Covid-19: Removal of Restrictions

Lord Patel Excerpts

Tuesday 21st April 2020 Lords Chamber

[The Lord Speaker (Lord Fowler)]

Lord Mackay of Clashfern. No? Okay, we will go on. Lord Patel.

[Lord Patel (CB)]

Noble Lords cannot see me, but I hope they can hear me. One of the five conditions the Government have set themselves before any changes will be made to the current lockdown is that they will have to be confident that there will not be a second wave of infection. What scientific evidence will the Government need in support of this decision, and what role will population-based serology testing play in this decision?

[Lord Bethell]

The noble Lord, Lord Patel, asks an incredibly perceptive question. The ultimate decisions will be made by the CMO, who, as noble Lords know, has enormous experience in this exact area. Serology tests play an extremely important role in this by giving an indication of the number of antibodies there are, whether people have a degree of immunity and therefore a sense of how far the virus has spread through the community. However, we are aware of reports that there are recurrences of the virus in people who have emerged and recovered. That creates a great sense of concern around our serology tests.

Coronavirus

Lord Patel Excerpts

Monday 9th March 2020 Lords Chamber

[Lord Bethell]

The noble Lord asks an important question about the critical element of the research phase of our plan, and we have announced £46 million of additional funding for this area. Britain’s scientists are providing a leading contribution to the international effort. That effort is being conducted in an extremely transparent, open source fashion, with important details on genomic material being shared widely and openly. My understanding is that it is being done in a spirit of public collaboration.

[Lord Patel (CB)]

My Lords, does the Minister agree that what we have learned so far from the outbreaks in other countries, and even the small number of deaths in this country, is that the vulnerable groups are people aged over 65—more men than women—and those with underlying conditions? What is the Government’s strategy to protect the elderly and reduce their risk of getting this disease?

[Lord Bethell]

The noble Lord is entirely right. The CMO’s effort is now to identify those groups who require the greatest priority of assistance. We are not sure, and the CMO has not declared, at exactly what age that should start. He is considering publication of the exact details of the priorities in future. It seems that it is not necessarily gender-specific but that the state of your immune system is the key driver. In some areas, of course, men have very bad habits when it comes to things such as drinking and smoking. The CMO has made it clear that if you want to do one thing to avoid getting the virus, it is giving up smoking.

Wuhan Coronavirus

Lord Patel Excerpts

Tuesday 11th February 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

As ever, my noble friend is astute on this issue. Contact tracing has been hugely effective, particularly for the 1,466 passengers and 95 staff who arrived in the UK on direct flights from Wuhan between 10 and 24 January. All those have now passed through the incubation period and none of them was a confirmed case. Of the remaining cases that we have found, a number are linked to contact tracing. We should be very proud of the effectiveness of our system.

On the question of antivirals, work and research is ongoing in regard to a particular HIV retroviral which has been used in this measure. That is being considered. There are three projects which aim to advance the vaccine candidates into clinical testing as quickly as possible. We are also looking at some correspondence from both diagnostic kit manufacturers and potential end users, and we are considering whether we can also improve the diagnostic kit.

[Lord Patel (CB)]

My Lords, it is always a pleasure to correct the former Secretary of State for Health. This virus is RNA in its genetic makeup. H1N1—the previous pandemic that we were worried about when we stockpiled the antivirals—had a DNA genetic make-up. Some antivirals work better with DNA than RNA, although the Minister was correct to say that there are several antivirals currently being tested to see whether they will work against the coronavirus. As far as a vaccine is concerned, it takes a long time to develop a vaccine; when you develop one, it takes even longer to see whether it is effective.

Last time we discussed this, I said that the Government were taking a proportionate action to contain the virus in the United Kingdom. I believe that to be so even today. However, we might be on the knife edge of a pandemic. If a pandemic is declared, the whole attitude to how we contain this changes. It becomes much more draconian, to stop the movement of people, isolate the index cases and identify the contacts. Currently, asking the Members of this House to wear masks would only make the public panic and ask why we are protecting ourselves when they are not being protected. It can be a good measure, but we have to wait to see how things develop. I would like to hear reassurance from the Minister that there are plans in place, so that if this becomes pandemic, the Government will take the draconian action that is required.

