Opticians Act 1989
Lord Prior of Brampton Excerpts(8 years, 3 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, I thank the noble Lord, Lord Newby, for bringing this subject, which is a new one for me, to our attention. I tried on a pair of adjustable-focus glasses a few days ago, and they are easy to use. The noble Lord is wearing some this evening, and although they may not be as fashionable as some pairs of glasses, I can see that they are perfectly serviceable.
It is odd for us on this side of the House—it is certainly odd for me—to find ourselves painted into the position of being against choice, competition and deregulation, which are now being advocated from the Liberal Democrat Benches. I do not normally associate them with that particular role. Instinctively I am a deregulator, and to be honest, many of the arguments that noble Lords have made resonate strongly with me. Clearly there is a huge vested interest at stake. Whether that is being improperly used in this case I do not know—but one can see that there will always be a strong voice for the status quo.
I should also pay tribute to the company for its work in Rwanda, which is clearly very important. Equally impressive, in many ways, is its breaking into the Japanese and American markets—no easy feat for a small private company. I take on board the words of the noble Lord, Lord Hunt, about how often we hear about companies finding it easier to break into overseas markets than into our own market. It is deeply frustrating, when we produce so many highly innovative products such as this one.
As for an independent review, perhaps we can come back to that question later. I rather like the thought, but although the role of the PSA was brought up in the context of the GDC, I am not sure what powers it has in such areas. That may be worth exploring. Unfortunately, however, I am going to disappoint the noble Lord, Lord Newby—but perhaps not wholly. We shall see when we get to the end. I shall put the other side of the argument, if I can—but in doing that I do not want to imply that the arguments we have heard are not powerful: they are. I know that my right honourable friend in the other House, Oliver Letwin, back when the Deregulation Bill was going through, would have instinctively been very positive towards the arguments that noble Lords are making.
As noble Lords are aware, in order to do what the noble Lord asks it would be necessary to amend the Opticians Act to remove requirements relating to the sale and supply of optical appliances. Clearly this is something we would do only after very careful consideration, and if we were confident that the proposal could stand parliamentary scrutiny. So if we were to take this forward at all, an independent review of some kind would be a requirement.
In the UK the sale of optical appliances is governed by the Opticians Act, which requires spectacles and contact lenses to be dispensed to a prescription issued by a registered optometrist or medical practitioner following a sight test. We are probably all aware of the exception that has been made. In response to the noble Lord, Lord Stoneham, I should say at this point that I will reread—or rather, read for the first time—the 1989 review, where similar arguments were put forward against the exception for reading glasses.
The Opticians Act does allow reading spectacles to be sold over the counter to adults with age-related sight loss. However, this exception has very limited criteria. The reading glasses must have the same power in both lenses, the power of the lenses must be in the range between 0 and 4 dioptres, and the glasses must be for reading purposes only. The General Optical Council is responsible for regulating the sale of glasses in the UK.
I am aware that Adlens has been in discussion with the GOC about its proposal that over the counter sale of its adjustable-focus glasses be allowed. As noble Lords know, in considering this issue the GOC sought the views of its standards committee, asking for its views on any benefits that adjustable-focus spectacles might bring, and any adverse effects that these products might have on the public’s health and safety. I am not aware of the extent to which it took into account the Charman report, which the noble Lord, Lord Hunt, mentioned. That is something that we should look into.
The standards committee raised a number of concerns, including concern about the safety of the product and the possibility that the product might not meet legal standards for driving.
Lord Hunt of Kings Heath
The point is that although the note we have says that the standards committee was provided with the independent report, it is not clear what it actually did with the report. It does not look as if the committee went through it in detail and considered the arguments—but that might just reflect the way in which the note was taken.
Lord Prior of Brampton
We have often been provided with reports, but that does not necessarily mean that we have read them and given them our full attention. I will ask that question.
I was going through the standards committee’s concerns. Another was that individuals may incorrectly self-adjust, causing a danger to the public when driving. Another was that the sale of these products may distract the public from having regular eye examinations. That is an issue that needs consideration. I appreciate that the noble Lord may not be convinced by the arguments put forward by the GOC’s standards committee, but we would be foolish not to take into consideration its professional view—the precautionary view that the noble Lord, Lord Hunt, mentioned. We have to give that due weight.
