Junior Doctors Contract

Lord Patel Excerpts

Monday 30th November 2015 Lords Chamber

[Lord Patel (CB)]

My Lords, I am not allowed by the rules to make any statement but only to ask a question, which is a pity because I wanted to make some comments about what the Minister just said. We will leave for another day the discussion of this mounting academic evidence that mortality rates are higher. They might be, but we need to investigate the cause-and-effect scenario. Leaving that aside, the Statement says:

“So our plans will support the many junior doctors who already work weekends with better consultant cover at weekends, seven-day diagnostics and other support services, and the ability to discharge at weekends into other parts of the NHS and the social care system”.

Is the Minister able to update us on whether we will have another Statement related to this or whether there are plans in process to deliver all that the Statement says?

[Lord Prior of Brampton]

There is a recognition that the weekend effect is caused by many factors. It is certainly not just the ability of trusts to roster junior doctors at weekends but the absence of senior cover and the fact that much diagnostic capacity is not available at weekends. Of course, you also have to be able to discharge patients at weekends, which means that social care has to be working as well. To have a truly seven-day NHS requires a lot more people and resources to be available than just junior doctors.

Health: Global Health

Lord Patel Excerpts

Monday 26th October 2015 Lords Chamber

[Lord Prior of Brampton]

I can assure the noble Baroness that this Government are fully committed to supporting our life sciences industry. I will look into her specific question on the Newton Fund and write to her directly.

[Lord Patel (CB)]

Following on from the Question from the noble Lord, Lord Crisp, does the Minister agree that, given the predicted growth of about 15% in the healthcare needs of countries such as India and China, we have a great opportunity not only to promote education but to develop health expertise? Does he agree that we need to have a stronger relationship with these countries in health?

[Lord Prior of Brampton]

I completely agree with the noble Lord. According to the report, health spending is likely to increase by 8% per annum in Asia for the foreseeable future and by some 5% in the rest of the world. This is a huge opportunity. The NHS is arguably the best-value healthcare system in the world, and the many lessons we have learnt since 1948 will be valuable when we go overseas.

Lyme Disease

Lord Patel Excerpts

Thursday 22nd October 2015 Grand Committee

[Lord Patel (CB)]

My Lords, I thank the noble Lord, Lord Greaves, for introducing this debate and I have pleasure in contributing to it. First, I want to talk about personal experience. My wife, Helen, whose chosen full-time occupation would be gardening, is continuously bitten by these things and is always pulling them out using sharp tweezers, except for the places that she cannot reach, in which case she has to wait until I get home. The year before last she had a tick bite and removed it. Unfortunately, a week or so later she developed some symptoms when I was not there—I was away. Fortunately, our resident young doctor, the partner of my son, realised that, having pulled out a tick a few days earlier, the symptoms could well have been those of Lyme disease. She found a GP and suggested that Lyme disease be considered as a possible diagnosis. The GP prescribed antibiotics and my wife was fine. However, it is a nasty disease if not treated properly.

Diagnosis is based on the so-called classical bull’s-eye rash, although it does not occur every time; nor can you find the tick on each occasion. Diagnosis can also be made through blood tests; the first is an antibody test. Antibodies do not develop until the bacteria have been in action for a while and the body responds to them—hence, if the initial test is made too early, it often gives a false negative. Another test is the Western blot test, which is much more reliable but has to be done much later. If you wait for that test without treatment, the question is whether the treatment is likely to be less satisfactory, particularly if the bacteria have progressed—because the disease is caused not by the tick but by the Borrelia bacteria. The vector is the tick but the primary reservoir is not the tick; it is either a mouse or other rodent, and it is carried by other mammals such as deer or even dogs, although they do not get infected. When the tick sucks blood from your body, the bacteria are transmitted. If while removing the tick you crush it or try to burn it off, the bacteria will spread and get into your blood, where it causes the different symptoms of the disease.

