Public Sector Productivity
Lord Patel Excerpts(1 month, 1 week ago)
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Lord Patel (CB)
My Lords, if the noble Baroness, Lady Neville-Rolfe, is looking for any answers that I might have about how to increase productivity in the NHS, she might be a bit disappointed. However, I will give my views.
NHS productivity has long been a focus of politicians and policymakers. Any debate about challenges facing the NHS ends up with a discussion about productivity—mostly about how to increase it. Several recent reports from official organisations and think tanks demonstrate the wide interest in the subject. I will refer to one or two of them, particularly one detailed report from the King’s Fund
In my view there are four key issues when looking at productivity in the NHS. The first is how productivity in the healthcare sector has changed over time. Secondly, what has driven the recent fall in productivity? The third is the limitations of official productivity data. Fourthly, and lastly, is productivity going to increase and what needs to be done for it to do so?
Looking at how productivity has changed, the ONS data shows that over the past few decades NHS productivity increased faster than that of other public sector services, such as education and social care, and even the wider economy. However, in 2021, health sector productivity fell by 23%. In 2021-22, it had a slight recovery but was still down 7% from pre-pandemic levels. The recent NHS England data, which focuses mostly on the acute sector, shows that it is still down by 11% compared to pre-pandemic.
A number of different factors have driven this recent fall. Investment has already been mentioned—capital investment in buildings and technology, as well as outdated equipment and buildings not fit for purpose. There is a low ratio of managers with the competency to manage the flow of patients to administrators, who end up increasing bureaucracy and waste. NHS staff sickness has led to experienced staff leaving the service and new staff replacing them—and we have had a considerable increase in staffing. Less experienced staff are not fully trained, hence the process slows down. Industrial action and more sick patients with multi- morbidity, requiring more complex care, requires greater resources. Compared to my day, today’s complex cancer surgeries, for instance, could take as long as 10 to 14 hours per patient. That requires a lot of resources.
There are limitations to official data. Not all data is captured on the new way of delivering care, particularly in the community. Different organisations use different metrics. Data is collected for the acute sector but not for community settings, which skews the numbers. There needs to be consensus on what data should be collected to measure productivity across the whole healthcare sector.
Is productivity going to increase? There are several initiatives, including the financial package of £3.4 billion announced in the last spring Budget, to build capacity in technology. The NHS productivity plan aims to save £35 billion by 2029, with yearly increases in productivity of 1.9% to 2.2%, and one hopes that that will happen. However, without addressing the capital funding backlog of £11.9 billion for more investment in social care, to improve patient care and to provide better support for hard-pressed staff, none of this will happen. It will be challenging to increase productivity to that level. Post-Covid, for reasons that are not obvious, productivity continues to decline. For example, out-patient appointments per consultant are down 7%, and surgical activity is down 12%, as has been identified in the Darzi report.
It is right that politicians focus on the productivity of the health sector but, as experience has shown, there needs to be some realism about how easily and quickly it can be achieved. We need also to recognise that, in healthcare, quality matters more than quantity. We need high-quality care delivered with the resources available and not more quantity, as some may think. I look forward to the Minister’s answers.
Covid-19: Lockdown Costs and Benefits
Lord Patel Excerpts(8 months, 1 week ago)
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Baroness Neville-Rolfe (Con)
I agree that hard evidence is important and I too value academic studies. A lot of academic studies and reviews of the pandemic in other countries have already been published and are generally available. We are focusing on responding to the Covid inquiry. Clearly, we hope that it will cover all these different points and make sure that future pandemics are tackled as expeditiously and as well as possible, looking at the broader impacts.
Lord Patel (CB)
My Lords, I was the one who first mentioned the dangers of this virus a few weeks before we entered lockdown. On whether lockdown worked, at that time we did not know much about the virus or its behaviour. The proof of the pudding was that every country that had a lockdown benefited from it by reducing the rate of infection. The only country that did not lock down was Sweden, and it had a higher rate of infection than its neighbouring countries, Norway and Denmark, which had a lockdown just like we did. It was implemented to control the infection.
Baroness Neville-Rolfe (Con)
I thank the noble Lord for his wise observations. I would observe that the health of the economy and the health of the population tend to go in tandem, and that was one of the things that we noted during the pandemic. However, I come back to my point that the inquiry needs to look at these things for us. We need to learn the lessons and look at evidence objectively.
Living in a COVID World: A Long-term Approach to Resilience and Wellbeing (COVID-19 Committee Report)
Lord Patel Excerpts(11 months, 3 weeks ago)
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Lord Patel (CB)
My Lords, I am pleased to be able to take part in this debate today. I was not a member of the Covid-19 Committee, but I congratulate its chair, the noble Baroness, Lady Lane-Fox of Soho, and her committee on producing an excellent report to address issues on future resilience and, importantly, the well-being of people post pandemic. I also congratulate the noble Baroness on the brilliant way in which she presented her report.
