National Health Service

Lord Patel Excerpts

Tuesday 10th October 2017 Lords Chamber

[Lord O'Shaughnessy]

I know that the noble Lord has been concerned about this issue. I hope that he heard my right honourable friend the Secretary of State announce last week not only an increase in the number of nursing associate places, where qualification is through an apprenticeship route, but a 25% increase in the number of degree training places and funding for the clinical placements that they involve.

[Lord Patel (CB)]

Can the Minister say whether he found helpful the House of Lords Select Committee report on the long-term sustainability of the NHS and social care?

[Lord O'Shaughnessy]

The noble Lord knows that I found it extremely helpful. It has pride of place on the coffee table in my office, and we will of course respond to it in due course.

NHS: Shared Business Services

Lord Patel Excerpts

Tuesday 27th June 2017 Lords Chamber

[Lord O'Shaughnessy]

Clearly, if there were such an incidence, the noble Lord is quite right that it would be dealt with very strongly—but it is important to point out that there has not been evidence that that has happened. Documents were destroyed that sat within SBS, but they were not part of the backlog and they conformed, as we understand it, to the protocols around destroying old papers when they have gone past a certain time limit. So there is no evidence that what the noble Lord described has happened in this instance—but, as he points out, if it had happened it would be of the utmost seriousness.

[Lord Patel (CB)]

My Lords, what is the governance mechanism of this joint private venture? Considering that one of the key tasks is to deliver letters and patient reports in a timely manner to GPs’ surgeries, what risk assessment was made during the process of the work?

[Lord O'Shaughnessy]

Yes, this specific case was a joint venture between a private company and the Department of Health, which has a share and director places on the board. The department had a director on the board of this joint venture throughout. Part of the problem was that the issue of this unacceptable practice was not brought to the attention of the board until far too late in the process. That is obvious from the timeline that has been set out. The particular issue about redirection is no longer the case. Mail is now returned to sender if it is not delivered, rather than creating opportunities for the things going wrong that happened through this redirection service.

NHS and Adult Social Care

Lord Patel Excerpts

Wednesday 5th April 2017 Lords Chamber

Asked by

[Lord Patel]

To ask Her Majesty’s Government what is their assessment of the long-term sustainability of the National Health Service and adult social care.

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

My Lords, the NHS and adult social care systems face unprecedented challenges due to an ageing, growing population and rising expectations. Making these systems sustainable for the long term depends on changing the way that services are delivered, with much greater emphasis on integration and keeping people well and independent for longer, as set out in the NHS Five Year Forward View and delivery plan.

[Lord Patel (CB)]

I was hoping that the Minister might thank us for the brilliant and well-written report published today. It is, following a great deal of difficulty, a consensus report from all sides of this House, including the Spiritual Benches, and I hope that it will be met with political consensus when the politicians have had time to digest it. It has identified some key threats to the long-term sustainability of health and social care, and I shall allude to just one of them: if we do not get a long-term settlement for social care funding, healthcare will continue to suffer. The report makes some good suggestions, including how individuals who can afford it can make a contribution to funding the long-term sustainability of social care. I hope that the Minister will take that on board when he devises the Green Paper on social care.

[Lord O'Shaughnessy]

I thank the noble Lord for that. I did not want to get ahead of myself but I thank him and all members of the committee for their work in putting together this document. I appreciate that it is an incredibly thorough and important piece of work, and I am also grateful to have received an embargoed copy of it yesterday. I will of course look carefully at all the recommendations and respond properly in due course. I am sure that we will also have an opportunity for a longer debate.

The noble Lord specifically asked about social care, and I completely agree with the priority attached to it in the report. He will know that the Government have committed more money in the short term to support social care, with £2 billion more having been announced at the Budget. But I know that his emphasis and the emphasis of his committee was on long-term reform. He is quite right to point out that the Green Paper is a very important opportunity to take a broad perspective and to put the system on a sustainable long-term footing.

