesday 3rd July 2018 Lords Chamber

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

My Lords, I begin by saying that I will try to be concise, as all Lords have been, but I want also to cover the many interesting and important points that have been made. I congratulate the committee and the noble Lord, Lord Jay of Ewelme, for his chairmanship and for clearly putting together a very good-quality piece of work, and congratulate all noble Lords who contributed through that committee and, indeed, in this debate.

We have discussed tonight how reciprocal healthcare arrangements help people to live, work and travel across Europe in the knowledge that healthcare access is not a barrier. They are especially important for elderly people and those with long-term conditions. They enable people to access treatments or give birth abroad, promoting choice and healthcare collaboration. They have other economic benefits as well, such as tourism and helping the NHS to manage demand.

That is why we believe as a Government that a reciprocal healthcare agreement between the UK and EU is in the best interests of all. It is worth stating that good progress has been made in negotiations so far, and that is one reason why we are confident that we will secure good reciprocal healthcare arrangements as part of our future relationship discussions. Many noble Lords have asked why we have not done more, or been able to promise more, so far. It has to be said that the rate-limiting step has been the Commission’s mandate in what we were allowed to discuss and, indeed, in its insistence that nothing is agreed until it is all agreed. That was not our position, but the mandate the Commission gave to the Article 50 negotiating team. We have achieved as much as we possibly could within that mandate.

It is important to note—and many noble Lords have done so—that there is history in this area. The UK has a long-standing tradition of reciprocal healthcare agreements. My noble friend Lord Ribeiro pointed out that, for the last century, UK and Irish citizens have been able to access healthcare in one another’s countries. Noble Lords have talked about the many powerful ways in which that co-operation brings benefits to the peoples of both countries.

Since the 1950s, the UK and its European neighbours have had reciprocal healthcare and social security agreements too. I will deal quickly with the point my noble friend Lord Kirkhope made about whether, during negotiations, we are always as good as we could be at securing the moneys that are owed to us; I think it is fair to say that historically, we have not been. It is something we are starting to do better. One example is that we are now able to flag immigration and entitlement status on electronic health records, so that doctors do not constantly have to ask for that kind of information; it can be logged and secured through these agreements.

The UK also has agreements with the rest of the world, including Greenland, the Faroes, the Balkans, Australia, New Zealand and many of our overseas territories; there are precedents, current and historical, for the kind of deal we are aiming to strike.

The Select Committee report rightly recognises the importance of reciprocal healthcare. It has been pointed out in the debate that the NHS currently provides healthcare to over 3 million EU nationals living in the UK and that there are about 1 million UK nationals who live, work and use healthcare in the EU.

The noble Lord, Lord Ricketts, rightly pointed out that about 190,000 UK state pensioners have chosen to retire in Europe, notably Ireland, France, Spain and Cyprus. I am not sure that Ireland is where you would go on holiday if you were after sunshine in the winter but you would certainly choose the other three. It is worth mentioning that this is not just about the number of people who carry EHIC cards; 250,000 medical incidents affecting UK tourists are resolved via an EHIC, and a further 1,500 UK residents travel for planned treatment via the S2 scheme. That is what is at stake.

Several noble Lords referred to the achievements to date. The first of those was the joint report agreed in December 2017, which covered the entitlements of those exercising their reciprocal healthcare rights on exit day. I shall go into more detail on that shortly.

Following the agreement in December, there was further agreement in March 2018 on the implementation period. That means that the rights secured through the negotiations so far will, once the implementation period is agreed, continue until 31 December 2020, providing more reassurance. It includes healthcare for pensioners and workers, as well as the EHIC and S2 schemes, and nothing will change over that period.

Before turning to the impact on British citizens of the withdrawal agreement and implementation period, it is worth talking about the status of EU citizens living in the UK. That was raised by the noble Baroness, Lady Janke, my noble friends Lord Balfe and Lord Kirkhope, the noble Baroness, Lady Thornton, and others. The Prime Minister has been very clear that EU citizens who have made their lives in the UK should be able to continue with their lives here. We have that agreement and, indeed, we now have a route for that. As noble Lords have commented, we have opened the settled status route, which provides a specific legal mechanism by which people can secure their status to live in this country.

I reassure noble Lords that the department was one of the first to act on this new route. We have written to all NHS trusts to make sure that the many staff whom they employ and whose work we value so much are able to access that route as quickly as possible so that we can secure their future in the NHS and social care system. We want to allay their anxiety and I hope that that goes some way to doing so. It is worth pointing out, as always, that there are more EU staff working in the NHS today than there were two years ago, and of course we hope that they will stay.

What does the withdrawal agreement mean for UK nationals in the EU? The noble Lord, Lord Ricketts, and the noble Baroness, Lady Thornton, talked about the state pensioners living in the EU. We have agreed that the S1 scheme will continue for that group so that they continue to be able to access reciprocal healthcare in the same way as they do now. To answer the question from the noble Baroness, Lady Thornton, we will of course look at data on whether there are returners, although we have not seen any evidence of them yet. It is also worth pointing out that this group of S1 beneficiaries will also be able to use an EHIC to obtain healthcare if they visit other member states—the so-called onward rights.

More broadly, UK nationals living and working in the EU at the end of 2020 will be able to access healthcare on terms similar to those in place now under the implementation agreement, in line with the rights that we have agreed for EU nationals living in the UK.

Turning to the EHIC and the S2 scheme, during the withdrawal agreement and implementation period discussions so far, we have not agreed long-term continuation of the EHIC and S2 schemes for the reason that I gave. However, we have agreed that a transitional arrangement will ensure that people visiting the UK or the EU on holiday or for study will be able to continue to use their EHIC while in that state of travel. People receiving planned treatment via the S2 route will be able to complete their course of treatment abroad, however long the treatment lasts, so that there will be no disruption to their care. We will also continue to press for the right of people covered by the withdrawal agreement to move to other member states—a right that we have been able to secure for pensioners under the S1 scheme.

Inevitably, the debate has focused on what the future relationship will look like. The Government have been clear about what we are seeking to achieve: the right of UK state pensioners who retire to the EU to access healthcare in those states; full ongoing UK participation in the EHIC scheme; and the right of UK residents to receive planned treatment in the EU, when the NHS authorises it.

The noble Lord, Lord Jay, asked: why S1 rights? I think that he has in mind, for example, frontier and posted workers. It will inevitably depend on wider agreements about mobility and security rights. There is a co-dependency between those citizens’ rights and the more extensive application of the S1 right to healthcare. However, the other elements of the reciprocal healthcare rights do not have the same co-dependency with the wider citizen rights.

The noble Baroness, Lady Janke, my noble friend Lord Balfe, the noble Baroness, Lady Thornton, and the noble Lord, Lord Ricketts, also asked about the no-deal arrangement. Indeed, if noble Lords did not mention it, it is certainly on everyone’s mind. The committee obviously heard about and described the anxiety that there would be if people could not easily access healthcare abroad, and it suggested solutions that we could adopt, such as bilateral agreements. I reassure noble Lords that it is our intention to secure a deal, given the commitment to protect the interests of citizens from both sides in the negotiations. I should also reassure noble Lords that the department is doing everything it can and everything necessary to avoid any kind of cliff edge. There is a programme of work that aligns with the ideas already posed by the committee in the unlikely event of a no deal.

We are of course planning for all scenarios. I think that British citizens would find it bizarre if we did not prepare for all eventualities, not just on reciprocal healthcare but on other health issues and across the piece. I am afraid that noble Lords will have to forgive me: this is not the time for me to go into further details about what those no-deal preparations look like, although of course at some point in the future we will have more to say. I shall resist the entreaty from the noble Baroness, Lady Thornton, to give her probabilities—I am terrible at betting, so she would not want to trust me anyway.

Ireland has obviously been a heavy feature of the debate and the report. My noble friend Lord Ribeiro spent much time highlighting the benefits of that relationship, and the noble Baronesses, Lady Pinnock and Lady Janke, talked about it as well. As somebody who has an Irish connection, it is something that features heavily in my, as well as the Government’s, thinking. I reassure noble Lords that the UK and Ireland have agreed that we will protect healthcare access and co-operation for our populations whatever the outcome of the EU exit. That would take place under the common travel area and other agreements that we have made together.

