Health: Pancreatic Cancer Treatment

Debate between Lord O'Shaughnessy and Lord Turnberg

Wednesday 19th December 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Baroness makes a very important point. I am sure that she is aware of the 14 Be Clear on Cancer campaigns that have been run over the last eight years, which are absolutely about raising the salience of these issues and making sure that people know the signs they should be looking for and can come to GPs earlier. We are seeing fewer people presenting with cancer diagnosis through emergency departments, which have the worst outcomes, and more coming through GPs. Of course, as I said, we are investing in these rapid diagnostic centres as well.

[Lord Turnberg (Lab)]

My Lords, the problem with pancreatic cancer is that, by the time a patient has symptoms and a diagnosis has been made, it is almost always too late. It hides itself away for far too long. The only way to make a real impact is by having some sort of method of determining whether someone will get pancreatic cancer by having a screening programme. That depends very much on new research into the ways in which we can detect cancer cells from DNA and the peripheral blood. Research into that area is vital if we are to make any impact on pancreatic cancer. Does the noble Lord agree?

[Lord O’Shaughnessy]

I absolutely agree on that point. I hoped we would pass the “Lord Young test” with a jargon-free and, at least, succinct White Paper—the Life Sciences Sector Deal 2, which we published recently. It outlines some very important commitments to research in this area, including the creation of new early diagnosis cohorts, using a cohort of healthy people to look for early signs. That is one of the investments we are making, as well as investment through the National Institute for Health Research. We are looking for those exciting innovations, like liquid biopsies, that can help us get the signs earlier.

NHS: Specialist Services in Remote Areas

Debate between Lord O'Shaughnessy and Lord Turnberg

Tuesday 11th December 2018 Lords Chamber

[Lord Turnberg (Lab)]

My Lords, there is one important way in which patients in remote parts of the country can access specialist care: telemedicine. It is quite easy to send X-ray pictures, scans and blood test results online, and even to interview patients. I send things via WhatsApp to my children almost every other day. It is entirely possible for me to do that on my iPhone; surely the NHS can do it too. I understand that Wales has managed to do it quite well. Is it possible for us to do the same in England?

[Lord O’Shaughnessy]

The noble Lord is right. Of course it is possible for us to do it in England; it is happening all over the country. Telemedicine offers fantastic opportunities, such as Skype-based GP consultations. Indeed, there is the example of Morecambe Bay’s remote clinician pilots in a variety of specialisms, such as gastroenterology and mental health care. Clearly, that is important. I point the noble Lord to the tech vision published by my relatively new Secretary of State this autumn, which points out the massive potential for digital health in reducing these kinds of inequalities.

Adult Social Care

Debate between Lord O'Shaughnessy and Lord Turnberg

Wednesday 11th July 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord is quite right that there is a need for more money in the social care system. That is why, in addition to the funding set out in the spending review, the Government have put £9.4 billion over three years into the system in the short term. The point he makes, which is right, is about the long-term sustainability of the settlement. I would point him to the seven principles underpinning the Green Paper, which my right honourable friend set out. One of those is a sustainable funding model—a model which, as we have said, cannot put pressure on the NHS. That means that we need to find the money to ensure that it can subsist.

[Lord Turnberg (Lab)]

My Lords, the noble Lord is well aware that we need more money for social care, and that integrated care is vital. He may also be aware that Salford has successfully integrated health and social care. I am sorry to keep banging on about Salford, but it is where I spent many happy years working. It has done it very successfully, and Sir David Dalton has led it wisely. What lessons are being learned centrally, not just from abroad but from the UK and similar experiments?

[Lord O’Shaughnessy]

The noble Lord speaks with great wisdom and he is absolutely right to highlight Salford, as he always does, because it is the root of the integrated care service being put in place in Greater Manchester with unique devolution powers, and we want to see that model rolled out across the country. Of course, the point of that is to ensure a better interface between the National Health Service and social care, so that one of the problems that bedevils us at the moment—delayed transfers of care—does not get in the way of proper care.

