Higher Education and Research Bill

Debate between Lord Patel and Lord Prior of Brampton

Committee: 7th sitting (Hansard - continued): House of Lords
Monday 30th January 2017 Lords Chamber

[Lord Prior of Brampton]

My Lords, I thank the noble Lord, Lord Patel, for a very thoughtful speech at the beginning of the debate. On Amendment 489, I want to make it clear that the Government agree that councils must be able to operate with autonomy and authority over decisions within their fields of activity. For that decision to be made, we must ensure that experts in their fields are involved in allocating grants. I can reassure the noble Lord, Lord Patel, that the objectives of his amendment are already achieved in the Bill.

The Bill ensures that UKRI cannot prevent any of the research councils carrying out their duties in their specialist areas by requiring UKRI to devolve its functions to the councils for these activities. This will give the councils the independence they need to pursue their research agendas while also being able to interact as part of UKRI. Furthermore, by bringing the councils together within UKRI, we introduce the opportunity for a strategic centre, but with responsibility to consider broader issues than any council can alone. This strategic focus is a feature that many noble Lords raised at Second Reading.

Amendment 503ZA examines the Secretary of State’s power of direction. Let me reassure noble Lords that powers of direction are rarely used, but given the very large sums of public money that UKRI will be accountable for—some £6 billion—it is proportionate. The Secretary of State currently has an equivalent power of direction over research councils, and our proposals are intended to mirror that. I can reassure noble Lords that the power will not be used day to day to steer UKRI’s operations, nor as an override to the Government’s long-term commitment to the Haldane principle. However, the Secretary of State must be able to deal swiftly with any financial issues arising, for example, from financial mismanagement.

Turning to Amendments 503A and 505C, I welcome the opportunity to restate the Government’s commitment to the Written Ministerial Statement on the Haldane principle made by my noble friend Lord Willetts in 2010 which will apply to all research funding allocated to UKRI. This Statement is carefully balanced and considers important, interrelated and sometimes conflicting factors. It is, however, a policy statement, not a legal document. Obtaining such a balance in legislation through a legal definition of Haldane is not a simple task. However I will reflect on the helpful comments made here today. I hope that noble Lords will accept that if we could write Haldane into the Bill in a non-equivocal and legal way, we would do so.

On dual support, the Bill sets out in legislation for the first time the dual support system for research referred to here as balanced funding. I hope this clarifies any potential misunderstandings about the relationship between the two. Some noble Lords have asked, not unreasonably, why a different description is used. It is because the protection of the two funding streams and the balance between them are both important, and both must be carefully considered by the Secretary of State when making grants to UKRI. I agree with noble Lords that the nature of dual support is anchored in the complementary allocation and evaluation mechanisms of the two funding streams. Amendment 505ZA would replace the need for the Secretary of State to consider both halves of the dual support with a need to consider only one part—the block grant.

Let me reassure noble Lords that Clauses 95 and 96 already put considerable conditions on the Secretary of State’s powers which protect the unhypothecated nature of quality-related funding and ensure that this will continue through Research England. These restrictions are consistent with Section 68 of the Further and Higher Education Act 1992. They protect academic freedom by ensuring that terms and conditions of grants cannot be framed in terms of particular courses of study, programmes of research, appointment of academic staff or admission of students.

The system of dual support sustains a dynamic balance between research that is strategically relevant and internationally peer reviewed, and research that is directed from within institutions. However, the precise modes of operation of the two streams have changed over time, for example through the evolution of the RAE into the REF. Similarly, we should not try to permanently fix what the balance should be between the two parts of dual support. Funding flows are dynamic, and there is no formula or set proportion for the balance of funding across the two parts of dual support. When considering what the balance of funding should be, as now, the Secretary of State will take advice from UKRI and consider issues such as the strategic priorities of the research base and the sustainability of higher education, research capability, and other research facilities supported through the UKRI budget.

I turn to the proposal in Amendment 495J, tabled by the noble Lord, Lord Mendelsohn, that the remit of Research England be extended to cover independent research organisations. At present, research councils accredit organisations to compete for funding if they possess the capacity to carry out research that enhances the national research base. These organisations include hospitals, museums and other public sector research establishments. Those organisations currently receive their underpinning capability funding, similar to the QR block grant from other parts of Government, and there are no plans to change this arrangement.

