General Practitioners: Indemnity Scheme

Lord Patel Excerpts

Monday 16th July 2018 Lords Chamber

[Lord O’Shaughnessy]

I can tell my noble friend that the scheme we are designing is for England, the jurisdiction that the department looks after. However, the Welsh Government have announced their intention to have a state-backed scheme and we are speaking to the devolved Administrations in Scotland and Northern Ireland to make sure that we act together in this regard.

[Lord Patel (CB)]

My Lords, when the scheme is introduced, what plans are there to reduce the level of litigation in primary care, considering that the majority of primary care practitioners are independent contractors, and those who are not are employed by GP principals and not by the National Health Service?

Hepatitis C

Lord Patel Excerpts

Monday 9th July 2018 Lords Chamber

[Lord O'Shaughnessy]

The first thing I would say to the noble Baroness is that, in terms of sexual health clinics, local authorities are mandated to commission comprehensive testing services. Clearly, however, testing needs to happen in many more areas. We have introduced testing in pharmacies, for example, for hepatitis C. That has proved very effective in identifying it in people who take drugs, as well as offering other opportunities to test particularly high-risk communities. Another example is that there has been an increased screening of the south Asian population, where there is a much higher prevalence. It is about using the opportunities of community health services and taking testing into those communities, so that we can deliver on our target.

[Lord Patel (CB)]

My Lords, direct-acting antivirals are the greatest advance that has occurred in trying to eliminate hepatitis C infection—it is effective in 95% of those who carry the infection. So a policy that does not treat everybody who is known to have the hepatitis C virus is wrong. Secondly, if we are to eliminate it, we need to identify those who carry the virus but are not diagnosed. Strategies focusing only on the prison population will not do that. Thirdly, we need to reduce the risk in the at-risk population by educating them. Unless we have a strategy across these three areas, we will not eliminate hepatitis C by 2025.

[Lord O'Shaughnessy]

I agree with the noble Lord that we need a whole-system approach, but I do not think that we necessarily need to condense that into a document. There are lots and lots of things going on, some of which I have talked about. Of course, the WHO target is about the elimination of hepatitis C as a public health risk; it is not about elimination completely. As he said, it is very difficult to find everybody who has not yet been diagnosed. The main thing is that it is reduced as a health risk: it does not kill people anymore and cannot be transmitted. That is what we are on track to do by 2025.

Health: Endoscopy and Bowel Cancer

Lord Patel Excerpts

Monday 2nd July 2018 Lords Chamber

[Lord O'Shaughnessy]

I will have to write to the noble Lord with an answer to his question about the type of endoscopy he mentions, as I do not have the details of it. The risk of false positives is one reason that we have to be extremely careful with screening programmes of all kinds, whether it is the faecal immunochemical test or an endoscopy. As he knows, whatever screening programmes are implemented, the National Screening Committee tries to reduce the number of false positives wherever possible.

[Lord Patel (CB)]

My Lords, given that we have one of the poorest outcomes compared with other health services in the developed world and that the demographic changes that will occur in the population may well mean that one in two people will develop cancer, are the Government aware of what determinants there are for poor outcomes? What plans do they have to improve them for cancer patients?

[Lord O'Shaughnessy]

The noble Lord is quite right to point that out. While outcomes have improved, they lag behind those of other countries, which we need to correct. The independent cancer taskforce set the goal of saving 30,000 extra lives a year by a number of different routes. The one that I pick out in particular is early diagnosis. We know that too many cancers are diagnosed at a late stage, so this year the NHS has committed to increasing the proportion of cancers diagnosed at stage 1 or stage 2, and we are spending £200 million in cancer alliances to support early diagnosis in the community.

Chronic Lymphocytic Leukaemia: Ibrutinib

Lord Patel Excerpts

Thursday 7th June 2018 Lords Chamber

[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.

