General Practitioners: Workforce

Lord Patel Excerpts

Monday 5th March 2018 Lords Chamber

[Lord O'Shaughnessy]

My noble friend is quite right—there has been anecdotal evidence that that is the case. Of course, any policy changes are well above my pay grade, but I should point out that that does not seem to have affected early retirement among dentists and consultants, so it is possible that another critical factor is at work.

[Lord Patel (CB)]

My Lords, it is suggested that part of the reason for the failure of junior doctors to be recruited as GPs is the nature of GP contracts, which treat them as independent contractors. I know that several are now employed as salaried doctors, but do we have figures for how many salaried GPs, as opposed to principal general practitioners, are employed by the NHS?

[Lord O'Shaughnessy]

That is an evolving model, as the noble Lord has pointed out, and I will write to him with the exact figures. The partnership model has an enduring popularity and importance, which is why the Secretary of State has asked for a review of it. However, as we see new models of care develop, I am sure that salaried GPs will become more of a feature of the system.

NHS: Waiting Lists

Lord Patel Excerpts

Monday 26th February 2018 Lords Chamber

[Lord O'Shaughnessy]

It is absolutely our goal and obligation to return to the referral-to-treatment standard. It is worth pointing out that the NHS has been dealing with an annual growth in demand of around 4%, which is extraordinary when looked at historically. What we have seen in the plan set out a few weeks ago are important steps to get a grip on that, including halving the number of 52-week waits, halting the growth in the waiting list and delivering more every year. Clearly that is an interim step and more needs to be done; the way to achieve that is by continuing to provide real-terms increases, which we have done and will continue to do, and by dramatically increasing the number of staff in the NHS, which again we have done. We have also increased the number of training places.

[Lord Patel (CB)]

My Lords, does the Minister agree that imposing a mandatory time of up to 16 weeks for elective surgery, as it has recently been reported that many clinical commissioning groups are doing, is wrong, and that how long a patient should wait for elective surgery needs to be a clinical decision?

[Lord O'Shaughnessy]

The length of time to wait should always be a clinical decision; I completely endorse that. CCGs have responsibility to manage demand according to local needs, but in the end, it must be a clinical decision.

Disabled People: Social Care

Lord Patel Excerpts

Tuesday 20th February 2018 Lords Chamber

[Lord O'Shaughnessy]

I do not want to disappoint the noble Baroness, but she is aware that more money is going in. To address the specific issue that she talks about—and I obviously can talk about it only from the point of view of the Department of Health—we want and are seeing more disabled people going into work. I would point to one big investment that the Department of Health is making, which is the disabled facilities grant. That is about making sure that disabled people can live at home and have their independence, which of course is critical to maintaining their physical health and confidence to make them, in a way, ready to go into work. I know that there are other programmes being put through job centres and the Department for Work and Pensions to make sure that they are supported, too.

[Lord Patel (CB)]

My Lords, I take this opportunity to thank the Minister for laying before Parliament today the government response, 11 months after the report was produced, to the House of Lords Select Committee report on the long-term sustainability of the NHS. We will now get an opportunity to debate the report and the Government’s response in due course. One recommendation that was accepted was the renaming of the Department of Health as the Department of Health and Social Care. Attached to that was the recommendation that the budgets should be amalgamated so that we can provide social care to all those who need it—both care for the disabled and adult social care. Would he like to comment on that?

[Lord O'Shaughnessy]

I am glad to be able to publish the response at last, and apologise again for how long it has taken. I am pleased to report that we have not just changed the name of the department but given the strategic direction for social care policy back to it. That also includes strategic direction of funding—but the actual funding settlement happens through the local government funding settlement. I have to disappoint the noble Lord on that because there are no current plans to change it.

Health: Pelvic Mesh Implants

Lord Patel Excerpts

Tuesday 6th February 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Baroness is quite right to say that it is not just about having the guidelines but making sure that clinicians follow them. Professional standards demand that clinicians do follow them, and indeed a clinician would need to be strongly justified in using mesh implants outside of the guidelines. They include things like gaining consent, providing information and registering operations that have been carried out. The guidelines are very strict and we expect clinicians to follow them.