We are fortunate that, apart from the Chief Medical Officer Chris Whitty, who is a first-rate epidemiologist, we have Professor Piot, who discovered the Ebola virus, and Jeremy Farrar, chief executive of the Wellcome Trust. They have better knowledge on containing pandemics than anyone else in the world; I hope the Government will use their expertise.

[Baroness Blackwood of North Oxford]

The noble Lord has demonstrated, far more eloquently than me, why we have more expertise in public health, and in particular in infectious diseases, than many other nations; we of course share our expertise through the WHO with Professor Piot, Professor Jeremy Farrar and our own Chief Medical Officer Chris Whitty. We operate using the best scientific evidence and advice from SAGE, which is currently advising the risk level of moderate. We keep that under constant review and are not complacent in any way. Through the preparations that we are putting through the NHS and all other parts of the system, we will be prepared for whatever situations might emerge should there be more sustained transmission in the UK. We will take the measures necessary to protect public health. The steps that we have taken so far have been proportionate and appropriate; they also demonstrate that the Government will act as necessary to make sure that we protect public health.

Coronavirus

Lord Patel Excerpts

Monday 3rd February 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness has rightly raised this issue with me before. She is quite right that flu can and should be managed much more effectively in the community and by individuals. I think we have had an effective flu campaign this year. The flu vaccine has been offered to 25 million people. We have also extended the flu programme this year to children in year 6 to improve herd immunity and drive up its impact. We are seeing the number of those with flu declining, so we are starting to see some improvement. However, I completely recognise the noble Baroness’s point about public health lessons and improving public education on the management of infectious conditions, which we live with every winter, not just when we have an infectious situation such as this. I thank the noble Baroness for an important question.

[Lord Patel (CB)]

My Lords, in my view the measures the Government have taken are balanced so as not to cause a panic and unnecessary alarm. The important thing, though, is that the Government remain on top of developments. If the virus mutates and spreads rapidly from human to human, it will require much more draconian measures to be taken.

It has been reported that the virus transmits from human to human and to people who have not been in China, although the numbers are small. An index or measure of human-to-human transfer is known as R0. It currently stands at about 1 to 2. If it increases, that means the virus is spreading faster. Sequencing of all the known cases so far suggests that the virus has not mutated. It remains 99.98% the same sequence, including in the two patients known in the United Kingdom. I hope the Government have a strategy in place to keep on top of developments and that they will take the steps required to stop the spread.

[Baroness Blackwood of North Oxford]

I thank the noble Lord. He is right that there is a global effort to keep on top of the sequencing of the virus to track any evolution of it. As he said, the indications are that the virus has not evolved in the past month, which is encouraging. The rate of transmission is as reported. That means that the infection control measures in place, which are based on clinical evidence and the data, are proportionate and appropriate. Combined with the public health advice that has come out and the contributions each of us can make as individuals to manage the spread of infection, we believe that this is the responsible and appropriate route. However, as the noble Lord said, we will keep the developing situation under a close eye so that we can respond quickly and nimbly as the situation goes forward.

Health: Sepsis

Lord Patel Excerpts

Wednesday 22nd January 2020 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank my noble friend for this Question and I pay tribute to his work on it, and the work of the UK Sepsis Trust. I am aware of the calls for a national sepsis registry for patients. It is important that we understand the data; we are confident that it provides an accurate indication. We think that UK data is as good as it can be at the moment but that there is a clear need for better data on sepsis. The problem with the registry as proposed is that it would use retrospective data collection. We want to go beyond this with the UK’s five-year national action plan for AMR, which includes a commitment to develop the real-time patient-level data of individual patients for infection, treatment and resistance history. Work is already under way by NHS England and NHS Improvement. I hope that is the kind of answer my noble friend was looking for.

[Lord Patel (CB)]

My Lords, as a country our record for the number of deaths due to sepsis is pretty abysmal, as stated already. Most of that is due to late diagnosis of sepsis. One-third of patients die and for every hour that a diagnosis is delayed, the death rate rises by 8%. Last year, on a visit to a biotechnical company in Northern Ireland, the Secretary of State commended the development of a quick diagnostic test, which will give a result within two hours so as to start appropriate antibiotics. Will the Government make a commitment that when this molecular test is available, which is likely to be soon, it will be immediately available to the whole of the NHS?