[Lord Patel (CB)]

My Lords, I agree with all the things that the noble Lord, Lord Forsyth of Drumlean, has said. Ibrutinib as a drug was developed after an extensive study to understand the biology of the disease, chronic lymphocytic leukaemia, which increasingly affects older people. Because it was developed following an extensive biological study, it is a targeted drug. In technological terms, it is a tyrosine kinase inhibitor. Therefore, it is more effective in the treatment of this disease and has a better outcome, and some countries have adopted this drug as the first line of treatment. We have used the guidelines that say that the first line of treatment—apart from patients who meet certain criteria, such as those with 17p deletion, who will be given the drug—will be chemotherapy. That then subjects people who have relapsed to a second toxic treatment with chemotherapy, which is wrong. For NHS England to use criteria that are completely arbitrary, except for cost, is also wrong. It should be required to produce the scientific evidence for that, and I hope that the Minister will agree.

[Lord O'Shaughnessy]

I thank the noble Lord for his question. There are two important issues here. First, on this treatment as a first-line treatment, the evidence that was put into NICE by the company itself did not propose its use as a first-line treatment, which is why it has been proposed as a second-line treatment. It is important to distinguish there. However, clearly there is this apparent discrepancy between the NICE guidelines and NHS England. I have, obviously, investigated this, subsequent to the meeting with my noble friend and sufferers. NHS England’s view is that its commissioning guidelines are consistent with the commissioning when the drug was in the cancer drugs fund, and the full NICE guidance, but I also know that that is not satisfactory to some of the patients suffering from this illness who have been in remission for three years. That is precisely what I want to get to the bottom of next week.

NHS: Cybersecurity

Lord Patel Excerpts

Wednesday 2nd May 2018 Lords Chamber

[Lord O'Shaughnessy]

My noble friend makes an excellent point. Not only is it critical that data is joined up for direct care—quite rightly, patients are amazed when that does not happen—it is an absolutely essential resource for research into new treatments. One thing we are doing to try to provide that reassurance to the public, which has not always been there, is introducing a new data opt-out at the end of this month to provide that reassurance for patients who do not want to be part of it. We are focused on providing that resilience and security so that they can be confident that, when the NHS holds their data, it uses it securely, safely and legally.

[Lord Patel (CB)]

My Lords, one of the lessons learned following the WannaCry attack was that the weakest links in the NHS had to be identified. The Minister has already referred to the upgrading of software that was found to be weak. What work is being done to identify other areas in the NHS that would be open to cyberattacks?

[Lord O'Shaughnessy]

The noble Lord makes an excellent point. One thing we are now doing is more intelligence-led penetration testing based on work that the Bank of England does, which is to probe in a safe way any weaknesses and to make sure that they are dealt with. The CQC has also added data security to its well-led criteria for inspections. We have now demanded that a board member of each trust takes responsibility for cybersecurity. Indeed, for a trust to be rated as well led, it has to demonstrate that competence.

The Long-term Sustainability of the NHS and Adult Social Care

Lord Patel Excerpts

Thursday 26th April 2018 Lords Chamber

[Lord Patel (CB)]

I truly say “Hear, hear” to the Minister, and thank him for his response. He has covered everybody’s concerns and the points raised in the debate in great detail, for which I thank him.

I recognise that good progress is being made, but among that good progress is a need to do more to integrate the care and make the NHS a truly outcome-based service. I was always for a commission. We had a debate here three years ago, in which there were 22 speakers, three previous Secretaries of State, and only two dissenters. Both dissenters were on the Front Benches, so there is nothing new; nothing changes. As I said in my introduction, the reason is that election time comes, and the NHS is a good topic for trying to win votes.

However, I now see a chink of support towards a political consensus, and I hope that today’s debate has contributed to that, and that there will be other times to help to do that. I also thank most sincerely each and every one of you who spoke today. It has been a tremendous effort. I recognise the great support that noble Lords have given to this report and to this debate today. There were many more: over 10 people had to drop out because the dates were changed, and I had more than 24 emails or notes from people saying that they would have liked to have taken part but could not. There is a great deal of interest in this House on the subject of the NHS and all the issues related to it, such as science, development, et cetera.

I see that there is no acceptance for an office for health and care sustainability, but its time will come. There will be a time when the public will demand it and some independent scrutiny of health and social care. I await the developments of the 70th-year celebration that the Minister mentioned. I await the Green Paper, and no doubt we will have an opportunity to discuss that. We await the report from the Institute for Government that is looking at bodies, like the OBR, that we suggested. It has been a great debate on which we have spent nearly seven hours, with fantastic contributions.

