Queen’s Speech

Lord O'Shaughnessy Excerpts

Thursday 29th June 2017 Lords Chamber

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

My Lords, in the spirit in which the noble Lord, Lord Hunt, started his speech, I, too, make declarations, not only of my position as a trustee of academy trust Floreat Education, which I set up, but, given that he has brought his family into it, that my wife is also a journalist. I think it is probably worth saying that.

I sincerely thank all noble Lords for this thought-provoking and wide-ranging debate. When I got my marching orders from the Leader’s Office, I thought that, compared with my noble friend Lord Ashton, who opened so expertly, I had perhaps pulled the short straw. But the opportunity to reflect on the wise and incisive comments made by noble Lords has been a privilege, and I am grateful for it.

I am particularly grateful for the speeches from the Front Bench from the noble Baronesses, Lady Sherlock and Lady Walmsley, and the noble Lords, Lord Hunt and Lord Storey, for their as ever searching questions. I also wanted to highlight what I felt were some of the more uplifting speeches. The right reverend Prelate the Bishop of Ely talked about how we could live well with difference and create a society that supports common flourishing. My noble friend Lady Stowell talked about the importance of behaving with dignity and respect for one another. I join the noble Baroness, Lady Masham, in paying tribute to the emergency services. My noble friend Lady Cumberlege mentioned a phrase that stuck with me: “treat me kindly”. The right reverend Prelate the Bishop of Gloucester talked about providing hope for the most vulnerable, and the noble Earl, Lord Listowel, about encouraging exchanges between young people. The noble Baroness, Lady Benjamin, in her fantastic way, gave a wonderful and optimistic exposition of the preciousness of childhood. My noble friend Lord Grade talked about bipartisanship —there is a thing—in praise of Gordon Brown. I may move off that slightly.

Before turning to noble Lords’ specific comments and questions, I would like to reflect on some of the measures in this Queen’s Speech. Some noble Lords have criticised the legislative agenda set before Parliament last week. I believe that that criticism is misguided. This Government are delivering on the British people’s desire to leave the European Union—a desire echoed in the recent general election when more than 80% of votes cast were for parties that supported leaving the European Union—and we wish to do so on good terms. The only magic trick at work here, the only illusion, is the attempt by the Liberal Democrats to pretend otherwise. This has rightly been described as the greatest peacetime challenge ever faced by any Government. Unambitious it ain’t.

Yet beyond that, the Queen’s Speech demonstrates the Government's commitment to broader social reform, and the business of government very much goes on. In the areas that we are discussing today, it includes enhancing our efforts to make the NHS the safest health system in the world, helping people to make more informed financial decisions, correcting 70 years of policy failure to deliver a high-quality system of technical education, improving the quality and safety of our digital economy, and challenging the culture of indifference that ranks mental health below physical health. This is an agenda that will deliver a strong and safe society in which everyone should have the chance to thrive. It is one of which any Government can be proud, and this Front Bench is delighted to be playing its part in delivering it.

The actions outlined in Her Majesty’s most gracious Speech build on a record of success, despite the gloomy prospectuses of so many noble Lords in this debate. I mention in passing that the ONS started collecting self-reported happiness measures in 2012 and, despite the tone of the debate, believe it or not they have never been higher. The ONS only started collecting them in 2012, so in the halcyon days of Tony Blair no doubt they were much higher. However, I believe that the word “crisis” has been used far too liberally. I gently chastise the noble Lord, Lord Pendry, for politicising the NHS in the way he did. The BMA was against the founding of the NHS some time ago, but things change, and the Conservative Party is deeply supportive, as supportive as any political party in this country, of what my noble friend Lord Lawson once described as the closest thing we have to a religion.

We recognise the pressures that our public servants are under, and I would not want to be involved in running down their achievements over the past seven years. We have 1.8 million more children in good and outstanding schools, the best ever health outcomes, low crime rates, record employment, the closing of the gender pay gap, and reductions in income inequality so that they are the lowest since 1984. These have been possible because of the sound economic management of this Government and their willingness to take decisions to restore public finances to order. These decisions have enabled record investment in schools and hospitals despite the need to reduce borrowing.

The Government recognise absolutely the impact these actions have had on public servants’ pay, and I agree with the noble Lord, Lord Storey, that they are our greatest asset. I also know that this period has been difficult for people in both the public and private sectors. That is all the more reason to finish the job so that we can deliver the pay increases that staff want. The alternative, set out in the Labour manifesto is, if I may say so, to promise free things for everyone. But nothing is free. It all has to be paid for by someone, so the question is: by whom? Either, as the Institute for Fiscal Studies has pointed out, by ordinary taxpayers, not just the rich because there is not enough there to soak, or through more borrowing and more debt, loading yet more costs on to future generations.

I do not believe that it is fair to ask the young to continue to support older generations, which is what is happening now. The noble Lord, Lord Whitty, laments the end of the benefits that his generation enjoyed, such as pensions, secure jobs and so on, but I wonder whether he has reflected on the fact that the reason young people do not have access to these things may be at least in part because of the choices made by his generation. Perhaps, as my noble friend Lady Browning hinted, the baby boomers might consider footing the bill to improve conditions for the young. We had some ideas for that in our manifesto. That might satisfy the desire for more taxes, which appears to have been picked up in the British Social Attitudes survey, as the noble Lords, Lord Kirkwood and Lord Warner, pointed out.

I shall move on to education and start where the noble Lord, Lord Hunt, finished: on the purpose of education, if you like—the philosophical element. I agree with him that the purpose of education is to provide a broad, rich and rounded education. At Floreat Education, we use a quote from Martin Luther King, who said:

“Intelligence plus character—that is the goal of true education”.


It is the development of that wider human flourishing that I think we are all seeking. That absolutely includes gardening, as the noble Baroness, Lady Benjamin, pointed out. Indeed, I do not know whether she noticed, but one of her colleagues, the noble Lord, Lord Wallace of Saltaire, is a chief grandparent at Floreat Wandsworth school and has been deeply involved in planting the new garden that has opened there in the past year, so I am a deep believer in it. Indeed, the Government’s purpose is to provide more good school places that are open to any pupil.

I turn now to school funding. We know that the current funding arrangements in England are unfair. That is why we have recently consulted on the national funding formula for schools and we will work with Parliament to bring forward proposals. The core schools budget, which the noble Baroness, Lady Sherlock, and the noble Lord, Lord Storey, referred to, has been protected in real terms since 2010 and is set to rise to £42 billion by 2019-20, albeit with increasing pupil numbers. Teacher numbers have also increased in recent years. There are more than 450,000 teachers in state-funded schools, which is up by 15,000 since 2010.

A great deal of concern has been voiced in the debate about the EBacc and arts education. I agree that every child should experience a high-quality arts and cultural education. Since the EBacc was announced, and bearing in mind that the point of the EBacc is to provide the foundation of a rich and robust academic education for every child, the proportion of state-funded pupils taking at least one arts subject increased from 45.8% in 2011 to 48% in 2016. Noble Lords may be wondering how that squares with some of the facts, but it is quite possible that each pupil is taking fewer subjects but more are taking subjects, meaning that more students are actually getting the balanced education that we want to see.

The right reverend Prelate the Bishop of Ely talked about the importance of character education. I am delighted to say that he has visited one of my schools, and that we continue to invest in that element. I can also reassure him that religious education is compulsory at all key stages and that entries into the RE GCSE full course have been rising each year since 2009.

On apprenticeships, raised by the noble Lord, Lord Aberdare, and the noble Baroness, Lady Bonham-Carter, we believe in the importance of apprenticeships in delivering skills. That is why the £2 billion raised by the apprenticeship levy is being invested. That is being designed by business; it is about having something that fits the needs of businesses.

As we set out in the manifesto, we want to look at the funding of further, technical and higher education to ensure that there is parity of esteem and the right approach so that we have the skills we need. As my noble friends Lady Stowell and Lady Stedman-Scott pointed out, it is vital that we value not just people who have been through the university route. That lies at the heart of our proposals to provide an extra £0.5 billion a year for technical education.

I should take this opportunity to respond to points made by the noble Baronesses, Lady Lawrence and Lady Cohen, about international students. We absolutely value the significant contribution that they make to our universities and our society. The UK remains the second most popular destination globally for international HE students. Our purpose as we leave the European Union is to gain control of, not to end, immigration. It becomes much easier to defend immigration to those concerned about it if there is a sense that the Government are in control.

Several noble Lords, including my noble friends Lady Stowell and Lady Stedman-Scott and the noble Lord, Lord Aberdare, talked about careers advice. The Careers & Enterprise Company is promoting careers education. As the noble Earl, Lord Kinnoull, pointed out, that is a vital part of social mobility. I welcome his committee’s report, which is influencing the way government thinks. However, as my noble friend Lady Stowell pointed out, we need to tread slightly carefully with social mobility. There is a version of social mobility that says simply that the most important thing is to get out of your community, but, as she said, we should provide the ability to succeed in your community; you should not need to leave where you come from to be considered a success.

The right reverend Prelate the Bishop of Gloucester, the noble Earl, Lord Listowel, and the noble Lord, Lord Addington, talked about vulnerable young people with learning difficulties. I can reassure them all that this is still very much a priority for the Government. I share their sadness that Edward Timpson lost his seat. We all acknowledge that he was an excellent Minister who was a truly passionate proponent of the issues relating to such children. I deeply hope he will be back; I am sure that he will be working hard on those issues in some other guise in the meantime.

The noble Lord, Lord Clement-Jones, asked about the data protection Bill and the digital charter, and about responding to and being guided by the reports from the Royal Society and the British Academy. We welcome those reports, which will be a useful contribution to the Government’s work across this agenda. We are looking at measures to share data in a way that is safe but brings benefits to citizens. HMRC holds a lot of data which are highly sensitive. The Digital Economy Act, taken through this House by my noble friend Lord Ashton, allows those data to be used subject to rigorous safeguards. We will bring those powers into force shortly.

The noble Baroness, Lady Sherlock, asked about protection for people using social media. As I have said before, as a parent of young children who are on the brink of getting into that world, what is possible frankly terrifies me. However, I think the manifesto— which, as we know, had some strengths and weaknesses—was commendably robust on those issues. We will bring forward an internet safety strategy to try to make the UK the safest place in the world to be online.

As for Channel 4 moving out of London, I can see that this could become a bun fight between different corners of the country. I do not want to weigh into that and suggest any kind of preference—I was born in Maidenhead, the Prime Minister’s constituency, so there might be a chance.

[Baroness Sherlock]

Durham!

[Lord O’Shaughnessy]

It is our intention that Channel 4 should move out of London to provide that stimulation to regional creative industries.

The noble Baroness, Lady Bonham-Carter, asked whether we would set up a licence fee committee. I shall have to disappoint her on that front.

There were a number of questions about the impact of Brexit on the creative and digital industries. This is an area where we can talk ourselves into a very negative position. As I stated at the beginning, the Government’s desire is to have a close and deep partnership with the European Union. The mood music we are picking up in Europe from industries—I know it is true in my own area of pharmaceuticals—is that there is that strong desire from the other side as well. It is about reaching for a strong and integrated partnership and not being tempted down a different route. The creative industries are clearly an absolute mainstay of the UK economy and a flagship pillar of the industrial strategy—I can reassure noble Lords that they are very much in our thoughts as the negotiations to leave the European Union go forward.

I have touched on immigration. The noble Lord, Lord Young, asked about cybersecurity. We are obviously under attack all the time in terms of cybersecurity. The Government have done a great deal in this area. There was a particular effect in the health service, as we know, back in May. There are new standards coming, through the Caldicott review for healthcare, which we will publish our response to in due course. The Government take this very seriously and have invested heavily in it.

The noble Lord, Lord Lee of Trafford, asked about tourism, another vital part of our economy which will remain vital.

Moving on to work and pensions, first, I thank the noble Lords, Lord Kirkwood and Lord McKenzie of Luton, for their support for the Financial Guidance and Claims Bill. It will make a big difference to people’s ability to make more effective financial decisions and to deal more competently with financial services.