[Baroness Blackwood of North Oxford]

The noble Lord, as always, speaks with great expertise in this area. I emphasise the work that has been ongoing to improve the picture on sepsis. Since 2015, screening for sepsis in emergency departments has improved from 52% to 89% and timely treatment for sepsis from 49% to 76%, but the noble Lord is absolutely right that we need to improve the outcomes. Early and accurate diagnosis is at the heart of this. I shall keep an eye on innovations in diagnostics. The noble Lord knows that innovation in this area is right at the heart of what I do, and I think that his proposal is very sensible.

Wuhan Novel Coronavirus: Threat to UK Citizens

Lord Patel Excerpts

Wednesday 22nd January 2020 Lords Chamber

Asked by

[Lord Patel]

To ask Her Majesty’s Government what is their strategy for protecting UK citizens from the threat posed by the spread of Wuhan novel coronavirus (WN-CoV).

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, we are monitoring closely the development of this virus. Advice from Public Health England and the Chief Medical Officer is that the risk to the UK is currently low. The UK is well prepared for the emergence of novel viruses. As part of our preparedness, we have introduced enhanced monitoring of direct flights from Wuhan to the UK and updated our travel advice for Wuhan. We continue to update health workers on how to identify, treat and contain any possible cases.

[Lord Patel (CB)]

My Lords, I thank the noble Baroness for her reply and commend the Government for publishing tomorrow initial measures for controlling the spread of this virus, if it comes to the United Kingdom. This is a newly identified virus, which probably originated in animals, particularly in the seafood markets in Wuhan. None the less, it is 80% genetically identical to the SARS virus, which killed a significant number of people. We now understand that, although the Chinese have sequenced the genome of the virus, it has mutated and can now spread directly from human to human, which raises the likelihood that it will spread more widely. The initial illness can vary and is sometimes very mild, hence the case in the United States where the diagnosis was not made on arrival at the airport in Seattle by the authorities, even though they had procedures in place. Will the Government keep a watch out and update the advice depending on how the virus develops? Secondly, will there be procedures for quarantine and follow-up contact if a case is identified, particularly if the virus mutates and becomes highly virulent?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his important and timely Question. I am happy to update the House that, from today, enhanced monitoring is in place for all direct flights from Wuhan to the UK. Public health officials will meet every direct flight from Wuhan to the UK and will be on hand to provide information about symptoms. Mandarin and Cantonese speakers will be on hand and leaflets will be available in several languages. We will also roll out enhanced monitoring of all flights arriving in the UK from China. Leaflets and information will be available across all UK airports, advising travellers from China on what to do if they feel unwell. The enhanced monitoring of direct flights will obviously be kept under continuous review and expanded if necessary. The risk to the public is low and the NHS is well prepared but, to answer the noble Lord, any patients assessed for this new disease would be isolated under standard procedures if necessary. There are a number of infectious disease units around the country that would be able to respond appropriately.

National Health Service: Pensions Tax

Lord Patel Excerpts

Wednesday 30th October 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank my noble friend for that very direct question. Our estimate is slightly different—that around one-third of GPs and consultants have earnings high enough to potentially be affected by the tapering of the annual allowance for tax-free pension savings. Not all clinicians are affected—it depends on the personal circumstances—but we accept that there is a need for urgent action in this area. That is why NHS employers have published guidance for short-term approaches that could have a mitigating effect on pension tax for the workforce this year and throughout the winter. We have also opened our consultation, which will close this Friday. We have already had 750 responses to it, and stakeholders are broadly supportive of the additional flexibility that has been proposed. We intend that flexibility to be available by April.

[Lord Patel (CB)]

My Lords, I apologise for asking another direct question. The results of a recent survey carried out by the Royal College of Surgeons of nearly 1,900 surgeons were that 68% of consultant surgeons are considering early retirement because of the pension tax situation, 64% have been advised to work fewer hours in the NHS and 69% have reduced the amount of time they spend working in the NHS. What effect does the Minister think that might have on surgical care?