The discussions are progressing well. I recently met my counterpart, the Irish Health Minister, Simon Harris. We are both satisfied by the progress in this area. I reassure noble Lords—particularly the noble Baroness, Lady Pinnock, who was very interested in this matter—that it is a priority for us and that we are making good progress.

My noble friend Lord Balfe asked about the devolved Administrations. We are of course engaging with them all the time and making sure that they are involved in the decision-making. As we go forward, we will be seeking a deal that works for all parts of the UK, and it therefore needs to work for and be agreed by the devolved Administrations too.

The noble Baroness, Lady Janke, made some important points about insurance, as did the noble Baroness, Lady Pinnock. We are continuing to engage with the Association of British Insurers. Clearly, the exact outcome and its implications for travel insurance will depend on the future relationship, we agree. But for the reasons that I have said, I will not go into the detail now of preparations for no-deal scenarios. I can tell the noble Baronesses that we have that open relationship and are having discussions, and we understand exactly what is at stake here.

Finally, my noble friend Lord Ribeiro raised the issue of radioisotopes. It is a topic that we have discussed several times. He will know that we are investigating not only domestic production but making sure that there are customs arrangements and other arrangements such as trading arrangements to make sure that the supply of radioisotopes is not impacted in any way by the circumstances under which we leave the European Union. I am reassured from the work that has gone on in this House through our debates on the withdrawal agreement and the Nuclear Safeguards Bill that we have a proper understanding of how we achieve that. Noble Lords made a fantastic contribution to that work. Of course, as the noble Lord will know, regarding the proton beam, there is a centre open at the Christie and another one to follow, so we will be able to provide more of that therapy at home for UK citizens.

I thank the committee again for its fantastic work, the noble Lord, Lord Jay, for his expert chairmanship and all speakers. I think we are all agreed on what we want to achieve from these negotiations and why we want to achieve it. It is inevitably a complex task. The input of the committee is highly welcome and has been very productive and influential on our thinking as a department. I want to make sure that that is reflected as much as possible in the work we do and the proposals we make, whether in a White Paper or other routes. I hope that we will continue that dialogue so that we can make sure that concerns are raised and properly dealt with and we end up with an outcome that protects citizens’ and patients’ rights after we leave the European Union.

Health: Endoscopy and Bowel Cancer

Lord O'Shaughnessy Excerpts

Monday 2nd July 2018 Lords Chamber

[Baroness Benjamin (LD)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and declare an interest as patron of Beating Bowel Cancer.

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

My Lords, the Health Education England Cancer Workforce Plan includes a commitment to invest in a further 200 clinical endoscopists by 2021 to support an increase in capacity for earlier diagnosis. This builds on the existing commitment to train 200 clinical endoscopists by the end of 2018. The Health Education England training programme has already recruited 130 trainee endoscopists against this target, with two further cohorts planned this year.

[Baroness Benjamin]

I thank the noble Lord for that Answer. Around 16,000 people die from bowel cancer each year—my mother was one of them—so early diagnosis is vital. I congratulate the Government on introducing FIT, a test which will save lives, but endoscopy units are already struggling to cope with the increase in referrals because of inadequate funding and a lack of highly trained NHS staff to carry out the procedures. What plans do the Government have to provide training for the staff needed, and when will details of the planned phased rollout of the FIT be published?

[Lord O'Shaughnessy]

I thank the noble Baroness for raising that question and am sorry to hear about her mother. As she will know, bowel cancer is unfortunately the third-most prevalent cancer and the second-biggest killer, and we need to go a long way to improve treatment. I have already mentioned the increase in the number of endoscopists, and that will help. There are also plans to make sure that existing staff within the cancer workforce have the necessary specialist skills. The size of the cancer workforce has increased over the last few years but there is a goal to dramatically increase it further. We know that the test that the noble Baroness mentioned is much more effective and can be administered much more easily. The rollout will take place from December this year.

[Lord Winston (Lab)]

My Lords, there is an increasing interest in capsule endoscopy, which of course is less invasive as it does not require an instrument to be put down into the abdomen. However, it requires training, which the medical literature clearly shows is insufficient. Can the Minister indicate whether the NHS is planning to provide more training for the provision of capsule endoscopies? Also, what is the risk of a large number of false positive results with all these endoscopies?

[Lord O'Shaughnessy]

I will have to write to the noble Lord with an answer to his question about the type of endoscopy he mentions, as I do not have the details of it. The risk of false positives is one reason that we have to be extremely careful with screening programmes of all kinds, whether it is the faecal immunochemical test or an endoscopy. As he knows, whatever screening programmes are implemented, the National Screening Committee tries to reduce the number of false positives wherever possible.

[Lord Patel (CB)]

My Lords, given that we have one of the poorest outcomes compared with other health services in the developed world and that the demographic changes that will occur in the population may well mean that one in two people will develop cancer, are the Government aware of what determinants there are for poor outcomes? What plans do they have to improve them for cancer patients?

[Lord O'Shaughnessy]

The noble Lord is quite right to point that out. While outcomes have improved, they lag behind those of other countries, which we need to correct. The independent cancer taskforce set the goal of saving 30,000 extra lives a year by a number of different routes. The one that I pick out in particular is early diagnosis. We know that too many cancers are diagnosed at a late stage, so this year the NHS has committed to increasing the proportion of cancers diagnosed at stage 1 or stage 2, and we are spending £200 million in cancer alliances to support early diagnosis in the community.

[Baroness Neville-Rolfe (Con)]

My noble friend has done much to bring the benefits of the digital revolution to the NHS. Are there digital solutions that might help to prevent bowel cancer and other cancers in the fight against this dreadful disease in the coming months and years?

[Lord O'Shaughnessy]

My noble friend is quite right to point out the potential of digital, particularly the analytical capability of artificial intelligence to look at samples. That was one reason why the Prime Minister recently pledged to have 50,000 more early cancer diagnoses by 2033—a long-term goal—precisely because the NHS is such a good place to use artificial intelligence to improve care.

[Baroness Jolly (LD)]

My Lords, after a cancer diagnosis, English patients have poorer outcomes than all but one of our European comparators. We welcome the announcement that the Minister has just made about new clinicians, but in some areas there are delays in referral, testing diagnosis and then treatment. The longest wait for treatment reported this year was 541 days. That is not good enough. How long does the Minister think we will have to wait for there to be sufficient clinicians and facilities to deliver a service that moves us significantly up the table?

[Lord O'Shaughnessy]

The noble Baroness is right to highlight the importance of waiting times. The 62-day standard is unfortunately not being hit at the moment. The NHS has pledged to get back on that standard this year. We are also piloting a faster, 28-day diagnosis standard in five areas at the moment with the idea of rolling that out so that there is a higher standard of care and fewer people have to wait longer.

[Baroness Thornton (Lab)]

We should probably be grateful that the Minister did not choose to bring a FIT as a visual aid, as his honourable friend did on the “Andrew Marr Show” yesterday. I welcome the Government’s announcement that that test will be in introduced in England in the autumn, but will the Minister confirm that all eligible people will receive the FIT kit in the autumn rather than through a phased introduction across England? How long will that take?

[Lord O’Shaughnessy]

I will not be rummaging around in my pocket to reveal something; nobody wants to see that. My understanding is that FIT will be introduced from the autumn and the intention is to get national coverage. I do not believe that it will be achieved immediately, but I will write to the noble Baroness with the specific timeframe.

[The Earl of Listowel (CB)]

My Lords, will the Minister look at access to mental health services, so that referrals can be made early on for patients who are identified with bowel cancer where that is helpful? Does he not agree that patients will make better recoveries if assessments are made of their mental health and emotional well-being, along with support groups and other services to help them with these aspects of their recovery?

--- Later in debate ---

[Lord O’Shaughnessy]

The noble Earl makes a good point. A cancer diagnosis can be a devastating piece of news. One way of ameliorating that is through the support of charities like Macmillan Cancer Support, as well as through clinical nurse specialists who can provide such support. Some 90% of people are seeing those nurses when they are diagnosed and our ambition is to see that percentage rise to 100% next year.