Motion agreed.

Health: Online Services

Lord Patel Excerpts

Monday 23rd April 2018 Lords Chamber

[Lord O’Shaughnessy]

I would have to look at the specific clinics that the noble Lord is talking about. The subject of the report was those providing online services. One of the things it discovered was that certain regulatory issues are unique to the provision of online services, an example of which is when the data is held offshore and what that means for regulation. As the CQC says in its report, it is reviewing its regulations to make sure that it can account for the unique aspects of online provision, so that the critical aspects, whether they are about truthful advertising or other aspects, are dealt with properly.

[Lord Patel (CB)]

My Lords, as the noble Lord is aware, there is an increasing number of independent primary care practitioners. What assessment have the Government made of the impact of that on the medical workforce of the NHS?

[Lord O’Shaughnessy]

I am not specifically aware of such an evaluation, but I know that there is a need for more general practitioners, which we are all aware of, and indeed for a plan to recruit many more to the service to ensure that all patients and citizens of this country can find a GP in the NHS when they need it.

Children and Young People: Mental Health

Lord Patel Excerpts

Wednesday 28th March 2018 Lords Chamber

[Lord O'Shaughnessy]

That is an excellent question. A terrifying statistic is that 8,000 of those under 10 years old are suffering from severe depression. The designated leaders will be in every school; that is the ambition. We are also rolling out mental health support teams to support all schools, both primary and secondary, so I can reassure the noble Baroness that primary schools are within the scope of the plans.

[Lord Patel (CB)]

My Lords, following on from the right reverend Prelate’s question, I would like to make a plea. Will the Minister agree that the proposed mental health support team should work with the voluntary sector—particularly the children’s voluntary sector—especially in the area of palliative care, and in children’s hospices, where children are bereaved by the death of their siblings and the incidence of mental health problems is also extremely high?

[Lord O'Shaughnessy]

The noble Lord makes an excellent point, and I will make sure it is fed back into our deliberations.

HPV Vaccinations

Lord Patel Excerpts

Monday 26th March 2018 Lords Chamber

[Lord O'Shaughnessy]

We are beginning a national rollout of the programme for men who have sex with men in terms of the provision, because of course they are not necessarily getting the indirect benefits from the girls’ immunisation programme. I do not have the details of the working relationships with the devolved Administrations, but I shall write to the noble Baroness with details.

[Lord Patel (CB)]

My Lords, I am glad that the Minister said that the committee looking at the benefits of immunisation to boys recognises the wider benefits of immunisation for both boys and girls. However, he did say that it was not convinced about the cost effectiveness. Is that cost effectiveness merely for the cost of the programme if instituted now or the long-term benefits?

[Lord O'Shaughnessy]

The committee has to take a number of considerations into account—the public health benefits, short-term and long-term, and cost effectiveness—just as NICE does when approving medicines. It has to make a judgment about whether the incremental pound spent could be better spent across the entire health system, where, of course, there are many competing demands. But it is up to it to make that decision, and that will inform its final advice.

Nurses: Training

Lord Patel Excerpts

Wednesday 7th March 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness has highlighted an important issue, which is the number of nurses in social care. I recognise that to be a problem, as does the department. A specific social care workforce consultation will get under way and is linked to the overall draft workforce plan that Health Education England has published. This is something that we are looking at. We can solve it to some extent by increasing the overall number of nurses, but we need to find ways of attracting them into the social care profession.

[Lord Patel (CB)]

My Lords, does the Minister agree that the lack of NHS nurses and other healthcare workers is due to the lack of a long-term sustainable workforce plan, as identified by the House of Lords committee report? If, following that report, the Government now have a long-term workforce plan for the NHS, when might it be published?

[Lord O'Shaughnessy]

I congratulate the noble Lord on his committee’s work in this area and on making a proposal, which we have followed in putting forward a 10-year draft plan. I hope that he will have had the chance to see that—it will of course firm into a concrete plan. It is fair to say that it is honest about both the successes and the challenges that we face in needing to train more nurses. We are trying to find new ways of doing that, not just through the university route but through apprenticeships.