[Baroness Blackwood of North Oxford]

The noble Lord is exactly right to raise this issue and we have taken it very seriously. I have met the president of the Royal College of Surgeons to take on board his concerns. It is exactly why we have brought forward this consultation as a matter of urgency and why the department is making strenuous representations to the Treasury, which is reviewing the operation of the annual tapered allowance, and it is why we will continue to make those representations. However, it is also why we are taking other actions around elective surgery so as to reduce the pressure on surgeons up and down the country.

Health Service Safety Investigations Bill [HL]

Lord Patel Excerpts

2nd reading (Hansard): House of Lords
Tuesday 29th October 2019 Lords Chamber

[Lord Patel (CB)]

My Lords, I am last and probably least. I have a problem: how much do I say? I have been here and I have done this.

It has been mentioned that this will be the first time that a world-class patient safety organisation is developed. That is wrong; it is not the first. We had one. It was called the National Patient Safety Agency, which was established by another Secretary of State. It was internationally respected for the work it did, but another Secretary of State decided that it was a quango and got rid of it. I remember the conversation that I had. He asked, “What has it achieved?” I can tell your Lordships, it achieved a lot and I can give loads of examples. However, it had also failed to achieve a lot, partly because of the volume and the methodology; it was only a drop in the ocean. It was disbanded, and I tried to persuade that Secretary of State that he should give it more statutory powers that it did not have, particularly of investigation.

Of course I welcome this Bill, because it gives the HSSIB statutory powers to investigate incidents that occur within the health service, which is not easy to do. I agree that the experiences of the aircraft industry are not always transferable to healthcare. Healthcare is complex, and many other types of issues can arise.

I should declare an interest. For 37 years I have been a maternity care clinician. I have had other positions in my life connected with patient safety, not only as a chairman of the National Patient Safety Agency but also in Scotland, implementing patient safety across the health service in all its aspects.

The noble Lord, Lord Turnberg, mentioned a case involving medicine being given through the wrong route. There were lots of examples, which have been investigated, of medicine being wrongly given through the spinal route or in long doses intravenously. We also found three cases of wrong-site surgery—but then we found that actually, there were 179 cases over three years. The agency established what is now universally regarded as an excellent idea: the surgical checklist. The Royal College of Surgeons gave it the credit—it does not deserve much credit otherwise—and it took it on board. Usually it is gung-ho, but it has taken on the responsibility of implementing what we developed as a safe surgical checklist. It is now universally accepted. By the way, the learning that we produced was also accepted in Canada, Australia and parts of the United States. Canada and Australia adopted our system in totality. So yes, it is possible to do this, but it is not easy to realise an ambition to stop however many hundreds of thousands of incidents. Neither is it necessary to chase that. It takes a long time to analyse where the system failure is. The safe space is a novel way to deal with it, but whether it is successful will depend totally on the respect that it gains of the profession, the patients and the public. If it does not gain their respect, it will be dead in the water.

There will be lots of challenges. We have already seen reports in the media—in one of the health journals, I think—about the dysfunctionality of the organisation. That will continue. We must also ensure that in its reporting it is fair and proportionate. Where it finds that there is a resource or staffing issue, as the noble Baroness, Lady Hollins, and others, mentioned, then it must say so, even though the Secretary of State and the NHS leadership might not like it. If it gives guidance that is directed to the leadership of the NHS, it must say so. That includes NHS England, the commissioners and anybody else. If it only targets the health professionals, it will fail, because system failures are not necessarily always the fault of the health professional, as we have found in many other areas. For instance, a drug was packaged in a 50-millilitre vial, even though it was always given as 5 millilitre infusion or less. The error occurred because somebody thought that 50 millilitres was the dosage and put that in an infusion, and the patient died. That had happened a couple of times in other hospitals, so we had to persuade the industry to change the packaging. It objected because of the cost, but in the end it was persuaded.

Incidents also occur in intensive care—for example, pneumonia-related incidents. By examining the system, the death rate from pneumonia caused by using a humidifier in intensive care was reduced to less than 30%. I could keep giving lots of examples but the point I am trying to make is that the systems must be examined. The organisation must also make sure that it gets the respect of the profession.