The noble Baroness, Lady Sherlock, asked about this Government’s commitment to the welfare state. I can tell her that our commitment is as deep and as strong as ever. We believe that there should be a strong welfare state, consisting not only of the social security system but of pensions, care, health and education, committed to helping everyone, with extra help for those who need it. Part of the reforms to the welfare state, to make it fit for purpose, involves universal credit. I believe it is a simplifying rather than a complicating of the system. It has clearly been introduced carefully to make sure that it works, as is right. The current system does not make sure that work pays in every instance, but that is something that universal credit does.

The noble Lord, Lord McKenzie, asked specifically about Grenfell Tower and the passage in the speech of my noble friend Lord Ashton of Hyde. I can confirm that no one will be worse off as a result of rehousing because of the fire at Grenfell Tower if they move into larger accommodation. I think that that provides the reassurance that the noble Lord was after.

Disability issues were raised by a number of noble Lords, including my noble friend Lord Shinkwin. I think we were all very moved and rather shocked to hear of the treatment he had received. I know I was when I read about it and then spoke to him about it. The Minister for Disabled People is taking an active interest in this and I know that my noble friend is talking to her. Improving the lives of disabled people is a core part of this Government’s approach. We had a Green Paper in October last year and a consultation was launched in February. Responses are being considered before we move ahead. The noble Lord, Lord Addington, talked about disability employment advisers and disability recruitment. There is not yet perhaps the coverage he would like, but there are nearly 500 employment advisers across the country and those numbers have been increasing. We will aim to get a million more people with disabilities into employment over the next 10 years. I think the Government have a very good record on that.

Finally, on health, the fundamental question that has been raised by the noble Baroness, Lady Masham, the noble Lords, Lord Warner and Lord Pendry, and others is the sustainability of the NHS. It has been working hard to manage its finances in a challenging period and yet, of course, it has been experiencing real-terms increases as well. Although I do not for a minute underestimate the challenges that it faces, with a growing and ageing population, we are planning to spend £8 billion more in real terms over the next few years to improve it. As a result, there are more people going through treatments, more people being seen in A&E and the targets that the noble Lord, Lord Hunt, referred to are still very much part, as he knows, of the NHS five-year forward view. Clearly, one of the ways we can improve health outcomes is to prevent accidents in the first place, as the noble Lord, Lord Jordan, my noble friend Lord Ribeiro and the noble Baroness, Lady Donaghy, said. I utterly agree with them about the importance of good health and safety. Public Health England works with the Child Accident Prevention Trust on these issues and preventing accidental injuries is part of the public health outcomes framework.

The noble Lord, Lord Pendry, and my noble friend Lady Browning talked about dementia. Dementia Friends has been a core part of the Government’s strategy and we understand just how deeply loneliness can harm health outcomes and cause misery and pain in people’s lives. Addressing that is an important part of this approach.

That brings me on to social care. The noble Baroness, Lady Pitkeathley, encouraged us to be bold and honest. I think if you could say anything about the manifesto promise, it is that it was bold and honest. Nevertheless, the ageing population presents one of our most difficult and profound challenges. As noble Lords know, more money is going into social care to put it on a stable footing in the short term. The proposals on which we will consult will include a floor and a limit on the amount that people can be asked to pay. I hope that provides reassurance to those who asked whether there will be proposals or yet more open-ended questions.

As part of our strategy, we need to think about carers. They do an amazing job in often extremely difficult circumstances—particularly older people looking after a spouse or children caring for their parents. We are considering carefully how to help those people.

My noble friend Lady Cumberlege, the noble Baroness, Lady Masham, and the noble Lord, Lord Freyberg, asked about maternity care. I feel very deeply about this issue. My eldest daughter was born in quite difficult circumstances and had to be delivered by emergency c-section. It was, frankly, a terrifying time. I want to ensure that there is good maternal safety, so that we do not risk what in her case was a strep B infection that had almost got up the umbilical cord—she had a raging temperature within the womb and a heart rate of 150 beats per minute. Your Lordships can imagine what that was like for us all, and for my wife in particular. So I feel that point very deeply and we have a real commitment from the Secretary of State on this issue.

I congratulate my noble friend Lady Cumberlege on her national maternity review. We are taking forward many of the ideas that she is interested in promoting, such as the rapid resolution and redress scheme, backed with more funding so that we can have a safer, more personalised and kinder approach to maternity, and prevent some of the awful injuries and deaths that sadly happen in that environment.

One issue that affects maternity and other areas is when there are staff shortages. The number of midwives has increased over the past few years. We know that there is growing demand from a growing population and we want a workforce that is capable of dealing with the challenges ahead—even more so given the impact of not only Brexit but, as we were discussing the other day, the language tests. That is why we are increasing the number of staff in training and offering new routes into the profession, such as the nursing associate and nursing apprenticeship.

I will touch briefly on the payment of the national minimum wage for sleep-in shifts, which was raised by the noble Baronesses, Lady Jolly and Lady Brinton. Through the living wage we want to make sure that pay is fair in all sectors of social care—but I understand the problem with this issue. We are looking at it and I will come back to update both noble Baronesses on the particular concerns they raised in the debate today.

Regarding mental health, the Government have a better story to tell than perhaps we have been given credit for. There is much more money going in—and, yes, it is getting to the front line, as well as other commitments, including waiting time commitments on treatment. There is an issue to be discussed, at another time, about the extent to which we have ring-fencing and direction, because the whole way the NHS works is predicated on clinical autonomy. Just as with the operational autonomy of the police force, that autonomy is rather important. Of course there should be targets—or goals, if you like—and sometimes they will be in conflict with one another. Nevertheless, it needs to be for professionals to make that decision. We will bring forward the Green Paper on children’s and young people’s mental health that the noble Earl, Lord Listowel, hoped for. I can reassure him on that front.

My noble friend Lady Browning asked about people in prison. They should absolutely be getting the same level of care as those who are out of prison. Patient safety has been talked about, and is at the core of this Queen’s Speech. We have the draft patient safety Bill, and it is our intention, as the noble Lord, Lord Freyberg, and my noble friend Lord Ribeiro, said, to learn the lessons from other sectors such as aviation, to make sure that we have one of the safest healthcare systems in the word. We intend to publish the Bill in draft later this year, ahead of pre-legislative scrutiny within this two-year Parliament.

The noble Lord, Lord Rennard, asked about tobacco control. I am afraid I cannot give him a precise date for the plan, although I know he is itching for one. He will understand that there has been a reorganisation of Ministers in our department since the election, but our commitment to it remains.

My noble friend Lord Astor asked about Lyme disease. There is a public health pathway on this issue, but I realise the seriousness—the growing seriousness—of it, and will write to him on the further work that we are doing.

My noble friend Lord Bridgeman raised the issue of GP surgeries. General practice is changing: partnerships are merging into federations, and there are other things going on, but improving primary care is at the heart of the five-year forward view. The nature of practices will change over time, but I totally understand what he says about making sure we do not punish those who are most entrepreneurial.

I am sure that your Lordships will be delighted that I am about to bring my speech to a close. I have tried to be comprehensive, but we have also agreed on the importance of arts and culture for children, and I am due to take my children to see “The Wind in the Willows” tonight, so I will bring my comments to a close.

Discussions in this Chamber are not always conducted without rancour, and I am as guilty of that as others, but on reflection it is noticeable that the speeches I highlighted to begin with for their uplifting qualities came largely from either Baronesses or Bishops, despite their being in a minority in this House—that is probably a lesson for us male, temporal Lords.

In an attempt to reach the bar that they have set, I would like to close the debates on the humble Address by turning to an idea that has motivated me through my life, and which I know motivates every Member of this House, those in another place and millions of citizens throughout this country. We are here and we serve our country because we believe in Britain. We believe that it has a great past but an even better future, and that our country is at its best when it pulls together in pursuit of an ambitious and admirable goal.

We have seen that attitude at work in response to the tragic incidents of which we have suffered too many recently. These tragedies all hit home in various ways, whether because our Parliament was attacked or because we live with, know or work with people affected. I can see the burned-out remains of Grenfell Tower from a window at home. It is right next to the leisure centre where I take my children swimming—no doubt some of the children who swam in that pool have died. It is a black scar on London's landscape and a dreadful reminder of the importance of looking after one another more carefully than we sometimes do.

However, it should not need tragedy to pull us together. As Brendan Cox, the courageous husband of murdered MP Jo Cox reminds us with great dignity, we have more in common than that which separates us. The task for this Government, and indeed this House and Parliament, is to bring people together. We need to create more and new opportunities for common enterprise—joint endeavours that allow our people to achieve happiness for themselves, their families and their communities. If this is what motivates us all in the years ahead, then, despite the challenges, I believe that we can face the future with confidence.

Motion agreed nemine dissentiente, and the Lord Chamberlain was ordered to present the Address to Her Majesty.

Brexit: Nursing Staff

Lord O'Shaughnessy Excerpts

Tuesday 27th June 2017 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what assessment they have made of the impact on the NHS of figures released by the Nursing and Midwifery Council showing a 96 per cent reduction in the number of nurses registering to work in the United Kingdom in the year since the referendum on leaving the European Union.

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

My Lords, the Government are aware of a reduction in the number of European Economic Area trained nurses applying to register with the Nursing and Midwifery Council. The department’s assessment suggests that this is largely a consequence of the NMC introducing language testing, rather than the vote to leave the European Union. The number of European nurses working in the NHS increased by more than 400 between June 2016 and March 2017.

[Lord Hunt of Kings Heath (Lab)]

My Lords, what the Minister did not say is that there has been a 96% fall in the number of nurses coming from EEA countries in the space of nine months. This comes on top of a shortage of thousands of nurses in the NHS. The RCN has today issued a statement which absolutely disproves the Minister’s argument that it is to do with English language testing. It is quite clear that it is to do with the Government’s obsession with migration control at the expense of our public services and the imposition of a pay cap on nurses and other NHS staff. He and his fellow Ministers have found £1 billion to bung the DUP; when are they going to find the money that is needed to get rid of the cap on nurses’ pay and pay them what they deserve?

[Lord O’Shaughnessy]

I am afraid the noble Lord is mistaking cause for correlation in this instance, and let me explain why we think that is the case. The General Pharmaceutical Council introduced language testing in November 2016; it had experienced no significant drop-off in applications from EEA member countries after Brexit but before that point and a big downturn in applications after that point. So it is language testing; it also happened with the GMC as well when it introduced language testing. I know this is something that the noble Lord supports—he said as much in a debate on this very issue in 2015—because it is an issue of safety. That is why language testing has been introduced. I would like to say, however, that of course we value the work of EU staff who come here, and, indeed, all nursing staff. As the Prime Minister set out yesterday, we want them to stay and have offered a generous package to allow them to do so, and there are more EU nurses here than there ever have been.

[Baroness Walmsley (LD)]

My Lords, the Department of Health’s own modelling predicts that there will be a shortage of 40,000 nurses by 2026. My own local hospital has 60 nurse vacancies, and I am sure other noble Lords have similar examples. What do the Government propose to do to avoid the NHS becoming unsafe because of these nursing shortages, given that some nurses are already being asked to stay on at the end of 12-hour shifts in order to fill gaps in the roster?

[Lord O’Shaughnessy]

I thank the noble Baroness for giving us the opportunity to talk about the fact that we have increased the number of nurses and health visitors by nearly 5,000 since 2010. She is quite right to say that we need more of them; we have a growing and ageing population and higher expectations of what the NHS should be delivering. It is for that reason that we have a number of things in action: we have 52,000 nurses in training; we have a return to practice programme, which has already prepared 2,000 nurses to come back into the profession; and we are introducing nursing apprenticeships and nursing associates. We are not complacent about this issue—we know it is important—but there are a number of programmes in train to fill the gap that she has identified.

[Baroness Watkins of Tavistock]

My Lords, perhaps the Minister could consider that one of the reasons that people are not coming from the European Union is that they feel unwelcome; housing is almost impossible to get, particularly in some of the metropolitan areas; the reduction in the value of the pound against European currencies means that salaries have stagnated even more for some of these people; and, actually, morale is so poor in parts of the health service and social services that people would rather remain and work in their own countries.