Long-term Plan for the NHS

Debate between Lord O'Shaughnessy and Lord Turnberg

Tuesday 19th June 2018 Lords Chamber

[Lord O’Shaughnessy]

My noble and learned friend is quite right: these commissions do not always produce action. I realise that there is some frustration in the House over the delay to the social care Green Paper. I hope noble Lords will respect the fact that it is sometimes difficult to fight battles on many fronts. We have made some progress on the NHS and the army moves on to win the war on social care as well.

[Lord Turnberg (Lab)]

My Lords, I for one from these Benches welcome the influx of funds. We have been waiting quite a while for it so it is well received. Everyone knows, however—we have heard today—that without changes and improvement in social care, this 3.5% will go down the drain as well. It is not just that we need to do both together; we need provision for social care at the same time as, if not in front of, the influx of funds for the NHS.

[Lord O’Shaughnessy]

I agree with the noble Lord and thank him for his welcome. We all agree; indeed, the Statement sets out clearly that the two must go hand in glove. I should point out that additional money for social care in the short term was put in a previous Budget by the Chancellor—£2 billion extra over three years, a budget that is now growing. Clearly that was a short-term measure. Now we need to find that long-term settlement that goes hand in hand with the NHS and ensure that we have true service integration as well.

Children: Obesity

Debate between Lord O'Shaughnessy and Lord Turnberg

Thursday 10th May 2018 Lords Chamber

[Lord O'Shaughnessy]

I am turning into the commissioner of children’s programming. I am trying to remember—I think that there is actually a CBBC programme that encourages children to cook. Its name has gone completely out of my mind but it was popular with my children. The noble Baroness raises an important point. Children learn to cook in primary schools, most of which have some sort of kit that allows them to do that. It is critical for them to understand that food does not just come from packets or shops but can be created by hand—and enjoyably, too.

[Lord Turnberg (Lab)]

My Lords, is the noble Lord aware that it has been shown that having a good breakfast, such as an egg or two in the morning, reduces one’s appetite for the rest of the day, and one’s weight? One of the problems for children is that many do not get a good breakfast. Can the Government do anything to encourage breakfast as a proper meal?

[Lord O'Shaughnessy]

It goes to show that public health campaigns can be effective. I remember the “Go to work on an egg” campaign—although I had a banana myself. The serious point is that too many children do not go to school after a proper breakfast, and one of the great advances with the sugar levy has been a commitment of around £26 million to support breakfast clubs in about 1,500 schools in areas that unfortunately have the worst outcomes for healthy children and obesity. That support will help those children go to school on a good breakfast and function properly.

Children: Obesity

Debate between Lord O'Shaughnessy and Lord Turnberg

Thursday 19th April 2018 Lords Chamber

[Lord O'Shaughnessy]

All I can say is that both my noble friends are excellent examples of slim and fit young men.

[Lord Turnberg (Lab)]

I am sure that the Minister is aware that while exercise is very good for children and adults—it improves mental and physical health—it does not do much for obesity. It is food that does the worst. It is not just sugar, it is fat, and ice cream, crisps and chocolates are so appealing to children. Ice cream has twice the calories of sugar. Will he consider how to get that message across?

[Lord O'Shaughnessy]

One thing I noticed at Easter was that Easter eggs seem to have got bigger. I was counting the calories on the Easter egg that my children had. There is a serious point there. It is about reformulation, it is not just about reduced sugar, salt and so on; it is also about smaller portion sizes, and that is a measure that we are tracking as well.

General Practitioners: Workforce

Debate between Lord O'Shaughnessy and Lord Turnberg

Monday 5th March 2018 Lords Chamber

[Lord O’Shaughnessy]

My noble friend is absolutely right. As well as our commitment to increase the number of GPs by 5,000, we also have a commitment to increase the number of GP practice staff by 5,000, including 1,500 pharmacists, who provide exactly the kind of support she outlined.