There are two aspects to this, one of which is prevention. In prevention, the key factor is that those who are likely to be exposed to the risk of tick bites should be aware of that and take precautions to avoid being bitten, which includes wearing clothing that may be impregnated with something like DEET, which is a powerful insecticide. The other is the need for heightened awareness among health workers of the likelihood of a diagnosis of Lyme disease. It is easy to diagnose when the patient has a history of a tick bite and there is a rash. However, while the guidance produced by NICE, which was revised in February 2015, is good, where I differ from it is that the guidance states that if you do not have a rash and there is no sign of a tick bite, antibiotics should not be prescribed. I think that if there is a history of a tick bite and the symptoms fit with those of Lyme disease, treatment with antibiotics should begin. If it is not treated early, the antibiotic treatment has to go on for a long period. Once the bacteria get into the spinal fluid or the nervous system, the disease is difficult to treat.

So the key issues are prevention and heightened public awareness, along with the need for greater awareness among health workers. They should think about Lyme disease if there is a history of tick bite and the patient presents with symptoms which, while they may seem flu-like, typically progress to other symptoms. Those are the key points which are reported. Why is it called Lyme disease? Because it started in a small town called Lyme in Connecticut.

Social Care

Lord Patel Excerpts

Thursday 15th October 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness raises two interesting points. There is a recruitment and a training issue involved in many care homes. This is being addressed by the Government in two ways: first, by raising the minimum wage to the national living wage so that it rises to about £9 an hour by 2020; and, secondly, by the introduction of the care certificate which came out of the Camilla Cavendish report after Mid Staffs, which should improve training in the sector. The funding of local authority-provided care is the issue on which we are awaiting the outcome of the spending round discussions.

[Lord Patel (CB)]

Does the Minister agree that the pressures mounting across the whole range of healthcare, from prevention to primary care, acute care and social care, will just keep getting worse until we address the fundamental issue of adequate resourcing of all the aspects of healthcare? Is it not time to start the debate more widely as to how we are going to do that?

[Lord Prior of Brampton]

I thank the noble Lord for his comments and, of course, I understand exactly what he is saying. I will put just two points. First, the fundamental problem is that the Government still have a very high level of public borrowing, which we inherited and has been there—

Primary Care: Targets

Lord Patel Excerpts

Tuesday 13th October 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, the deficit in the first quarter is indeed a matter of huge concern—I am not going to pretend otherwise—but the Government are wholly committed to seven-day services both within hospitals and in general practice. We are committed to investing £10 billion extra in the NHS over the next five years, and ensuring that we have enough GPs and enough support for them is a key priority.

[Lord Patel (CB)]

My Lords, does the Minister agree that, before anybody is qualified to prescribe, the important part is that the correct diagnosis is made before the prescription is given? Having said that, does he think that qualified high-street pharmacists may have a role in prescribing, apart from the clinical pharmacists who are attached to general practitioners?

[Lord Prior of Brampton]

I fully accept, of course, that diagnosis is extremely important but I think that advanced nurse practitioners can play a role in diagnosis, as well as in treatment, as can physician associates, given that both are supervised by GPs. I believe that high-street or community pharmacists can play a big part in supporting the role of clinical pharmacists.

NHS: Clinical Commissioning Groups

Lord Patel Excerpts

Wednesday 16th September 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I am not convinced that the method of allocation is unfair. ACRA will soon be reviewing its method of allocation for 2016-17. I repeat that it is an independent process. How CCGs allocate the money they receive to mental health, physical health, public health or anything else is up to them. With the King’s Fund, we are introducing a range of measures to enable us to see how individual CCGs are performing.

[Lord Patel (CB)]

My Lords, is not the fundamental problem that we have more than 400 commissioning bodies commissioning in different aspects for different services, and that leads to variability? The answer has to be what the Barker commission recommended: a single commissioner that commissions for primary care, community care, acute services and mental health and asks for the outcomes that we need.