Gene Editing: Agriculture and Medicine

Lord Patel Excerpts

Monday 27th March 2017 Lords Chamber

[Lord Patel (CB)]

My Lords, I would like to take the discussion about regulation further. The question that the noble Lord, Lord Winston, just asked emphasises that we need a regulation in place now that is balanced, so that we can allow the researchers to progress further, including if necessary to demonstrate why germline gene editing may be necessary but should not be allowed. We lead the world in immune gene editing, as shown in the example of Layla, a one year-old girl who was treated for acute megaloblastic leukaemia, which was the first such case in the world. Does the Minister think it right to ask the appropriate departments in those agencies to produce something now on the regulation of gene editing that would be appropriate for Parliament to discuss?

[Lord O’Shaughnessy]

My noble friend is right to highlight the potential of gene editing by referring to that life-saving treatment of a girl with leukaemia. We have a world-leading regulatory climate and there are strict rules governing research in this area: for example, research involving the use of embryos is allowed up until 14 days but not beyond. We should certainly carry on with that research—indeed, we have a more permissive regulatory environment than in much of the world. As my noble friend rightly points out, we need to do that with the purpose of respecting life and of course reducing harm, driven by the desire to do so.

Tobacco Control Plan

Lord Patel Excerpts

Thursday 23rd February 2017 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord makes an extremely important point. There are big variations in levels of smoking, not just by socioeconomic group. I was disturbed to see that 37% of people with mental health conditions smoke, which is twice the overall prevalence. We also know that there is a huge variation in the number of women who smoke when pregnant. Targeting that variation, which has a number of dimensions, will be a core part of the strategy.

[Lord Patel (CB)]

My Lords, there are 4,500 admissions to hospitals per day of people suffering from smoking-related diseases, and over 80,000 people per year die from such diseases. I know the Government have stated their plan for a policy that will reduce this harm. In that context, does the Minister think there might be lessons for us to learn from Finland’s plan to be tobacco-free?

[Lord O’Shaughnessy]

I will certainly look at what they are doing in Finland. I was not aware of that, and it is a very ambitious goal. As a former smoker, I have to say I know the benefits both in health terms and in my pocket from reducing smoking. It is essential that we continue on the trajectory of reducing smoking that has been going for a long time. England is a world leader in this area, and we should recognise that. There has been huge success but clearly there is a lot more to do.

Health Service Medical Supplies (Costs) Bill

Lord Patel Excerpts

Report stage (Hansard): House of Lords
Tuesday 7th February 2017 Lords Chamber

[Baroness Masham of Ilton]

My Lords, there is considerable frustration on the part of patients and the industries when NICE approves new drugs which can be important for preserving life but which patients cannot get. We need to encourage the development of new drugs as there are so many complicated and rare conditions which need them. It takes time and effort to submit the drugs to NICE. Noble Lords can imagine the frustration when they are approved but then not used. I support Amendment 3.

[Lord Patel (CB)]

My Lords, I support this amendment, to which I have added my name. I do not agree with the noble Lord, Lord Lansley, that the second part of the amendment is not crucial. I take a completely opposite view. I consider that that is the crucial part of the amendment. The proposed new paragraph (b) refers to the need to,

“ensure that patients have rapid clinical access to new clinically effective and cost-effective medicines and treatments approved by the National Institute for Health and Care Excellence through their technology appraisal process”.

The terms “clinically effective” and “cost-effective” are important. I would insert the word “thorough” so that the amendment reads “thorough technology appraisal process”. That is what NICE does. That is what we set it up to do. Parliament agreed that if NICE approved a drug that was cost effective and clinically effective, it should be available to patients. Now we are saying that that should occur only if certain provisions apply, and in certain circumstances they do not. So what are we saying? What message are we sending out if NHS patients cannot get medicines and treatments that are deemed to be clinically effective and cost effective, including drugs and treatments developed by our own scientists and produced by our own life sciences industry? People from our own industry have told me that when the NICE-approved drug is not available in the United Kingdom and we try to market it in other countries, their competitors say, “Why is it not available in your country when you’re trying to persuade us to use it?”. As has been said, many drugs are often available in countries such as Germany, France, Canada, Austria and many others that are not available in the United Kingdom. The noble Lord, Lord Hunt of Kings Heath, mentioned cancer drugs that are not available. Some would say that that leads to the poor cancer outcomes in our country compared with those in some other countries.