My very brief comments relate to how the pandemic changed and accelerated the use of digital media in healthcare, with online consultations and treatment being widely used now. Paragraph 74 of the report highlights—as the noble Lord, Lord Alderdice, mentioned —the lack of training of health professionals in conducting online consultations. The report rightly points to the need for approving and evaluating online health interventions. Your Lordships may have read the report in the Telegraph today, which points out the problems that have occurred because that was not done in the first place.
In paragraph 75, the report alludes to the possible widening of health inequalities. That is an important point, because we know that people from lower socioeconomic groups already have lower life expectancy and spend a fewer number of years that are disease-free compared to people who are better off, and significantly so. As the report points out, the shift to online delivery of healthcare is likely to deepen the inequalities in health outcomes, emphasising further the need for evaluation. It is estimated that nearly 16% of people do not have the means or ability to be able to take part in digital consultations.
In my view, the report rightly recommends the need for training and continuous professional development of healthcare professionals to deliver online healthcare—in fact, I would go further, in that their competency to do so should also be measured and ascertained. I am pleased that the General Medical Council and the royal colleges, particularly the RCGP, are now beginning to establish training courses for doctors for online consultations and their assessment of the courses.
During the Covid-19 pandemic, patients benefited from remote consultations by GPs—we should accept that—and restrictions in travel because of the lockdown benefited older patients, those at risk of infections, patients who were immunocompromised and those patients suffering from long-term conditions. It might not have been the perfect outcome for them, but it was a way to manage the pandemic. The benefits were thought to be so great that it prompted the then Secretary of State, Matt Hancock, to call for all consultations in the future to be remote except in exceptional circumstances —that was rather too forward-thinking and probably inappropriate. Overall, during the pandemic emergency, online consultations were seen to be beneficial. Only later did the unintended consequences of missed cancer diagnoses and increased prescribing of antibiotics become apparent. Antibiotics prescribing went up by nearly 36%, although we are in fact trying to reduce the prescribing of antibiotics. Again, today’s detailed report in newspapers and the BMJ points to that.
Now with the pandemic under some control, it is important to evaluate what this immense change in technology-driven healthcare means, especially for patient outcomes, safety and equity. It is the last that concerns me most. With the arrival of better data, health records and generative AI, some people think that we have arrived at a tipping point in the use of technology in healthcare. As the report rightly points out, the rapid introduction of a data-driven and digital healthcare may not only make deeper the current huge health inequalities that exist but exclude people who are not able to make best use of technology. To mitigate this, the Government need to ensure that policies are in place that take a more inclusive approach to digital healthcare.
There are several key challenges that will need to be addressed, as highlighted by the report by the Health Foundation and the Ada Lovelace Institute. Policies that focus on key challenges include: digital exclusion and access to healthcare; developing clear metrics for monitoring inequalities in health outcomes in data-driven systems; addressing the lack of public confidence in data use and protection; the lack of social context in data, as the report correctly points out; appropriate communication across all healthcare professionals throughout the data pipeline; and much more. A survey of public attitudes to health technology showed that the public are on the whole supportive of it, particularly when technology enables them to manage their conditions better and to connect more easily with the NHS. Currently, that does not happen with GP appointments, as highlighted by the noble Lord, Lord Alderdice. The public are less happy when technology comes between them and the clinicians. In this context, the report’s recommendations in relation to the patient’s right of access to online healthcare seems appropriate.
A long-term approach to resilience and the well-being of people in vulnerable groups post the pandemic and the rapid introduction of data-driven health system runs the risk of widening inequalities. That is my key worry. The inequalities that already exist in healthcare and outcomes will become worse. To mitigate that requires policies across government departments. I hope the Minister will agree.
Economy: The Growth Plan 2022
Lord Patel Excerpts(2 years, 1 month ago)
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Lord Patel (CB)
My Lords, I congratulate the noble Baroness, Lady Gohir, on her powerful maiden speech and I look forward to hearing more from her. I also wish the right reverend Prelate the Bishop of Birmingham well in his retirement from this House. I join others in saying that we will miss his contributions.
It is widely recognised that innovations drive the economy. America’s ability and genius for innovation is estimated to contribute to 50% of its annual rise in GDP. The United Kingdom is a world leader in science and research, with some of the world’s top universities. Our strength in science and ability to innovate was evidenced during the pandemic. Our biotech industry alone contributes nearly £50 billion a year to UK GDP and employs over 50,000 people. In life sciences today the UK leads in gene and cell therapies, genomic science and cancer research, including areas of immunotherapy and messenger RNA-related technology, to mention some.