This debate has covered some of the most fundamental matters about how we undertake research in the UK. I have listened very carefully, seeking to draw on the experience here in this House. With the hope of further constructive dialogue, I ask the noble Lord, Lord Patel, to withdraw his amendment.

[Lord Patel]

My Lords, I thank the Minister for his comments. I was encouraged by his reassurances about maintaining the autonomy of research councils. Putting that on record is satisfactory to me. I am grateful to other noble Lords, and I hope that they have found that their amendments were responded to. On that basis, I beg leave to withdraw the amendment.

Cataract Operations

Debate between Lord Patel and Lord Prior of Brampton

Wednesday 16th November 2016 Lords Chamber

[Lord Prior of Brampton]

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

[Lord Patel (CB)]

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

[Lord Prior of Brampton]

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

Adult Social Care

Debate between Lord Patel and Lord Prior of Brampton

Tuesday 15th November 2016 Lords Chamber

[Lord Prior of Brampton]

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

[Lord Patel (CB)]

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

[Lord Prior of Brampton]

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

NHS Funding

Debate between Lord Patel and Lord Prior of Brampton

Monday 31st October 2016 Lords Chamber

[Lord Prior of Brampton]

I entirely agree with my noble friend that the independence of NHS England has been very important. Had the NHS plan been developed by politicians it would have had a lot less credibility. I entirely agree that prevention and public health are hugely important, but of course it takes a long time for public health initiatives to have an impact, so I do not think that any reductions in them in the last two years will have any major impact over the five-year period. Clearly, it will have an impact over a longer period. As for the changes to Health Education England, those savings have largely been generated by moving from a bursary system for nurses to a loans system, which will actually deliver more nurses and therefore help to deliver the five-year forward view.

[Lord Patel (CB)]

My Lords, is the Minister saying that there are no financial pressures on the NHS? If he is, that is contrary to every piece of evidence that the House of Lords Select Committee on the Long-Term Sustainability of the NHS has heard. Furthermore, it is the lack of a settlement in social care that is killing healthcare. Is it not time that we had a new settlement for both healthcare and social care that is sustainable in the long term?

[Lord Prior of Brampton]

My Lords, I acknowledge that there is tremendous pressure on all parts of the health service and in social care, but if there is not pressure, there will not be change. Getting the radical, fundamental change we need in the health service will not be achieved if we just pour more money into the existing system: we have to have change.

Junior Doctors: Contract

Debate between Lord Patel and Lord Prior of Brampton

Thursday 5th May 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I think there is general recognition that many of the issues that lie behind the dispute over the contract are not actually involved in the contract itself. It is about how junior doctors are trained, valued and integrated into hospitals and the workforce. These are much broader issues than just the contract, and I assure the noble Lord that the Government are fully aware of that. Once this dispute has been settled, we can start to resolve those bigger, deeper and more fundamental issues.

[Lord Patel (CB)]

My Lords, I am surprised but delighted at the news this morning that the Department of Health has agreed to enter into discussions with the junior doctors. I hope that both sides will enter into them in the spirit of finding a resolution, rather than finding faults. I am sure that the talks will resolve the issue, because as far as I am concerned striking is not the answer. Anything that prolongs the exercise is detrimental to patient care.

[Lord Prior of Brampton]

My Lords, I wholly, 100% agree with the words of the noble Lord.

Health: Hepatitis C

Debate between Lord Patel and Lord Prior of Brampton

Thursday 28th April 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I do not think I can answer that question as I do not fully understand it. Perhaps I could meet the noble Baroness outside the Chamber. All I can say is that NHS England is funding the new interferon-free treatments in accordance with the NICE technology appraisals, and is prioritising people on the basis of unmet need. I think the modelling assumption shows that 10,000 people will receive the new treatment in the coming year. I cannot answer the specifics of the noble Baroness’s question but I will follow it up outside, if I can.