[Lord Prior of Brampton]

The noble Lord makes an interesting and perceptive point. I have no doubt that if we look at the commissioning landscape in five years’ time there will be a lot more integrated commissioning and that social care and healthcare will be much more joined up.

Health Funding

Lord Patel Excerpts

Thursday 9th July 2015 Lords Chamber

[Lord Prior of Brampton]

I will certainly have a word with my friend the Secretary of State for Health. Clearly the Government have an important role in this area; I will have a discussion with him and come back to my noble friend.

[Lord Patel (CB)]

My Lords, this is my first opportunity to ask the noble Lord a question and I welcome him to his new brief. If he were looking at the evidence-based delivery of services, the evidence shows that 40% of illnesses are related to lifestyle. If that is the case, why do we not have a national plan for public health and prevention of disease, rather than leaving it to local authorities, where it will vary?

[Lord Prior of Brampton]

The noble Lord raises an interesting point, which we may come back to in the debate later. Public health spending is divided into two: £3.2 billion is decentralised to local authorities and the remaining amount, some £2 billion, is retained by Public Health England—which does have a national plan, but it may be that the plan could be better articulated.

National Health Service: Sustainability

Lord Patel Excerpts

Thursday 9th July 2015 Lords Chamber

Moved by

[Lord Patel]

That this House takes note of the sustainability of the National Health Service as a public service free at the point of need.

[Lord Patel (CB)]

My Lords, it is a great pleasure to open this debate. I was a little concerned that, because of today’s Tube strike, our numbers might be devastated, but I am pleased to see that they are not—too much.

I am grateful to all noble Lords who will be taking part, many with a long experience in health. I am particularly delighted to see the noble Lord, Lord Mawhinney, in his seat and taking part in the debate.

Health is determined by a complex interaction of individual characteristics; lifestyle; and physical, social and economic environment—that is, your genetics, your epigenetics and your lifestyle. To keep the citizens of a nation healthy needs a strategy with appropriate policies and resources to address all these interactions. A system that keeps the citizens of a nation healthy needs to be a partnership of individuals, the wider community and the state.

While the state has a role in all aspects of health—prevention, healthcare and social care—the limits of that role have to be clearly defined and can be arrived at only by a wide consensus that includes the public, wider stakeholders and the state, each recognising and accepting their responsibility. What we have today in the NHS is primarily a service that treats patients when they are ill—some say a “sickness service”. It is clear that, when it comes to prevention, both the state and the individual need to do more—and I would say that the individual has a greater responsibility.

The consequences of not tackling disease prevention are grim, in terms both of individual misery and state resources. It is also clear that a changing demography—with a population increase—and increasing life expectancy will lead to an increase in the number of people needing social care.

The association of lifestyle with disease is well known, and yet in the UK 70% of the population is inactive, and 26% is obese, which will increase to 40% by 2025. This will result in 4 million people with diabetes. Some 70% of the population have poor diet and 21% smoke. Some 27% of men and 18% of women drink alcohol well above the safe limits. Some 40% of disease is related to lifestyle, including cancers and Alzheimer’s. The scale of preventable illness is staggering. An effective national plan—dare I say, which we do not have—for preventable illness could reduce mortality by 25% by 2025. Otherwise, the impact of lifestyle-related diseases and changing demography will put an even greater strain on resources.

The projected scenario is that there will be, apart from diabetes, 2.9 million people living with a long-term condition and 4 million living with cancer. By 2026, 1.4 million people will have dementia, costing about £3.5 billion a year. Some 4.5 million people will need help with daily living and 17 million people will have arthritis and other joint conditions. Providing social care will take a greater proportion of resources. The cost of care alone could consume 2.5% of GDP. A survey that showed that only 26% of older people think that they need to make provision for their social care demonstrates a lack of public concern and involvement.