Recent proposed changes relate to the budget impact threshold of £20 million over two years. The noble Lord, Lord Lansley, is right that this sword has two sharp edges. Whichever way you tackle it, the patient gets hurt. Around 20% of new treatments with a positive NICE recommendation could have their introduction delayed if we adopt NHS England’s new proposals. For example, about 35,000 patients suffer from secondary or metastatic breast cancer. However, a drug costing £1.56 per patient per day would meet the budget impact threshold of £20 million. It would therefore be delayed for introduction to treat these 35,000 patients. For most of them, their life—quality life—could be prolonged by about six months to a year, but they will be dead before the drug is made available at a cost of £1.56 per patient per day. That is what this proposal of £20 million means. It is a budget impact threshold.

People with rare diseases will fare even worse. There are about 7,000 known rare diseases. Treatment exists for only about 5% of those patients. The British company Shire, for example, has about 30 products in its pipeline to treat rare diseases. But why would it manufacture them at some cost when it might find that it falls foul of the new arrangements even if the new drugs prove effective?

I recognise the economic challenges that the NHS faces. I have heard the 20,000 pages of evidence given to the committee that I chair on your Lordships’ behalf and which we will soon be publishing. We need a system that prepares the United Kingdom to deliver the next generations of innovative medicines, including gene and cell therapy. If we are going to do that, it is important that pharma and the industry have certainty of patient access. That is crucial when companies make decisions on new investments in research and manufacturing.

Regarding proposed new paragraph (a), I would simply say that as we prepare to leave the EU, the delivery of an internationally competitive industrial environment for the bioscience and life science sectors is more important than ever. By making it more difficult for patients to access highly innovative, first-to-market, cost-effective and clinically effective medical products, we not only deny our patients the treatment they need but risk the future of our world-leading life science industry. I am sure we do not want to do that.

The Prime Minister’s industrial strategy, which will invest in science, research and innovation, has already been mentioned. The life science sector—not the pharma industry, which the noble Lord, Lord Warner, mentioned —brings in over £60 billion a year and employs over 220,000 people. British science, with investment in genomics, gene sequences, diagnostics, and now the production of gene and cell therapy, is again investing huge sums of money. To promote this, the Higher Education and Research Bill, which is currently going through your Lordships’ House, creates UK Research and Innovation to do research and innovate therapies, all of it in life science. As to our charity sector, the Wellcome Trust invests probably in the region of £1.3 billion a year in science, which will go to innovation. Cancer Research UK is about to announce four grand challenges. It makes awards of £20 million to find causes and treatments for cancer, and the British Heart Foundation also makes an enormous investment.

Hitherto we have had a pact that operates for the public, the NHS, the scientists and the industry on the availability of medicines and treatments for both diagnosis and treatment, delivered at a cost that is fair, transparent and appropriate. When we break that pact by not making available treatments to patients even though they are cost effective and clinically effective, we are denying treatment to many patients. The fundamental basis of the pact—which Parliament approved when agreeing to how NICE should operate—is that if NICE deems that a medicine is cost effective and clinically effective, patients should get it. That is why I strongly support the amendment.

[Lord O'Shaughnessy]

My Lords, I am grateful for the quality of the debate on this amendment. Before I turn to the specifics of the amendment, I join noble Lords in reflecting on the success of the UK life sciences industry. The UK has a lot to be proud of. We have a world-class science base and an excellent reputation for the quality and rigour of our clinical trials and the data they produce. The UK has one of the strongest life sciences industries in the world, generating turnover of more than £60 billion each year. Indeed, it is our most productive industry. This Government are deeply committed to supporting that industry to flourish and, in doing so, to provide jobs and transform the health of the nation. That is why it was a Conservative-led Government which introduced the first life sciences strategy in 2011.