I understand that one of the original intentions behind the development of these glasses was to bring accessible vision correction to the developing world, particularly to areas where there was little or no affordable eye care. In the UK we are lucky enough to have no barriers to accessing sight tests and optical appliances which correct refractive errors. The NHS provides free sight tests to children, older people, those with or at risk of eye disease, and people on low incomes. In addition, help with the cost of glasses is available to children and people on low incomes.
It is already the case that self-adjustable glasses can be supplied by a registered medical practitioner or optometrist if they would benefit patients in particular circumstances. I do not think that we should downplay the important role of optometrists in carrying out sight tests. Optometrists are healthcare specialists trained to examine the eyes to detect defects of vision, signs of injury and ocular diseases, as well as problems with general health. Anyone who has had a sight test in recent years will know how much more is done these days than would have been done four or five years ago. Optometrists also offer valuable clinical advice, in addition to prescribing glasses and contact lenses.
One of the concerns raised by the standards committee was that members of the public might be discouraged from attending for regular sight tests. I appreciate that noble Lords do not agree with this argument, given that the availability of ready readers has not had such an impact. However, ready readers have a minimal prescription power and are for reading only.
Lord Stoneham of Droxford
I reiterate to the Minister why it is so important to read the report about reading glasses. Exactly the same arguments were used then—that they would undermine eye tests—yet exactly the opposite happened.
Lord Prior of Brampton
I have made a promise, and that will be among my other reading material. I do not know how long the review is; we shall see.
However, reading glasses are for a very specific, limited purpose, so might not lead people to think that a sight test is no longer necessary. Self-adjustable glasses, on the other hand, are for wider use, and could potentially lead people to think that their vision needs have been met. They may make do with those glasses for longer, and not consider the need for a sight test. In that way, the case might be slightly different from that of reading glasses.
I accept that there is reasonable concern about the potential impact on the take-up of sight tests if these glasses were to be made available over the counter. It is important to be clear that a sight test is not only about checking whether or not you need glasses. As I said earlier, it goes much further than that. A sight test can identify at an early stage diseases such as macular degeneration, glaucoma, diabetic retinopathy and cataracts. Good vision is also particularly important for safety on our roads, both for drivers and pedestrians. So I appreciate the concern raised by the GOC in respect of the safety of drivers using these self-adjustable glasses.
I draw a distinction between the current proposal—which, as I understand it, is for a range of magnification beyond that of ready readers—and magnification restricted to that of ready readers. I am not sure whether or not that makes sense. It makes sense if you read it slowly.
Even if the concerns I have outlined were overcome, it would be very difficult to justify a greater range for the adjustable, and arguably more risky, product than is allowed for ready readers. There is no appetite that I am aware of to extend the exemption applied to ready readers to stronger prescriptions, and similar objections would apply in that they would cease to be simply aids for the limited activity of reading.
However, I note that while the GOC standards committee did not endorse the idea of sale of adjustable glasses restricted to the ready readers range, it commented, as the noble Lord mentioned, that this might be acceptable. I do not know whether those proposing change have had further discussions with the GOC on this point but, if not, it would be sensible to do so before further consideration by the Government. I am not sure whether the noble Lord has had further discussions with the GOC. He might like to say so at the end. This does not mean that the GOC is convinced that this would be a sensible change or that the Government are minded to consult in the near future. I merely highlight that the GOC’s response was nuanced.
Changes to primary legislation are for government, although noble Lords will obviously appreciate that changes will only be made in the light of professional advice, and one of the sources of that advice will be the GOC. The GOC’s report was nuanced and is probably worth following up. I have an instinctive gut feeling of sympathy for the arguments made by the noble Lord but there are genuine objections from the GOC.
Health: Zika Virus
Lord Prior of Brampton Excerpts(8 years, 3 months ago)
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The Earl of Selborne
To ask Her Majesty’s Government what is their assessment of the World Health Organisation’s warning on the spread of the Zika virus.
The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, we welcome the WHO recommendations, and the Government are considering our response. PHE’s experts are liaising closely with WHO and other agencies to understand the developing evidence and give the best advice possible. Given the serious implications of a link with microcephaly, the current travel advice is highly precautionary. Those travelling to affected areas should review this advice, pregnant women should consider the need to travel and all travellers should take scrupulous bite avoidance measures.
