Southern Health NHS Foundation Trust

Lord Patel Excerpts

Thursday 10th December 2015 Lords Chamber

[Lord Prior of Brampton]

Avoidable deaths are estimated at some 10,000 a year. “Unavoidable deaths” is the phrase that I think I used, which are estimated at some 10,000 a year. That is not out of line with what is found in other countries, such as America and Germany. However, it should not be accepted, which is why the Secretary of State has asked Bruce Keogh to produce these new statistics for every trust, starting from next spring.

[Lord Patel (CB)]

The Minister might want to look at those figures again, and correct them with a letter if necessary, regarding avoidable and unavoidable deaths. Turning to my question, on a daily basis now we get at least two items of bad news relating to the NHS, mental health, public health or other issues in social care. Is it not time to look at the whole organisation of the NHS, including funding and so on, through an independent commission? Why would the Government not do that? The Opposition might not support it but it would take politicians out of it and we might end up with a better service.

[Lord Prior of Brampton]

The noble Lord makes an interesting point. We have a much more transparent system than we used to. Surely it is better that we know about what is going wrong within the NHS rather than that we cover it up as it was in the past.

Alcohol

Lord Patel Excerpts

Wednesday 9th December 2015 Lords Chamber

[Lord Prior of Brampton]

I am happy to be told that by my noble friend and I can only agree with him.

[Lord Patel (CB)]

My Lords, as it is Christmas, does the Minister think that the Parliamentary Estate should be alcohol-free, as it is smoke-free?

[Lord Prior of Brampton]

My Lords, I think that we would be setting an excellent example if we did that.

National Health Service (Licensing and Pricing) (Amendment) Regulations 2015

Lord Patel Excerpts

Tuesday 1st December 2015 Lords Chamber

[Lord Patel (CB)]

My Lords, perhaps I might start by suggesting to the Minister that this is another example of why the NHS might be unsustainable and that we probably need an independent commission to look at the whole of the NHS. I realise that neither he nor the Opposition Front Bench are likely to agree with me on that, but I make the point that this is yet another nail in the coffin, so to speak, which will get us to that end some day.

I find myself in agreement with some of the things that the noble Lord, Lord Hunt, has just said. We have an example here of where raising the tariff to 66% actually means ruling out the ability of the providers to engage in any kind of discussions relating to the tariff because the target is too high. If that is the case and the providers are therefore not able to engage with NHS England and Monitor, which sets the tariffs, what other mechanisms do they have? They cannot see the proposed tariffs until the consultation occurs, which is rather too late for them even to road test whether the tariffs are likely to be workable—particularly if they involve, for instance, any implications on pensions or proposals that the Government may have brought about pay deals, or any other issues that may impact on the cost. So how is the provider likely to get any input at an early stage and engage with the tariff-setting mechanism? There will be no such input, I suggest, through these proposals, which will make it impossible. They will therefore have to live with the tariff.

I realise that the big providers might be able to do that, because they might save some money from other aspects, but let us take the specialist providers. We can particularly imagine this in paediatrics and with some cancers, where providers work on small margins and the costs may escalate. Because of a few patients having highly complex issues, costs can overrun. That is why the top-up fees of some £300 million were introduced, 70% of which go to paediatric specialist services. Now the proposal is to remove those or reduce them considerably. In paediatrics, the top-up might go down from £217 million to £95 million. So these specialist providers have a choice: either to provide poor-quality service, which impacts on the patients, or to opt out. Who will then suffer? It will be not the commissioners, NHS England or Monitor but the patients—because they will not have a service or will have a poor-quality service.

I agree with the noble Lord, Lord Hunt, that there needs to be some kind of mechanism where there is early involvement of the providers, which can engage in the tariff-setting mechanism. They would not necessarily dictate it; they might disagree with it but suggest some proposals. One of the ways, as he suggests, would be a stakeholder forum involving all the parties at an early stage. The Department of Health can then have some accountability from all the people in the stakeholder forum, including the providers. I am attracted to that suggestion, and I hope the Minister will respond to it.

The Minister responding in the other place sounded sympathetic—or at least suggested that he understood the issues. I hope that we can go further today and that the Minister will say that it sounds attractive and that he might look at it.

Accident and Emergency Departments

Lord Patel Excerpts

Monday 30th November 2015 Lords Chamber

[Lord Prior of Brampton]

The report done by Queen Mary’s, which was based in Oxford, indicated that the under-fives attending A&E departments accounted for 7% of all attendances, which gives an idea of the scale of what we might try to achieve. The reduction, in real terms, in local authority spending over the next five years is 3.9% per annum. Our feeling is that local authorities are well equipped to live with that kind of reduction.

[Lord Patel (CB)]

How good are A&E departments nationally at collecting information on the nature of the accident, and at root cause analysis to prevent it, and how is this information fed into a national database?

[Lord Prior of Brampton]

I am afraid that I am not aware of how A&E departments collect and collate this information, but I will write to the noble Lord on that matter.

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.