[Lord O'Shaughnessy]

I reiterate the point that the Prime Minister made yesterday about the welcome, and indeed the offer of settled status, not just to nurses but to any other EU citizens and workers in the country. It is absolutely not the case that they are unwelcome—quite the opposite. They are as valued as much as any other person working in the health service. The noble Baroness mentioned housing, and she is right, of course, that housing is a huge issue for everybody. Indeed, one thing that I want to look at in the next few years is how we can take surplus land that sits within the NHS and make sure that some of it is used to provide the kind of key-worker housing that nurses, doctors and, indeed, other members of the public sector can use, so that they are able to come into the service and support our hospitals.

[Lord Clark of Windermere (Lab)]

My Lords—

--- Later in debate ---

[Baroness Manzoor]

My Lords, it is a fallacy to continue repeatedly to suggest that EU nurses and doctors are not welcome in this country. Quite frankly, I am fed up with it. I worked in the NHS for over 25 years, and this is damaging staff morale because people are almost being targeted to feel that way. EU nurses and doctors do tremendous good work, and they are respected, welcomed and valued, as are other nurses and doctors from across the world. We have a great opportunity to celebrate this. Does the Minister agree?

[Lord O'Shaughnessy]

I completely agree with my noble friend, who speaks from experience. It is important not to peddle a myth of unwelcomeness, when it is clearly the case that nobody has said that they are unwelcome. No one in government has said that they are unwelcome; nor has the BMA, the RCN, or anyone else for that matter. They are valued as highly as any other member of the medical profession.

[Lord Clark of Windermere]

My Lords, does the Minister accept that any fall-off in the number of nurses and doctors from the EC poses a real risk to the health service? Does he accept that, while the number of nurses in training may be increasing now, the Government were wrong in the coalition period after 2010 to cut the number of nurses in training in the UK?

[Lord O'Shaughnessy]

The critical point is to have enough nurses and, indeed, enough medical staff. Of course, where they come from is going to be dictated by various circumstances. As I have discussed already, language controls have been introduced in order to focus on patient safety. We do need to increase the number of nurses in the health sector. That has happened since 2010. There has been an increase. There are more in training. But clearly there need to be more as we have a growing and ageing population.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister know how many unfilled vacancies there are at this time for nurses?

[Lord O'Shaughnessy]

I do not have that information at my fingertips. Of course, at any time there will be unfilled vacancies as nurses move around. As I said, we know that recruiting more nurses into the health service is an important priority for the years ahead, which is why we are undertaking the programmes that I mentioned.

NHS: Shared Business Services

Lord O'Shaughnessy Excerpts

Tuesday 27th June 2017 Lords Chamber

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

My Lords, with your permission, I shall now repeat the Answer to an Urgent Question given in another place by my right honourable friend the Secretary of State for Health on NHS Shared Business Services. The Answer is as follows:

“As the House knows, on 24 March 2016 I was informed of a serious incident involving a large backlog of unprocessed NHS patient correspondence by the company contracted to deliver it to GP surgeries, NHS Shared Business Services, or SBS. The backlog arose from the primary care services GP mail redirection service that SBS was contracted to run. None of the documents was lost and all were kept in secure storage, but my immediate concern was that patient safety had been compromised by the delay in forwarding correspondence, so a rapid process was started to identify whether anyone was or had been put at risk. The Department of Health and NHS England immediately established an incident team.

All the documentation has now been sent on to the relevant GP surgery, where it is possible to do so, following an initial clinical assessment of where any patient risk might lie. Some 200,000 pieces were temporary residence forms and a further 535,000 pieces were assessed as low risk. A first triage identified 2,508 items with a higher potential risk of harm, of which the vast majority have now been assessed by a GP. Of those, 84% were confirmed as no harm to patients and 9% as needing a further clinical review. To date, no harm has been confirmed to any patients as a result of this incident.

Today’s National Audit Office report confirms that patient safety was the department’s and NHS England’s primary concern. But, as well as patient safety, transparency both with the public and this House has been my priority. I was advised by my officials not to make the issue public last March until an assessment of the risks to patient safety had been completed and all relevant GP surgeries informed. I accepted that advice for the simple reason that publicising the issue could have meant GP surgeries being inundated with inquiries from worried patients which would have prevented them from doing the most important work: namely, investigating the named patients who were potentially at risk.

A proactive statement about what had happened was again not recommended by my department in July for the same reasons, and because the process was not complete. However, as I explained to the House in February, on balance I decided that it was important for the House to know what had happened before we broke for recess, so I overruled that advice and placed a Written Statement on 21 July.

Since then, the Public Accounts Committee has been kept regularly informed, most recently being updated by my Permanent Secretary in February. The Information Commissioner was updated in August. I committed in July 2016 to keeping the House updated once the investigations were complete and more was known, and will continue to do so”.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to the Minister for repeating that. Clearly, this is a serious matter. More than 700,000 letters with patient information were waylaid, with more than 1,700 cases of potential harm to patients. The correspondence lost included blood test results, cancer screening appointments, medication changes and child protection notes. I will put just three quick points to the Minister.

I noticed that the Secretary of State, in this Statement, referred a lot to advice that he received from civil servants. I find it rather odd that a Secretary of State should announce to Parliament the advice given by civil servants, which usually is not disclosed. Why can he not stand on his own two feet in relation to the decision made to delay an announcement to Parliament by four months? Secondly, I am still not clear from the Statement why such a perfunctory Written Statement was made the day before Summer Recess last year. Why was a full Statement not made?

Thirdly, I understand that Shared Business Services makes £80 million a year from this NHS contract, and that so far the exercise of trying to discover where the letters have gone and to put this right has cost £6 million. Can the Minister confirm that the entire cost will be paid by Shared Business Services? Can he also say what other penalties the company will pay? Finally, the NAO points out that the Secretary of State has a conflict of interest, as he is a major shareholder in this outsourced company. Is this why he was so reluctant to come to Parliament to give information?

[Lord O'Shaughnessy]

I will answer the noble Lord’s four questions. The first was on taking advice from officials. I think the noble Lord would probably be alarmed if the Secretary of State was not taking advice from officials. That should be welcomed. It is clearly the case that he was thinking on his own, because he took the decision to follow that advice in the first instance in March, but was of the view by July that enough was known and that it was important to update Parliament before recess.

The second question was about the timing of the Statement. The noble Lord will remember that summer 2016 was a reasonably busy period after the EU referendum. The main point here is that the Statement was made before recess and was not held back until the autumn. As regards NHS Shared Business Services and the consequences for it, those consequences have been severe: it no longer has this contract and will, as my right honourable friend confirmed in another place just now, pay its share of the costs.

Finally, as my right honourable friend said, it could appear that there was a potential for conflict of interest, but in his view there was not one, because at all times—as confirmed in the NAO report—patient safety was the driving force behind the actions of the department and NHS England. It will always be the case, whatever arrangements the department has with an ALB—whether a standard agency, a joint company or whatever it is—that patient safety must come first. That was confirmed in the NAO report today.

[Baroness Walmsley (LD)]

My Lords, as I understand it, that Statement on the last day of term before the Summer Recess last year was one of 30—which implies to me that the Government consider the last day of term to be a very good day to hide bad news.

The Minister suggests that the company, or its shareholders, will have to pay its share of the costs of investigating this scandal. Can he assure us that the NHS will not be out of pocket, particularly in the light of the fact that the loss is not just financial? A lot of doctors and various officials, in both the department and trusts, have had to spend a great deal of their time looking into this—and, of course, time is money. Will this scandal actually cause the Government to be a little more cautious in future when they claim that putting health services out to private companies always gives better value to the taxpayer and the NHS?

[Lord O'Shaughnessy]

The noble Baroness will know that I was not in post at the end of last summer, so I cannot explain why there were the number of Statements that there were. I know that Governments of perhaps different hues have also tended to put out Written Statements, so I do not think any political party is entirely innocent in this regard. The point is that the information was made available to Parliament.

On the point about cost settlement, there are interested parties here and the costs need to be settled once we have got to the bottom of exactly what has happened and once those inquiries and indeed the investigations into the potential for patient harm have been settled. I underline that as yet no instances of patient harm have been discovered.

Finally, the point about privatisation is quite an important one. The noble Baroness will know that the private sector is involved in the delivery of all parts of the NHS. Breach of contract, which is what this is, and the covering up of mistakes happen in all parts of the health service—public, private, shared and all the rest of it. It is not a case of “private sector bad, public sector good”: we know that from instances like Mid Staffs and so on. The core point is that we need very strong data security standards, and that is why the Government will be responding in due course to the Caldicott review and the review of these issues by the CQC.

[Lord Reid of Cardowan (Lab)]

On one of the points the Minister responded to, perhaps I may politely offer him a piece of advice. Everyone here knows that officials advise and Ministers decide—but it is not convention, protocol or indeed courtesy to announce in Parliament that advice has been given by Ministers’ officials and he has decided to overrule it. That is not just a matter of useless etiquette; it is a fundamental aspect of maintaining the trust between Parliament and the Minister and between the Minister and his officials, which will serve him well in future.

[Lord O'Shaughnessy]

I take the noble Lord’s advice very seriously. Indeed, I note that he, as a former Secretary of State for Health, understands what is going on and the dynamics within the department. I would say only that the NAO report has described a set of actions that have taken place and why they have taken place. It has described the decision-making process, which is why the Statement responds to the content of the NAO report as it was set out today.

[Lord Tugendhat (Con)]

Could I press the Minister further on shared costs? Why is the company paying only some of the costs? Is the NHS paying the rest of the costs or is there some other body, public or private, that is going to put up some of the money? It is difficult to understand why the company is not paying the whole of the costs.

--- Later in debate ---

[Lord O'Shaughnessy]

To date, the cost of dealing with this problem is around £6 million. Clearly there is a contractual relationship between NHS SBS and various bits of the NHS. It needs to be established clearly, independently and objectively where the culpability lies for any incurrence of costs, both with the problem in the first instance and in dealing with it. Once that has been established, costs will be fairly and correctly apportioned to whoever caused the problem in the first place.

[Lord Clark of Windermere (Lab)]

Has the Minister seen the reports that managers moved many of the documents out of sight and actually destroyed many of them? If that is the case, it is very serious. If it were a wholly private company, its directors would be suspended pending investigation. If it is the case that documents were deliberately destroyed, will the most serious action be taken against the directors of that company?

[Lord O'Shaughnessy]

Clearly, if there were such an incidence, the noble Lord is quite right that it would be dealt with very strongly—but it is important to point out that there has not been evidence that that has happened. Documents were destroyed that sat within SBS, but they were not part of the backlog and they conformed, as we understand it, to the protocols around destroying old papers when they have gone past a certain time limit. So there is no evidence that what the noble Lord described has happened in this instance—but, as he points out, if it had happened it would be of the utmost seriousness.

[Lord Patel (CB)]

My Lords, what is the governance mechanism of this joint private venture? Considering that one of the key tasks is to deliver letters and patient reports in a timely manner to GPs’ surgeries, what risk assessment was made during the process of the work?

[Lord O'Shaughnessy]

Yes, this specific case was a joint venture between a private company and the Department of Health, which has a share and director places on the board. The department had a director on the board of this joint venture throughout. Part of the problem was that the issue of this unacceptable practice was not brought to the attention of the board until far too late in the process. That is obvious from the timeline that has been set out. The particular issue about redirection is no longer the case. Mail is now returned to sender if it is not delivered, rather than creating opportunities for the things going wrong that happened through this redirection service.

Health: Electronic Patient Records

Lord O'Shaughnessy Excerpts

Thursday 27th April 2017 Lords Chamber

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

My Lords, the Government are committed to making patient and care records digital, real-time and interoperable by 2020. Ahead of that, summary care records, which provide essential information about a patient, such as their medication, allergies and adverse reactions, are now available in many parts of the country in key areas of the NHS, such as ambulance and A&E services. Healthcare professionals can view these, with patient consent, to inform decisions about care.