I now come to the current state of the NHS: the care part of the health equation. The founding of the NHS, 67 years and four days ago, was heralded as a great piece of social legislation—and so it was. The public’s love affair with it has not diminished. At its launch, the annual budget was £280 million. In 2013-14, the NHS spend was approximately £116 billion—close to 9% of GDP—and the pressure on resources continues. The demand for care is not diminishing. Financial problems are now endemic among NHS providers. Even the previously best-performing trusts are heading towards deficit. Some 89% of trusts are forecasting deficits, faced with increasing demands, cuts in tariffs and the withdrawal of performance payments. Provider deficit could top £20 billion this year. The Five Year Forward View of Simon Stevens was a commendable document that I will return to later because it tries to address some of these issues. It predicts a need for extra funding of £8 billion a year by 2020-21. I know that the Chancellor yesterday said that he will fund it by £10 billion—but he included £2 billion already given to the NHS.

At the same time, the service has delivered already in the last Parliament £20 billion-worth of efficiency savings, mostly through limiting staff salaries, cutting administration costs and the lucky break of blockbuster drugs coming off patent. An ambition to deliver further efficiency savings of £22 billion a year by 2020-21 through productivity gains of 2% to 3%, if it can be achieved, will be challenging. Further reducing staff salaries and holding pay rises to 1% for the next four years, as announced yesterday, and reducing the price paid for treatment is an option likely to lead to a further decrease in morale and less commitment from staff, leading to poorer-quality care, poorer outcomes and, dare I say, less likelihood of getting the productivity gains proposed.

Historically, the NHS has never achieved productivity gains above 0.4% year on year. Achieving productivity gains of 1.5% will result in a shortfall of £16 billion; there will be a £21 billion shortfall if the gains are only 0.8%. In this scenario, the NHS will need an annual budget of nearly £200 billion by 2030 and one-fifth of the nation’s entire wealth by 2060.

The current financial pressures are despite more than 20 major reorganisations and policy changes, mostly to cut costs, over the past 20 years—and these continue. Most recently, further policies to cut costs include: the reversal of safe nurse-to-patient ratios; the removal of some clinical targets; reducing the cost of agency nurses; and reducing the cost of having consultants and the pay of senior managers. The recent Carter report addresses efficiency and productivity gains that could—I use the word “could” because that is what the document says—save £5 billion in procurement per year. We have had three previous reports on procurement in the NHS.

Not only do we have financial pressures but the performance of the NHS in terms of outcomes is not good. Although the NHS is rated very highly by the Commonwealth Fund for several parameters—no doubt the Minister will remind me about that—it is also rated second from bottom for avoidable deaths. Recent similar findings have been reported in a Health Foundation report for cancers, vascular disease and lung disease. There are 25,000 excess deaths associated with diabetes and 2,000 child deaths can be avoided. There is great variation in care throughout the country.

Primary care does not fare any better, with long waits for appointments in some areas, late diagnoses leading to an increased number of deaths, and a dwindling workforce. It is difficult to see how a seven-day service in both the primary and acute sectors can be delivered without higher costs, with patients with long-term conditions resorting to attendance at A&E because of the lack of community care. The separation of community care from hospital-based services and social care inhibits integration, makes the delivery system weak and fragmented, and thwarts innovation in care. The NHS has never been great at innovating for service delivery. While I accept that not all is bad in the NHS—we must not throw away all the good things that it has—the system as a whole is not performing well.

Is the current system sustainable? There are some who would say, “Yes, but it needs more resources”. Others would say, “Yes, if only we can produce the efficiency and productivity that is there to be had. It needs to improve”—there is room to do so, I agree—“and cutting waste will solve some of the problems”. Others feel that we need to look for a new settlement, for more durable, long-term solutions that will keep the citizens of this nation healthy for as long as possible in their life—a new system where prevention, care and social care are a continuum; in which the individual, the community and the state have a commitment and a shared responsibility; where people with long-term conditions are able to manage their own illnesses; where individuals plan for their own health and are helped to plan for their social care if they need it; and which can adopt new ways of care and embrace innovation.