The key thing is learning; where we failed was in implementing the learning. Here, the organisation must address the issue of who will implement the learning. If that is not done, three years later we will be having the same problems and the organisation will be blamed for not doing much, rather than the people who should be blamed for the implementation. In that respect, you need all the other people: not just the leadership of the NHS but professional organisations and others. I will give the example of an airline pilot’s wife who died because of failed intubation during minor surgery, in the presence of an ENT surgeon. They were all concentrating on getting the tube down to intubate while the surgeon, who was completely scrubbed, was standing there and could have done the tracheostomy in 30 seconds. But that patient died, and the Royal College of Anaesthetists took on board how to find a safe system so that that might not happen again. It implemented that through its training procedures; anaesthetists in training practised this on models. I pay great credit to it but there are lots of other examples.

I agree with the noble Lord, Lord O’Shaughnessy, and others who mentioned that a culture change is required whenever a safety incident happens. It is important to work wherever it happened to bring about culture change, so that we grow an attitude and mindset about patient safety. We tried to do that when working with Don Berwick, who was mentioned earlier—I think by the right reverend prelate the Bishop of London. In Scotland, we employed his expertise for three years to bring about the culture change that was required.

Governance was mentioned—I think by the noble Lord, Lord Hunt of Kings Heath—and it is an important issue. When I took over, I faced the problem of poor governance that was making the organisation dysfunctional. I spent nine months trying to get rid of everybody in the leadership of that organisation. I was the bad guy, but it was not respected because of its poor governance issues. In that respect, it would help a great deal to have a chair with experience of patient safety. I am sure that we could find one.

I also agree about the private sector. I know that I commented yesterday to the noble Baroness, Lady Finlay, that maybe the private sector ought not to be involved. However, there should be an all-systems approach. I note that a briefing I got from the private sector says that it would like to be involved.

Maternity care and childbirth injuries are an area crying out for urgent attention. Litigation is to a large degree about money. Any practice that may cause damage to the new-born is horrendous—it should not happen. There should be zero tolerance of a baby that has grown normally having hypoxaemia at birth and brain damage for the rest of its life. It must not happen. We must not talk any more about who should do it and in what way; just have a strategy so that it does not happen. I assure your Lordships that it can be done. I would not like to blow my colleagues’ trumpets, but it is possible to do it. I know that the current medical director of the HSSIB is capable of undertaking this exercise—a preliminary study on how to investigate and bring about the change that is needed in order to have zero tolerance of childbirth injury to the baby. It is possible to do that.

I look forward to Committee—whenever we get it—and I hope I can be fully involved then.

Queen’s Speech

Lord Patel Excerpts

Tuesday 22nd October 2019 Lords Chamber

[Lord Patel (CB)]

My Lords, it is a pleasure to follow the speech of the noble Baroness, Lady Doocey. I have of course been deprived of being able to congratulate the noble Baroness, Lady Emerton, on her valedictory speech, but nevertheless I would like to put on the record some points because I think that she might have been amused by what I have to say about her.

I never referred to the noble Baroness as “Baroness Emerton” or “Audrey”—I always called her matron. I think she enjoyed the idea that I, as a perhaps one-time senior doctor, was petrified of matron, as I always was. She is a formidable lady and was referred to as such by the noble Baroness, Lady Cumberlege, on the day she made her maiden speech. I say to the noble Baroness, Lady Watkins, that three nurses spoke that day: the noble Baronesses, Lady Emerton and Lady Cox, and Lady McFarlane of Llandaff—three formidable ladies, you might say. We all know that the noble Baroness, Lady Emerton, has contributed an enormous amount, quite forcefully, and has championed the causes she felt strongly about—particularly the health service and, within it, the important role that nurses play. I was interested to see that her motto is “Pro fide, pro utilitate hominum”—quite appropriate for a nurse, you might say. A more appropriate motto for her might have been “Cibum non est mecum”. I hope my Latin from a long time ago makes the point. For noble Lords who cannot translate: “Don’t mess with me”.

The Queen’s Speech said:

“Measures will be brought forward to support and strengthen the National Health Service”,


and its workforce. Furthermore, it said that legislation will be brought forward to establish,

“an independent body to investigate serious healthcare incidents”.

It also said:

“My Government will bring forward proposals to reform adult social care”.