[Lord Patel (CB)]

My Lords, does the noble Lord agree that, while we cannot be sure why New Zealand and Australia have suddenly announced total bans on the use of mesh implants, the evidence suggests that of the 20% of women who suffer from complications, most of them had been treated for pelvic floor prolapse, not stress incontinence? Banning their use completely at this stage for women with certain conditions who may benefit from them would, without further evidence, be completely wrong.

[Lord O’Shaughnessy]

The noble Lord speaks with great experience. Obviously, a number of procedures are involved, and NICE is now looking at extra procedures to provide the guidance. It does look like it is not the right thing to do in cases of prolapse, but it can be a very successful course of treatment for other conditions. It is important to take a differentiated approach.

NHS: Clinical Negligence

Lord Patel Excerpts

Wednesday 31st January 2018 Lords Chamber

[Lord O'Shaughnessy]

We absolutely have. Indeed, the PAC investigation and the National Audit Office report on this issue are very thorough and looked at the causes and drivers behind it. One is increased NHS activity—not worse safety but the fact that the NHS is doing more. The investigation also looked at the legal environment and some of the changes that have occurred. The noble Baroness is right: a number of firms offer these services. That is important for access to justice but we also need to fix the costs that they can claim so that we get this budget under control.

[Lord Patel (CB)]

My Lords, the statistics show that 46% of the litigation cases involve misdiagnosis and 34% involve surgical errors. However, the largest settlements are for obstetric cases, particularly those related to babies who have suffered brain damage at birth. The important thing is to prevent these accidents occurring. The key issue here is better and continuous training in interpreting foetal heartrate patterns during labour. That is what we should focus on—preventing these cases happening.

[Lord O'Shaughnessy]

I completely agree with the noble Lord and make two points in response. He will know of the Secretary of State’s great passion for this area and of the maternity safety training funding and other training funding. From April, we will introduce the healthcare safety investigation branch, which will investigate each of the 1,000 incidents noted by the Each Baby Counts project which occur at birth, whether brain damage or neonatal death, precisely so that we can learn from that experience and make sure that those who provide these services are properly trained to avoid these incidents wherever humanly possible.

NHS: Nurse Retention

Lord Patel Excerpts

Wednesday 17th January 2018 Lords Chamber

[Lord O’Shaughnessy]

On the specific and most recent workforce data—if we are going to get into the specifics of nurses only—in May 2010 there were 273,071 nurses and in September 2017 there were 275,356, so that is an increase. I shall certainly look into the figures with which I wrote to the noble Lord. Of course, I intend always to be truthful. I am reading from the latest workforce stats.

As for nurses on wards, the noble Lord will know that the number has gone up. An important response to the scandal of Mid Staffordshire and the Francis report was to increase nurse numbers. We know that that has a consequence for other professions—I have talked about that quite openly—and in mental health and district nursing. That is why we want to increase the number of nurses in those areas.

[Lord Patel (CB)]

Does the Minister agree that the real issue is the lack of long-term workforce planning of all health professions, including social care? That planning should address the changing demography of citizens and the changing pattern of disease—and involve flexible training. Does he agree that that is what is required, and that what we have now is too many individuals or organisations trying to address the workforce? While he is at it, could the Minister also put on record when the Government will respond to the Select Committee of this House’s report on NHS long-term sustainability, which was published 10 months ago?

[Lord O’Shaughnessy]

The noble Lord speaks with great wisdom and experience. He is quite right about the need for long-term workforce planning. I hope that is why he will welcome the 10-year strategy that Health Education England is launching. It is looking at diversifying the working population—for example, through the growth in the number of nursing associate training places.

On the report, I can only apologise again for the delay. I hope that at least the noble Lord will welcome the fact that in the reshuffle the health department gained social care policy. That was one of the issues on which he wanted to promote greater integration.