Health: Stroke Survivors

Lord O'Shaughnessy Excerpts

Thursday 28th June 2018 Grand Committee

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

My Lords, I congratulate my noble friend Lord Lingfield on securing this debate. As the noble Baroness, Lady Wheeler, has just pointed out, it has been short but sweet—rather, we have had a small cast list but a high quality of output. The experience of the noble Baroness and that of her partner has been invaluable, while the noble Baroness, Lady Barker, asked some searching questions, which I shall attempt to answer. The noble Baroness, Lady Coussins, will be amused to learn that in my briefing it states of her, “Does not normally ask health questions”. I am absolutely delighted that she is here, because hers is a perspective that we have not had before. I hope that it is not the last time that we see her taking part in a debate of this kind, and I shall come to the very interesting ideas that she mentioned. Along with other noble Lords, I recognise and applaud the work of charities like ARNI, while my noble friend also referred to the Stroke Association, Canine Partners and others. They make a valid and vital contribution to care in this area.

We have talked about the impact of stroke. In England some 80,000 people a year are being admitted to hospital. We also know about the impact that strokes can have not only on the lives of sufferers themselves, but also on their families, friends and carers. The statistic that stroke leaves half of those affected with a disability is a sobering one. We know also that the difficulties are not just physical. As we have discussed, they include communication difficulties, psychological cognitive fatigue and others. Indeed, stroke is the leading cause of complex disability, as well as the fourth largest cause of death, which is why it has quite rightly been the focus of successive Governments.

It is worth saying that major improvements have been made in stroke prevention, treatment and outcomes since the publication of the 2007 strategy, for which the then Labour Government deserve much credit. I shall highlight one or two of those outcomes, because they highlight some of the questions which have been asked. Over the past 20 years, the 30-day mortality rate has dropped from 30% to 13.5% in 2015-16. There is now better compliance with the occupational therapy standards, from 56% to 83%, while physiotherapy standards have risen, along with speech and language therapy. However, it is notable that even with speech and language therapy, where compliance has doubled, it remains at less than 50%, which goes to the heart of some of the points about variations in provision which noble Lords have pointed out. While improvements have been made, it is clear that a lot more needs to be done.

As several noble Lords mentioned, one way that we can improve rehabilitation is to get the care right in the first place. The noble Baronesses, Lady Barker and Lady Wheeler, mentioned mechanical thrombectomy, which is highly effective at preventing severe disability. The statistics are interesting: for every 100 patients treated, 38 will experience a less disabled outcome than with the best medical management—an extraordinary improvement—with 20 more achieving functional independence. Having national coverage is clearly important, and I will come on to how we try to achieve that.

The noble Baroness, Lady Wheeler, talked about how her partner had benefited from Public Health England’s Act Fast campaign. That is reducing the amount of time between someone having a stroke and arriving at hospital. The campaign has been going for about nine years now, during which 5,365 fewer people have become disabled as a result of a stroke, saving the equivalent of 12,200 quality-adjusted life years. This is quite an achievement for a public health campaign. The third area on the acute side where big improvements have been made, and which noble Lords have spoken about, is the centralisation of services, including hyper-acute stroke services. The noble Baroness mentioned the work which our colleague, the noble Lord, Lord Darzi, did in London. Because of that, a significantly higher proportion of patients are receiving care compliant with the guidelines and processes. That alone has delivered a 5% relative reduction in mortality at 90 days, another significant improvement.

Those things are at the acute end, but the topic for today is rehabilitation. As has been mentioned, there are over 1 million stroke survivors. Not only do half of those have a disability but half are also living with four or more co-morbidities. The question is: how do we get their lives back on track? We know that rehabilitation delivers better outcomes, improves quality of life and reduces health inequality. It also provides good value for money; it is the right thing to do on every level. It is also important to approach this with an optimistic mind set. As noble Lords have pointed out, stroke can be a recoverable condition, with survivors continuing to improve for months after their stroke.

We know from stroke survivors and the charities that represent them, and we have heard today, that they need early and ongoing rehabilitation and support. The testimony of the noble Baroness, Lady Wheeler, and her partner brought this to life. This includes holistic reviews of progress; a personalised care and support plan which is regularly updated; the provision of information; the availability of the right therapies; and so on. This obviously has to happen in the acute setting but, more importantly, it needs to happen in the post-acute setting as well.

My noble friend Lord Lingfield and the noble Baroness, Lady Wheeler, talked about the stroke working party guideline of 45 minutes, but they also said that that is being missed all too often. What are the Government doing about it? The governing document has been the strategy which began in 2007, which has now been replaced with the stroke programme board, established in March this year. It is chaired by the national medical director of NHS England and the CEO of the Stroke Association and is developing a costed stroke plan to address the challenges of prevention, service reconfiguration, optimising rehab services, workforce development and data. I do not have a date at this time, but I shall endeavour to write to the noble Baroness and other noble Lords with that.

The board is looking at some changes. It has been said, quite rightly, that there needs to be seven-day availability of the right workforce. We need to make sure that nurses, therapists and other medical staff are there round the clock. As we know, there is some silo thinking on clinical expertise in the NHS. As the noble Baroness, Lady Barker, pointed out, the availability of mechanical thrombectomy is hampered by a shortage not just of skilled neuroradiologists but of other trained consultants. Reconfiguration can deal with some of that, but we need to do more to deal with it at a national level.

Through the work of the programme board we intend, first, to include stroke-specific plans within workforce strategies and to support integration across care settings. Secondly, we will establish training pathways from other medical specialties to increase the interventional neuroradiology workforce. Thirdly, we will include experience in stroke medicine early on in the undergraduate curricula of foundation medical training programmes, to encourage early career choices to pursue stroke training.

The noble Baronesses, Lady Barker and Lady Wheeler, also talked about the need for better data. That is absolutely right, and is happening in a couple of ways. First, a new national clinical audit of cardiovascular disease prevention in primary care is being instigated. Secondly, in reference to one question that was put, we are making sure that the research strategy of the NHS will address key evidence gaps in stroke, particularly around post-acute care. I shall certainly take away the suggestion by the noble Baroness, Lady Wheeler, about a specific type of stroke and the under-resourced or under-researched nature of it.

Much of the funding for research comes through the National Institute for Health Research—a domestic source, although this issue is international in scale. As for Brexit, following our exit from the European Union, we are looking to achieve participation in the next iteration—the successor programme to Horizon 2020. Third countries are already participating, so it is within our grasp, as was set out in the Government’s Collaboration on Science and Innovation: A Future Partnership Paper.

On commissioning, which was also mentioned, NHS RightCare: Stroke Pathway was published in October 2017 and is the governing document. We need to ensure that the guidance that includes information about early supported discharge and community provision is adhered to. I do not know what the mechanisms are by which we will improve compliance, some of which is quite good and some, frankly, too low. That is a topic of work for the programme board. I shall write to noble Lords with its ideas on how it intends to make that bite, so that there is CCG compliance in commissioning frameworks.

Finally, we need a different approach to rehabilitation, one that is collaborative and integrated across health, social care and, critically, the third sector. In addition to rehabilitation, stroke survivors need a very broad set of services, including spasticity services, psychology, orthoptics, pain and continence services. As we have also heard, stroke survivors often need help with housing adaptations.

We have, therefore, three goals to achieve this rehabilitation revolution. First, we must make sure that there is proper commissioning of stroke specialist rehabilitation of the required intensity seven days a week for stroke victims through their in-patient stay, as recommended by the clinical guidelines. That will be driven by NHS England. Secondly, we must ensure that stroke survivors have access, within 24 hours of discharge from hospital, to a stroke specialist rehabilitation service that can provide support for the early discharged patient at the same rehabilitation intensity as stroke unit care, seven days a week. Thirdly, we need to develop a national service specification for the structure and process of stroke specialist rehabilitation services provided immediately after discharge, including early supported discharge, that describes appropriate staffing levels and, critically, addresses rurality. We must not only set those guidelines but make sure that they are complied with.

I shall briefly answer questions where I have not yet had a chance to do so. My noble friend Lord Lingfield asked about grants from public funds to rehab charities. Local authorities do that kind of work through their social care function. I am not aware of what CCGs and the NHS itself do, but I will endeavour to find out what support is available.

The noble Baroness, Lady Coussins, took us on a very interesting journey into the power of language, and second languages. I knew about its benefits for dementia sufferers, but not about its benefits for stroke sufferers. I shall certainly be happy to find out more about the scheme and whether we can help. It sounds like a fascinating idea; considering the annual cost of stroke, and what the cost of educating children in a second language at school would be, the cost-benefit analysis looks quite good. It is something to think about, and I am glad that my right honourable friend Nick Gibb is enthusiastic about it.