More recently, we have introduced a range of measures through the taxation system to create good conditions for business growth and to encourage business investment. These include: R&D tax credits for small and medium-sized enterprises; R&D expenditure credit for larger firms; the patent box; a permanent annual investment allowance; and the seed enterprise investment scheme, the enterprise investment scheme and the venture capital trust scheme, as well as entrepreneurs’ relief.

Take just one of those examples: the patent box. Phased in from 2013, under a Conservative-led Government, it incentivises companies to develop and manufacture new, innovative patented products in the UK by giving an effective 10% corporation tax rate on UK profits derived from the product’s qualifying UK and EU patents and equivalent forms of intellectual property. In 2013-14, a total of 700 companies claimed relief under the patent box, with a total value of £342.9 million, with 64% of those in manufacturing. In 2013, GSK decided to invest more than £500 million in the UK after the patent box was announced. Its CEO Sir Andrew Witty said:

“The introduction of the patent box has transformed the way in which we view the UK as a location for new investments”.


The Government’s R&D tax credit is one of the biggest sources of financial support for innovative UK companies and one of the most competitive in the world. It is widely commended and, in 2014-15, almost 21,000 companies claimed tax relief, totalling £2.45 billion, with R&D expenditure used to make these claims reaching £21.8 billion. The Autumn Statement announced £4 billion of additional investment in R&D, specifically targeting industry-academia collaboration, which is so important in the life sciences. We would expect the life sciences industry to be a substantial beneficiary. I am sure your Lordships will agree that these are bold, new, high-value measures which demonstrate that the Government are serious about attracting inwards R&D investment into cutting-edge industries like the life sciences.

This determined action is reaping rewards. The UK ranks top in major European economies for foreign direct investment projects in the life sciences. Just last week, Danish drugs company Novo Nordisk announced a new £115 million investment in a science research centre in Oxford. This comes on top of £275 million additional investment announced by GSK in June and AstraZeneca reaffirming its commitment to a £390 million investment in establishing headquarters and a research centre in Cambridge. As the noble Lord, Lord Patel, mentioned, we are also working on the creation of UK Research and Innovation to enhance this further. These are examples of the positive policy changes that are supporting the life sciences industry and transforming the health of our nation.

Looking ahead, Professor Sir John Bell, whom several noble Lords have mentioned, has agreed to lead the development of a new life sciences strategy for the long-term success of the UK. The formation of the strategy will bring together broad representation from across the sector, including from industry, charities, academia and the health and care system. It is aligned with the industrial strategy announced recently by the Department for Business, Energy and Industrial Strategy. The strategy will outline what the life sciences industry can deliver for the UK economy and for UK patients and set out what actions government needs to take to set the framework on the road to success. Building on a sector deal for this diverse and complex sector, the life sciences strategy will be bold and ambitious as befits the needs of a global Britain. We will seek to make the UK the global home of medical innovation, creating jobs, improving health outcomes and transforming the NHS.

As all noble Lords have mentioned in the debate today, the issue of access to or uptake of new medicines in the NHS must be a key part of that life sciences offer. I recognise and share the desire of noble Lords to ensure that the NHS is at the forefront of innovation, and that medicines which have been approved by NICE are made available quickly to the patients who could benefit from them. This Government have been very active in improving access, and have already taken a number of important steps to do so. The early access to medicines scheme, introduced in 2014, provides a platform for drugs that do not yet have a licence to get to patients at a much faster rate than before. We have now seen 29 promising innovative medicine designations, and 10 positive scientific opinions have been awarded by the MHRA, the regulator. As my noble friend Lord Lansley mentioned—and I must give him credit for the introduction of this policy—the cancer drugs fund, created in 2011 and renewed in 2016, has provided over 95,000 patients with access to innovative cancer drugs that would otherwise not have been available.