[Lord Patel (CB)]

My Lords, an estimated 220,000 individuals in the United Kingdom are chronically infected with hepatitis C virus. Deaths among the under-60s from end-stage liver disease and liver cancers due to the virus have doubled over the last decade. We have in the interferon-free treatment a drug that is effective in successfully treating the disease, as it reduces the viral load in 98% of patients treated to virtually zero in the whole spectrum of genome of hepatitis C virus. Therefore, it is an effective preventive drug for developing end-stage disease. It has the potential to eradicate the disease in the population. In that scenario, why would we treat only 10,000 patients per year, as the guidance says, for the next two years and not treat every patient who is a chronic carrier of hepatitis C virus?

[Lord Prior of Brampton]

My Lords, there is clearly a budgetary constraint. The noble Lord mentioned 220,000 people—I thought it was slightly less than that—and this drug costs many tens of thousands of pounds per treatment. Clearly, however much we would like to treat 220,000 people, it is just not feasible to do so. That is why we have NICE, which has produced its appraisals and said that, using its modelling, the number of people who need to be treated in the coming year is likely to be between 7,000 and 10,000, rising to 15,000 by 2021. However, I agree with the noble Lord that this interferon-free treatment is a massive improvement on previous treatments, with a very high cure rate.

Health: Treatment Rationing

Debate between Lord Patel and Lord Prior of Brampton

Tuesday 26th April 2016 Lords Chamber

[Lord Prior of Brampton]

Yes, my Lords. The noble Lord has quoted almost verbatim from the recommendations of the Royal College of Surgeons report, which I have in front of me. I agree with him completely.

[Lord Patel (CB)]

My Lords, does the Minister agree that CCGs should be obliged to publish their evidence base for their policies? If he does not, will he say why not? Further, what recourse does a patient have to challenge their CCG when they do not receive surgical treatment because of the latter’s policies?

[Lord Prior of Brampton]

My Lords, the noble Lord will be aware of the Atlas of Variation, which encompasses a new programme, Right Care; it looks at variations in medical and surgical practice across different populations and tries to spot unwarranted variation. That is the best way to identify where different CCGs are not delivering the kind of care that we would expect. In view of what we have just said, I am tempted to say that where an individual does not get the treatment he expects, he should complain to his local Healthwatch. That would be one way to do it but every hospital has a PALS and he could always write to his MP. There are lots of ways in which individuals can raise concerns if they wish to do so.

Junior Doctors: Industrial Action

Debate between Lord Patel and Lord Prior of Brampton

Monday 25th April 2016 Lords Chamber

[Lord Prior of Brampton]

On mortality rates at weekends, the noble Lord is absolutely right that there has been confusion about the difference between the terms “excess mortality” and “avoidable mortality”—the two are clearly very different. However, having said that, I think it is widely recognised that the lack of senior cover and diagnostic support, particularly at weekends, is not at all satisfactory. Certainly Bruce Keogh and others have looked at this—I think that there have been six very detailed studies looking at mortality at weekends. The fact that there is a higher level of mortality than you would expect is ground for providing greater support at weekends. As for the suggestion that there should be a pilot scheme to study the contract, I tried to answer that in my response to his noble friend and I have nothing else to add to that.

[Lord Patel (CB)]

My Lords, what will happen tomorrow and the day after is unprecedented in the history of the NHS: junior doctors will withdraw their services from emergency care. Despite some of my own family disagreeing with me, I, as a doctor, could never have contemplated taking that action. But the junior doctors today do feel hard done by for many reasons, which the Minister has stated, about how they and their training are valued—and that is an issue that we need to address. I am not allowed to make a speech today, and I will not, so let me come to the crucial point. The Minister said that the crucial issue is that of Saturday pay. It cannot be impossible for both sides to agree to sit down to break this deadlock and discuss these pay issues. Otherwise, where are we going to go? We have to find a solution. On the one hand, the junior doctors are saying, “Do not impose the contract on us”, and on the other hand, the Secretary of State is saying, “I have to impose the contract because you won’t agree with my pay conditions”. There has to be a solution. What solution does the Minister think we might have?