[Baroness Manzoor]

I thank my noble friend for that comprehensive Answer. I am rather concerned that the National Data Guardian’s third report, which was out last year, does not fully address the issue of who those electronic patient data belong to. Do they belong to the GPs? Do they belong to NHS England? Do they belong to NHS Digital? This is particularly important because some GPs are moving towards only localised electronic patient record-sharing, which will have an adverse effect on the efficiency of the NHS. Can my noble friend the Minister assure the House and me that electronic patient data records will be kept nationally and that it is the patient’s choice over who has access to those records?

[Lord O'Shaughnessy]

My noble friend makes an important point about the use of data. There is a balance to be struck. The first point to be made about the use of data is that patients need to be part of any decision about sharing them. In 2012, the NHS Future Forum published an independent report on this issue and used the phrase,

“No decision about me without me”,


to describe the role of patients. There is of course a need to share data among clinicians, particularly when they treat a patient themselves. There can also be wider concerns: for example, in a public health pandemic or some such incident data would need to be shared more widely. But that can be done only with patients being informed and offering their consent.

[Lord Hunt of Kings Heath (Lab)]

My Lords, is there not a problem here? If all the focus is at national level, that usually takes a long time and it inhibits local progress. Does the Minister agree that one of the great challenges is being able to share information between the health service and social care if integrated care, particularly for older people who are discharged from hospital, is to be delivered? Is any progress being made in getting full integration at local level, which is clearly a challenging area?

[Lord O'Shaughnessy]

The truth is that there is patchy use of data within the health service. Practically all GPs now offer electronic patient records and something like 9 million people have registered to make appointments online. But it is not at the same level in acute trusts, mental health trusts and so on; there is still paper usage. The intention has been to have a paperless NHS by 2020. This means that with patient consent based around clinical need we would have the ability to share data around the patient pathway, whatever part of the health service they were in.

[Baroness Walmsley (LD)]

My Lords, given the continued revelations of data security breaches, along with the absence of a response to last year’s report from Dame Fiona Caldicott, how do the Government intend to avoid a repeat of the fiasco several years ago over care.data? Does the Minister agree that it is vital that patients are given confidence in the security of their data so that they do not withdraw from allowing their data to be used for vital medical research?

[Lord O'Shaughnessy]

The noble Baroness is quite right that the National Data Guardian produced her report last summer. There has been the intention to reply to that report but purdah has had an inevitable impact, unfortunately. She made points in that report about the simplified process for opting out but was also clear that vital uses can be made of suitably anonymised data which benefit patients directly, particularly through medical and clinical research, and about making sure that patients know about that so that they can choose to have their data shared. It is encouraging that at the moment, only around 2% of all patients have opted to have their summary care records not shared. This suggests that when it is explained properly and there are suitable safeguards, people are happy to share their data.

[Lord Marlesford (Con)]

My Lords, on the subject of records, my noble friend on the Front Bench will have studied the February House of Commons Public Accounts Committee report, NHS Treatment for Overseas Patients. The PAC is chaired by the Labour Party at present. It identified a leakage of up to £2 billion a year in the treatment of patients who are either not entitled to NHS treatment free in Britain or whose treatment should be reimbursed by the countries from which they come. The target which the Government have for this leakage is only £500 million a year, or 25%. Will the Minister undertake that in the event of the Government being successful in the election they will make a real effort to stem this leakage, which is diluting the impact of the health service on the British people?

[Lord O'Shaughnessy]

I am obviously not going to make any commitments for any future Government but I can tell my noble friend about the work that the Government have been doing on this issue. We are making sure that there are identity checks for overseas patients in hospitals to ensure that those people who are not entitled to free care, either through reciprocal arrangements or by some other means, pay for the care that is provided for them, while making sure that at all times anybody who is in need of urgent care has that care given to them, even if they then have to pay later.

[Lord Maxton (Lab)]

My Lords, will the Minister make it clear to the House that there are four health services in the United Kingdom, not one? What negotiations are taking place with his equivalent colleagues in the other Administrations in the United Kingdom to ensure that there is one common computer system across the whole of the United Kingdom? Electronic patient records depend upon there being one computer system not a variety of computer systems across the whole of the country.

--- Later in debate ---

[Lord O'Shaughnessy]

The noble Lord is quite right that the UK Government speak only for the English health system. There is a difference between having a single ICT system—we have been down that road and billions have been wasted—and having systems that can speak to one another and a common code of usage around data security, robustness, sharing patient opt-outs and so on to make sure that there is the ongoing access to information that the noble Lord is talking about, particularly for people who live in border areas who move between the different health systems.

[Baroness Greengross (CB)]

My Lords, while of course patient confidentiality must always be respected, in the recent Next Steps on the NHS Five Year Forward View there was a very concerning item on urgent treatment centres. I find it worrying that personalised care plans for patients in mental health crisis or at the end of life would be available in only 40% of emergency care settings, assuming that the target of the report is met. Are the Government prepared to look at these figures and consider them carefully?

[Lord O'Shaughnessy]

The picture that the noble Baroness paints starts from a position of not a great amount of sharing, particularly outside primary healthcare. That is what the Government have been trying to address. The primary route for doing that has been through the global digital exemplars which are enabling data sharing with all the appropriate safeguards in acute trusts and mental health trusts. The intention has been to continue to increase that over time.

Education (Student Fees, Awards and Support)(Amendment) Regulations 2017

Lord O'Shaughnessy Excerpts

Thursday 27th April 2017 Lords Chamber

[Lord Watson of Invergowrie (Lab)]

My Lords, when, in February, I was granted a topical Question on this subject—which, incidentally, I very much appreciate my noble friend Lord Clark raising—the Minister, the noble Lord, Lord O’Shaughnessy, chose to characterise my opposition to the Government’s damaging proposal as a sign that I did not support the policy of student loans. He was being disingenuous because, when student loans were first introduced by a Labour Government in 1988, those studying for nursing, midwifery and allied health professions were specifically excluded.

As tuition fees rose and student loans followed, successive Governments—Labour, coalition and, until now, Conservative—maintained that exclusion. We do not need to ask why. My noble friend Lord Clark and other speakers in this debate have made it quite clear that students building a career in those professions are quite unlike the wider student population. Perhaps the most revealing statistic on that—I will not repeat the others—is that 41% in those categories are over the age of 25, compared with 18% of the total student population. That sets them apart. As the noble Baroness, Lady Walmsley, has just said, they are unable to support themselves as other students can do, and often need to do, during their studies because of the hours required of students in nursing, midwifery and allied health professions.

However, none of that was taken into account by the Government—a Government anxious to make only “savings”. Worse, despite having those facts set out before them, they have declined to alter the course on which they are so dogmatically set. As my noble friend Lord Clark said, the nursing workforce already has severe shortages—up to 25,000 and rising—and already we know that fewer nurses from the EU are coming to work here and that by 2020 nearly half the workforce will be eligible for retirement.

So what do the Government do? They end the established practice of providing nursing students with bursaries and tell them to take out loans that will leave them with debts of at least £50,000 by the time they qualify. I heard what the noble Lord, Lord Willetts, said about loans—it is an argument that he repeated during the passage of the Higher Education and Research Bill. None the less, it is a fact that for those seeking to study for nursing, midwifery and allied health professions on the basis that they would have a bursary, it is quite a shock to find that that is not the case. Those going through school and going to university for what one might term more mainstream courses have known all along that that would be the situation. This is a sudden shock brought about by the Government, and it will have a detrimental effect on those wanting to study.

We like to think that, whenever we need the NHS, it is there for us and our families, but we are naturally anxious when we or our loved ones need to spend time in hospital, and we require an adequate number of nurses for that treatment. The Government are failing the NHS. A further example was provided just today when, in response to my noble friend Lord Hunt, counsel’s opinion was that the Government are acting illegally by not compelling NHS England to treat the required 92% of patients within 18 weeks. My noble friend Lord Hunt has submitted a Motion—for those noble Lords who are interested, it appears on page 4 of House of Lords Business—and I think that that highlights the fact that the Government are cavalier in the way they are allowing patients to be treated.

As we heard in February, the applications for nursing courses starting in September last year were down by some 23%, and the latest data available for March show that that decline is continuing. Although the ratio of applicants to training places is still 2:1, the fall in the number of applications could compromise the quality of candidates applying, as well as geographical provision, which of course is important in the long term. Moreover, it could deter prospective students once they understand fully the implications of the student loan system.

Janet Davies, the general secretary of the Royal College of Nursing, said:

“The nursing workforce is in crisis and if fewer nurses graduate in 2020 it will exacerbate what is already an unsustainable situation. … The outlook is bleak”.


Those are her words. She is the general secretary of the Royal College of Nursing—she should know. The National Health Service Pay Review Body in its 29th report said that,

“The removal of bursaries for student nurses could also have a disruptive impact on supply or the quality of supply”,


and that,

“the removal of the incentive of the bursary could have an unsettling effect on the number and quality of applications for nursing training places”.

They, too, should know. Why are the Government certain that, as always, they have a monopoly on wisdom? Why do they think they know better than the professionals in the NHS?

We should also ask why the Government are doing it. They have given two reasons. The first is the claim that it will add an extra 10,000 nurses up to 2020. But as I have said, far from encouraging additional training places by that time, cutting NHS bursaries will discourage many from becoming a nurse, midwife or allied health professional because of the fear of debt. The House of Commons Public Accounts Committee said in its report entitled Managing the Supply of NHS Clinical Staff in England that,

“the changes could have a negative impact on both the overall number of applicants and on certain groups, such as mature students or those with children”.

If the student numbers are not there, higher education institutions will be worse off because of the decline and the need to finance access bursaries under the Office for Fair Access guidance.

The Government’s proposal also stated that it will ensure sustainable funding for universities, but as yet there has been no indication of an increase in funding that the Government provide for clinical placements. Yet a study by London Economics, a leading policy and economics consultancy used by the Department for Education, found that higher education institutions would be worse off by around £50 million per cohort. Approximately half of that decline will be as a result of the decline in student numbers to which I referred. As a result, there is a real danger that some universities may decide to stop running some health-related courses altogether if they are deemed to be unsustainable. That is related to another government objective—to widen access to nursing training. I want to make clear that we are not opposed to that, but not at the expense of the traditional route through university.

The Government have also said that scrapping NHS bursaries will save the Treasury money. But there will in fact be no cost savings to the Exchequer because most nurses will not earn enough to repay the entire loan and the decline in numbers entering nursing will increase agency nursing staffing costs to cover shortfalls. London Economics also estimated that, with those increased agency costs to cover staffing shortfalls, there will be more than an additional £100 million cost by trusts per cohort wiping out any potential cost savings.

These proposals should not be proceeded with, at least until the Government have published the results of the second stage of their consultation on these measures—a point made and expanded on by the noble Baroness, Lady Walmsley. That consultation has been delayed and of course we will not see it now until the other side of the election, if we see it at all. That is entirely unsatisfactory. It is confirmation of what is no more than a leap into the dark. That is no way to treat the career development of some of our most valuable public servants. These changes are high risk at a time when the NHS is ill-equipped to manage such risk. We support the Motion in the name of my noble friend Lord Clark because it is a risk that should not be taken.

I end by responding to the rather dismissive jibe by the noble Lord, Lord Forsyth. Yes, we are keen to get on with campaigning for the leader of the Opposition. That is what we will do to encourage the people of the UK to elect a Government who will properly fund the NHS and properly value its dedicated staff. Bring it on.

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

My Lords, I thank all noble Lords who have contributed to this debate and congratulate the noble Lord, Lord Clark of Windermere, on his prescience in scheduling this debate several weeks ago. He clearly has admirers in the Leader of the Opposition’s office if they have taken his proposal and put it in their manifesto. I leave it to others to judge whether having a policy adopted by Jeremy Corbyn is a good thing or not.

[Noble Lords]

Oh!

[Lord O'Shaughnessy]

While the noble Lord may have been prescient and influential, I fear that on this issue he, the Labour Party and the Liberal Democrat party are wrong. They are wrong because the system that we are introducing for student nurses matches that experienced by other undergraduate students—a system that has been the primary driver of the big expansion of higher education and improved participation among disadvantaged young people—and wrong because of the fears of the impact of Brexit that he has evoked. I thought that the Labour Party was in favour of leaving the European Union, although having heard the tortured exposition of Labour’s policy earlier this week that is anyone’s guess. But I reassure the House that this Government not only understand the difficult choices that need to be made to ensure that our NHS has the resources and personnel that it needs to thrive, but, if we are fortunate enough to be re-elected, intend to make a success of Brexit and, as immigration is reduced, to bring more of our domestic workers into the NHS to meet the challenges ahead.