The Earl of Selborne (Con)
I thank my noble friend for that reply. It is helpful to know that there is a rapid response call for research applications aimed at tackling the Zika virus. Does my noble friend agree that the immediate priority is to eliminate the species of mosquitoes which spread the virus? Will the Government support field trials with Latin American nations into the release of genetically modified non-replicating mosquitoes, as recommended by the Science and Technology Committee in December?
Lord Prior of Brampton
My Lords, I think we are the second biggest contributor of funds to WHO and have just contributed £6.2 million to its emergency contingency relief fund. I think that the work that we have done in the UK on developing genetically modified mosquitoes to combat this disease and other diseases spread by mosquitoes will almost certainly play a very major part as we go forward.
Lord Taverne (LD)
My Lords, since there is no prospect of an early vaccine to deal with Zika, is not the only show in town which could deliver an early answer to Zika the genetically modified mosquitoes to which the noble Earl, Lord Selborne, referred? This is a mosquito that has been modified so that its offspring die off before they can develop, and it is a mosquito that transmits both the dengue and the Zika virus. Since there has been astonishing success in the Oxitec company’s trials in parts of Brazil which, after the release of hundreds of millions of the modified mosquitoes, has virtually extinguished dengue, should the Government not support and fund extended trials by this company in Brazil? That would be extremely good not only for the reputation of British science but for the economy, since this is a field in which Britain leads the world.
Lord Prior of Brampton
There is no doubt that the work that we have done in this country on developing genetically modified mosquitoes will play a very large part in tackling Zika and other infectious diseases of this type. Sally Davies, the Chief Medical Officer, has convened a science committee which is meeting either today or tomorrow to assess the issues raised by the current outbreak. I am absolutely sure that she will be considering what the noble Lord has said as part of our response.
Lord Collins of Highbury (Lab)
My Lords, obviously effective control is essential, but since the WHO declaration we have had news of a sexually transmitted case of the virus. What lessons are the department taking, or what can they take, from this in terms of guidance and action in this country, particularly for travellers?
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.
Baroness Seccombe (Con)
My Lords, is the fever notifiable, so that a record is kept of this event?
Lord Prior of Brampton
My Lords, one of the problems of this illness is that four out of five people are asymptomatic—they have no symptoms. For many of the others, the symptoms are such that it is a very light cold or light flu. That is one of the problems with this illness.
Lord Hunt of Chesterton (Lab)
With the Olympic Games coming up, are particular precautions being considered and are you in contact with the organisations dealing with travel to the Games?
Lord Prior of Brampton
Comprehensive travel advice is on a number of different websites. The Royal College of General Practitioners and the Royal College of Obstetricians and Gynaecologists have been notified and the information has been cascaded down, so I think that there will be enough travel advice as we near the Olympics.
Baroness Tonge (Ind LD)
My Lords, is the Minister aware that in Brazil around 80,000 women die from unsafe abortion because of the lack of provision there? This figure will surely increase as a result of this terrible disaster. Is there any way that our Government can put pressure on the Brazilian Government to allow safe abortion in that country?
Lord Prior of Brampton
My Lords, that strays slightly away from the brief that I have on the subject today. May I take that on consideration? I will raise it with my honourable friend in the other House, the Minister for Public Health.
Baroness Masham of Ilton (CB)
My Lords, are the aeroplanes coming from the countries where there are these mosquitoes being sprayed?
Lord Prior of Brampton
My Lords, that is something that is under consideration at the moment. It varies from airline to airline—that is the truthful answer at the moment—but we are considering whether all flights from areas that have Zika virus should be sprayed.
Drugs
Lord Prior of Brampton Excerpts(8 years, 3 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, I thank the noble Lord, Lord Patel, for raising this issue. It is clearly hugely important. He said that this rise in deaths was a direct result of government policy. We should take that very seriously coming from someone who knows so much about the issue. I also thank him for warning me earlier about the likely thrust of his comments.
This debate is particularly timely as we are currently finalising our new drug strategy and thinking about what it needs to say in relation to this important issue. It will take a very close look at the impact of the current strategy. It is due to be published later in the year. The noble Lord’s comments today will certainly be taken into account.
We are especially concerned about the increase in drug-related deaths. Separately, Public Health England is now convening an inquiry into the reasons for the rise. I encourage noble Lords to give their views to PHE. A key part of its inquiry will be an in-depth analysis of the drug-death data. A national expert group will rapidly review the data, including the ONS data, and local experiences to better understand the causes of these deaths and how they can be prevented. That report is expected in a few months. This is not a Chilcot inquiry; it will be out in a few months, and it will include looking at dual diagnosis.
