NHS: Accident and Emergency Departments

Debate between Lord O'Shaughnessy and Baroness Manzoor

Tuesday 5th February 2019 Lords Chamber

[Baroness Manzoor]

My Lords, I have already said that performance targets are important. The Academy of Medical Royal Colleges released a statement on 30 January, which said:

“Reviewing, updating and improving the clinical standards to ensure that they remain relevant and appropriate is sensible and overdue. We support an evidence based review that is driven by clinical considerations as to what is appropriate, that informs and promotes changes in service delivery where needed and involves wide input from all relevant parties … any review may suggest change or reinforce current measures”.


I could not have put it better myself.

[Lord O'Shaughnessy (Con)]

My Lords, the acid test for any waiting-time targets is the clinical outcomes they deliver. In 2017, NHS England recommended—and the department subsequently accepted—reforms to the ambulance waiting-time targets, but that took place only after a two-year clinical trial and an independent assessment by the University of Sheffield of the impact on patients of all kinds of severity. I suggest that, if there is to be movement in this area, it should proceed cautiously and only after following a similarly robust and objective process.

[Baroness Manzoor]

My Lords, of course I entirely agree with my noble friend. As I have said, there will be robust evaluation, monitoring and assessment before any targets are put in place.

Sepsis: National Register

Debate between Lord O'Shaughnessy and Baroness Manzoor

Wednesday 30th January 2019 Lords Chamber

[Baroness Manzoor]

My Lords, there is a clear need for better data collection on sepsis, but a registry uses retrospective data collection. Through the Government’s new national action plan on AMR, we will go beyond this and develop real-time patient data collection through data linkage. We will be working on this very closely.

[Lord O’Shaughnessy (Con)]

My Lords, my noble friend is quite right to highlight this issue, and collecting this dataset is incredibly important. One of the ways it can be useful is in developing new diagnostic tools that will diagnose sepsis earlier through the use of technology. Can the Minister reassure the House that the dataset that she says will be collected will be available to the researchers and innovators developing these tools, to make sure we can diagnose sepsis quickly, fight it and deal with some of the deaths that my noble friend has highlighted?

[Baroness Manzoor]

My noble friend is right. Data linkage will make it easier to identify those most at risk of infections and sepsis, and to get them treated much quicker. Once that data is available, we will ensure that clinicians and everybody else in the NHS has that information so that they can deliver treatment as quickly as possible.

Health: Medicines Shortage

Debate between Lord O'Shaughnessy and Baroness Manzoor

Tuesday 22nd January 2019 Lords Chamber

[Baroness Manzoor]

My Lords, absolutely. Having medicines for some of the most vulnerable people in our society is key and fundamental. Of course, as a government department we are doing everything we possibly can to ensure medicines reach those who need them.

[Lord O'Shaughnessy (Con)]

My Lords, my noble friend has given us reassurances about the work that the department has been doing, and it is good to see that, in securing the additional ferry capacity, the need for all medical products—not just prescription only, but general medicines and others—has been catered for. One thing we also need to look out for are those who would seek to take advantage of the situation we face as a country to hike up prices. In 2017, the Government took powers in the health service supplies Act to make sure that, in extremis, we can not only ask for information but also impose prices where we think inappropriate pricing may be happening. Can my noble friend reassure us that, if necessary—and I hope it will not be—the department would be prepared to act?

[Baroness Manzoor]

I thank my noble friend for that question. From a personal perspective, the answer must of course be yes, and the noble Lord will know that better than I. But I am afraid I do not have that answer, and so I cannot confirm it at this point. I will have to write to my noble friend.

Health: Chief Medical Officer’s Recommendations

Debate between Lord O'Shaughnessy and Baroness Manzoor

Monday 21st January 2019 Lords Chamber

[Baroness Manzoor]

My Lords, as I said, the Government take very seriously the CMO’s recommendations and in previous years have taken them on board. The Government are striving to address the inequalities, and, as we said in the Statement on the NHS plan, £4.5 billion is going into the preventive agenda through increased investment in primary medical and community care. We are addressing inequalities in obesity and are looking to reduce by 2030 the gap in obesity between children from the most and least deprived areas.

[Lord O’Shaughnessy (Con)]

My Lords, one of the best ways to reduce health inequalities is to make sure that we have truly personalised medicine—which the CMO references in her report. She talks about health being transformed by 2040 by integrating biomedicine, technology and behavioural sciences. Can my noble friend say what the NHS is doing to embrace the innovations that will lead to this kind of healthcare?

[Baroness Manzoor]

My noble friend is absolutely right: emerging technologies will transform healthcare and are doing so already. Variables can transform the prevention, diagnosis and management of long-term conditions such as diabetes. Indeed, information from monitors worn by patients with atrial fibrillation can be downloaded by their clinicians. We are also looking at more creative solutions regarding artificial intelligence, which will go a long way to improving the healthcare of patients.

NHS Long-term Plan

Debate between Lord O'Shaughnessy and Baroness Manzoor

Monday 7th January 2019 Lords Chamber

[Baroness Manzoor]

That is almost all my brief. I echo the sentiments expressed by the noble Lord about my noble friend Lord O’Shaughnessy. The noble Lord is basically asking about next steps and who will be accountable for the plans. That is the question I asked: who is in charge? NHS Improvement and Health Education England are looking at workforce planning and clinical placements for nurses. They will relate to NHS England which is looking at the overall framework. The intention is that the work that my noble friend Lady Harding will be taking on will feed into workforce planning, and we will produce an overall framework in relation to clinical issues. A template will also be produced so that we know what best practice is, and this can then be filtered down to local areas through the integrated care system and clinical commissioning groups. NHS England will retain the overall strategy for all this. I hope that I have answered the noble Lord’s questions. As he knows, there are variations and a number of health inequalities around the country. It is imperative that we begin to address those and that is behind part of the framework.