I join other noble Lords in paying tribute to the amazing work that more than 2.5 million people working in the NHS and care systems do every day, often in challenging conditions. They represent values to which we all aspire—service, hard work, compassion—and are an inspiration to us all. There can be no person in this country who does not have cause to give them thanks for their expertise and commitment.

The Government are taking action on several fronts to support that workforce so that it can deliver excellent patient care through flexible working, good leadership, expanded routes into practice and new career structures. As part of these changes, from August 2017 new full-time students studying pre-registration nursing, midwifery or one of the allied health subjects will have access to the standard student support system for tuition fee loans and maintenance loans.

These reforms will enable more money to go into front-line services—around £1 billion a year to be reinvested in the NHS. Additionally, they will help to secure the future supply of nurses and other health professionals in several ways, such as by removing the cap, identified by my noble friend Lord Willetts as being a feature of the current system, so that more applicants can gain a place. Universities will be able to deliver up to 10,000 additional training places. The changes also enable a typical provision of a 25% increase in living-cost support for healthcare students and put universities in a stronger financial and competitive position so they can invest sustainably for the long term. The noble Baroness, Lady Watkins, in her excellent and of course, expert and well-informed speech, also pointed out that they remove a perverse incentive of the current system where it is the sole degree that is subsidised in that way. That brings with it a number of benefits, including addressing the issue identified by the noble Baroness, Lady Walmsley, of the retention on courses of people who are fully committed to taking part in a nursing career.

Successive Governments’ reforms to student finance have put a system in place that is designed to make higher education accessible to all, as my noble friend Lord Willetts pointed out in his excellent intervention. This has allowed more people than ever to benefit from a university education and has spread more fairly the burden of costs between society at large via the taxpayer and the individuals who benefit financially from the degree course. As a consequence, disadvantaged people are now 43% more likely to go to university than in 2009, and for the last application cycle the entry rate for 18 year-olds from disadvantaged backgrounds is at a record high: 19.5% in 2016, compared with 13.6% in the last year of the Labour Government in 2009. That is what we mean by a country that works for everyone. It is precisely because of these positive effects that moves towards a loan-based system have been supported by political parties across the House. They were introduced by a Labour Government, extended by a Conservative and Liberal Democrat Government and taken on by this Conservative Government.

Turning to the applications for nursing and midwifery courses, the latest data published by UCAS on 6 April show around a 22% fall in the number of applicants to nursing and midwifery courses in England compared with the same point in the 2016 application cycle. However, as my noble friend Lord Willetts pointed out, in previous cases when fees have been introduced application numbers have gone down but rebounded in future years. The same UCAS data also show that since January there have been more than 3,000 additional applicants for nursing and midwifery places, taking the current total to more than 40,000 applicants for around 23,000 places in England. The chair of the Council of Deans of Health, Dame Jessica Corner, has commented on the situation, saying:

“It is to be expected that there would be fewer applications in the first year following the changes to the funding system, but we would expect this to pick up in future years”.


The Chief Nursing Officer, Jane Cummings, said:

“Despite the drop, the level of applications received suggest that at a national level, we are still on track to meet this target in England although we need to monitor this very carefully. We are also introducing a number of opportunities to support future applicants including additional routes to become a graduate nurse”.


Based on all of the information available, Health Education England is confident that it will still fill the required number of training places for the NHS in England.

On the issues raised around Brexit, future arrangements for student support after the UK leaves the EU will need to be considered as part of wider discussions about the UK’s relationship with the EU. However, the Government have confirmed that EU students starting their courses in 2017-18 or before will continue to be eligible for student loans and home fee status for the duration of their course.

On numbers of non-UK nurses, it is correct that the Nursing and Midwifery Council has seen a reduction in the number of registration applications from nurses in the European Union. At the moment, it is unclear whether the drop is attributable to the introduction of more robust language testing by the NMC, rather than as a result of the decision for the UK to leave the EU. The drop in the number of applications is balanced by a reduction in outflows from the profession, meaning that, while monthly fluctuations continue, the number of EU-born nurses is broadly the same. Indeed, slightly more nurses from the EU are working in NHS trusts and CCGs than in June 2016, the time of the referendum.

[Lord Watson of Invergowrie]

Will not the figure that the Minister has just cited be significantly skewed by the immigration skills charge, where, for every overseas person coming in on a type 2 visa, the NHS will have to pay £1,000? Will that not have an effect on nursing figures?

[Lord O'Shaughnessy]

I am not going to speculate on the impact of that. What I can tell the noble Lord is that, despite the scare stories that numbers will have been affected, there have been more EU-based nurses in the past year. That is the point that I wish to get across.

The real issue at stake is whether the number of staff in the NHS is increasing to meet the growing demands on it, and here the Government have a strong record. Over the past year, the NHS has seen record numbers of staff working in it. The most recent monthly workforce statistics show that, since May 2010, there are now over 33,000 more professionally qualified full-time equivalent staff in NHS trusts and clinical commissioning groups, including over 4,000 more nurses.

Health Education England’s Return to Practice campaign has resulted in 2,000 nurses ready to enter employment and more than 900 nurses back on the front line since 2014. There has been a 15% increase in the number of nurse training places since 2013, plus the introduction of up to 1,000 new nursing apprenticeships and the creation of nursing associate roles—the kind of non-graduate nursing roles that my noble friend Lord Forsyth pointed out as being such a crucial part of the mix. These all form part of our plan to provide an additional 40,000 domestically trained nurses for the NHS. These new and additional routes into the nursing profession will allow thousands of people from all backgrounds to pursue careers in the health and care sectors and, critically, allow NHS employers to grow their own workforce.

I will end as I began. I believe that this regret Motion is misguided. The extension of the loan-based system to nursing and midwifery training is a natural development of reforms that have received cross-party support, successfully expanded higher education, dramatically improved the participation of disadvantaged groups and provided a fairer distribution of the costs of funding higher education.

Despite the pessimism of some, the decision by the British people to leave the European Union, which this party respects, has not had a material impact on the workforce. Furthermore, and paid for in part by the resources freed up by our changes to student finance, this Government have put in place a series of programmes that have successfully increased the number of staff in the NHS and provided more training places than ever, allowing us better to grow our own workforce among UK residents.

The true source of regret is that the Opposition have used this opportunity to run scare stories about both the impact of sensible funding changes we have made and the impact of leaving the European Union on the NHS workforce. I urge all Members of this House to vote against the Motion.

[Lord Clark of Windermere]

My Lords, I have listened very carefully to the Minister. I wanted to be persuaded; I am not persuaded. I believe that the Government are taking a big risk. They have gambled before. It may not be known, but in 2011, 2012 and 2013, they reduced the number of nurses in training because they thought we had sufficient. As a result, several thousand nurses were short-trained in those three years, because the Government got the figures wrong. I believe that they have got the figures wrong again. It is a big risk that we do not need to take. It is unfair on the nurse’s career, but, most of all, it is unfair to potential patients in the National Health Service. I want to test the opinion of the House.

Health Service Medical Supplies (Costs) Bill

Lord O'Shaughnessy Excerpts

Ping Pong (Hansard): House of Lords
Wednesday 26th April 2017 Lords Chamber

Moved by

[Lord O'Shaughnessy]

That this House do not insist on its Amendment 3B and do agree with the Commons in their Amendments 3C and 3D in lieu.

Commons Amendments in lieu

3C: Page 2, line 19, at end insert—
“( ) after “body” insert “and any other person the Secretary of State thinks appropriate”,”

3D: Page 2, line 27, at end insert—
“( ) After subsection (1) insert—
“(1A) Consultation about the proposed exercise of a power under subsection (1) must include consultation about the following—
(a) the economic consequences for the life sciences industry in the United Kingdom;
(b) the consequences for the economy of the United Kingdom;
(c) the consequences for patients to whom any health service medicines are to be supplied and for other health service patients.””

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

My Lords, I beg to move Motion A. In doing so, I apologise to the House for the late change to the running order. Noble Lords who were expecting—or indeed hoping—that my noble friend Lord Nash would be taking the Bill through will have to make do with me.

We are here again to consider whether and how the Government can take into account the impact that exercising the powers in the Bill will have on the life sciences industry and on access to new medicines for patients who may benefit from them.

When we last debated these issues, I set out clearly the Government’s reasons for disagreeing with Amendment 3B. As I explained at the time, it would undermine one of the core purposes of the Bill by undermining the Government’s ability to put effective cost controls in place. This could encourage companies to bring legal challenges where cost controls have not in themselves promoted growth in the life sciences industry, seriously hindering the Government’s ability to exercise their powers effectively to control costs. This would have a detrimental effect if the Government were to take action to control the price of an unbranded generic medicine where it is clear that the company is exploiting the NHS, because the Government might be challenged on the basis that the action does not promote the life sciences sector. Nevertheless, as I am sure that all noble Lords agree, in such an instance it would of course be the right thing to do for the NHS, for patients and for taxpayers. The powers in the Bill that enable such action have received universal support in both Houses throughout the Bill’s passage.

Through our previous debates on this issue, we clarified that there was no intention to undermine the core purposes of the Bill; rather, the intention is to ensure that a mechanism is laid out in the Bill to ensure that the Government pause to reflect on the impact of any proposed statutory price control scheme on the life sciences industry, and on access to cost-effective medicines. With this clarity, the Government have now put forward their own amendment in lieu which will achieve just that, without undermining the Bill’s core purpose.

Consultation requirements are already set out in Section 263 of the NHS Act, prior to the implementation of any statutory price control scheme for medicines. Our amendment, which received support from all parties in the other place, would mean that the Bill would amend the NHS Act to include particular additional factors that must be consulted on. These are: first, the economic consequences for the life sciences industry in the United Kingdom; secondly, the consequences for the economy of the United Kingdom; and, thirdly, the consequences for patients to whom any health service medicines are to be supplied and for other health service patients.

The requirements are framed in this way in order not only to consider the economic consequences for the life sciences industry and for patients who may benefit from new medicines but to balance these factors against wider considerations. I am sure that we can all agree that, although a thriving life sciences industry and access to new medicines are highly desirable, it must not come at any cost and it is the Government’s responsibility to achieve the right balance and to be held to account for it. As with all consultations, the Government must give all responses due consideration before finalising policy. Setting these requirements out in the Bill does not limit the scope of any consultation on a statutory pricing scheme, offering both the Government and consultees the opportunity to give all relevant issues proper consideration.

The amendment is specific to Section 263 of the NHS Act—that is to say, the powers to put a statutory scheme in place for medicines. Where action is being taken against a specific instance of high prices, it would not be appropriate for it to be subject to such a wide-ranging consultation. In such cases, the NHS Act requires consultation with the appropriate industry body or bodies prior to the exercise of the powers.

With this amendment, the Government have therefore addressed the real intent behind Peers’ concerns, giving assurance of proper, balanced consideration of the effects of any statutory pricing scheme on the life sciences industry and patient access to medicine without undermining the Government’s ability to operate such a scheme. I hope that it will meet with the approval of the House.

Before closing, I thank the many noble Lords who have contributed not only to the development of the amendment but to the Bill as a whole. I thank the noble Lords, Lord Warner and Lord Hunt, and the noble Baroness, Lady Walmsley, as well as my noble friend Lord Lansley and the noble Baroness, Lady Finlay, for their contributions to improving the Bill. Finally, I also thank other noble Lords who have made important contributions to the debate, including the noble Lord, Lord Patel, and the noble Baronesses, Lady Masham and Lady Wheeler. I believe that we have worked in a constructive and open spirit and, as a result, the Bill is better and stronger than when we found it. I beg to move.