The noble Baroness, Lady Barker, asked about stem cell and gene therapies. It is a really good question. We have a fantastic network of biomedical research centres, funded by the National Institute for Health Research. I do not know if she has had the opportunity to visit any of them but I thoroughly recommend it. Sometimes we are a bit hard on ourselves in this country in asking ourselves whether we really have access to cutting-edge, world-leading therapies in cancer, stroke, cardiovascular, or whatever. This is where it happens—where the translation from lab to the clinical setting happens. People here are among the first in the world to get these therapies. I thoroughly recommend seeing that, and if the noble Baroness were to get in touch I would be delighted to recommend a suitable one. We have the opportunity to be involved in this field, and a good track record in it.

Finally, the noble Baroness, Lady Wheeler, asked several questions. I hope that I have responded to most of them. If I have not, I will of course follow up with a letter.

I close by once again thanking all noble Lords for their contributions. It has been a fascinating and useful debate. With the programme board in place, I think that we have the opportunity and the leadership to make sure that we improve stroke services. We are in the happy position of knowing what is necessary; now, we need to deliver it. I am sure that, working together, we can start to transform rehabilitation care so that it is of the intensity required and provides a lifeline to stroke sufferers.

Childhood Obesity Strategy

Lord O'Shaughnessy Excerpts

Monday 25th June 2018 Lords Chamber

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

My Lords, with the leave of the House, I shall now repeat in the form of a Statement the Answer given by my honourable friend the Parliamentary Under-Secretary of State for Public Health and Primary Care to an Urgent Question in another place. The Statement is as follows:

“Today, the Government have published the second chapter of the childhood obesity plan. This plan is informed by the latest evidence and sets a new national ambition to halve childhood obesity and to significantly reduce the gap in obesity between children from the most and least deprived areas by 2030.

Childhood obesity is one of the biggest health problems this country faces, with almost a quarter of children overweight or obese before they start school, rising to over a third by the time they leave. This burden is being felt hardest in the most deprived areas, with children growing up in low-income households more likely to be overweight or obese than more affluent children.

Childhood obesity has profound effects that compromise children’s physical and mental health both now and in the future. We know that obese children are more likely to experience bullying, stigma and low self-esteem. They are also more likely to become obese adults and face an increased risk of developing some forms of cancer, type 2 diabetes and heart and liver disease. Obesity is placing unsustainable costs on the NHS and our UK taxpayers, currently estimated at around £6.1 billion per year. Total costs to society are higher, estimated at around £27 billion per year, with some placing this figure even higher than that.

The measures we outline today look to address the heavy promotion and advertising of food and drink products high in fat, salt and sugar on TV, online and in shops. Alongside this we want to equip parents with the information they need to make healthy informed decisions about the food they and their children are eating when out and about. We are also promoting a new national ambition for all primary schools to adopt an ‘active mile’ initiative, such as the Daily Mile, and will be launching a trailblazer programme working closely with local authorities to show what can be achieved and find solutions to barriers at a local level to address childhood obesity.

In conclusion, childhood obesity is a complex issue that has been decades in the making, and we recognise that no single action or plan will help us to solve the challenge of childhood obesity on its own. Our ambition requires a concerted effort and a united approach across businesses, local authorities, schools, health professionals and families up and down the country. I look forward to working with them all”.

--- Later in debate ---

[Lord O'Shaughnessy]

An upgrade in our grade is, I suppose, something to be welcomed. The noble Baroness is being a little unfair. The last obesity plan probably went beyond that of almost any country in the world, and this one certainly goes well beyond that. We know that we need to do more—that much is obvious from the facts—because, unfortunately, obesity continues to rise. We have taken big action through the soft drinks levy, improvements in reformulation and so on but it has not gone as far as we want. So we recognise the need to do more.

The noble Baroness referred to consultations but, if anything, you can accuse this paper of being too honest because any action requires consultation to go forward. I would not want her to be distracted by that because within it are some hard commitments. There is a commitment to voluntarism if we can make it work but, equally throughout, there is a commitment to legislate if that does not produce the right outcomes.

The noble Baroness asked about milk products. Again, if voluntary reformulation does not work, these will be considered by the Treasury as being liable for the levy on soft drinks to bring down the sugar content.

On advertising, the idea that we should have a 9 pm watershed across broadcasting is truly radical, and it is only right that we consult properly. There is a desire to do that by the end of this year, so the noble Baroness cannot accuse us of not moving quickly enough.

The Obesity Health Alliance, which counts dozens of bodies among its membership, has welcomed the plan set out today. Of course it wants us to get a move on—and we will—but it is important to note the radical change in policy to try to deal with this epidemic that we all face.

[Baroness Jolly (LD)]

My Lords, I thank the Minister for repeating the Answer to the UQ. Anything is welcome and I am at the stage where more questions are being raised than answered. A debate in this House would be useful and perhaps put some flesh on the bones. That is absolutely the wrong thing to say, but the House knows what I mean. It would give more clarity.

I wish to push the Minister a little further on the advertising issue. I appreciate that a consultation is coming up. We welcome the idea of using the watershed, but I am not clear from the Statement or from chapter 2 whether it includes all programmes before 9 pm or only programmes that are aimed at young people before 9 pm. That is an important distinction and it will be useful to know what is going to be consulted upon.

Families were mentioned in passing. I would like to know what work is to be done with families. I appreciate that there is not in this land a typical family, but we are trying to take out 500 calories a day from people’s diets and we need to point out the high calorific value not only of chips, which may seem obvious, but of pasta, rice—which everyone thinks is healthy—bread and buttered mash. There is still work to be done with families to make them understand quite what they are putting on their children’s table which seems healthy and fine.

--- Later in debate ---

[Lord O'Shaughnessy]

It is always a pleasure to debate issues in this House. This topic is worthy of that debate because there is a huge interest in it in this House.

The noble Baroness is quite right to talk about advertising. It states in the paper:

“Consult, before the end of 2018, on introducing a 9pm watershed on TV advertising of HFSS”—


high in fat, sugar and salt—

“products and similar protection for children viewing adverts online”.

I take that to mean across the board as opposed to those solely aimed at children, which are already subject to world-leading restrictions.

The noble Baroness asked about families. Much of this is about helping families to do the right things. We know how difficult it can be when you are with young children in a shop to resist this, that or the other. You talk about protecting your teeth or eating well, but it is not always obvious what is good for you and what is bad for you. Again, in the paper there is reference to calorie labelling and going much further in terms of restaurants and store promotions. The noble Baroness and her party are always keen to make sure that we can get the most out of Brexit, and going further than the European Union will allow us with food labelling and simple nutrition information is just one of the many opportunities we will enjoy after 2019.

[Baroness Jenkin of Kennington (Con)]

My Lords, my noble friend may be aware that I chaired a commission for the Centre for Social Justice last year, so I welcome the acknowledgement that this issue particularly affects children in the most deprived areas. Can my noble friend give more clarity about the consultation and when it will end? Although I have not read every word in it yet, can he also say whether the Government will look at the “eatwell plate”, which is carb heavy at the moment? I am not sure whether that advice is covered in the paper.

[Lord O'Shaughnessy]

I thank my noble friend for her questions. I salute the work she has done and the leadership she has shown on this issue. As to the content of the consultations, that will depend on when they are launched but it refers in the paper to consulting before the end of 2018 on a number of issues, so that will go through the normal process, I suppose, of a three-month consultation.

I shall look at the issue of the “eatwell plate”. It is worth pointing out that, under the “Schools” heading, there is a desire to update school food standards, reduce sugar consumption, strengthen nutrition standards and the government buying standards for food and catering services. So there is a desire to look at the official guidance that goes out and to make sure that it reflects the best science and enables any institution that is looking after children, families, schools, adults and others to give the best possible nutritional food that they can.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I welcome the proposals for further action, but I am sorry that the Government have not seen fit, if they are taking this really seriously, to make a Statement about it without the requirement for an Urgent Question to elicit a response. I have two points. I regret that there is still no mention of the point that the noble Lord, Lord McColl, has been pressing so vigorously—that we need to bring together these numerous initiatives and try to present a single campaign for parents and children. I also regret that there is still no mention of the Government dealing with the major broadcasters, in particular the BBC, to see how a longer-term plan might be produced which would make a direct link with children and thus try to ensure that effective changes take place.