[Lord Turnberg (Lab)]

My Lords, one of the reasons why general practice is less attractive than it used to be is because of the enormous bureaucratic load that is placed on GPs nowadays. They have to sit on committees and on CCGs, and they rush around doing non-clinical work. Is there any way to reduce this non-clinical workload?

[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.

Children: Oral Health

Debate between Lord O'Shaughnessy and Lord Turnberg

Monday 4th December 2017 Lords Chamber

[Lord O'Shaughnessy]

Yes, I agree with my noble friend. Preventive care is important. Pilot schemes have been going on in 75 practices to look at incentivising preventive care and population care. I understand that an evaluation report of that first full year of prototyping is due to be published in the new year.

[Lord Turnberg (Lab)]

My Lords, regarding fluoride and dental decay in children, can the Minister provide figures for the incidence of dental decay in areas that fluoridate their water compared with those that do not?

[Lord O'Shaughnessy]

I do not have that exact comparison in front of me. I understand that areas that fluoridate have much better oral health than others, which is why, as I said to my noble friend, we encourage all local areas to look at the evidence and make decisions accordingly.

Nurses and Midwives: Numbers

Debate between Lord O'Shaughnessy and Lord Turnberg

Monday 4th December 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Lord’s mental maths are far better than mine. I agree that it will provide for the possibility of yet more funding for the NHS, which is something that this Government have delivered in the past seven years.

[Lord Turnberg (Lab)]

My Lords, I wonder whether the Minister can help clear up my confusion. He is telling us that the number of training places is increasing while my noble friend Lady Thornton suggested that the number of people coming into those places is decreasing. What is the correct interpretation? Have we got more, fewer, or what?

[Lord O'Shaughnessy]

I will do my best to provide clarity. If you look at nurse training places in universities, in 2016 the number was 3% higher than this year. One reason for that has obviously been the change in the financing arrangements. However, this year still represents the second-highest number since it became a degree profession. If we look to the future, from 2018 onwards there will be 5,000 more funded clinical placements which will enable the number of nurse training places to increase by some 20% to 25%.

Health and Social Care: Falls Prevention

Debate between Lord O'Shaughnessy and Lord Turnberg

Thursday 30th November 2017 Lords Chamber

[Lord O’Shaughnessy]

I accept that there is a challenge that we have to meet in social care: it is the reason that the Government are committed to a social care Green Paper next summer to provide long-lasting reform. In the meantime, I hope that my noble friend will recognise that another £2 billion was announced in the previous Budget to go into social care over the next three years in order to move people out of inappropriate hospital stays and into their homes. That is backed up, as I pointed out, by a doubling of the disabled facilities grant year on year, precisely to provide the kind of interventions that have a huge pay-off for the public sector. Something like £1 spent on the disabled facilities grant saves £4 in the wider public sector, so this is very important work.

[Lord Turnberg (Lab)]

My Lords, one of the main causes of fracture of the hip in someone who falls is osteoporosis, which is both preventable and treatable. Will the Minister consider starting a screening programme for at-risk groups?

[Lord O'Shaughnessy]

That is a very interesting idea. I will write to the noble Lord. Of course, since this summer general practices are now obliged to carry out screening of over-65s specifically to look at frailty, looking at those with mild, moderate and severe frailty, and that may already include osteoporosis. But I will write to him with the specific details.

Greater Manchester Combined Authority (Public Health Functions) Order 2017

Debate between Lord O'Shaughnessy and Lord Turnberg

Tuesday 7th November 2017 Lords Chamber

[Lord Turnberg (Lab)]

My Lords, perhaps I may ask the Minister about infectious diseases and express my interest as a past chairman of what was the Public Health Laboratory Service and as a Mancunian. Infectious diseases know no boundaries, and it is important with any infectious disease outbreak, which may occur anywhere in the UK, that information is spread very easily to epidemiological centres and central laboratories, so that such outbreaks can be traced and checked. Is there anything in this agreement that will ensure that there is association, collaboration and co-operation with the central laboratory services?