The ABPI estimates that investment in life sciences in the United Kingdom would increase GDP by another £68 billion over the next 25 years. Apart from our strengths in life sciences, other areas of science that the UK excels at and has the potential to deliver innovations in are the next generation of batteries and fuel cells, artificial intelligence, data science, digital technology, microchip design, and in many areas of environmental science, to list just a few.
The last two Prime Ministers strongly supported science, research and innovation. The previous Prime Minister Boris Johnson wanted the UK to be a science and technology superpower and a world centre for innovation by 2030. Academia and industry welcomed the vision articulated in the government report UK Innovation Strategy: Leading the Future By Creating It, published by BEIS in July 2021. This and the creation of ARIA—the Advanced Research and Invention Agency—demonstrated the Government’s commitment to science. By the way, it was a big coup for the Government to get somebody of the status of Ilan Gur from California to be chief executive officer of ARIA. I wish him well. To deliver on the vision articulated in the innovation strategy report and grow the economy will now need a laser-like focus on implementation, across government departments.
The Government’s commitment to increase R&D funding to 2.4% of GDP by 2027 and an ambition to increase it to 3% of GDP by 2030 have been widely welcomed by academia and industry. It is important that this commitment is honoured. I hope the Minister can confirm that that will be so.
What is my concern? We finally have a Minister of State for Science. I wish the Minister, Nusrat Ghani, well, and know that the science and technology community will be willing to give her all the assistance she needs to make her job a success. However, the fact that she will not attend Cabinet meetings means that the position does not have the status it needs and deserves; in addition, a Cabinet sub-committee, the National Science and Technology Council, chaired by the previous Prime Minister, will no longer continue, gives the impression that the current Prime Minister does not value science nor its potential contribution to economic growth. I hope that the Minister can provide reassurance. Can he also say who will be responsible for driving the Government’s innovation strategy across all government departments?
Covid-19: Vaccination Passport
Lord Patel Excerpts(3 years, 9 months ago)
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Lord True (Con)
My Lords, I understand where my noble friend is coming from, but repeat what I said in reply to the previous question: the Government’s objective is to see a safe and sustainable return to international travel for business and pleasure. I put business first advisedly. We have to do this in a safe and sustainable way, and the Prime Minister has set out a road map towards it.
Lord Patel (CB) [V]
Does the Minister agree with the well-researched report by the Royal Society relating to SARS-CoV-2 vaccine certificates? It identifies 12 key areas that need better understanding before the introduction of Covid passports for international travel, including: the effectiveness of various vaccines; the nature and duration of the immune response; the ability of variants to escape vaccine-induced immunity; and the transmission or otherwise of the virus by those vaccinated, as mentioned by the Minister. Will the Government consider the scientific advice before any plans to introduce Covid passports?
Lord True (Con)
My Lords, I am not the lead Minister on that narrow area, but I note what the noble Lord says and will pass on his comments to colleagues.
EU-UK Trade and Cooperation Agreement
Lord Patel Excerpts(3 years, 10 months ago)
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Lord Patel (CB) [V]
My Lords, I want to focus my remarks on the agreement as it relates to the future UK-EU science research relationship. Scientists, researchers and academics are delighted that the UK will continue to participate, albeit as an associate member, in Horizon Europe, an €85 billion research programme. Apart from participation in research programmes, the agreement will shape data-sharing and regulation, research student exchange, nuclear research, space research and clinical trials.
Although the good news is that UK scientists will be able to benefit from grants under Horizon Europe programmes and from the European Research Council, and take part in the Marie Sklodowska-Curie Actions programme, can the Minister confirm that the UK is excluded from the European Innovation Council Fund, designed to support start-ups and SMEs? This is a big loss. From the start of the Horizon 2020 programme up to December 2019, the UK had received £694 million in SME funding, involving 2,400 UK participants. How will the UK fund the aspects of research that lead to innovation? Also, there will be a cap on the total funding for research that the UK can receive in grants, above which there will be a penalty clause. Can the Minister clarify that?
Agreement on the mutual recognition of quality standards for medicines will allow for the unhindered movement of drugs, including the testing of drugs for clinical trials, but any cross-border, multicountry clinical trials, which are very necessary for rare diseases and cancer, will require the UK to be represented legally in the EU—a big drawback. Furthermore, until the data protection regulations are agreed, the transfer of patient data from clinical trials cannot take place. The Minister may wish to comment on that.
Finally, I turn to the deal as it relates to the movement of research students et cetera from the EU, related to the implementation programme. They are expected to be treated in the same way as domestic people under a review of services and so on. It would be helpful to understand how this will work in the context of the new immigration system and regulations. I look forward to the Minister’s response.
