General Practitioners: Shortage

Lord Patel Excerpts

Tuesday 12th July 2022 Lords Chamber

[Lord Kamall (Con)]

My noble friend makes a very important point, and she referred continually throughout the passage of the Health and Care Act to practices in rural areas. We have looked at the challenges and have asked GPs about this in surveys, and we know that there are problems about the reduction of working hours, administrative burdens, some stress and burnout, and some issues about equitable distribution. One thing we do have is the Targeted Enhanced Recruitment Scheme launched in 2016, which has attracted hundreds of doctors to train in hard-to-recruit areas by providing a one-off financial incentive.

[Lord Patel (CB)]

My Lords, in 2017, a House of Lords report recommended that the current small business model of primary care is not fit for purpose. The same has been said by the Royal College of General Practitioners, which produced a report; the British Medical Association; two think tanks, the Nuffield Trust and the King’s Fund; and, more recently, Policy Exchange, which produced a report on the model being fit for the future. Is it not time that the Government had plans to look at future models of delivering primary care? If they do not have such an intention, does the Minister agree that the House of Lords should set up a Select Committee to follow on from the excellent report produced on the NHS in 2017?

[Lord Kamall (Con)]

I thank the noble Lord for that question, but I should explain to him that I have been warned for exceeding my powers, as it were, in the past. I think setting up a Select Committee is a bit beyond my powers. The noble Lord and I, and many noble Lords across the House, including previous Health Ministers of all parties, have had this conversation, and we know that the old-fashioned model of a five to 10-minute appointment with your GP, only to be referred elsewhere and into secondary care, is broken in many ways. We need a much more modern model. We have seen primary care take on some of the functions of secondary care, but we have also seen, at the GP level, that the GP does not have to do everything, and that there are other workers such as nurses, physio- therapists and pharmacists who can do more of what the GP has done in the past.

Coronavirus: New Cases

Lord Patel Excerpts

Monday 11th July 2022 Lords Chamber

[Lord Kamall (Con)]

As I said, we are keeping everything under review. We called our strategy Living with Covid-19 as opposed to “We’ve Got Over Covid-19” because we knew it could come back at any time. We have seen that, with the omicron variant, some medication is less effective. We continue to monitor that, and we are ready to stand up the measures that may be needed if the number of cases dictates that, on the advice of the JCVI and the UKHSA.

[Lord Patel (CB)]

My Lords, we all agree that the numbers are increasing by the day. Can the Minister say what is driving this rise in numbers? Are particular groups driving the rise, and if so, is the policy based on that information?

Bread and Flour Regulations: Folic Acid

Lord Patel Excerpts

Wednesday 6th July 2022 Lords Chamber

[Lord Kamall (Con)]

I hope the noble Lord appreciates that there is debate here. He has written to me a number of times about Professor Wald’s paper, which has been put before the advisers in the department. I think what we are seeing is scientific contestation: some people say that the science is settled, but others say that you have to be very aware of the unintended consequences. The NHS website advises people with certain conditions not to take folic acid, the worry being that, for people who do have levels of folic acid, we may end up solving one problem and unintentionally creating another.

[Lord Patel (CB)]

My Lords, we have now discussed the scientific validity several times. The Minister arranged a meeting, and I thought we had resolved this issue. Which scientific evidence is confusing the departmental advisers?

GP Access

Lord Patel Excerpts

Tuesday 7th June 2022 Lords Chamber

[Lord Kamall (Con)]

I am sure the noble Lord will remember from the debates on the Health and Care Bill that that Act provides for workforce plans every five years. In addition, Health Education England has been commissioned to do work on workforce needs of a much more decentralised nature, rather than top-down from Whitehall and Westminster: at the trust level and the CCG level and, in future, at the ICS level to look at needs and the mix of skills that are needed to serve local populations.

[Lord Patel (CB)]

My Lords, following on from the Question asked by the noble Lord, Lord Hunt, does the Minister agree that there is a need to rethink the model of primary and community care in the light of shortages, and considering that more and more GPs are now providing only private healthcare—at the last count, there were 1,500 of them—and 57% of GPs are working three days a week or fewer?

[Lord Kamall (Con)]

There are indeed a number of challenges. One is that many GPs are nearing retirement age and some are worried that their pension will be affected if they carry on working. Also, as an IPPR report recently said, the nature of illness and patient expectations have changed but the model of care has remained the same throughout. We expect five-minute appointments with referrals, but what we need in primary care is a much more networked model, with GPs, nurses, mental health officials, pharmacists, link workers and charities providing a joined-up service so that it does not always have to be the GP.

Children: Cancer

Lord Patel Excerpts

Thursday 26th May 2022 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for the question and for discussing the issue with me previously. As he rightly says, even though it is rare, cancer is the biggest killer of children aged up to about the age of 15. The Government’s new 10-year plan for cancer care is under development. It will address the cancer needs of the entire population, including those of children. We also recognise the severe impact that cancer has on not only the patient but their family and friends, and are focusing in particular on interventions that support patients through difficult journeys of diagnosis, treatment and aftercare.