[Lord O’Shaughnessy]

I thank noble Lords for their contributions and for their broad support for the order before the House today. As I outlined, it represents another significant milestone in the Government’s devolution agenda and I am glad that that has been welcomed across the House. I will try to respond to the various points that noble Lords have made.

Like the noble Lord, Lord Hunt, we support the idea of the population plan, which will clearly differ from place to place where there is this kind of devolution. I stress that an important and distinctive part of this plan is that it confers on the combined authority the same powers and responsibilities as a local authority. It is therefore about them acting concurrently, rather than in an overbearing way, or seeking to override.

I have been in your Lordships’ House long enough to know that fluoridation is an area of particular interest. I wonder only why it has taken so long for me to have to answer a question on it. This is a devolution deal, and it is therefore about those powers being taken locally and acting in concert. I do not think it is consistent with the idea of devolution for me to urge any combined authority to point in one direction or another, and it sounds like my noble friend Lady Gardner has been doing plenty of urging already. Any such move would have to be made in concert by all 10 of the local authorities and the combined authorities and be done through the usual processes of consultation and so on, with regard to all the responsibilities that attend on those public health powers. I hope that provides some reassurance to my noble friend Lady McIntosh.

Health: Sepsis

Debate between Lord O'Shaughnessy and Lord Turnberg

Thursday 14th September 2017 Lords Chamber

[Lord O’Shaughnessy]

I am sorry to hear that sepsis has affected the noble Baroness’s husband in that way and I am glad to learn that he is not one of the more than 40,000 people who die from the condition every year. Public awareness is critical and, as I say, we are looking at new ideas for how to get the message across using a range of routes. The point about clinical awareness is also very important. Until a couple of years ago, there was no widespread clinical awareness of the symptoms of sepsis and how to assess and then treat people, but we have seen quite a big improvement. I can give one example. For those presenting with symptoms in emergency departments, previously only around half were assessed for sepsis; the figure is now up to nearly 90%. I see that as good progress, but clearly there is much more to do.

[Lord Turnberg (Lab)]

My Lords, one of the major difficulties with sepsis is the fact that it is so speedy. It can kill within a few hours. Awareness of this speed is vital—for the public and for practitioners.

[Lord O'Shaughnessy]

That is absolutely right but I draw the attention of the noble Lord to a couple of things. First, in the NICE quality standard published yesterday there are some very clear statements about the speed with which people suspected of these symptoms should be treated. Those are quite robust in terms of getting intravenous antibiotics to people within an hour, being reassessed by a senior clinician if they then fail to improve within an hour and so on. That is very clear and there is implementation guidance going through. Another thing announced yesterday is quite important. It is a slightly odd phrase but “safety netting” is where someone has been assessed on whether they have sepsis, does not have it but is sent away with materials that show what the symptoms might be and how to report back if their condition deteriorates.

Health Workers: Training

Debate between Lord O'Shaughnessy and Lord Turnberg

Wednesday 18th January 2017 Lords Chamber

[Lord O'Shaughnessy]

The Prime Minister has been incredibly clear on this point—and was again yesterday. It is our intention to do so, and to agree that early with our EU partners. But that is something that needs to be reciprocated.

[Lord Turnberg]

My Lords, we certainly need more doctors and nurses. The problem is that we are not retaining as many as we should, and there is no doubt that they feel denigrated and devalued. They really need to feel appreciated rather than kicked around all the time. Are the Government going to help them in any way whatever, or are they going to be constantly criticised?

[Lord O'Shaughnessy]

I do not believe that we are criticising. To take the noble Lord’s point, he is right that there is often negativity in the media about the performance of health professionals. But it is worth pointing out that in a recent poll earlier this week, those who believe that the NHS provides a high standard of care is now at 71%, up 13% since 2013. That is a huge testament to the amazing work that our NHS does.