Health: Atrial Fibrillation and Stroke

Lord Patel Excerpts

Tuesday 12th December 2017 Lords Chamber

[Lord O’Shaughnessy]

On the stroke strategy, a follow-on plan is being developed by NHS England and its partners, including the Stroke Association, which will take forward that approach. The noble Lord will also be pleased to know that it is an integrated-service approach including ambulances, community care and secondary care. On the point about reorganisation, he is quite right that London has seen excellent success through the specialisation and concentration of services, and we certainly encourage the rest of the country to do that too.

[Lord Patel (CB)]

My Lords, during the House of Lords Select Committee inquiry on the long-term sustainability of the NHS we heard a great deal of evidence demonstrating the great variations in care, in the treatment not only of atrial fibrillation but of other conditions. Is it not time that we made the NICE guidelines, which are very clear about the management of patients with atrial fibrillation, mandatory to reduce the variation in care and improve outcomes?

[Lord O’Shaughnessy]

As the noble Lord will know better than anyone, making them mandatory is a challenge because of the importance of clinical autonomy. What we can make mandatory is an understanding of those guidelines and that they inform every treatment pathway. That is part of what the NHS RightCare programme, which is now rolled out across the country, is doing. It is introducing new things such as stroke pathways so that there is clarity about the options available. Patient choice is at the centre of that decision.

HIV Prevention Services: Public Health Funding

Lord Patel Excerpts

Thursday 30th November 2017 Lords Chamber

[Lord O'Shaughnessy]

I quite agree with the noble Baroness. As I said, across England about 12% or 13% of gay and bisexual men and other men who have sex with men are undiagnosed. That is clearly unacceptable and means we are still not yet meeting the UNAIDS target. I will point out a couple of the interventions happening to try to address that in addition to the ones that I have already mentioned. A new contract has been awarded by Public Health England to the national HIV prevention programme for the most at-risk populations precisely to try to reach them. Another £600,000 is being given to 12 schemes under the HIV innovation fund. By definition, the people we need to reach next are the most difficult to reach because they have not come into the system.

[Lord Patel (CB)]

My Lords, as PrEP is clearly scientifically assessed through meta-analysis to be the most effective treatment for reducing incidence of HIV for the at-risk population, will the Minister say how widely this treatment is available for the at-risk population through the NHS?

Maternal Safety Strategy

Lord Patel Excerpts

Tuesday 28th November 2017 Lords Chamber

[Lord Patel (CB)]

My Lords, credit where credit is due: I commend the Government for this initiative. It was first suggested some years ago but that does not matter; it is here now. My question relates to the root cause analysis, which is rightly the way to analyse stillbirths that occur. It should take account of all the circumstances, including staffing levels, as mentioned. It is not just about the care itself. Can the Minister clarify how the system of doing root cause analysis of every stillbirth will work if, at the same time, a coroner is doing an investigation?

[Lord O’Shaughnessy]

I thank the noble Lord for his support for today’s announcements. Obviously, independent investigations are just that. They will be operated by HSIB, which will be able to delve into the causes of the tragedy, however it might have happened, and provide an opinion on that. On the interaction with the coroner’s report, obviously we have focused mainly today on these new independent investigations and we are looking at extending coronial law to take in stillbirths that were previously not included. That is one of the issues that needs to be worked out in the coming months through interaction with the Ministry of Justice.

NHS: Deficit

Lord Patel Excerpts

Wednesday 22nd November 2017 Lords Chamber

[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.

[Lord Patel (CB)]

My Lords, the Minister has said previously that he read the cross-party House of Lords report on the long-term sustainability of the NHS and adult social care with enthusiasm. No doubt he will have noticed several recommendations in it that would go a long way towards making the NHS financially stable and sustainable over the long term. Does he agree that what is now enthusiastically required from him and from the Government is to accept those recommendations? A short answer made up of a three-letter word will suffice.

[Lord O’Shaughnessy]

The noble Lord waits patiently. I pay tribute to the quality of the report and we have already accepted some of the ideas set out in it. Now that the Budget is over and the Treasury can turn its mind to additional things, we will be responding to the report very soon.