[Lord Prior of Brampton]

My Lords, we have discussed this issue outside the Chamber. Although one must never give up hope, I find it hard at the moment to see how a negotiated, agreed solution might be found. We have had three years of negotiations; we have had 75 meetings. We came within a hair’s breadth of a solution, with the Government making concessions around how much of Saturday should attract premium pay, but we were unable to do the deal. Sir David Dalton, a very distinguished, well-respected chief executive of Salford Royal, led those negotiations and his advice to us afterwards was that he could not find a way through it. His advice then was that we had no choice but to impose the contract. None of us wanted to impose the contract; we all wanted to find a solution. But with the current BMA executive we found that impossible. Much as I regret it, as things stand this evening, I do not see a solution.

NHS: 111 Service

Debate between Lord Patel and Lord Prior of Brampton

Monday 21st March 2016 Lords Chamber

[Lord Prior of Brampton]

There have been a number of terrible tragedies. The most recent of these was William Mead, a very young baby who died as a consequence of not getting the right treatment quickly enough. NHS England has done a root-cause analysis. Some of the problems lay within 111 but others were with the out-of-hours service and with diagnosis by the GPs concerned. The noble Lord is wrong to say that the 111 service is not operating well throughout the country. Some 90% of all those who use 111 believe they get a good service from it.

[Lord Patel (CB)]

My Lords, what suggestions does the Minister have for improving the performance of the 111 service?

[Lord Prior of Brampton]

My Lords, there are two things which we need to do to improve the 111 service. First—and this is in response to part of the Question asked by the noble Lord, Lord Hunt—we need to have more clinicians within the 111 hubs. Secondly, people need to have access to the patient’s electronic summary care record so that they can see what has gone on before coming to a final judgment.

NHS: Hospital Overcrowding

Debate between Lord Patel and Lord Prior of Brampton

Tuesday 15th March 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, clearly, step-down facilities, including community hospitals, have a very important role to play. The whole thrust of the five-year forward view is to treat more people outside acute hospital settings. That is the NHS’s plan, which the Government support.

[Lord Patel (CB)]

My Lords, does the Minister agree that there needs to be a reform of the tariff paid for the workload that A&E departments now bear? If there is an appropriate tariff, the hospitals will invest in better facilities and better staffing, such as collocation of out-of-hour GP services, pharmacies, and even mental health assessment services, alongside A&E departments. Does he therefore agree that there needs to be a reform of the tariff paid to A&E?

[Lord Prior of Brampton]

My Lords, the tariff has been changed. Acute hospitals now receive 70% of the tariff, rather than 50%, for the excess numbers of people coming into A&E departments. The noble Lord is absolutely right, though, that those hospitals that have collocated GPs and A&E departments, and have invested in psychiatry liaison nurses and other people, have seen huge improvement. The question is: do we want to invest? Are A&E departments the right places to invest, or ought we to be putting that investment into primary and community care? That is the big issue that will be decided over the next five years.

Mental Health Taskforce

Debate between Lord Patel and Lord Prior of Brampton

Tuesday 23rd February 2016 Lords Chamber

[Lord Prior of Brampton]

My noble friend is absolutely right. I am glad he finished by referring to quality in outcomes rather than just activity. That is the critical thing about getting the tariff right, that it is based not just on activity but on quality in outcomes.

[Lord Patel (CB)]

In responding to the task force report, is it the Government’s intention to produce a mental health strategy that will encompass all the issues, including the funding?

[Lord Prior of Brampton]

Together, the task force report, the report produced by the noble Lord, Lord Crisp, and the earlier report on children and young people really do comprise a strategy for mental health for the next five years.

Health: Zika Virus

Debate between Lord Patel and Lord Prior of Brampton

Thursday 4th February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, there has been one case where Zika may have been sexually transmitted—I use the words “may have been” advisedly because it is not proven. Indeed, the link between Zika and microcephaly is not yet scientifically proven. There seems to be a strong probability that that is the case, but we should bear in mind that Zika was first identified back in 1947 in Africa and since then there has been no such connection with microcephaly, although in Brazil there appears to be a very strong connection now. There has been one case in Texas, where there may have been sexual transmission and the advice for men who are sleeping with women who may become pregnant is to wear a condom.

[Lord Patel (CB)]

My Lords, while absolutely agreeing that we should carry on supporting the science of genetically modified mosquitoes, it may be that mosquitoes that are already genetically modified for dengue can do the same job for Zika, but we do not know that. Much more important is the recent report and questions about the assessment of the spread of the Zika virus. The Minister has just referred to sexual transmission, but that applies to any bodily fluids, not just sexual transmission. The other worrying thing is that the common mosquitoes have now been found possibly to be infected by Zika. That is a much more worrying prospect, because they are much more widespread.