[Lord Warner (CB)]

My Lords, I am grateful to the Minister for the further thought that he has given to the amendment that your Lordships passed at an earlier stage. I am also grateful to him for his courtesy in showing me the amendments before he went forward with them; I very much appreciate that. I accept the Government’s arguments for the new approach that they have provided on the set of concerns that we had across the House about the adequacy of the provisions in the Bill on the life sciences industry and on speedy access to NICE-approved drugs. I accept their arguments that the original amendment was to some extent too restrictive on their freedom of manoeuvre when they need to act on unreasonable high prices. The Government have skilfully met the concerns of your Lordships’ House and I am very pleased to be able to support the amendment.

While I am on my feet, I will also thank the Minister for the courteous way in which he has listened to concerns throughout this Bill and taken the issues away, considered them with his officials and come back and tried to respond to many of the concerns. Across the Benches of this House, we are grateful for the way in which he has conducted the discussions during the passage of the Bill.

--- Later in debate ---

[Lord Hunt of Kings Heath (Lab)]

My Lords, I look forward to the Minister’s answer to that last question. From the opposition Benches, I very much welcome the agreed amendment that has come forward from the Government today. It is good to see how wash-up can concentrate minds no end, and we have reached a very satisfactory outcome. I am very grateful to the Minister and his officials for their co-operation on this.

The Opposition have been in no doubt whatever that it is absolutely right to take action against those companies that have clearly been abusing the system. We should also pay tribute to the Times newspaper for its campaign, which has opened up some transparency in a pretty murky area.

There are two key issues that need to be taken forward. First, the key message of debates in your Lordships’ House is that, in seeking to deal with this particular problem, we must not underestimate the contribution of the pharmaceutical industry to this country, to the economy and to the life sciences sector. We have a problem in that we are incredibly innovative in the number of new drugs that are developed in this country, but the NHS is finding it increasingly difficult to invest in them and patients are not getting the benefit.

The second is the whole question of balance between the statutory and voluntary schemes—the noble Lord, Lord Lansley, referred to this. I have reached the conclusion that the current arrangements are simply not up to scratch in relation to how government should negotiate with the industry in the future. The patent lack of transparency about the real price paid by the NHS for individual drugs means, in my view, that the arrangements are no longer fit for purpose. I hope that the Government—whichever Government are in power post election—will look afresh at the need for new arrangements in negotiation which get a fair price and also lead to the adoption of innovative new drugs for NHS patients.

Can the Minister say when he thinks the Government will be in a position to implement the key provisions in this Bill in relation to prices?

[Lord O'Shaughnessy]

My Lords, I thank all noble Lords for their warm words and I reciprocate those feelings: it has been a very interesting, challenging and enjoyable experience working with noble Lords on this Bill on what is—as the noble Lord, Lord Hunt, has pointed out—a critical matter. It is critical not just that we get the best possible prices for drugs and that we crack down on those who are trying to rip off the system, but that we make sure we are also supporting the life sciences industry and are improving access for patients.

I am particularly grateful for the work done by the noble Lord, Lord Warner, and I appreciate his support for this amendment. My noble friend Lord Lansley and the noble Lord, Lord Hunt, made the point about the equivalence between the voluntary schemes and statutory schemes. There is equivalence in law and equivalence in spirit. It is in the nature of voluntary schemes that they take into account issues around access and life sciences, because that is, in a way, why they come about. You would not have one if you could not have some agreement on that. By making this amendment today we have provided something that was taken into account by the voluntary schemes by moving it into the statutory schemes and providing that equivalence.

My noble friend is quite right about the need to work in a constructive manner. It is possible to create a system in which the interests of patients, industry and the NHS align. There is no necessary reason for them to be in conflict and, indeed, we all want a system where we have improved access and keen prices that raise the standard of care available on the NHS.

I join the noble Lord, Lord Hunt, in congratulating the Times on its investigations, which continue. Indeed, I think that there was a story at the beginning of the week or the end of last week about that. It has put a turbo boost under this, but clearly there is more to do. This Bill will allow us to get up stream and not have to wait until things get to the Competition and Markets Authority many years down the track; it will allow us to improve things up front.

As to whether the current arrangements are up to scratch and what might happen in the future, noble Lords will understand if I resist making a comment on what might happen in the future, or what a future Government might do. My own observation—this is my way of answering the question from the noble Baroness, Lady Masham, which I will avoid slightly—is that any new system ought to be trying to rebalance spending towards innovative drugs, which can of course be done in any fiscal envelope; it is not necessarily a point about spending per se but about the balance of spending. Any system would probably benefit from being both simpler and quicker. I am sure that is something that Ministers in the Department of Health, whoever they may be after the next election, will want to grapple with.

I thank my officials who have done a fantastic job and have worked very hard with noble Lords across the House on the Bill and on amendments. I am very grateful to them. I think that 24 government amendments have now improved the Bill.

On a personal note, I have very much enjoyed taking my first piece of legislation through your Lordships’ House. Pending the election result, it may be my last, but I hope it will not be. Others may disagree.

[Lord Hunt of Kings Heath]

My Lords, I will not comment on that last remark. The key clause is Clause 5. Can I take it that once the Bill receives Royal Assent the Government can implement that straightaway?

[Lord O'Shaughnessy]

I believe that would be the case. Of course, there is a difference between what officials can do and what Ministers can give instructions to do in a period of purdah. However, as soon as the measure is in law, it is enforceable.

Motion A agreed.

NHS and Adult Social Care

Lord O'Shaughnessy Excerpts

Wednesday 5th April 2017 Lords Chamber

[Lord Patel]

To ask Her Majesty’s Government what is their assessment of the long-term sustainability of the National Health Service and adult social care.

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

My Lords, the NHS and adult social care systems face unprecedented challenges due to an ageing, growing population and rising expectations. Making these systems sustainable for the long term depends on changing the way that services are delivered, with much greater emphasis on integration and keeping people well and independent for longer, as set out in the NHS Five Year Forward View and delivery plan.

[Lord Patel (CB)]

I was hoping that the Minister might thank us for the brilliant and well-written report published today. It is, following a great deal of difficulty, a consensus report from all sides of this House, including the Spiritual Benches, and I hope that it will be met with political consensus when the politicians have had time to digest it. It has identified some key threats to the long-term sustainability of health and social care, and I shall allude to just one of them: if we do not get a long-term settlement for social care funding, healthcare will continue to suffer. The report makes some good suggestions, including how individuals who can afford it can make a contribution to funding the long-term sustainability of social care. I hope that the Minister will take that on board when he devises the Green Paper on social care.

[Lord O'Shaughnessy]

I thank the noble Lord for that. I did not want to get ahead of myself but I thank him and all members of the committee for their work in putting together this document. I appreciate that it is an incredibly thorough and important piece of work, and I am also grateful to have received an embargoed copy of it yesterday. I will of course look carefully at all the recommendations and respond properly in due course. I am sure that we will also have an opportunity for a longer debate.

The noble Lord specifically asked about social care, and I completely agree with the priority attached to it in the report. He will know that the Government have committed more money in the short term to support social care, with £2 billion more having been announced at the Budget. But I know that his emphasis and the emphasis of his committee was on long-term reform. He is quite right to point out that the Green Paper is a very important opportunity to take a broad perspective and to put the system on a sustainable long-term footing.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I too commend the noble Lord and his committee for a thorough report, which I endorse and on which I hope we can have a full debate in due course. On the future of long-term care, the noble Lord will know that before the 2010 election Andy Burnham, as Secretary of State for Health, made some very striking proposals for its funding. I wonder whether the Minister regrets that David Cameron and other Conservative leaders at the time condemned this as a “death tax” and put back the search for consensus on the funding of social care for many, many years.

[Lord O'Shaughnessy]

The so-called “death tax”, to use the noble Lord’s words—

[Noble Lords]

Oh!

[Lord O'Shaughnessy]

Those were the words just repeated by the noble Lord. The so-called “death tax” was a percentage levy on all estates, regardless of the use of social care systems. The proposals that the coalition Government came forward with—the Dilnot proposals—were about capping amounts and therefore were much more responsive to the amounts being spent. The Chancellor has recently recommitted us to not looking at that proposal but we will, through the Green Paper, seek to put the social care system on a sustainable basis and, of course, seek consensus wherever we can.

[Baroness Walmsley (LD)]

My Lords, does the Minister recognise the logic of the committee’s criticism of the cuts to public health funding? Will he go back and commit himself to promoting the prevention agenda and good health agenda, not just in his own department but across government, because so many other departments have an effect on the health of the nation?

[Lord O'Shaughnessy]

The noble Baroness is quite right about the importance of public health. It is worth pointing out that it is not just an issue of money. This country was the first in Europe to act on cigarette packaging, to introduce a soft drinks industry levy and to develop a childhood obesity plan. As we have talked about previously, if you look at the risky behaviours displayed by young people, you will see good evidence that this approach is working.

[Baroness Redfern (Con)]

My Lords, as the population ages and the financial pressures on the health and care system increase, evidence tells us of the need to be better at providing proactive, preventive care to ensure that people can live independent, fulfilling lives for longer. Will the Minister do all he can in expressing these concerns and look at ways to address, as a priority, the uptake of innovation and technology, together with data sharing across the NHS, to emphasise the need to develop a credible strategy?

[Lord O'Shaughnessy]

I thank my noble friend for that and for her contribution to the work of the committee. She speaks with great experience and authority from her role in running a local authority. She is quite right that technology offers huge opportunities. The key is to make sure that the NHS and social care systems see technology as an opportunity to improve productivity rather than as providing an additional cost. That is why we are taking a variety of actions through the life sciences industrial strategy, the accelerated access review and other routes to make sure that technology is improving outcomes.

[Baroness Campbell of Surbiton (CB)]

My Lords, the current social care narrative is dominated by the lack of residential homes and home care services for older people. Given that working-age disabled adults make up one-third of those reliant on social care, is it not time that we had a more comprehensive government social care strategy that reflects the diverse needs of all service users, and to work with disabled people to produce it?

[Lord O'Shaughnessy]

The noble Baroness makes an incredibly important point. Despite the ageing population, the fastest-growing part of the adult social care budget is, I think, for adults with learning difficulties. She is quite right that there needs to be a comprehensive approach. That is why additional funding is going in to support not just older people but working-age adults too.

[Baroness Blackstone (Lab)]

My Lords, I declare an interest as the chair of the board of Great Ormond Street Hospital. I was also a member of the Select Committee. I want to pick up on what the Minister said just now about public health—which, if I may say so, I thought was rather complacent. The public health budget has been cut year after year over the past decade. Will he give the House an assurance that this budget will not only be protected but enhanced? Unless that is done, the terrible crisis we have in obesity will not be prevented, and many other areas of public health such as smoking, drugs and alcohol will not be addressed properly.

[Lord O'Shaughnessy]

The budget for all health services has been set out now for the spending review period until 2021. I completely agree with the noble Baroness about the importance of these kinds of activities. We are, of course, moving to a system where local authorities are able to retain their business rates. They have primary responsibility for the delivery of much of the public health services and we are trying to put them on a long-term financial basis so that they will be able to continue with the kind of work she has highlighted.

Health Service Medical Supplies (Costs) Bill

Lord O'Shaughnessy Excerpts

Wednesday 5th April 2017 Lords Chamber

Moved by

[Lord O'Shaughnessy]

That this House do not insist on its Amendment 3 to which the Commons have disagreed for their Reason 3A.

Commons Reason

3A: Because it would not always be appropriate to use the powers conferred on the Secretary of State to control the price of medicines and other medical supplies to promote and support the growth of the life sciences sector, and those powers cannot be exercised to ensure that patients have access to medicines and treatments.

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

My Lords, before I address the specifics of the Motion I would like to remind the House of the wider policy context in which this Bill sits. In their approach to medicines and the life sciences industry, the Government have three objectives: to make sure that patients have access to the most effective treatments; to secure value for money for the NHS and for the taxpayer; and to encourage innovations that save lives. That is the overall role of government and, indeed, these are the three objectives that I have to balance in my ministerial portfolio.

We must remember that the Bill is about only that middle objective: securing value for money. It is not the appropriate vehicle for fulfilling the other objectives that government has in this area, as important as they are. That is why we have tabled Motion A and oppose the amendment put forward by the noble Lord, Lord Warner. I do not downplay the importance of patient access to innovative medicines or the importance of a strong life sciences industry in this country—quite the opposite—but achieving these objectives is best done through other means, and I will return to this point a little later.