It has been said enough already that there is, as yet, no Green Paper on reforming adult social care; we all await that.

Furthermore, the Speech said that:

“My Government is committed to establishing the United Kingdom as a world leader in scientific capability”,


and that there will be,

“a more open visa system”,

to encourage and recruit talented individuals from overseas to support our science. We have no workforce strategy as such. We have repeated comments that we are recruiting more nurses or doctors, or that we have more places for medical students or nurses. But the challenge of the NHS and social care workforce is far too great to be dealt with by those policies. I do not criticise the Government; I just say that more needs to be done.

The report following the House of Lords inquiry, The Long-term Sustainability of the NHS and Adult Social Care, made the point that the greatest challenge the NHS faces for its sustainability is its workforce. We need to do more about it. Let me give a small example. I thought the Government would bring in legislation to regulate health professionals following their July report, Promoting Professionalism, Reforming Regulation, but that did not happen. The legislation that governs the UK’s medical regulation is not fit for purpose. Noble Lords might be shocked to hear me to say that, but it is true. It is the regulation that followed the Medical Act 1983. It does not allow the flexibility to easily put on the registers GPs and specialists, particularly fully trained senior people. It has no flexibility and legislation is needed to change that. The General Medical Council is very open to this and wishes it would be done, but it is not in the Queen’s Speech.

Making specialist and GP registration more flexible could make it more accessible to doctors to join both registers and would go some way to dealing with the workforce required. We are trying to recruit more doctors because we are short of psychiatrists—as we heard yesterday—geriatricians, radiologists and many others. There is an enormous shortage of nurses, too. Change here would be helpful, and I hope the Government will bring in legislation through another Bill; otherwise, I will be minded to put forward an amendment at some stage to do this.

I now come to the science side. Two-fifths of the UK’s academic workforce in science and technology are from overseas, and 50% of postgraduate researchers are overseas staff, so we need to make sure our visa system is more flexible.

Finally, I will have a lot to say about the Health Service Safety Investigations Bill when it comes to Second Reading. All I will say at this stage is that I wish we had not started it in this place.

National Health Service: Healthcare Advice

Lord Patel Excerpts

Tuesday 16th July 2019 Lords Chamber

Asked by

[Lord Patel]

To ask Her Majesty's Government what analysis they have conducted of the impact of the National Health Service introducing the use of devices such as Amazon’s Alexa for health care advice.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, digital technology will play a key role in making the NHS sustainable. The Secretary of State’s technology vision sets the foundation for a new generation of digital services focused on user need, privacy and security, interoperability and inclusion. The collaboration with Amazon simply connects people to medical information and is already freely available through the NHS website. This service does not provide advice or any form of diagnosis. More modes to access medically verified NHS information can only give UK citizens a better understanding of different medical conditions. The agreement with Amazon is convenient for those who rely on voice-activated technology, in particular blind and visually impaired people.

[Lord Patel (CB)]

My Lords, I thank the Minister for her response and might I say it was a good defence? While I have absolute confidence that Matthew Gould—our previous ambassador to Israel who leads on the project—will get it right, voice-recognition technology has its problems. It must recognise the correct phrase, word and accent. It might be interesting to hear the answers that the Opposition Chief Whip were to get if he asked a question with his accent. I asked five questions at the weekend; all health-related. One I repeated twice and got two different pieces of advice: one was to call 999 and the other was to go to bed and rest.

I know that it is not a diagnostic technology, but it runs the risk of a diagnosis being made, so the key questions are what trials are being carried out, what data protection do we have against Amazon collecting vast amounts of data, and what is the risk of misdiagnosis?

[Baroness Blackwood of North Oxford]

The noble Lord makes very important points. It is important to understand that this is not a technology to offer advice or diagnosis. NHS Digital and NHSX have built an interface to connect the NHS website so that other organisations can make NHS information available on their own sites. That is so that a greater number of people can access NHS information. It has already been made available through a number of other examples such as NHS Go, which is designed to inform young people, accuRx and eConsult. No health data is collected by Amazon. No money is exchanged via this route and all data protection laws, such as GDPR and the NHS data protection rules, still apply. Data protection is still required to protect data through this system.