[Lord Patel (CB)]

My Lords, research for finding new treatments for cancers, particularly childhood cancers, where the numbers are small, requires international collaboration. Some 42% of current CRUK clinical trials have international partners. The Government are consulting on clinical trials regulation and we have data sharing and protection legislation going through Parliament. Does the Minister agree that it is important that neither the regulation related to clinical trials nor the legislation related to data sharing should in any way jeopardise our international role in clinical trials collaboration?

[Lord Kamall (Con)]

I thank the noble Lord for the question, which cuts across three of the priority areas in my ministerial portfolio: data sharing, the life sciences industry—in which clinical trials and research play a huge part—and international collaboration. It is really important that we continue international collaboration. However, one of the challenges we face is that we have to make sure that patients are comfortable with researchers having access to their data. As part of that work, we have called in civil liberties organisations to help us along that journey. So, while we encourage more people to share data, we have to make sure that they have those protections. We can have the best systems in the world, but, if people opt out, they are useless.

Long Covid

Lord Patel Excerpts

Monday 23rd May 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness emphasises just how wide, varying and diverse the symptoms of long Covid are. We know that children and young people can develop long Covid, just as adults can. NHS England has therefore not only established specialised paediatric services to provide care for children and young people, but is looking at providing specialist advice and support to general paediatric services as we learn more, as well as co-operating with international partners to learn from their experience.

[Lord Patel (CB)]

My Lords, the Minister quite rightly referred to the correct definition for people who suffer from long Covid as having a post-Covid-19 syndrome. That implies that people may suffer from multi-organ conditions and, in that respect, training is important. Does the Minister agree that NICE should be asked to publish guidelines for all professionals to recognise this condition?

[Lord Kamall (Con)]

The NICE guidelines start with the definitions as I have laid out previously, and the NICE definitions are aligned with the World Health Organization. On the noble Lord’s specific question, I will have to write to him.

National Institute for Health and Care Excellence

Lord Patel Excerpts

Monday 23rd May 2022 Lords Chamber

[Lord Kamall (Con)]

I will try my best. If I may, I shall use this opportunity to respond to the noble Baroness’s earlier question. We have seen horizon scanning in regulatory science, which means that ILAP is at the forefront of cutting-edge developments. It is open to commercial and non-commercial, and UK-based and global developers of medicines. As I said, I will write to the noble Baroness with more detail. On doing something about NICE and the NHS, I have constant meetings with the NHS, as do other Ministers. One of the challenges that came up during the passage of the Health and Care Bill—I know that noble Lords who have been Ministers previously made this point—was that Ministers here have to respond on issues but decisions are quite often taken at NHS level.

[Lord Patel (CB)]

My Lords, I am yet another doctor. In defence of NICE, it has, despite the financial constraint, delivered 50% more appraisals in 2020-21 and is likely to do an extra 20% this year. The important point I want to make is the point made by the noble Baroness, Lady Morgan of Drefelin: patients need to have access to effective treatment sooner. If the appraisals are causing delay, for whatever reason, that is the place where NICE needs help, to get patients early access. For instance, a breast cancer drug that treats patients with triple-negative breast cancers, with a higher mortality, is available in one part of the United Kingdom now, but it is not available in England.

[Lord Kamall (Con)]

The noble Lord makes a very important point. One of the things we are looking at, so that we will not only be a centre for life sciences but make sure that our NHS is at the forefront of healthcare worldwide, is to make sure that we look at the different stages of medicines when they are approved, if they have conditional marketing, and the different stages of approval to see whether we can get them to patients earlier. As the noble Lord says, we should share the good news about NICE. It issued guidance within 90 days for licensing of 100% of new active substances in 2021-22 and has the highest number of technology appraisals in any year since appraisals began. There is some good news, but NICE recognises that it has to do more and we are in conversation about that.

International Healthcare Outcomes

Lord Patel Excerpts

Thursday 19th May 2022 Lords Chamber

[Lord Kamall (Con)]

As the noble Baroness will be aware, during the debates on the Health and Social Care Bill, we made quite clear the different approaches to the workforce strategy. Indeed, Health Education England has been asked to compile a strategy. The NHS has the people recovery task force, which involves health and well-being and is not only for retention. Also, in our recruitment, we are on track to meet our manifesto commitment of 50,000 nurses. We had over 30,000 more nurses by February 2022. We are looking at different areas, not only from the department but from the ground, bottom up.

[Lord Patel (CB)]

My Lords, does the Minister think that the government target of diagnosing 75% of all cancers at stage 1 and 2 by 2028 needs revising?

[Lord Kamall (Con)]

When one looks at these reports, one sees that one area where the UK clearly needs to improve is on cancer. One of the great issues of this is diagnosis. As many noble Lords will know, when we look at the waiting lists and the backlog, we see that 80% of those people are waiting for diagnosis. It is essential that we tackle that. For children, the one-year survival rate has risen in recent years. We will continue to focus more on diagnosis, including community diagnosis centres.