My second point is that last week the Minister was kind enough to reply to my Question for Written Answer about the extent to which the Government are aware of how much children between the ages of 12 and 16 weigh. I am surprised to hear that while we weigh children at the ages of four and 11, nothing is done about weighing children beyond that age. We do not know what the scale of the problem is up to the age of 16. A survey has been undertaken in which only 2,000 people were involved. There is a requirement that we move towards weighing these children. Is the Minister prepared to consider doing that?

[Lord O’Shaughnessy]

There is a single campaign which is exemplified in the document and we need to put that across. I know that the noble Lord is working with broadcasters. I am not sure about the merits of weighing teenagers, but I will look into that and write to him.

[Baroness Neville-Rolfe (Con)]

My Lords, I declare my interests as set out in the register. I have a few doubts about some of the interventionist proposals in this strategy and therefore I welcome a consultation process on the detail. However, I am keen that people should be able to take responsibility for themselves by helping them to develop good habits, so I congratulate the Government, and indeed the Daily Mail, ITV, INEOS and local authorities on the Daily Mile initiative, which could be transformational.

The Minister and I are both interested in the advances in the science of sleep. We know that poor sleep is linked to obesity. Could the Minister agree to making use of this new science in his strategy?

[Lord O’Shaughnessy]

My noble friend makes an excellent point and I am glad that she has welcomed the introduction of the Daily Mile initiative, which is an important national ambition embedded in the strategy. I know of the benefits of sleep by its absence, but nevertheless I agree absolutely with my noble friend. This second chapter sets out a lot of good progress and intent. Clearly it is not the last word because this is a developing science, although we know more and more both about the causes of obesity and its consequences. Given that, there is a good opportunity through the consultations to bring the science about the benefits of sleep to bear in this conversation, not only for younger people but for adults as well so that it is properly reflected in the final documents that come out.

Nursing and Midwifery (Amendment) Order 2018

Lord O'Shaughnessy Excerpts

Monday 25th June 2018 Lords Chamber

Moved by

[Lord O'Shaughnessy]

That the draft Order laid before the House on 17 May be approved.

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

My Lords, today we are debating legislation that puts in place provisions to regulate the nursing associate role in England.

Health Education England’s Shape of Caring review made a series of recommendations to strengthen the capacity and skills of the nursing and caring workforce. The report identified strong support from employers, managers and staff in the health and social care sectors for a new nursing support role that would act as a bridge between the unregulated care assistant workforce and the registered nursing workforce. Health Education England undertook a public consultation on introducing the nursing associate role in England. The majority of respondents, a large proportion of whom were registered nurses, supported the new role, and there was strong support for it to be regulated.

Nursing associates will have their own defined role, augmenting and supporting the work of nurses in carrying out critical functions. They will deliver hands-on care, enabling registered nurses to spend more time using their specialist skills to focus on clinical duties and take more of a lead in decisions on patient care. We do not expect nursing associates to be primary assessors of care, but they will monitor the condition and health needs of those in their care and be able to recognise when it is necessary to refer to others for reassessment.

Although this new role will open a new career pathway into the nursing profession, I reassure all noble Lords that nursing associates are not substitute nurses. We want more not fewer nurses, which is why in October 2017 the Government announced a 25% increase in funded training posts for nurses to ensure that the NHS meets current and future nursing workforce needs.

It is vital that the right safeguards are in place. The Government’s view is that the most appropriate way to achieve this is through statutory regulation. This will support employers to use the role to its full potential and help ensure patient protection.

First, the effects of the proposed amendments to the Nursing and Midwifery Order 2001 are to give statutory responsibility to the Nursing and Midwifery Council to regulate the nursing associate profession in England. Secondly, they are to extend the NMC’s current powers and duties contained in the order to nursing associates, in particular the key functions of: registration of nursing associates in England; setting standards of proficiency, education and training and continuing professional development and conduct for nursing associates in England; approving nursing associate programmes in England; operating fitness-to-practise procedures in respect of nursing associates; and recognising Scottish, Northern Irish, Welsh, European Economic Area and international qualifications for the purpose of registration to the nursing associate part of the register.

Thirdly, this order amends the offence provisions in the Nursing and Midwifery Order. These amendments provide that a person commits an offence when falsely claiming to be on the nursing associate part of the register, falsely claiming to hold a nursing associate qualification or using the title “nursing associate” when not entitled to. The offences have been drafted to reflect that nursing associates will be regulated in England only.

Fourthly, the order makes provisions that allow admission to the register for those who have completed or commenced their training by 26 July 2019 through the pilot courses being run by Health Education England or an apprenticeship route. Fifthly, it excludes nursing associates from being given temporary prescribing rights in a time of national emergency, such as a pandemic flu outbreak. Sixthly, the order also removes the screener provisions from the Nursing and Midwifery Order 2001, as these are now redundant. Seventhly, it makes consequential amendments to the Nursing and Midwifery Council’s rules and to other legislation.

Finally, the order closes sub-part 2 of the nurses’ part of the register by amending the Order in Council which determines the parts of the NMC’s register and the titles which may be used by persons included in the register.

These are important changes to the governing legislation of the Nursing and Midwifery Council which introduce the nursing associate role into regulation. Employers have told us that they need a more flexible workforce to keep pace with developments in treatments and interventions. This role will enrich the skill mix available to employers within multidisciplinary teams and support the increase of nurse numbers by providing a clear pathway into the nursing profession.

Once the order comes into force, it is proposed that the Nursing and Midwifery Council will open the new nursing associate register in January 2019. I beg to move.

--- Later in debate ---

[Baroness Jolly (LD)]

My Lords, my contribution will be very short, as noble Lords have already said everything. We, too, welcome the role of the nursing associate. I commend the work of my noble friend Lord Willis of Knaresborough in making this happen and say to him that he can have the Front Bench if he is happy to take all that goes with it.

The noble Earl, Lord Listowel, made the point about impact. I just make one extra point. In remote locations—I live in Cornwall, but this could account for anywhere far-flung where there are hospitals and health establishments—there will be uptake from healthcare assistants who feel that they cannot leave home to train as a nurse because the distance is too great and they have family responsibilities or other commitments, but they could manage the two-year course. That would be really positive. Nursing associates would then improve in those establishments the quality, but also the skill mix, of nursing teams in areas where it is also particularly difficult to appoint.

I understand the timing of this SI. The noble Lord, Lord Clark of Windermere, said that perhaps there was still stuff to look at. It is really important that it gets on to the statute book, because we will have real live trainee nursing associates who need to register next year. Sadly, we cannot take any more time to do this, but from these Benches we really welcome the role of the nursing associate and the help it will give the NHS.

[Lord O’Shaughnessy]

My Lords, I sincerely thank every noble Lord who has spoken in the debate and engaged with these regulations so thoroughly. It has been a really important discussion about not just the new role of nursing associate but its impact on the overall health and care workforce. I am very grateful to all corners of the House for the broad welcome, albeit with questions and conditions, for the creation of this role.

I want to deal up front with the urgency of these regulations. I agree that there has been an element of rush, and I think we are all agreed on the requirement for it. But like all overnight successes, this has been a long time brewing, as the noble Lord, Lord Willis, pointed out. A lot of work has been done, and I salute, along with all noble Lords, the many people at the RCN, the NMC and others who have contributed to this, and the many people behind the scenes. It is quite right to acknowledge them. No doubt there is more work to come.

The primary debate, or part of it, revolved around the distinction between the nurse role and the nursing associate role. It is very important to be clear, as I hope I was in my speaking note, that these are distinct professions. They may all be part of the same family—there is a certain amount of semantics involved here—but they are distinct professions, which will be regulated distinctly, albeit in a joined-up way through the same regulator, which is quite right. The NMC is currently consulting on standards of proficiency. The department, with all the necessary arm’s-length bodies and others, will develop guidance for that separate profession. While nursing associates can inevitably support nurses, doctors and others, they will not just be the handmaidens to others, in the evocative phrase of the noble Lord, Lord Clark. They will be professionals in their own right.

It is also worth pointing out that, in the consultation going on at the moment on standards and proficiency, the NMC is also looking at the code of conduct and amendments to it. That consultation ends on 2 July so, again, I warmly encourage all noble Lords to contribute to that, because some of the ideas set out today could have an important role in getting that right.