The history of the past two and a half decades tells us that political parties will continue to manage the health service according to their ideology—managing scandals and giving a bit more money—but with no long-term planning as there will be no political consensus. We need a wider dialogue with the public, stakeholders and politicians to explore a new settlement, a new way of delivering care and social care, and, above all, a strategy to prevent illness. We need a national consensus that recognises and accepts that individuals, communities—including employers—and the state have a role in health and contributing to it. To do this, we need an independent national commission that is free to look at all the issues, not just at financing the service. The current system is not sustainable. I have no doubt that changes will be brought about. If we persist in the same way as we have done for the last 20 years we will see a gradual shift to a two-tier system: those who can pay will get care; those who cannot will not. The variations in care will get wider.

I hope that today’s debate can start a wider conversation. If that happens, I, for one, can imagine that the logical conclusion will be that we need an independent commission to explore a new way, a new settlement for health that is compassionate and caring, and where all citizens have a stake to contribute to make their life healthier. I think that Simon Stevens’ Five Year Forward View is a good strategy and a good point on which we can build.

I have two simple questions for the Minister. First, does he agree that the current system is unsustainable? Secondly, does he agree that all I have said about current and future scenarios is true? I beg to move.

--- Later in debate ---

[Lord Patel]

I thank the Minister for his response, and I am encouraged by his last comments. A 10% gain is still a gain—I would not have expected him to agree. By the way, I did not use the words, “royal commission”. I asked for an independent commission. I understand why political parties may not like the idea of a royal commission, but I am encouraged by what the Minister said.

I am grateful to all noble Lords who have taken part. It has been an excellent debate and the stature of those who have spoken indicates the interest in the subject. I do not think that the matter will be left today, just for another debate. I have to say to the noble Lord, Lord Hunt, that I get the feeling that political parties want to keep the health service in some trouble all the time, so they can use that for the next election.

[Lord Hunt of Kings Heath]

My Lords, the noble Lord is far too cynical.

[Lord Patel]

I wonder what makes me cynical.

Motion agreed.

General Medical Council (Fitness to Practise and Over-arching Objective) and the Professional Standards Authority for Health and Social Care (References to Court) Order 2015

Lord Patel Excerpts

Tuesday 17th March 2015 Grand Committee

[Lord Patel (CB)]

My Lords, I rise briefly to support the order. I declare an interest that, maybe for a short while only, I am a licensed practitioner and a registered practitioner, and the rules of the GMC may not be sufficient for me to revalidate.

However, the issue to which I want to refer is the separation of the functions, of which I approve—we have discussed that many times—but for the fact that the GMC can appeal against the decision made by the MPTS. Its role becomes that of an adjudicator as well. I would like the noble Earl to clarify that. I know that in the consultation process there were the same number of responses—39, as mentioned by the noble Earl.

Another issue that we have discussed before is that these changes are welcome, but there are other changes that the Law Commission identified in its report, published in April 2014, on the regulation of health and social care professionals Bill. The Government indicated that they would bring in legislation to deal with all the issues. This is obviously a piecemeal measure taken out of that Bill, so the noble Earl may want to comment on that.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I, too, thank the noble Earl for introducing the order. I shall say at once that the Opposition support it. Like the noble Lord, Lord Patel, we are disappointed that it is yet another Section 60 order being considered in Committee. We should have had the Law Commission Bill, either in pre-legislative scrutiny or in its substantive form. It is disappointing that we are having to deal with these various professional regulation bodies in such a piecemeal fashion.

That said, on the question of the overarching objective, we very much support that and the three pursuits set out in Article 21(1B),

“to protect, promote and maintain the health, safety and well-being of the public … to promote and maintain public confidence in the medical profession, and … to promote and maintain proper professional standards and conduct for members of that profession”.