As noble Lords on all sides of the House have agreed, the Bill plays a vital role in delivering better value for money for the NHS and for taxpayers. NHS spending on medicines is second only to spending on staffing costs, with a spend of over £15 billion during 2015-16. In 2015-16, total spend on medicines grew by 7%, more than twice the growth rate of the overall NHS budget. The Bill helps us to tackle some particular issues which have contributed to this rising spending. It will allow us to align our statutory scheme for the control of prices of branded medicines more closely with our voluntary scheme, it gives us stronger powers to set the prices of unbranded generic medicines if companies charge unwarranted prices in the absence of competition, and it allows us to secure better information with which to operate our pricing schemes, reimburse community pharmacies and make sure that the supply chain is delivering good value for money.

As a result of close and welcome scrutiny by your Lordships, significant improvements have been made to the Bill and 23 government amendments have been proposed. I am grateful to the work of all noble Lords who contributed to those changes. That work has been acknowledged by Members of the other place, who accepted all the amendments put to them, with the exception of Amendment 3, to which we return today.

While the Bill represents an important part of our strategy to deliver value for money, we are engaged in a substantial and transformative programme of work to support the life sciences and improve access to medicines. Following the publication of the industrial strategy Green Paper in January, we are working with industry and the NHS to develop a new strategy for the long-term success of life sciences in the UK. This work is being led by Professor Sir John Bell, and its aim is for the UK to be the global home of clinical research and medical innovation, with huge benefits to the UK economy and NHS patients.

I expect the life sciences industrial strategy to be published by late spring, to be followed by discussions on an ambitious sector deal that we aim to conclude this summer. The emerging strategy is focusing on six pillars: science; growth; skills; regulation; digital and data; and NHS uptake. I want to reflect for a moment on these themes.

On the science base, the UK is a world leader in this area, and the Government are supporting it by investing more than £1 billion a year in health and care research through the National Institute for Health Research, including 20 new biomedical research centres and 23 clinical research facilities for experimental medicine, to help to speed up the translation of scientific advances for the benefit of patients. The 2016 Autumn Statement announced £4 billion additional investment in R&D, specifically targeting industry-academia collaboration, and we expect the life sciences industry to be a substantial beneficiary.

On growth, this Government continue to support innovative businesses through our highly competitive taxation regime, including measures such as the patent box and R&D tax credits. The recent Budget contained a welcome announcement of investment in a new wave of advanced manufacturing centres to support the development of cell and gene therapies. This determined action is reaping rewards. The UK has one of the strongest life sciences industries in the world, generating turnover of more than £60 billion each year. Indeed, it is our most productive industry.

On skills, we know that attracting the most talented individuals to our life sciences industry is essential. As the Prime Minister has made clear, the UK will always remain open to those with the skills, drive and expertise to support our economic growth. The Budget announced that more than £100 million will be invested in global research talent over the next four years to attract the brightest minds to the UK.

The future of medicine regulation after Brexit is a critical issue. Any future regulatory model will need to ensure that patients have timely access to safe, effective medicines and support a flourishing life sciences sector. I am having extensive discussions with the industry and other stakeholders, and our strong desire is to form a constructive new partnership with the EU on medicine licensing.

On digital and data, technology is already helping to improve patient care, and we are investing £4.2 billion over the spending review period in digital and data transformation, including areas such as electronic patient records, apps and wearable devices, telehealth and assistive technologies. Furthermore, the NHS has a unique opportunity to work with the life sciences industry to use data to patients’ benefit, and we expect the life sciences strategy to provide proposals that will accelerate clinical trials and the uptake of medical innovations.

I reiterate our commitment to improving patient access to new medicines and technologies, a subject that we have spoken about many times in the process of going through the Bill. It is a critical objective of our life sciences strategy. The early access to medicines scheme, introduced in 2014, provides a platform from which to provide patients with innovative medicines prior to licensing. The Cancer Drugs Fund has allowed over 100,000 patients to access innovative, life-saving medicines. NHS England’s test beds programme, launched last year, provides an opportunity to link new technologies with new ways of delivering healthcare, and its commissioning through evaluation programme provides an opportunity for promising but experimental treatments to be brought forward for patient use.

There is clear evidence that those actions are having a positive impact. The latest innovation scorecard, published in January, showed that, of the 77 medicines that are measured, over half saw growth in uptake of over 10% year on year. Still, there is of course more to do. That is why the Government will be responding shortly to the recommendations of the accelerated access review, with the aim of getting transformative products to patients who need them up to four years earlier than we do now.

In discussing patient access, I am aware of concerns about changes that NHS England and the National Institute for Health and Care Excellence are making to the way in which drugs and other treatments are assessed and adopted in the NHS. I must remind noble Lords that these changes have been made in response to the recommendations of the Public Accounts Committee, which stated that NICE should,

“ensure affordability is considered when making decisions”.

I come to the changes themselves. The first is that NICE is introducing a fast-track appraisal process that will bring forward access for NHS patients by around five months to very cost-effective new treatments. In other words, should pharmaceutical companies offer very good value to the NHS in the pricing of their products, we will see faster patient access—a win for patients, a win for the NHS and a win for industry.

Secondly, NICE and NHS England are introducing a budget impact test for new medicines that are expected to cost more than £20 million in any of the first three years after introduction. I want to take this opportunity to address a number of misconceptions about this policy. The budget impact test is not a cap. It does not represent the maximum that the NHS will spend on any individual drug in a given year. The test is simply intended to provide an opportunity for NHS England to enter into commercial negotiations with companies to bring down the price of medicines that have a significant budget impact on the NHS, and in doing so will allow for the kind of flexibilities—for example, commitments around volume—that companies have been asking for. The proposal will affect only around one in five drugs and, while the proposals are intended to improve affordability, they are not intended to create delay. Most negotiations will be concluded quickly and, where agreement is not reached, a managed access scheme will ensure that those whose clinical need is greatest will be prioritised. Patients will continue to have a right to NICE-recommended drugs, as enshrined in the NHS constitution.

Thirdly, the proposals introduce a sliding cost-benefit threshold for very expensive drugs for rare diseases, evaluated through NICE’s highly specialised technologies programme. It will be possible for transformative treatments that offer significant health gains to be approved up to £300,000 per quality adjusted life year, or QALY. That is 10 times greater than NICE’s threshold for treatments considered by its mainstream technology appraisal process. I do not believe, as some have suggested, that the new threshold will prevent medicines being approved via this route. In fact, with increased commercial capacity within NHS England to strike win-win deals, I am very optimistic that patient access will continue for genuinely transformative medicines.

Lastly, let me also be clear that these arrangements apply to new medicines after 1 April. Any suggestion that a patient receiving a medicine approved under the previous arrangements will have their medicine withdrawn due to these changes is wrong.

I turn to the amendments considered in the other place. The Commons rejected the previous amendment proposed by the noble Lord, Lord Warner, a new version of which he has tabled for discussion today. For reasons I have already explained, I do not believe that the Bill is the right vehicle for promoting the life sciences sector or improving patient access: it is only about providing value for money. Furthermore, there are three specific problems with the amendment.

--- Later in debate ---

The Minister says that the Bill is concerned only with value for money and not with patient access and investment in life sciences. However, this is the Bill before us and this is our opportunity to say to the Government that they have got to do something about speeding up access to medicines, not only for patients but in order to strengthen and support a key element in our economy. For that reason, I support the amendment.

[Lord O'Shaughnessy]

My Lords, I am grateful to all noble Lords for the points they have made in the discussion we have just had. I will try to deal with as many of them as I can in my response.

I am afraid that we do not agree with the first point of the noble Lord, Lord Warner, about the change of wording to make it more flexible. Such wording as exists in the current amendment would increase the risk of judicial review. As my noble friend Lord Lansley pointed out, it would impair our ability to crack down on those companies that are abusing the NHS by raising prices in a completely unwarranted way. I cannot believe that this is what noble Lords want.

The noble Lord, Lord Warner, referred to the Bill providing a pausing mechanism. It is important to point out and remind noble Lords that the Bill requires a consultation before the beginning of any new statutory scheme. One of the key amendments that we made—indeed, I accepted proposals from others in Committee and on Report—was to introduce an affirmative resolution on extending price controls into the devices realm. So those consultations and pauses already exist—and they do so in a way that is appropriate to the core purpose of this Bill, which is to control costs.

The noble Baroness, Lady Walmsley, referred to the balance that is being struck. She is quite right that there is a balance to be struck, but that does not mean that the balance needs to be struck in each and every item of government policy. As my noble friend Lord Lansley pointed out, this Bill is not the right vehicle to achieve support for the life sciences and industry and to improve patient access. These aims are achieved through other routes, as I have outlined, and the Government are doing a huge amount of work on them.

I wholeheartedly agree with all noble Lords on the importance of the life sciences sector and of improving patient access. The noble Lord, Lord Hunt, was right to point out that, post Brexit, it will be more important than ever. The noble Baroness, Lady Masham, said that this is not just a macroeconomic point; it is about the lives of humans, often in great suffering, who need to have access to medicines. I thank her for bringing that out. It is precisely why the Government are developing an ambitious strategy and a sector deal; and it is precisely why I have been keen to ensure that the NHS is seen as a partner and beneficiary of that deal. Rather than this being seen as something that is done to it, it has to be a counterparty, as it were. I disagree with the noble Lord, Lord Hunt, because we are seeing improvements in uptake for the reasons that I have outlined.

In the course of dealing with the Bill, while I have had complaints from the life sciences sector about certain things that we have done—I will touch on those in a moment—it is fair to say that I have not received any complaints from the industry that this Bill will affect it negatively. It understands that the Bill is about providing equality between the statutory and voluntary schemes, cracking down on those who seek to abuse the system and making sure that there is proper information to inform the price control schemes that we have.

Looking further ahead, from 2019 onwards we will need to look at the medicine and pricing regulation system in the round—and we will be doing so from a position of being outside the European Union. It is therefore absolutely essential that we have a world-leading price and regulatory environment. I am looking at all aspects of that now and talking to industry and others. As my noble friend Lord Lansley pointed out, it is only right to consider the changes introduced by NICE and NHS England as we look to a comprehensive solution from 2019 onwards.

While we are talking about the outcome of that consultation, I should point out that it was provided in response to the Public Accounts Committee and that there is no threat to the independence of those organisations. I completely agree with the noble Baroness, Lady Finlay, in applauding the reputation that NICE has around the world and the fact that the life sciences industry values getting NICE technology approvals.

The changes being made are consistent with the NHS constitution. I explained in my opening statement how this will work and I have addressed the misconceptions. This is not about delay or reducing uptake, it is about costs, and indeed the changes bring about a variety of positive and welcome benefits to commercial agreements and to a fast-track appraisal process.

The noble Baroness, Lady Finlay, asked what proportion of the growth in the drugs bill has been driven by branded drugs. She will know that that is quite difficult to define because of the issue of what are known as parallel imports. These are branded drugs that are outside the schemes which come in, but of course they make a contribution to the bill. As a country we are one of the best, if not the best, in the OECD in terms of the use of generic drugs, which of course is one way of holding down the bill and creating headroom for innovative drugs. There is a good story to be told about that.

The noble Baroness also mentioned orphan drugs and she is quite right to highlight them. There is the highly specialised technology route. I should also point out that there are routes and specialised commissioning within NHS England, including the commissioning through evaluation programme. These routes have been invented by NHS England to facilitate access to drugs, not to delay it.

To conclude, I want to return to the amendment itself. I should stress to noble Lords that this is not a cost-free amendment and it is not simply a declaratory piece of legislation. It would increase costs to the NHS for drugs for no benefit. No more drugs would be bought and no more people would take them up. Indeed, it would take money away from other care settings. The Government cannot agree with an amendment that would put the NHS at such a disadvantage. I do not believe that it would be in the interests of either patients or the health service. The House of Commons was right to reject the first version of the amendment and this version does not substantively change the intent. I hope and trust that noble Lords will take the same approach in rejecting it, but before that I would like to ask the noble Lord, Lord Warner, on the basis of the arguments that I have made in response to his key points, to withdraw it.