[Lord Prior of Brampton]

I understand that the common mosquito which we find in southern Europe could potentially carry Zika, which I think was reported in the Times today. There is as yet no evidence that it does carry Zika, but it is something that we need to watch very carefully.

Sugar Tax

Debate between Lord Patel and Lord Prior of Brampton

Wednesday 3rd February 2016 Lords Chamber

[Lord Patel (CB)]

My Lords, I am sure the Minister is aware of a meta-analysis study carried out of nine studies which compared the pricing of sugar-sweetened beverages against the reduction of consumption of such drinks. It showed considerable price elasticity. Therefore, it is difficult to determine in an economy like ours the level of taxation that is required to achieve the right reduction. What plans do the Government have to find such evidence?

[Lord Prior of Brampton]

My Lords, it is interesting that in the plans put forward for consultation by Simon Stevens of NHS England they are looking at a levy of 20% on sweetened beverages. In Mexico, they brought in a sugar tax of 10%, which according to a study by the Lancet resulted in a reduction in consumption of some 12%. But it is very difficult to isolate the particular impact of tax when many other measures are being used at the same time.

NHS: Trust Finances

Debate between Lord Patel and Lord Prior of Brampton

Monday 1st February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, it is true indeed that Jim Mackey mentioned those figures. He is hoping that he can get that deficit down to £1.8 billion by the end of the year as a result of some of the capital to revenue and other accounting adjustments to which the noble Lord referred. We are also hoping that the reduction in agency spend will start to have a big impact in the final quarter of the year. We will get the third quarter results in two weeks’ time, when we will have a better idea as to where we will end up at the end of the year.

[Lord Patel (CB)]

Correct me if I am wrong, but the noble Lord mentioned in his Statement imposing a tariff on agency staff, cutting down on consultancy fees and the potential savings that the report of the noble Lord, Lord Carter, might produce—although most people doubt that it will. Where does he think that the finances of the NHS will be on 1 April 2017? What is his prediction?

[Lord Prior of Brampton]

The cap on agency staffing rates and on agency staff has really started to apply only in the past six weeks. So far, it looks as if we are making significant progress there. As I said in answer to the Question, the NHS is receiving £3.8 billion of extra funding in the forthcoming year. We believe that that will enable it to restore its finances to a proper balance by April 2017.

Pregnancy: Neural Tube Defects

Debate between Lord Patel and Lord Prior of Brampton

Monday 21st December 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I do not think that what the noble Lord has said is entirely correct. My honourable friend Jane Ellison received a letter from the SACN, the committee on nutrition, on 20 October that indicated that many more women were below the foliate level than had previously been thought. That evidence is quite new and came in at the end of October. That is what she is now considering.

[Lord Patel (CB)]

My Lords, the Minister has said that he is against mass medication. Do we really think that this is mass medication? We are talking about adding to flour micro amounts of nutrition that is lacking, to give a choice to people: if they intend to get pregnant, they eat bread made from that flour and not unfortified flour.

[Lord Prior of Brampton]

Just to correct the noble Lord. I did not say that I was against mass medication; I said that it was one of the things that should be considered. It is also worth saying that, even if there was mass medication, it probably would affect between 15% and 30% of women who have babies with neural tube defects and not all women.

Southern Health NHS Foundation Trust

Debate between Lord Patel and Lord Prior of Brampton

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

Debate between Lord Patel and Lord Prior of Brampton

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.

Junior Doctors Contract

Debate between Lord Patel and Lord Prior of Brampton

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.

Accident and Emergency Departments

Debate between Lord Patel and Lord Prior of Brampton

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.

Health: Global Health

Debate between Lord Patel and Lord Prior of Brampton

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.

Social Care

Debate between Lord Patel and Lord Prior of Brampton

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

Debate between Lord Patel and Lord Prior of Brampton

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

Debate between Lord Patel and Lord Prior of Brampton

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

Debate between Lord Patel and Lord Prior of Brampton

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.