Folic Acid Fortification

Lord Patel Excerpts

Wednesday 6th April 2022 Lords Chamber

[Lord Patel (CB)]

My Lords, the United Kingdom has a high incidence of babies born with neural tube defects. What evidence have the Government collected as to the decrease in the incidence of neural tube defects in babies that would occur if an appropriate daily amount of folic acid was available in the nutrition of United Kingdom citizens?

[Lord Kamall (Con)]

I think the noble Lord will be aware that pregnant women are advised to take 400 micrograms of folic acid. That high level cannot be put into other foods because there are some unintended consequences. For example, it disguises some other traits and conditions in the older population. Therefore, one needs to get the right balance and proportion for the wider population.

Health and Care Bill

Lord Patel Excerpts

Lords Hansard - Part 1 & Report stage
Monday 7th March 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I have put my name to the amendments tabled by the noble and learned Lord and have tabled amendments of my own. As the noble and learned Lord said, his amendments simply take out the HSSIB provisions from the Bill, whereas mine take out the reference to senior coroners.

I think we are all united in supporting the concept of HSSIB improving safety in the health service. A stand-alone Bill in 2019 had a Second Reading in which we were beginning to get to grips with some of the issues around the construct of HSSIB and, particularly, the safe spaces concept. This is very important in the health service because of the traditional reluctance of staff to come forward with information about where things have gone wrong because experience has shown that whistleblowers have often been treated very poorly indeed.

I fully support the concept of HSSIB and safe spaces and believe that if it is implemented properly it will lead to improved safety. However, as the noble and learned Lord has so eloquently pointed out, the problem is that the inclusion in the Bill of the coroner’s ability to access this information would render the whole safe space concept unworkable. Staff will simply not trust it if these provisions are left in the Bill.

We are faced with two options. One is to take out the whole of the HSSIB provisions. Ideally, I would support that because it would benefit from a stand-alone Bill, where we could give it the scrutiny it clearly deserves. On the other hand, our job here is to be constructive as a revising Chamber. On that basis, we would be much safer removing the coroner elements and giving the Government a little more time to discuss this further before the Bill goes on to Third Reading and back to the other place.

I think there are ways through. I have been attracted, for instance, to one solution put forward by the noble Baroness, Lady Brinton, in relation to a memorandum of understanding between the noble Earl’s department and the MoJ. We need to discuss that; in order to do so now, I believe we should remove the coroner provisions from the Bill.

[Lord Patel (CB)]

My Lords, I apologise for rising because I know we need to move on but before I speak to this amendment perhaps I may take the opportunity, as I was not here on the first day of Report, to thank the Ministers for listening—and taking action after doing so on many aspects. I thank them all for that. I also thank all those who sent me good wishes. It helped, and I did not realise I had so many friends.

I shall not speak at length on this group. I have my name on both sets of amendments. The reason I supported removing the whole clause was that there are a lot of issues arising, not just the invasion of the safe space. However, I agree with the noble Lord, Lord Hunt of Kings Heath, that it gives the Government another chance if it is confined to removing the coroner provisions. I agree with what has been said: the medical profession particularly, but even other health professionals, will find it difficult if the safe space of what they say confidentially can be invaded, so I support that proposal.

[Baroness Walmsley (LD)]

My Lords, I well recall hearing Jeremy Hunt announce that we would have this organisation and thinking at the time how important it would be in turning the NHS into a learning organisation, in the interests of patient safety. I would prefer not to take the whole clause out but to amend it.

The predecessor non-statutory organisation’s chief inspector has written to us, pointing out that when his organisation was set up it was made clear that full statutory independence, along with the fully enclosed prohibition on disclosure, would be essential to its success. I am concerned that if this power to disclose information to coroners is left in then this organisation, which we all so much support, will be set up to fail. That would be a very bad thing for patients and the whole NHS.

Quite honestly, the number of cases that the HSSIB is going to investigate—only 30—is highly unlikely to cut across anything that the coroner wants to do. In fact, the Joint Committee which scrutinised the previous Bill in 2018, which got only as far as Second Reading, concluded that the safe space would in no way impede the ability of coroners, regulators, the PHSO or the police in undertaking their own investigations or speaking to witnesses. That is not what we heard in the meetings which the Ministers have been kind enough to set up on Zoom, or from the Ministry of Justice. They obviously disagreed with the Joint Committee that scrutinised this carefully.

I hope the Minister is not going to rely on paragraph 6(7) of Schedule 14 because, as it stands, the so-called protections in that part of the Bill are completely unknowable. How can the High Court know whether a disclosure to the coroner will deter future witnesses from giving full disclosure? It simply cannot know that but there is a big danger. Nor can it know whether it will have an

“impact on securing the improvement of the safety”

of the health service. This is an empty protection and I hope the Government will not rely on it when arguing against the amendment of the noble Lord, Lord Hunt.