The noble Baroness, Lady Thornton, asked about the financial risks involved in setting up the courses—making sure that they are properly constituted and so on. My department has a memorandum of understanding in place with the NMC to keep the costs of the set-up within agreed cost parameters. The costs of accrediting nursing associate courses are met from the annual registration fees paid by the NMC’s registrants. Therefore, the financial modelling has been investigated and we understand what we need to stick to.

--- Later in debate ---

[Lord Clark of Windermere]

May I press the Minister a little further on the training costs? Is he saying that all students on the nursing associate courses will be apprentices and that no student on the nursing associate course will pay towards the cost of that course?

[Lord O’Shaughnessy]

I thank the noble Lord for that question. My understanding is that the nursing associate is a two-year apprenticeship that provides a level 5 qualification. Therefore, there is currently a consultation about the nature of the role—the balance between work and training and so on—but obviously if it counts as an apprenticeship any organisation providing it can draw down on the apprenticeship levy fund to pay for those training costs. Whether it is in theory possible to train through an alternative route that would involve the paying of fees is something I will need to investigate and write to the noble Lord about. Of course, I will put that letter in the Library. The funding is there and the NHS is paying it. It is not necessarily drawing it down at the moment; this is an opportunity for us, with a course that is tailor-made for apprenticeships, to take advantage of that money to fund the courses.

I hope I have been able to answer noble Lords’ questions. This is an exciting moment in the development of the workforce. It provides an extra gear to the workforce to provide for the ever more complex care needs of our population. This is a good step forward. We are moving quickly and I look forward to working with noble Lords in the coming months to make sure we can put this course and its regulation on a statutory footing, attract many thousands of people into it and welcome a new profession into the health and care family. On that basis I commend the order to the House.

Motion agreed.

Cannabis-based Medicines

Lord O'Shaughnessy Excerpts

Thursday 21st June 2018 Lords Chamber

[Baroness Meacher]

To ask Her Majesty’s Government what the terms of reference will be for the expert panel of clinicians to advise ministers on applications to prescribe cannabis-based medicines.

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

My Lords, the commission from the Home Secretary is clear: he has asked Professor Dame Sally Davies to set up an expert clinical panel to provide advice to Ministers on licence applications made by a patient’s medical team for the use of cannabis-based products. Professor Dame Sally Davies is currently establishing a clinical panel that will agree the terms of reference.

[Baroness Meacher (CB)]

My Lords, I applaud the Home Secretary for his decisive action on medical cannabis. My Question relates to the second part of Professor Dame Sally Davies’s review. Bedrocan cannabis medicines have been used very safely and successfully in Holland for more than 20 years and are used increasingly across Europe. These medicines are currently subject to 23 random controlled trials and are also approved by European manufacturing standards. Can the Minister assure the House that the terms of reference for the wider review—I am not referring to the initial piece of work—will include the need for the MHRA, which regulates medicines, to consider defining a special category for whole-plant cannabis medicines? This idea came from within the MHRA, so I do not think it is unreasonable. If the review fails to make these medicines available in this country, is the Minister aware that 200,000 people in the UK with uncontrolled epileptic seizures will continue to be further brain-damaged every single day? This is a matter of urgency.

[Lord O’Shaughnessy]

I am grateful to the noble Baroness for her question. Like her, I applaud the speed with which the Home Secretary and the Health Secretary have acted in this matter. It is incredibly important to think about the various stages and actions that have been taken. First, there is an urgent need for the panel which Professor Dame Sally Davies is setting to consider specific licence applications. The second part is to review whether there are therapeutic benefits of cannabis and cannabis-derived products. Then there is the evidence-gathering process, and all the relevant evidence, including the major piece of work done by the US National Academy of Sciences and the paper to be published by the WHO, will be collected as part of that. As the Home Secretary set out on Tuesday, it will make recommendations to the Advisory Council on the Misuse of Drugs subsequent to proposals for rescheduling. That will happen this autumn, if those proposals come forward.

If I may just take the time to say this, the noble Baroness raises a third issue, which is long-term horizon scanning for Schedule 1 drugs for which a therapeutic benefit has not yet been demonstrated but which may be demonstrated in future. We clearly need to set up a device to do that, and the MHRA may be the right vehicle. That is something we are considering.

[Baroness Wheeler (Lab)]

My Lords, can the Minister update the House on the number of cases the expert panel is expected to consider? Assuming they are current cases, can we be reassured that they will be dealt with in a way that avoids the awful situation faced by Alfie Dingley and his parents and ensures they have the best possible medical treatment?

[Lord O’Shaughnessy]

I completely agree with the noble Baroness about the need for speediness. Frankly, at this point we do not know the number of cases. The Home Secretary said on Tuesday that the service will be up and running and receiving applications within a week of his Statement—so from next Tuesday onwards, with a panel constituted rapidly so that it can start considering them.

[Lord Forsyth of Drumlean (Con)]

My Lords, will my noble friend pass on the good wishes of this House to the Home Secretary and the Health Secretary for the speed with which they have acted in making cannabis-based medication available for the treatment of certain conditions? However, will the Health Secretary also take steps to make people aware of the real damage that cannabis taken for recreational use can do to our young people, in particular creating paranoia and mental illness? It would be irresponsible for any Government to condone the use of recreational cannabis given the damage that is caused to our young people in some cases.

--- Later in debate ---

[Lord O’Shaughnessy]

I will pass on my noble friend’s thanks to my right honourable colleagues. We agree with him that there is a very clear distinction: we know cannabis-based products can create harm but the question is whether they can also have therapeutic benefits. If they can, they need to be weighed in the balance and rescheduled appropriately. That does not diminish the negative impact that he has described that the recreational use of cannabis, particularly very strong strains, can have on young people.

[Baroness Walmsley (LD)]

My Lords, I thank the Minister for showing that he quite clearly understands the distinction between recreational and medicinal use. Is he also aware that Epidiolex, which is medicine produced by GW Pharmaceuticals for epilepsy sufferers and which will soon be approved, will not help children like Alfie Dingley who have uncontrolled epilepsy seizures? I understand that the cannabinoid CBDV is very important to such sufferers, and there is none of it in Epidiolex. Will the Minister ensure that the review takes account of the special needs of the 200,000 patients with uncontrollable seizures? Will the panel be able to hear from patients as well as studying research?

[Lord O’Shaughnessy]

The noble Baroness makes excellent points. I know she has been deeply involved in the Alfie Dingley case and I thank her for her work on that. What we are discovering is that it is not the case that just one drug is going to fix this for the 200,000 people who are suffering. There is a need for variety. So it cannot be the case that just because one thing is licensed it is used for everyone; it needs to be specific to the needs of the patient, which is the noble Baroness’s main point. The interim panel is there precisely to make decisions on an individual basis. It is a patch to the system, if you like, not a long-term change, which is why the review is in place so that we can ensure that many other products derived from cannabis, if they are proven to have therapeutic benefits, can be developed into drugs for the range of needs that are out there.

[Lord Blunkett (Lab)]

My Lords, 15 years ago trials were undertaken, one of which led to a separate authorisation of a derivative from cannabis for MS sufferers. I have not been clear on this from any of the reporting, so will the Minister say what trials are currently taking place in this country that could be brought to fruition? What evidence can we very quickly obtain from trials and evidence of legitimate use for medicinal purposes from the rest of the democratic world? How can it possibly be justifiable for us to provide 45% of usage for derivatives from cannabis grown in this country but not to be able to use it ourselves?

[Lord O’Shaughnessy]

The noble Lord speaks with great wisdom on this topic. The problem, as he knows, is that these drugs have been in Schedule 1 and, although in theory that allows for research, in reality it creates a very cautious environment that makes research difficult. That means that apart from Sativex, which has been licensed, and Epidiolex, which is in the process of being licensed, there are very few, if any, other drugs actually going through the clinical trials process in this country because of the very tight rules that have governed usage. Other countries have of course relaxed their rules and developed that evidence, and it is precisely that kind of evidence base that will be considered by Professor Davies in her review.