I want to pick up the point raised by the noble Baroness, Lady Finlay, and the British Medical Association. I suppose it is an issue of proportionality. In its report, the Law Commission expressed concern about examples given, suggesting that regulators were inappropriately imposing moral judgments in essentially private matters under the guise of maintaining confidence. The BMA has raised the issue of whether the order might end up punishing doctors who pose no threat to the health and safety of the public, on the basis that failure to do so might incur the public’s disapproval. The Law Commission has urged regulators to look carefully at regulatory interventions that do not take some colour from the need to protect the public.

This is a very important point. I have been very impressed with the GMC and the way in which it has improved its procedures and processes—and certainly with its current leadership. However, there are other regulators, perhaps not so much in the health sector, which clearly lack confidence and which are very much influenced by the flow and ebb of media comment and potential political interventions. I think that we have to be very careful about regulators which, in a sense, lose confidence in their own ability to make common sense judgments, and then have knee-jerk reactions in the face of media storms. I hope that the noble Earl will agree that that is not the intention in the case of the health regulators, and like me, he will express confidence, particularly in the GMC to apply common sense judgments in response to the points raised by the noble Baroness, Lady Finlay.

I now come to the question of the Medical Practitioners Tribunal Service. The Minister referred to the fact that the consultation demonstrated strong support for enhancing the GMC’s investigative and adjudication roles, but that 52% of respondents took the view that creating an entirely independent body would be preferable, with only 27% supporting the proposal to put the MPTS on a statutory footing.

We must refer in particular to the evidence of the Professional Standards Authority. It,

“did not agree that the proposals to establish the MPTS as a statutory committee of the GMC would achieve the aim”,

of appropriate separation of function. It commented that,

“former and current members of GMC staff should be excluded from sitting on medical practitioner tribunals or interim orders tribunals … The PSA also asked about the ability of the GMC to make rules delegating functions from the MPTS committee to ‘officers of the Council’”,

and it,

“referred to the fact that case managers will be paid by the GMC, but case managers will be performing a statutory office”.

The PSA was obviously concerned that because those managers were paid by the GMC, they might come under undue influence. As the Explanatory Memorandum points out, the PSA,

“conducts annual performance reviews of each of the health and care professional regulatory bodies”.

I would like the noble Earl to explain why the views of the PSA, above all others, were ignored in relation to this issue.

To pick up the point raised by the noble Baroness, Lady Finlay, about guidance, again, the Explanatory Memorandum says that:

“The Department does not intend to publish any guidance in respect of”,

this statutory instrument but that the GMC,

“will publish guidance as appropriate”.

Is the Minister in a position to respond to the noble Baroness about what kind of guidance will actually be produced?

However, overall I believe that the GMC has made great strides in recent years. It deserves to be supported for what it is doing. I accept that this will speed up processes to protect the public and provide more and better information about doctors on the register. It will improve doctors’ education and training and increase efficiency, and on that basis we are very glad to support the order.

Maternity Services in Morecambe Bay

Lord Patel Excerpts

Tuesday 3rd March 2015 Lords Chamber

[Earl Howe]

On the noble Baroness’s second point, I shall of course take due note of her recommendation. It is something to which we will give very careful thought. On the principal issue that she raised about supervision, as she knows, the statutory supervision of midwives was designed more than 100 years ago—in 1902, I believe—to protect the public. In our view, it no longer meets the needs of current midwifery practice. The King’s Fund was commissioned by the NMC to review midwifery regulation following the findings of the ombudsman that midwifery regulation was structurally flawed as a framework for public protection. The current structure does not differentiate between the requirements of regulation and clinical supervision.

If, as I anticipate, legislation is needed to change this—I think it is clear that it is—that is likely to take up to two years, even on the best estimate. During that time the Department of Health will work with the UK chief nursing officers, the NMC and the Royal College of Midwives to develop a four-country approach, which it has to be, as the noble Baroness will understand, to midwifery supervision that will replace the current statutory midwifery supervision. I hope that that is helpful.