[Lord Warner]

My Lords, this has been an interesting debate and I thank noble Lords for their contributions. I do not interpret this amendment in the same way as the Minister and I am slightly surprised that he thinks there is a happy mood in the industry about all this because that certainly does not square with my contacts. I would also like to draw his attention to a comment made during a pink ribbon conference recently by the oncologist who heads chemotherapy commissioning for NHS England. He was talking about the budget impact test: “That is why we expect the £20 million figure to hit cancer drugs much more than other drugs”. I think that that is quite an interesting revelation which suggests that some of those who are closer to this than perhaps the Minister and me take a different view about how the budget impact test actually works in practice.

The Minister would have had plenty of time, if he had accepted the principle behind the amendment, to negotiate with us a form of wording that would deliver its intent. He has spent his time trying to get us to take it out of the Bill. He has more access to draftspeople than I do. If he had accepted the principle, we could have come up with wording that is more to his taste. Neither he nor his officials have co-operated with that kind of approach. I believe that this amendment as it stands would be of benefit to patients, to UK plc and to the industry. I wish to test the opinion of the House.

Healthcare: Spending

Lord O'Shaughnessy Excerpts

Tuesday 4th April 2017 Lords Chamber

[Lord Clark of Windermere]

To ask Her Majesty’s Government whether they will increase spending on healthcare as a percentage of gross domestic product to be in line with the G7 average.

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

My Lords, since 2010 health spend has increased in real terms and is broadly in line with the EU average. This Government are giving the NHS an additional £10 billion above-inflation increase in its annual funding by 2021. We have now gone beyond that, with £425 million of new capital spending for the NHS announced at the spring Budget, and we have pledged to provide further capital at the autumn Budget.

[Lord Clark of Windermere (Lab)]

My Lords, I thank the Minister for his Answer, which goes a long way towards explaining why the NHS is at breaking point. Our hospitals and GPs’ surgeries are full, social care is on its knees and staff are working in impossible conditions. Those are not my words; they are the words of the BMC, which knows what it is talking about. My Question is not about Europe; it is about the G7. First, will the Minister confirm that as a country we are next to the bottom of the G7 nations in health spend? Secondly, why will the Government not commit us to meeting the average of the G7 countries, which would go a long way towards reviving our wonderful National Health Service?

[Lord O'Shaughnessy]

The noble Lord makes the point that the NHS is operating in challenging conditions, not least because of rising demand and expectations. Notwithstanding that, there is a huge improvement in performance. More operations are being performed, there are more diagnostic tests, more people are starting cancer treatment, and people say that they have never been more satisfied with the quality and dignity of care that they are receiving. Those are the points that we need to bear in mind when we talk about the fantastic work that NHS staff do.

[Baroness Brinton (LD)]

My Lords, perhaps we can push the Minister for a clear answer on this. The average spend of G7 economies is 10.4% of their GDP in comparison with the UK’s 9.8%—a gap of £10.3 billion. The Government are proudly saying that they are putting in just under £0.5 billion this spring, with a bit more capital to follow, but what are they going to do to address that shortage, given that £10 billion could provide 10,000 extra GPs and other help in primary care?

[Lord O'Shaughnessy]

As I referred to in my previous answer, the Government have provided additional funding to the NHS—£10 billion more by 2020. It is also worth noting that since the 2015 election over £9 billion of additional funding has been found for social care, which of course has huge strains upon it, and that makes a big difference.

[Lord Bird (CB)]

Does the noble Lord agree with Brian Ferguson, the chief economist of Public Health England, when he says that prevention is much more cost effective than other forms of intervention and that we have to push up the amount of spending on that, which is in the region of 4% to 5%? Is the Minister prepared to talk to MPs and Lords who want to push up the amount spent by this Government on prevention methodology in this country?

[Lord O'Shaughnessy]

The noble Lord is quite right: we need to move from an NHS that deals with illness to one that promotes healthcare, and preventive healthcare is a huge part of that. We are providing over £16 billion of public health funding for local authorities to do that over the period of the spending review. Of course, I shall be delighted to meet any Peers and MPs who want to talk about that further.

[Lord Davies of Oldham (Lab)]

What is the Minister’s response to the fact that we have seen the largest sustained reduction in spending as a percentage of GDP in the history of the NHS? Does not that explain why the NHS system is in crisis?

--- Later in debate ---

[Lord O'Shaughnessy]

The noble Lord might be interested to know that health funding as a proportion of public spending has increased since 2010, from just over 18% to almost 20%. He talks about a challenging position, but that is not just because of rising demand or an ageing population. It is worth remembering that when the coalition Government came into office, we were borrowing £150 billion a year. It is a fantastic testament that we have managed to increase spending on healthcare in real terms while dealing with the problems that Labour left us.

[Lord Lamont of Lerwick (Con)]

Does my noble friend not agree that in making comparisons between the proportion of GDP spent on health by ourselves and other G7 countries, one reason there is a difference is because most other countries in the G7 have a variety of funding sources and are not all providing tax-funded services? Some of them have larger voluntary sectors and some have a larger contribution from the private sector. Although this is a very real problem, is not one avenue for changing things that ought to be considered looking to expand the private and voluntary sectors as well?

[Lord O'Shaughnessy]

My noble friend is quite right to point out that there are different funding systems in different countries. We, of course, have a taxpayer-funded system that is free at the point of use, which this Government are fully committed to. There are different ways of funding healthcare. However, it is worth reflecting on polling carried out by Ipsos MORI which showed that 69% of the public said they get good healthcare in the UK, contrasted to just 57% in France and 59% in Germany. That is a huge testament to the work that everyone in the NHS does.

[Lord Crisp (CB)]

My Lords, does the Minister accept that there is a real problem here? On prevention and the work that NHS England is trying to do to change the system, does he further accept that there is a need for transitional funding, not least for running services in parallel? Additional funding is needed to make the changes that need to happen.

[Lord O'Shaughnessy]

The noble Lord is quite right and he speaks with great authority on this issue. The sustainability and transformation plans are providing the changes that we are looking for. That is precisely why additional capital funding was announced in the Budget: to provide and seed that kind of change so that we can run in parallel services that we need to reduce and upscale those that we need to increase, particularly community care.

Hospitals: Patient Transport

Lord O'Shaughnessy Excerpts

Tuesday 4th April 2017 Lords Chamber

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

My Lords, it is the responsibility of local NHS commissioners to decide how best to deliver patient transport services. We do not centrally monitor these waiting times. The eligibility criteria for patient transport services stipulate that patients should reach appointments in a reasonable time, in reasonable comfort and without detriment to their medical condition. Where local issues arise in the delivery of these services, we expect commissioners to take swift action.

[Lord Harries of Pentregarth (CB)]

I thank the Minister for his reply. Recently, I had to take my wife, who is extremely disabled, to hospital using hospital patient transport. After a satisfactory medical appointment we then had to wait three and a half hours for hospital transport to take us home. The following day I took her to another hospital and there we had to wait one and three-quarter hours. In the light of this experience, I asked around and discovered that some people are having to wait as long as six hours—and these are people who are extremely disabled, and some of them are without escorts to take them to the loo. Does the Minister agree that this is totally unsatisfactory and that there needs to be a proper system of monitoring and, if necessary, sanctioning the private companies that are now operating this service?

[Lord O'Shaughnessy]

I am sorry to hear of the wait faced by the noble and right reverend Lord’s wife, and indeed others. Those delays do not sound acceptable. There are clear guidelines in the standard contract for commissioners to outline the quality of patient services, and they are inspected by the CQC. I would certainly be happy to meet him to talk about this in more detail and find out exactly what is going on.

[Baroness Walmsley (LD)]

My Lords, according to the NHS website, there are some areas in which patient transport services are not available. I want to ask the Minister two things about that. First, what should patients in those areas do if they need transport? Secondly, are the Government going to hold to account the CCGs that are not commissioning these services?

[Lord O'Shaughnessy]

There are challenges in patient transport, particularly in rural areas. That was one of the reasons for the Department for Transport creating the Total Transport pilots in an attempt to deal with the problem. In Devon, the local authority and CCG are now working together to provide better transport. As I said, it is in the clinical commissioning standard contract to provide that kind of transport and NHS England is responsible for making sure that it is provided.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister said that there are no national targets in relation to patient transport services, but there are targets in relation to ambulance services. Can he tell the House when those targets were last met by the ambulance services in England? Can he also tell me why, in the mandate for 2017-18 to NHS England, no guarantee is given that the NHS will come back to meeting those ambulance targets? Can I take it that, just as the Government have now decided to drop the 18-week target for surgery, they are also dropping the idea of a target for ambulance services to be met?

[Lord O'Shaughnessy]

I am afraid the noble Lord is wrong on the 18-week target—it has not been dropped. It is within the mandate. The 18-week target is being fulfilled in the vast majority of cases. Performance is much better than it was 10 years ago in terms of both median waits and the number of people who are waiting. I do not have the precise figure for ambulance services. However, they are in the mandate and local trusts are expected to deliver against the targets in the mandate.

[Lord Polak (Con)]

My Lords, some patients cannot use patient transport. Your Lordships will be aware of the story in the press over the past 24 hours about the desperately ill young man and father of two. If he lives past midnight tomorrow, when the changes to the widowed parent’s allowance take effect, it will mean a substantial financial loss to his family. This is not a story—it is real. His wife and mother of his two children is a close friend of my wife. Other families will be in the same situation. Will the Minister talk to his ministerial colleagues so that the Government can display understanding and humanity and allow this brave young man to pass peacefully from this world with dignity, in the knowledge that the financial future of his children is taken care of?

[Lord O'Shaughnessy]

I am sorry to hear about the case of this young man and offer my sympathies to both him and his family. I appreciate the urgency and I understand that this person may not have long to live. I shall certainly speak to colleagues as soon as humanly possible and come back to the noble Lord with information on the situation.

[Lord Hunt of Kings Heath]

My Lords, the noble Lord said the Government have not dropped the 18-week target. What on earth, then, did the chief executive of the NHS mean when he said on Friday that the NHS would not achieve that target and that it would take less priority than other targets?

[Lord O'Shaughnessy]

The chief executive of the NHS was talking about the relative priority and importance of achieving A&E waiting times in particular to the targets that it is not hitting at the moment. The five-year forward view delivery plan refers to the fact that elective operations will continue to increase and that the median wait may move marginally. However, it is worth pointing out that 10 years ago the median wait for an in-patient for an elective procedure was 15.6 weeks—under a Labour Government, of course—and in January this year it was 10.6 weeks. The median may increase but it is still within the 18-week target.

[Baroness Royall of Blaisdon (Lab)]

My Lords, the statement from Simon Stevens was very honest and welcome but it means some profound changes in the National Health Service. Will the Government come forward with a statement as to how these changes will be implemented and when?

--- Later in debate ---

[Lord O’Shaughnessy]

The five-year forward view delivery plan is a publication by NHS England. We continue to back it to deliver its ambitious plans, which include further increases in diagnostic tests and making sure that even more people survive cancer. We are focused on ensuring that the system is as efficient as possible in order to do this.

[The Archbishop of York]

My Lords, the Minister speaks with such clear diction that we can hear every word he says. He is not producing a drama, but although I have been listening to him carefully, I do not think that he has answered the Question put to him by the noble and right reverend Lord, Lord Harries. He asked what steps were being taken,

“to reduce waiting times for patients using hospital patient transport”.

I did not hear the answer. All I heard was that the Minister was willing to have a word with him, but it is not just about the noble and right reverend Lord and his wife. A lot of other people are in the same predicament. We want to know what those steps are. That is the nature of the Question and, if I did not hear the response, I apologise.

[Lord O’Shaughnessy]

I thank the most reverend Primate for giving me the opportunity to come back on this. First, NHS England is working with clinical commissioning groups to make sure that the kind of delays outlined by the noble and right reverend Lord, Lord Harries, do not happen. Also, a series of 39 pilots are being conducted in rural areas which are particularly badly affected by patient transport delays to put in place the kind of transport necessary to make sure that people who cannot get to hospitals and may miss appointments are able to do so.