Sustainability and Transformation Plans

Lord Patel Excerpts

Thursday 26th January 2017 Lords Chamber

[Lord O'Shaughnessy]

Clinicians and local authorities are involved in these plans. The whole point of the plans is that they bring everybody together within an area to create changes that are driven from the bottom up, so as to provide a much more efficient service. The noble Lord knows full well that more money is going into both primary care and the service overall.

[Lord Patel (CB)]

My Lords, STPs are a major systems change in the way healthcare will be delivered. As the Minister said, there will be significant demand for the resources going into them. What are the governance arrangements for the STPs?

[Lord O'Shaughnessy]

I thank the noble Lord for that question. STPs are voluntary groupings of all the relevant people—whether that is at the acute level, in primary care or local authorities—coming together under leadership to create the changes. Those then turn into operational plans that are delivered by individual hospitals, primary care settings and so on.

Social Care

Lord Patel Excerpts

Thursday 1st December 2016 Lords Chamber

[Lord Patel (CB)]

My Lords, it is a pleasure and an absolute privilege to follow the noble Baroness, Lady Cavendish of Little Venice. On behalf of the whole House, I congratulate her on a brilliant, thought-provoking and only marginally controversial maiden speech. We would have been surprised if it had not been thought-provoking, from someone who had been a director of the No. 10 Policy Unit, and if it had not been challenging or a little controversial, from someone who has written so many articles; I have scanned through upwards of 450 of them.

Some noble Lords may remember the noble Baroness as a campaigning journalist with the Times, and latterly with the Sunday Times, when she campaigned about the practices of the family courts regarding children. At the time, those who opposed her branded her as confused, biased, salacious and even malicious, but she was proved right and legislation was brought in to change the situation. In policy terms, she obviously convinced the Prime Minister and Chancellor that sugar and fat are bad for us, hence the legislation that has come forward relating to the sugar tax. We hope she will deal with some other matters in future, such as alcohol.

I found her writings interesting. If she goes back to journalism, particularly to the Times, it will be interesting to see how her articles on climate change contrast with those of the noble Viscount, Lord Ridley. In my view, the noble Baroness is the country’s best social analyst and thinker. No doubt we will be privileged to listen to her in future.

Noble Lords might wonder if there are any chinks in her armour. I found one, and I think it is from a reliable source. I do not think she campaigned to ban homework but she certainly thought about doing so when she forgot to take her son’s homework when they went to a literary festival in Cheltenham—I see that she suddenly remembers. The thought about banning homework may have come from François Hollande, who tried to ban it in France.

I hope the noble Baroness will speak often in this House. I encourage her to do so; I suspect she will be challenging, thought-provoking and entertaining to listen to. For today, I have the privilege of welcoming her to the House, and I look forward to hearing more from her.

I turn to my small contribution relating to social care. I currently chair your Lordships’ Committee on the Long-Term Sustainability of the NHS. Witness after witness has told us to concentrate on social care and, as the noble Baroness, Lady Cavendish, alluded to, have a wider public debate about social care and its implications. The noble Baroness, Lady Pitkeathley, and others have referred to how a lack of social care and the problems associated with it are currently killing the NHS. Hospital beds are blocked by people who should be in social care.

With regard to the workforce, we have heard evidence suggesting that by 2037, the gap in the workforce will be around 1.1 million if we have zero immigration or, if we have full immigration, 370,000. That is a huge gap in the social care workforce. On funding, the evidence we have heard from several witnesses is that the gap will be between £2.8 billion and £3.2 billion per year. That may not seem a large sum in terms of our national debt of trillions of pounds, but none the less it is a considerable gap in the funding, particularly of the local councils that have to deal with this.

So with that in the background, we need a solution that must involve the public. We must have a debate about the role of the state, of individuals, of the family and of the community in the provision of social care, and how individuals are going to take responsibility for their social care in future.