Childhood Obesity: Yoga

Lord O'Shaughnessy Excerpts

Thursday 21st June 2018 Lords Chamber

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

My Lords, while there is some evidence that regular yoga is beneficial for people with high blood pressure, heart disease, aches and pains, depression and stress, no central assessment has been made of its benefits for obese schoolchildren.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I am grateful for the noble Lord’s observation. Is he aware that the largest NGO in India, the Kripa Foundation, uses yoga as a means of attracting young drug addicts, drunks and people with HIV into recovery? Given the success there and the problems we have with our current obesity plan, which fails to get into the heads of young people—we have great difficulty in making connections so that they can become more self-aware about the need to take responsibility for their own health—might we explore methods such as yoga with them? It might be a means whereby they could take a closer look at themselves, their problems and the opportunities they have to make a better life in the future.

[Lord O’Shaughnessy]

I am not aware of the charity that the noble Lord mentioned, although after university I spent six months in India as a teacher. The school I taught in practised yoga with its children and it seemed to have a calming effect on them—which is just as well, because I am not sure my teaching skills had such an effect. I am sure many noble Lords know personally the benefits of yoga. It has not been proven to have any impact on obesity, although it has many other benefits, as the noble Lord pointed out. It is something that schools can and do use as part of their repertoire in the PE curriculum to provide exercise for children, although it does not count towards the moderate and higher levels of activity demanded by the PE curriculum.

[Lord McColl of Dulwich (Con)]

Does the Minister agree that exercise does not deal with the obesity problem at all? There is only one way of dealing with obesity: eating less. Does he also agree that pregnant women who are obese transfer that tendency of obesity to their offspring by a mechanism, which we do not understand, called epigenetics? While we are on the subject, I congratulate the Minister on being a shining example of controlling his measurements. I have noticed that his waist measurement is less than half his height.

[Lord O’Shaughnessy]

I am wondering how my noble friend has made such an accurate assessment. He did not see my weight on the scales this morning. He is quite right. Of course, it is a combination of exercise and healthy eating, which is why there has been a push for both those things in our schools. There are great risks to pregnant women from being obese, not only to themselves with diabetes in pregnancy, which tends to reappear in later life, but in the impact on their children. That is why it is so important that pregnant women get good advice about healthy eating.

[Lord Stone of Blackheath (Lab)]

My Lords, today is International Yoga Day, on which we are about to launch the All-Party Parliamentary Group on Yoga in Society. As with mindfulness, we will be offering staff here on the Estate, MPs and Peers courses in seated yoga and breathing techniques, which have other benefits besides tackling obesity. I ask the Minister and other noble Lords to sign up to such courses.

[Lord O’Shaughnessy]

I will bring my mat.

[Baroness Jolly (LD)]

My Lords, as the Minister said, there really should be an evidence base before we pursue this too far. Does the department know whether there are sufficient teachers trained to teach children in yoga? Would there need to be appropriate safeguarding?

[Lord O’Shaughnessy]

I am afraid I do not know whether we know that. I suspect we do not. Yoga is an incredibly popular pastime for children and adults. Indeed, I think there are mother-and-baby yoga classes, which are also popular. I am sure safeguarding concerns will always be foremost when dealing with young children.

[Lord Geddes (Con)]

Will my noble friend join me in wishing the noble Lord, Lord Brooke of Alverthorpe, a very happy birthday?

[Lord O’Shaughnessy]

I wish the noble Lord a very happy birthday and I hope he has done his sun salutations this morning.

[Baroness Morgan of Huyton (Lab)]

My Lords, widening the conversation, when the NHS settlement is detailed in full, will the well-being of schoolchildren be looked at very carefully, particularly in relation to school nurses and the support that a lot of young people, particularly teenagers, need in schools and possibly are not getting sufficiently at the moment?

[Lord O’Shaughnessy]

The noble Baroness is quite right to raise that issue. Of course, it is something we are looking at. I also point to the pledge made in the children and young people’s mental health Green Paper to dramatically increase the number of staff on mental health support teams, which are providing not just help for children who are in crisis or having difficulties but well-being skills so that they do not experience those problems in the first place.

[Baroness Jenkin of Kennington (Con)]

My Lords, my noble friend will be aware that I am an enthusiastic advocate of the Daily Mile for schoolchildren. With the terrifying rise in obesity among schoolchildren, I hope it will be included in the updated childhood obesity plan. Can the Minister give us any idea when that plan might be coming?

[Lord O’Shaughnessy]

I am glad that my noble friend has highlighted that. I can confirm that the next chapter of the plan will be coming very shortly. We will be discussing some proposals on the Daily Mile in that plan.

[Lord Dubs (Lab)]

My Lords, while yoga is undoubtedly important—although I know nothing about it—surely there is one simple point about childhood obesity: excessive sugar consumption, in drinks or elsewhere. We have to tackle that much more positively. I hope that the Government’s new plan will do that.

--- Later in debate ---

[Lord O’Shaughnessy]

The noble Lord is quite right: it is not just sugar that is eaten but sugar that is drunk as well. The sugar levy has been a significant success. Half the drinks it applied to have been reformulated to reduce their sugar, saving 45 million kilograms of sugar being consumed each year. We have more to do on sugar reduction beyond fizzy drinks. We did not hit our target in the first year but we will take further action to make sure that we do so.

[Lord Wallace of Saltaire (LD)]

My Lords, is the Minister aware of recent research by the Institute of Education of University College London that shows that communal singing in primary and secondary schools has a strong calming effect and improves concentration, discipline and everything else, yet many schools are losing their music teachers, leaving no one in the school with any music qualification? I declare an interest as a trustee of the VCM Foundation.

[Lord O’Shaughnessy]

I understand that the noble Lord is a member of the parliamentary choir, so he is a living example of the benefits of communal singing, or maybe not. I am sure he is very tuneful. The noble Lord is quite right: singing and, indeed, all arts are good for the soul and should be part of the school day.

National Health Service: Mental Health Funding

Lord O'Shaughnessy Excerpts

Wednesday 20th June 2018 Lords Chamber

[Lord Cotter]

To ask Her Majesty’s Government what proportion of mental health treatment is funded by the National Health Service nationally as against local funding.

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

My Lords, the Government are committed to increasing spending on mental health. In 2017-18, the NHS spent an indicative figure of £11.86 billion on mental health. Of this total, £9.97 billion was locally funded by clinical commissioning groups, with the remainder for nationally commissioned specialised services.

[Lord Cotter (LD)]

I hear what the Minister says, but parity between mental and physical health remains a concern. He knows about the facility for mental health in Weston-super-Mare and the problems associated with its future. However, I have found this problem around facilities in local areas to be widespread throughout the country. Their funding is not predominantly mainstream NHS money for mental health services, but NHS money is often used to plug holes elsewhere and local mental health units are struggling. Will the Minister address the issues of parity and funding for local mental health care?

[Lord O’Shaughnessy]

I agree with the noble Lord that we need to increase funding for local mental health services. That has been happening over the past few years; indeed, between 2015-16 and 2018-19 it has gone up by £1 billion. I turn to his point about mental health funding being used for other purposes. I want to be clear that there is NHS England guidance that that should not happen, and from this financial year all CCGs will have to meet what is called the mental health investment standard, which means that they are to increase their spending on mental health at least as much as, if not more than, their spending on physical health.

[Baroness Uddin (Non-Afl)]

My Lords, regardless of what the Minister says, does he accept that there has been a systematic destruction of voluntary organisations providing many mental health services? This has had a particular impact on survivors of domestic violence. What are the Government doing to ensure that Women’s Aid and other organisations that provide support for women suffering from and the survivors of domestic violence have funding available through the means to which he has referred?

[Lord O’Shaughnessy]

Although the particular funding the noble Baroness is talking about is a Home Office issue, I can say that £100 million is available until 2020 to support the victims of domestic violence. From the health service perspective, obviously we are increasing the amount of money spent on treating those with mental illness, regardless of the cause that gave them their illness in the first place.

[Baroness Hollins (CB)]

My Lords, does the Minister agree that more oversight is needed—not just through the mental health dashboard—of how and how well clinical commissioning groups meet the mental health investment standard, previously known as parity of esteem? Can he also explain why the mental health investment standard does not include people with learning disabilities who have mental health needs? Further, what assurances are there that clinical commissioning groups will continue with their current level of investment once the national sustainability and transformation fund finishes?

