NHS: Staff

Debate between Lord O'Shaughnessy and Lord Forsyth of Drumlean

Tuesday 13th November 2018 Lords Chamber

[Lord O'Shaughnessy]

We agree that there is a need for more staff, and indeed there are more NHS staff than ever. I can tell the noble Lord that we are increasing doctor, nurse and midwife training places, and more GPs than ever started training in the NHS this year. With an ageing and growing population, we absolutely recognise the need for more doctors, nurses, midwives and many other professions. The Budget made no changes to health spending.

[Lord Forsyth of Drumlean (Con)]

My Lords, will my noble friend acknowledge that, as nurses are not paid highly, they will not repay the loan for their maintenance grant or tuition fees? Therefore, would it not make sense to allow them to go back to bursaries? In the long run, this would save the taxpayer money and mean that 30 years from now we would not have to write off a substantial loan—or, rather, the nurses who have not benefited from that support would not have to pay to write off that loan. Is it not time that the Government looked at the fiscal illusion that has led to this state of affairs and moved instead to a system that would help in the recruitment of more nurses?

[Lord O'Shaughnessy]

I greatly respect my noble friend on this topic, which we have gone around several times. As he knows, I defend the current system as being the most progressive. Nevertheless, I am grateful for his report, which he sent me and which I am reading with interest. However, at this point, we are confident that we have the right policy.

General Practitioners

Debate between Lord O'Shaughnessy and Lord Forsyth of Drumlean

Wednesday 17th October 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is correct, unfortunately: she is using accurate figures. We have not achieved the GPs numbers that we wanted but we still intend and need to recruit those other 5,000 GPs. It is worth pointing out that the funding for general practice will have increased by around £2.5 billion over the five years between 2015 and 2020, so I do not accept her point about funding shortfalls. The money is there, but we need to recruit more GPs and keep them in the service.

[Lord Forsyth of Drumlean (Con)]

Is my noble friend aware that one of the reasons that the numbers of GPs are falling is because, when they get to age 55, they find that their pension contributions are taxed at 55% due to the Government’s decision to lower the threshold for their pension funds? They then rejoin the health service as locum doctors, thus costing it more. Is it not time that the Treasury learned the unintended consequences of interfering with pension rules?

Personal Social Care: Funding

Debate between Lord O'Shaughnessy and Lord Forsyth of Drumlean

Tuesday 16th October 2018 Lords Chamber

[Lord O'Shaughnessy]

It is the Scottish Government’s decision to do that. Of course, they receive higher public funding per citizen than we do in England, and we make different decisions, just as we have on higher education funding and so on. As I said to the noble Baroness, the details of the proposal will be set out in the Green Paper during the year, and I am afraid that the noble Lord will have to wait.

[Lord Forsyth of Drumlean (Con)]

Will my noble friend resist the temptation to do what has been done in Scotland, which is to announce free personal care, only for people to find that the resources are not there and the care is not available to them because of rationing? We need a properly funded system which will give everyone the quality of care that they need.

NHS: Staffing

Debate between Lord O'Shaughnessy and Lord Forsyth of Drumlean

Wednesday 10th October 2018 Lords Chamber

[Lord O'Shaughnessy]

It is absolutely not the case that they are not valued as much as in Scotland. This country has completely different higher education funding arrangements from those in Scotland. We are taking multiple routes to increase the number of nursing staff in the NHS, including increased funding for clinical places, the nursing apprenticeship route, more retention and bringing nurses back into the profession. We are determined to increase nursing numbers.

[Lord Forsyth of Drumlean (Con)]

My Lords, has my noble friend had the opportunity to read the Economic Affairs Committee report, Treating Students Fairly, which shows that by 2050 the write-off on student loans will be £1.2 trillion? Given that most student nurses are not paid sufficiently to be able to repay most of that money, why not write off the loans for graduate nurses at an early stage in their careers and show a commitment to the health service—and actually save the taxpayer a lot of money 30 years from now?