[Lord Patel (CB)]

My Lords, I have to admit that, as an obstetrician, when I read this report, my immediate response was intense anger, anger at this systems failure on a grand scale. None of these things should have occurred. This is not an example of failure of a mild degree or of a relationship. This is failure on a major scale. No maternity unit in the country would tolerate these kinds of tragedies occurring in their own unit.

I commend the report. I have worked with the chairman and several of the expert advisers. Dr Kirkup worked with me when I carried out the inquiry on cancer services in Gateshead. He was a member of the team and I know the others, particularly as they come from my own hospital. Professor Stewart Forsyth was neonatologist with me, and I know James Walker, whose father is responsible for all the successes I have had in obstetrics and none of the failures. His name was also James Walker.

What can we do? There is the idea of mandatory reporting of unexpected maternal deaths and stillbirths. We have a stillbirth rate in the antenatal period that has not reduced in this country for 40 years. We have unexpectedly high numbers of normally formed babies who die in the interpartum period but who should not die. If that kind of tragedy ever occurred in my unit, there was a major investigation immediately afterwards. Mandatory reporting may highlight this issue because we need to address it.

I will focus on one recommendation of the several that are addressed regarding the professional organisations in medicine and midwifery. They need to step up to the plate and respond positively to this report on what their role will be in making maternity services safer in this country. The noble Earl referred to an airline-type investigation for root cause analysis. I accept that that is absolutely necessary but it requires experience and training and it must be done soon after the event to learn the lessons that might be applicable to other maternity units. I am encouraged to hear that NHS England will carry out a review of maternity services and I hope that it will be an in-depth review with the specific purpose of making maternity services safer. It should not be about demarcation issues with which we got ourselves tied up previously between different professional groups. It should not be about relocating services. It should be about making maternity services safer.

I have lots of questions but they are not for today and I will save them for another time. I hope all of us—no matter who the Government are—will now work to make maternity services in this country among the best possible.

[Lord Winston (Lab)]

Does the noble Lord not agree that one of the key issues is that nurses as midwives and obstetricians no longer work together as a team? They work separately and conflict with each other instead of seeing patients together. Would that not solve many of the problems identified in this shocking report?

[Lord Patel]

The noble Lord is absolutely right. That is why I said that the review must address how to make maternity services safer and not address any of the demarcation issues. I work with midwives. Midwives taught me—I have said that before in this House—so there should be no issues between different professional groups, whether they be nurses, midwives, doctors, neonatologists, anaesthetists or whoever.

[Earl Howe]

My Lords, anyone who reads this report will not fail to alight on the phrase that Dr Kirkup uses—that what we had at this hospital was a “lethal mix”, comprising, among other things, substandard clinical competence, poor working relationships in the maternity unit, a move among the midwives to pursue normal childbirth at any cost, shooing obstetricians away at various points, and failures of risk assessment and care planning that led to unsafe care. All these things should pull us up short and, indeed, do so. They are shocking. We certainly expect the relevant professional regulatory bodies, including the GMC and the NMC, to review the findings of this investigation report and act on the recommendations. Those organisations should review the findings of the report concerning the professional conduct of registrants involved in the care of patients at the trust to ensure that appropriate action is taken against anyone who has broken their professional code, but building on those lessons to see whether there are wider matters around safety to be considered.

On mandatory reporting, I can only add to the remarks that I made to the noble Lord, Lord Hunt, by saying that we remain totally committed to the principle of the reforms. Further progress will be informed by reconsideration of the detail of the new system in the light of other positive developments on patient safety since 2010 and by a subsequent public consultation exercise. We are working with the health departments in the devolved Administrations, NHS England and the professional bodies to consider how standardised reviews for all perinatal losses might be introduced.