[Lord O’Shaughnessy]

I reassure the noble Baroness that there is independent audit of performance against the mental health investment standard. Anyone with mental health problems, whether they have learning disabilities or not, should certainly be included in the figures. I am alarmed by what she has said and obviously I will look into it and write to her. However, it is important to say that CCGs have been increasing their spending. In 2016-17 they were expected to deliver at least 3.7% growth in mental health spending, but the actual outturn was 6.3% growth, so that is a good story.

[The Lord Bishop of Lincoln]

My Lords, I speak for one of the most rural parts of England. Does the Minister recognise the higher level of suicide in rural areas? In part, this is due to rural isolation and the sparsity of mental health provision. What plans do the Government have to increase local and accessible provision in these areas?

[Lord O’Shaughnessy]

I agree with the right reverend Prelate that, unfortunately, that is a feature of rural communities. I understand that the MHCLG has a sparsity fund to help with that issue. Indeed, particular funding is going into support and more community-based care for those at risk of suicide and other mental illness.

[Lord Polak (Con)]

My Lords, last Thursday, I was walking past Lambeth fire station just before the minute’s silence. Together with Charles Hanks, the station manager, I stood with those brave and professional firefighters. Afterwards, I asked about ongoing support and access to counselling services. Tracey Dennison, from the fire brigade, told me today that there was a slight increase in absenteeism as the anniversary approached and the inquiry began. The Fire Fighters Charity stepped up to provide family support. Can the Minister ensure, in the sad event of another serious tragedy, that emergency capacity for immediate and ongoing counselling support is available for our brave emergency services?

[Lord O’Shaughnessy]

My noble friend is absolutely right to highlight this issue. Individually, our emergency workers did extraordinary deeds of bravery, for which we are all deeply grateful, during the Grenfell fire. In the aftermath of that fire, the north-west London mental health service was the lead trust in providing mental health support for not just the families and individuals who were victims of the fire but emergency service workers who had been through that very traumatic experience. I strongly encourage any emergency service workers who are experiencing trauma—of course, that can happen many months, indeed years, afterwards—to get in contact with mental health services.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, does the Minister agree that £1 spent today on child and adolescent mental health services is likely to save the NHS a considerable number of pounds in the future? What proportion of the money spent on mental health services is going to child and adolescent services? Will that proportion increase in the future?

[Lord O’Shaughnessy]

The noble Baroness makes an excellent point. The emerging science tells us that heading off mental illness in adolescence is critical to ensuring that it does not deepen and become more severe in later life, with great human as well as economic cost. At the moment, the mental health budget for children and young people does not reflect the burden that children and young people have, which is why the Prime Minister announced an extra £1.4 billion for children and young peoples’ services, as well as £300 million on top of that to support the plans set out in the child mental health Green Paper.

[Baroness Tyler of Enfield (LD)]

My Lords, the Minister has already referred to the mental health investment standard, but recent figures issued by the Royal College of Psychiatrists show that 15% of clinical commissioning groups are not following NHS England’s instruction to increase the proportion of their spend on mental health. What practical steps are the Government taking to ensure that all CCGs meet this standard?

[Lord O'Shaughnessy]

The noble Baroness is quite right in her figures: it was 85% compliance in 2017-18—175 of the 207 trusts. It has to be 100%. It will be independently audited and reported against. Indeed, interventions will take place if that does not happen.

National Health Service: Assaults on Staff

Lord O'Shaughnessy Excerpts

Wednesday 20th June 2018 Lords Chamber

[Lord Clark of Windermere]

To ask Her Majesty’s Government how many attacks on NHS staff were reported in 2016-17 and 2015-16.

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

My Lords, the Government are committed to taking action against those who abuse or attack NHS staff. In 2015-16, NHS organisations, which are responsible for protecting their staff, reported 70,555 physical assaults. Of those, 52,704 were due to patients’ conditions or treatments they were receiving. Data has not been collected for 2016-17. We are reviewing with the NHS how in future information about assaults and abuse of NHS staff can help trusts promote best practice.

[Lord Clark of Windermere (Lab)]

I thank the Minister for his Answer. Can I give him a little help with the updated figures? Has he seen the figures produced by the Health Service Journal and Unison which show a 10% increase in violence against NHS staff in the latest year? That is just unacceptable. Why did the Government in November 2017 abolish NHS Protect, which had the responsibility to protect NHS staff against violence? I know that it was replaced and that its staff, but not its functions, were transferred to the NHS Counter Fraud Authority, which focuses on fraud and protection of buildings. Will the Minister confirm that there is now no body responsible for the safety of NHS staff? I am drawn to the conclusion that this Government value property more than people.

--- Later in debate ---

[Lord O’Shaughnessy]

I have to take issue with the point the noble Lord makes. It is absolutely not the case that the Government value property more than staff. We all value the work that NHS staff do every day in very difficult conditions. That is one of the reasons that we announced our historic funding settlement at the beginning of this week. On the problem that the noble Lord raises, he is right to say that, looking back over NHS Protect’s data, starting in 2008-09, there has been a steady rise in the number of assaults on and incidents of abuse of NHS staff. Clearly that is completely unacceptable. However, there is disagreement about the reasons for that, and it is worth dwelling on that. They include not just the greater volume of patients and better reporting, but the increase in mental illness and dementia, and more severe mental illness being dealt with in hospitals rather than police cells. I do not use that as an excuse, but merely to explain that there is some uncertainty about the reasons for it. It was under NHS Protect’s aegis that this steady rise happened. It has fulfilled its function, which is to make sure that security management services are available to every NHS trust—but in the end it has to be down to every trust to take responsibility for the safety of its staff, and that is the system we are moving ahead with now.

[Baroness Finlay of Llandaff (CB)]

My Lords, given that alcohol is involved in more than 60% of assaults in the acute sector, more than 30% of assaults in the mental health sector and more than 70% of assaults in the ambulance sector, will the Minister explain why the Government have abandoned progress with the sobriety scheme pilot, which showed a very high success rate in avoiding reoffending in alcohol-fuelled crime? It would provide a tool for non-custodial sentencing where people are known to have assaulted NHS staff under the influence of alcohol.

[Lord O’Shaughnessy]

I will look into the specific issue that the noble Baroness mentions. I do not have the details in front of me. I know that all local authorities provide free, taxpayer-funded rehabilitation services for those who are suffering from alcohol addiction. I should also point out that this Government have increased progressive taxation on stronger alcohol, such as white cider, specifically to try to change people’s drinking habits and to reduce alcohol-related violence.

[Lord Ribeiro (Con)]

Following the theme of alcohol, the Minister was kind enough to meet me and members of the Alcohol Health Alliance on 30 April. We stressed that accepting a minimum unit price, as in Scotland, would do much to remove alcohol—and, particularly, cheap alcohol—from vulnerable people, some of whom are responsible for the attacks to which we are referring. When will England accept a minimum unit price and implement it?

[Lord O’Shaughnessy]

I was delighted to meet my noble friend on this topic. I know he cares passionately about it. We have said—and I have said in this House before—that we are looking at the Scottish example with interest now that Scotland has gone ahead with it. There is a growing evidence base to demonstrate the benefits of minimum unit pricing, but we want to see what transpires in Scotland before making any decisions about whether to move ahead.

[Baroness Jolly (LD)]

My Lords, in England around 200 attacks on NHS staff occur every day, and this is nothing short of scandalous. Next week we have the Second Reading of a Private Member’s Bill, which has come from the other place, on assaulting emergency workers. Will the Minister confirm whether the Government are minded to support it—and, if not, what further action will be taken to protect health workers?

[Lord O’Shaughnessy]

I agree with the noble Baroness that it is scandalous and that we therefore want to support the Bill. I believe that it will have its Second Reading here on 29 June. I can confirm that the Government will be supporting the Bill.

[Baroness Donaghy (Lab)]

I am grateful for that reply from the Minister. I have the privilege of taking the Bill through its Second Reading next week. It will create, for the first time, an aggravated offence for those who attack all emergency workers, including paramedics, nurses, doctors and all those associated with helping NHS staff in emergency work, such as St John Ambulance and other volunteers, if they are doing emergency work. So I am thankful that the Government have provided time, and I hope that we will be able to get the Bill through quickly by the summer.

[Lord O'Shaughnessy]

I salute the noble Baroness for taking it through its stages in the House of Lords. I reiterate our support for it—not just the principles behind it but the specific measures in it. Clearly it is unacceptable to assault the very people who devote their lives to serving.