[Lord O'Shaughnessy]

I am aware of my noble friend’s long-standing interest in this area. It is an issue on which we disagree. I happen to think that the changes to the funding of higher education introduced by a Labour Government and continued by the coalition Government provide a fair distribution of benefit and cost to both the taxpayer and those who benefit from higher education.

NHS: Equitable Access

Debate between Lord O'Shaughnessy and Lord Forsyth of Drumlean

Thursday 5th July 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Baroness made some fantastic recommendations, which we have adopted. I mentioned the Topol review of skills, which will make sure that clinical skills are there to adopt technology. It is expected that all GP practices and secondary care trusts will offer free wi-fi by the end of this year.

[Lord Forsyth of Drumlean (Con)]

My Lords, the Question is on the availability of new drugs equitably across the NHS. Is my noble friend satisfied with the independence of NICE, given that ibrutinib is not available to patients in England after a round of chemotherapy of more than three years, but is available to patients throughout the rest of the United Kingdom?

[Lord O’Shaughnessy]

I am more than satisfied with the independence of NICE. I am grateful to my noble friend for raising this issue, which we have talked about both in and outside the Chamber. NHS England is currently considering further evidence on the prescribing of that drug for that group of patients, after I asked it to do so.

Cannabis-based Medicines

Debate between Lord O'Shaughnessy and Lord Forsyth of Drumlean

Thursday 21st June 2018 Lords Chamber

[Lord O’Shaughnessy]

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

[Lord Forsyth of Drumlean (Con)]

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

Hospices: Impact of NHS Pay Increases

Debate between Lord O'Shaughnessy and Lord Forsyth of Drumlean

Monday 18th June 2018 Lords Chamber

[Lord O'Shaughnessy]

It is important to reiterate that, in looking at one of the consequences of the Agenda for Change pay deal, the Government have committed to look at the impact not just on hospices but on staff who are not employed on Agenda for Change NHS contracts and to make sure that they are properly rewarded for the work they do.

[Lord Forsyth of Drumlean (Con)]

My Lords—

Chronic Lymphocytic Leukaemia: Ibrutinib

Debate between Lord O'Shaughnessy and Lord Forsyth of Drumlean

Thursday 7th June 2018 Lords Chamber

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

My Lords, the National Institute for Health and Care Excellence recommends Ibrutinib for the treatment of patients with chronic lymphocytic leukaemia who meet specified clinical criteria. NHS England is required to make funding available so that clinicians can prescribe treatments in line with NICE’s recommendations. NHS England has processes in place to transfer NICE’s recommendations into its commissioning systems, and I will be meeting both NHS England and NICE on Tuesday to seek assurance that their processes were appropriate in this case.

[Lord Forsyth of Drumlean (Con)]

My Lords, I am very grateful to my noble friend for that Answer and for his courtesy in meeting the patient support group at very short notice before the recess. What is the point of NICE if NHS England can get away with denying funding to some patients with relapsed chronic lymphocytic leukaemia, contrary to NICE guidance that Ibrutinib was an option for all patients relapsing after chemo-immunotherapy? Is my noble friend comfortable that clinicians in England, but not in Scotland or Wales, are being forced to reuse chemotherapy against their clinical judgment and at considerable risk and suffering to their patients? Is it not now time to listen to the advice set out in a letter to the Times of 18 May by our leading clinicians and bring the bean counters in NHS England to heel?

[Lord O'Shaughnessy]

First, I thank my noble friend for the question and for the opportunity to meet sufferers of this illness two weeks ago. As he and the House know, the point of NICE is to provide that expert, objective evaluation of the benefits of drugs both clinically and in terms of value for money. It has clearly made a recommendation in this case. I also know that there is concern about the discrepancy between NICE’s guidance—or, I should say, the summary in section 1 of that guidance—and NHS England’s commissioning guidance, which is narrower. It is precisely that concern about a discrepancy that we are investigating at the moment, and which will be the subject of the meeting that we are having. Once I have more information on that, I shall of course write to him and place a copy of that letter in the Library.