[Lord O'Shaughnessy (Con)]

My Lords, I thank my noble friend and other noble Lords for their kind words. It has been an absolute pleasure to work with them on health and social care issues over the last two years, as well as with the amazing staff in our health and social care system, who inspire us, treat us and look after us all the time. Like my noble friend, I am incredibly proud that in the 70th year of the NHS it is a Conservative Government who are making this historic funding settlement. However, I believe that this is an important document for another reason, which is that it marks a significant milestone in moving towards truly personal care that delivers precision medicine designed for individuals and better uses technology and the kinds of genomic medicines and innovations that the noble Lord, Lord Kakkar, talked about. It became clear to me during my time as a Minister that this can happen only if we complete the digitalisation and joining up of patients’ data so that, wherever patients land in the health system, any clinician has access to all the relevant information about them and can tailor treatments to them. Not only does that bring tremendous benefits for direct care but it has a huge positive impact on our life sciences industry, which is one of the great strengths of this country and one of our great hopes for the future. Can my noble friend confirm that the long-term plan involves the ambition of fully digitising the NHS and bringing that data together for the benefits that I have described?

[Baroness Manzoor]

I thank my noble friend Lord O’Shaughnessy for his comments. Of course, data and information are very important. It is very difficult for clinicians when they do not have good information and data, because they have to start again, asking questions and looking at the investigations that have been undertaken on a particular patient. Therefore, the future lies in the greater use of technology and data-sharing but, at the same time, this must be balanced with ensuring that safeguards regarding who accesses the data are put in place, as well as ensuring that the data is accessed with the patient’s consent.

NHS: Deficit

Debate between Lord O'Shaughnessy and Baroness Manzoor

Wednesday 22nd November 2017 Lords Chamber

[Lord O’Shaughnessy]

As the noble Baroness pointed out, additional spending is going in. I should point out that the proportion of public spending on health has increased under this Government, so even while fiscal retrenchment has taken place, more money has been spent on health. On the idea of a cross-party convention, we talk about building a cross-party consensus on social care with the Green Paper that will come out in due course. We need to focus on action. The danger with conventions and commissions is that they just prolong the process of making decisions, whereas moving ahead with decisions on both integration in the NHS and getting consensus behind reforming social care is the way forward.

[Baroness Manzoor (Con)]

My Lords, does my noble friend agree that there is nothing to prevent NHS organisations, acute services and social care working together? There are no barriers and that can be done currently. Therefore, having a commission that will prolong things is not necessary. We must exclude any barriers that exist now.

[Lord O’Shaughnessy]

My noble friend is absolutely right: there are no barriers. Indeed, the five-year forward view, in which the NHS sets out its own future, talks about integration and moving towards accountable care systems. Some capital programmes have been announced today under what will amount to a £10 billion capital programme over five years. These are precisely to deliver the transformation which is needed by making the kind of investment to provide that level of integration.

Health: Flu

Debate between Lord O'Shaughnessy and Baroness Manzoor

Monday 30th October 2017 Lords Chamber

[Lord O'Shaughnessy]

That is unexpected and would be worrying if it is true. That is not the information on which we have based our policy. Our information is that, for most people—though not all—flu jabs are effective in mitigating the risk of flu in care settings.

[Baroness Manzoor (Con)]

My Lords, the World Health Organization recommends what strain of vaccine should be developed, nine months to a year ahead. This happened before the Australian epidemic which affected the elderly and killed many people. Will the Minister confirm that the vaccine which has been developed here in the UK is both effective and relevant and that the young and elderly people do need to access it?

[Lord O'Shaughnessy]

My noble friend is absolutely right. Back in September, Simon Stevens, the head of the NHS, warned about the impact of the flu epidemic in Australia and New Zealand. The feedback on that was that the particularly vulnerable groups were the over-80s and five to nine year-olds. We have talked about helping younger children through school-based immunisation. We also have the highest uptake in Europe of over-65s getting flu jabs. There is clearly more to do because around one-third of people still do not.

Adult Social Care in England

Debate between Lord O'Shaughnessy and Baroness Manzoor

Tuesday 10th October 2017 Lords Chamber

[Lord O'Shaughnessy]

The consultation is looking primarily at the funding situation but in doing so it will have to consider the shape of the market and making sure that the whole system is put on a sustainable basis for the future, which obviously will involve looking at some of the issues the noble Lord has highlighted.

[Baroness Manzoor (Con)]

My Lords, first, I congratulate the Government on making £2 billion available to social care. That is very welcome, but there is great variation in social care across the country which needs to be tackled, as well as the need to focus and co-ordinate services between acute and social care. Can my noble friend the Minister say exactly how NHS England will be helped to ensure that this is tackled quite urgently?

[Lord O'Shaughnessy]

The noble Baroness is quite right. In social care and the delayed transfers of care from hospitals, there is a huge amount of variation across the country. The additional money that was announced in the Budget comes with a variety of conditions, which has not been the case previously. One of these is to reduce the amount of variation in the quality of services available from local authority to local authority. For the first time, a set of reviews is taking place of local authorities—some of which will be facing challenges, others will not yet be—to make sure that that interface between the NHS and social care, which is one of the big problems where the system falls down, is looked at; that people are moving forward smoothly; that money is crossing those silos; and that the kind of service being provided is joined up and is actually providing for the needs of the people affected.

Brexit: Nursing Staff

Debate between Lord O'Shaughnessy and Baroness Manzoor

Tuesday 27th June 2017 Lords Chamber

[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.

Health: Electronic Patient Records

Debate between Lord O'Shaughnessy and Baroness Manzoor

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.