NHS England: HIV Prevention
Lord Patel Excerpts(8 years, 1 month ago)
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Baroness Chisholm of Owlpen
I think that we are about to get a decision on the dispute; in fact, we thought it would be this week. It will probably be by the end of this week or the beginning of next.
Lord Patel (CB)
My Lords, this method of preventing HIV is highly effective: one tablet taken a day has a success rate of 99%. The lifetime cost of treating one patient with HIV is more than £300,000. Are we not talking about a false economy here when we could prevent some 300 or more new cases a year and avoid the risk of these high-risk individuals passing on the HIV? This decision has been based on fundamental disputes about who should be funding it and not by the logic of successful treatment.
Baroness Chisholm of Owlpen
Truvada is clinically effective for HIV, as we know, but a number of other issues are also important to consider, including uptake and adherence, sexual behaviour, drug resistance, safety and prioritisation for prophylaxis and cost effectiveness. Clinical trials certainly did find that Truvada reduced the relative risk of acquiring HIV for between 44% and 86% of cases, and the PROUD findings showed the figure was 86%.
Armed Forces Bill
Lord Patel Excerpts(13 years, 2 months ago)
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Lord Patel
“NHS numbers for discharged service people
(1) Section 331 of AFA 2006 (discharge etc from the regular forces and transfer to the reserve forces) is amended as follows.
(2) After subsection (4) insert—
“(5) The Defence Council must also make regulations about the creation of a database of NHS numbers given to those who are discharged from the armed services to facilitate future research.””
Lord Patel
My Lords, the noble Lord, Lord Kakkar, regrets that he is in the other Chamber for a debate. I have also put my name to the amendment and shall speak to it. In a way, it is a probing amendment. On another amendment we have already discussed the need for service personnel who are injured or suffer harm during their service to have appropriate access to healthcare and to have the ability to follow up on their injuries on a long-term basis, and the Minister replied positively. The amendment merely proposes a way in which a defence counsel may facilitate that happening and give out a number that is linked to the NHS number. I know that all UK citizens have an NHS number, and having a number given to service personnel that was linked to the NHS number would enable the long-term tracking of service personnel, particularly those who needed to access healthcare or had been injured or suffered harm during their time in the service. I beg to move.
Lord Wallace of Saltaire
My Lords, there has been a long-standing difficulty in being able to identify veterans within the general population. We have traditionally relied on organisations such as the Royal British Legion to help to understand their longer-term health needs. I agree with the noble Lord that there are clear benefits in being able to identify former service personnel to facilitate research and long-term studies into the health effects of service. In order to do so, it seems eminently sensible to use NHS numbers in England and Wales and equivalent patient tracking numbers in the other devolved Administrations.
Because we understand the importance of such identification, much activity has already taken place in this area. The Surgeon-General already has work in hand with colleagues at the Department of Health to determine the best means of identifying former service personnel through their GPs and NHS numbers. This is part of the wider work to inform GPs about the healthcare needs of veterans and their entitlement to priority treatment.
By coincidence, the Royal College of General Practitioners, in collaboration with the Department of Health and the Ministry of Defence, is launching an e-learning package next week that will also highlight to GPs what additional services are available for veterans. This will further encourage GPs to flag any individual’s veteran status on his or her medical record.
We are also putting in measures for the benefit of current members of the Armed Forces. The task of tracking those who are currently serving for the purpose of research is made easier by measures already in hand in the Ministry of Defence. Following agreement between the MoD and the DoH, any service person now referred to the NHS in England and Wales is provided with an NHS number. There is also an ongoing programme of work with the devolved Administrations that will provide an NHS number, or its equivalent in Scotland or Northern Ireland, to all serving personnel. The primary purpose of this is to provide service personnel with seamless access to secondary healthcare and other NHS services. However, it will also allow us to have a robust evidence base through which to understand the healthcare needs of service personnel once they leave the Armed Forces.
I must, however, disagree with the noble Lord on a couple of points. First, I do not agree that we would want to create a bespoke database to capture such information. There are likely to be more cost-effective methods of gaining such information through existing systems. There are also issues of confidentiality and the personal security of individuals that would need to be taken into consideration if such a database were created. I imagine that the noble Lord will understand better than I do the complexity and additional costs of establishing such a bespoke database.
Secondly, I understand that there is simply no need to legislate for such a requirement, and I am sure that none of us would wish to legislate where there was no need.
I trust that I have reassured the noble Lord and the Committee that work is already in train to achieve the effect that the noble Lord desires. I therefore hope that he will feel able to withdraw his amendment after these assurances.
Lord Patel
My Lords, I thank the Minister for his detailed, informative and reassuring comments. I am content that the procedures that we are putting in place will suffice to track the service personnel who access healthcare. As I said, this amendment was just a means of probing to see how that would work. On that basis, I beg leave to withdraw the amendment.