Health: Cancer Nurses

Debate between Lord O'Shaughnessy and Lord Forsyth of Drumlean

Wednesday 2nd May 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness will know that the NHS benefits from many of those visas issued under tier 2, which obviously has great benefits for our workforce. It is in the long-term interests of this country that we recruit more of our staff, wherever possible, from the domestic workforce. On that basis, Health Education England has committed to increase the number of cancer consultants by more than 20% between 2016 and 2021, as well as increasing the number of radiographers and others.

[Lord Forsyth of Drumlean (Con)]

My Lords, does my noble friend really think it necessary that specialist cancer nurses are educated to degree level? If he does think that, given that because of their levels of remuneration most of the student loan will not be paid back, would it not be a good idea to consider writing off those student loans for those nurses who stay for a period within the health service?

[Lord O'Shaughnessy]

What comes to life in the cancer workforce strategy and the Macmillan report is the complexity of the workload that these nurses carry out, so a very high level of qualification is required. One thing we do not have at the moment is a national competency framework, which is being designed. Funding for nurses is obviously a topic that we come to often in this House and it is worth noting that the income point at which repayment of the loan starts has been increased by this Government, to make sure that lower-paid nurses and other staff are alleviated from that burden.

General Practitioners: Workforce

Debate between Lord O'Shaughnessy and Lord Forsyth of Drumlean

Monday 5th March 2018 Lords Chamber

[Lord O’Shaughnessy]

That is an important issue. We know that workload is a problem. I point the noble Lord and other noble Lords to NHS England’s 10 high-impact actions. These are actions which all GP surgeries can take; for instance, using technology such as e-booking and e-prescribing to reduce the kind of workload he is talking about.

[Lord Forsyth of Drumlean (Con)]

My Lords, does my noble friend not acknowledge that one reason that GPs are retiring after the age of 55 is that their salaries are such that their pension exceeds the limit, which the previous Chancellor reduced from £1.8 million to £1 million, and they find themselves having to pay tax on their pension contributions at 55%? Would not the simple solution be to raise the threshold, thereby allowing GPs to continue in practice and not be taxed on their pension contributions unfairly?

Nurses: Tuition Fees

Debate between Lord O'Shaughnessy and Lord Forsyth of Drumlean

Wednesday 29th November 2017 Lords Chamber

[Lord Forsyth of Drumlean (Con)]

Can my noble friend indicate what percentage of the borrowing by student nurses under the student loans scheme will be paid back at the point when it is written off after 30 years? If so, would it not be better to do this earlier in their careers, rather than at the end of them?

[Lord O'Shaughnessy]

My noble friend is quite right to point out that student debt is forgiven after 30 years. The point of that is to ensure there is an equitable system, where those who earn more pay back more over the course of their working lives. It is important to point out that, with the new threshold moving up to £25,000, a nurse earning £26,000 in band 5 of the Agenda for Change pay scale would pay back £7.50 of that loan per calendar month.

Health and Social Care

Debate between Lord O'Shaughnessy and Lord Forsyth of Drumlean

Thursday 12th October 2017 Lords Chamber

[Lord O'Shaughnessy]

The Government have not dropped Dilnot. We will be consulting on both the cap and the floor in the proposals that come forward on social care funding, which build on the Dilnot proposals.

[Lord Forsyth of Drumlean (Con)]

Does my noble friend recognise that the importance of the cap on people’s contributions was that it made it an insurable element, and therefore it could be incorporated in people’s long-term pension and other plans? Will the Government please revisit the idea of abandoning the cap, which was a central part of Dilnot?

[Lord O'Shaughnessy]

I reassure my noble friend that he is quite right to point out the benefits that attend to a cap. The intention is to consult on both the floor and the cap.