A Guardian article in October suggested that the Government have no intention of implementing Dilnot, but the Minister may correct me on that. If that is the case, a different solution needs to be found. In my view, the solution must be some commitment from the individual. It can only be through insurance. Insurance companies have hitherto not been encouraged to provide that and have never shown any enthusiasm to do so.

National insurance, as operates in Germany or Japan, is another way. In Germany, individuals pay 2.35% of their salary, which next year will increase by another 0.25%, which provides social care—although not all of it is provided; the public understand, and are encouraged to take out top-up insurance to cover for what state insurance does not cover. The Japanese system is interesting, because, over the age of 40, it is related to your income. You pay about 2%, related to your income, but it covers the totality of social care, including building modifications, appliances that are needed, respite care and all that. That is on top of the tax-funded health insurance, which covers most of the rest. Although I have not witnessed it, I am told that it works very effectively. However, part of its effectiveness is because of the responsibility that their family and communities take.

Will the Minister tell us, first, whether there is an intention to implement Dilnot? If not, given the crisis developing in social care, which some say is a bigger crisis than the pensions crisis, is any thinking going on as to how we will deal with and fix this crisis? Perhaps I may suggest that here is an opportunity for some bold thinking for a Prior solution that could be synonymous with the Beveridge solution and that fixes the social care problem for the long-term.

Cataract Operations

Lord Patel Excerpts

Wednesday 16th November 2016 Lords Chamber

[Lord Prior of Brampton]

The cataract operation is remarkable; it can literally give back people’s sight in the course of a 10-minute operation. I think I am right in saying to the noble Baroness that the first cataract operation was done in 1787.

[Lord Patel (CB)]

My Lords, the Minister is absolutely right in accepting that there is a huge variation in the availability of cataract surgery. In fact, the variation is fourfold. Nearly 35% of people over 65 will require cataract surgery, and such surgery is the definitive form of treatment for cataracts. Incidence will rise with age and, with ethnicity, it is even higher. As the Minister accepted in part, the variation is caused by variation in commissioning, which is based on clinical judgments, not the scientific evidence that CCGs need. Better guidance will help, as he suggested, but unless the guidance is appropriately monitored and the CCGs follow it, nothing will change—40% of people do not get second eye surgery because CCGs will not commission it.

[Lord Prior of Brampton]

I mentioned earlier that NICE will bring forward its evidence-based guidelines in 2017. It will be up to CCGs to commission on the basis of those guidelines, and they in turn are monitored by NHS England. Clearly there is variation; there is variation wherever we look in the National Health Service. One of the reasons why Professor Briggs is doing his Getting it right first time work is to try to identify that variation and address it.

Adult Social Care

Lord Patel Excerpts

Tuesday 15th November 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the squeeze in social care started in 2010. Between 2010 and 2015, spending on social care declined in real terms by 12.8%. That was a significant reduction in spending when the noble Baroness’s party was in power in the coalition Government. Since then, it remains very tight in social care. As I said, we are putting more money into the NHS at the front end of this Parliament. We have introduced the 2% precept for local authorities to raise money for social care and we have put £1.5 billion into the better care fund, starting from 2017-18, which will provide more money for social care at the end of this Parliament.

[Lord Patel (CB)]

My Lords, everybody agrees that there is enormous pressure on social care which, as has already been mentioned, is impacting adversely on the NHS. Is it not time for an independent commission with cross-party support to look at the whole area of health and social care, including something like the Japanese model, which funds social care so successfully?

[Lord Prior of Brampton]

My Lords, I know that the noble Lord is very keen on an independent commission, and he knows my views on that. I do not think we need an independent commission to tell us that social care and health care must be more joined up and integrated; we all know that. We can do that through a major reorganisation from the centre—but we know what big reorganisations do to the health service: they stymie it for years—or we can work locally in the STP and local authority areas to try to drive this at local level, which I think is the right way forward.