Although my comments today will largely cover England, since health is now a devolved matter, the PHE inquiry will look at experience in Wales and Scotland. Interestingly, both countries have widely differing results, so if there are lessons that we can learn from them, clearly we will do so. I will come back to the specific question about payment by results, if I can, towards the end.
As the noble Lord said, the ONS reports of 2013 and 2014 showed that registered drug-misuse deaths increased in England very significantly from about 1,500 in 2012 to 2,120 in 2014. They are a matter of huge concern and highlight the need for further national and local action. A small part of the increase might be explained by changes in the speed of registration of death. That is probably not significant, but it will be looked at in the PHE review. We are assuming that it will not be material.
Overall, fewer people are using drugs such as heroin. Those that do form an ageing cohort, which means that the health harms from the use of heroin are increasingly concentrated among older, more vulnerable users, particularly men aged between 40 and 49—the “Trainspotting” era, in a sense—and those who have not had recent contact with the treatment system. We may need to accept that because of their long-term drug use, the health problems associated with that and the recent availability of purer heroin, all of which can contribute to a much greater risk of death, deaths may still rise in future years, despite our best efforts to reduce them. Again, that is something that PHE will be looking at very carefully. This means that although overall drug use has declined in recent years and the treatment system has helped many more people to recover—some 70,000 in 2014-15—we need an enhanced effort to help these entrenched users and thus reduce the number of deaths.
Local authorities are best placed to be responsible for drug prevention and treatment because of their knowledge of the local population and its needs. They can approach a system on a place and local population basis, bringing together their experience of local employment, education, housing, social services and the like. That is the reason why this has been devolved to local authorities. Much improvement has been achieved, and the Government are determined to continue that improvement. We have therefore added a condition to the central public health grant which requires local authorities to further improve the take-up of the drug treatment services they provide and to achieve improved outcomes. I will turn to funding later on, if I can.
About half of the deaths involved opiate users. PHE analysis found that most of those who died from opiate overdose were not in treatment and, in most cases, had not been receiving treatment for some time. This emphasises the need to encourage drug users to engage with treatment services, because treatment has a protective effect, as the noble Lord referred to in his speech, and can help prevent deaths. It also emphasises the need for local authorities to ensure that vulnerable drug users outside the treatment system are given advice on how to reduce the risks from drug misuse and are encouraged into treatment—all the more so as heroin is becoming purer.
As mentioned earlier, Public Health England is convening an inquiry into the recent rise in drug-related deaths. The national expert group will rapidly review data and local experiences to better understand the causes of those deaths, how they interplay with other health issues such as mental health, and how those deaths can be prevented. We know that some parts of the country have much higher death rates than others, and PHE’s local centres are working with those areas to understand the factors contributing to those higher figures and what can be done to reduce them: for example, by spreading best practice.
We have also asked PHE to work with local authorities to make sure that services are available to anyone who needs them. So PHE is working with local commissioners and providing them with expert advice, evidence and management information, including outcomes and value for money data. This helps to ensure that services are evidence-based, effective, available, integrated with local health services and supported by local housing and employment policies.
In October 2015, we changed medicines regulations to widen the availability of naloxone. Naloxone is a medicine that almost instantaneously reverses the effects of opiates, and we have made it easier for drug services to supply naloxone to more people who might witness overdoses and could use it to prevent overdose deaths.
Turning to prisons, the thematic report by Her Majesty’s Inspectorate of Prisons, Changing Patterns of Substance Misuse in Adult Prisons and Service Responses, published in December 2015, acknowledges that substance misuse treatment provision in prisons has improved very significantly over the past 10 years. I am told that there is strong evidence that evidence-based commissioning by the NHS has had a positive impact on prison health more generally, as well as in this area.
PHE, NOMS and NHS England are working together under the auspices of the National Partnership Agreement to tackle the new challenges presented by new psychoactive substances and the misuse of prescribed medication. PHE recently published a toolkit for custody and healthcare staff to support their response to NPS and is currently delivering a national training programme across the prison estate.
PHE is working closely with the National Offender Management Service and NHS England to improve “through-the-gate” arrangements between prison and community services, including improved commissioning of services. It is also using new post-release supervision arrangements and licence conditions to make sure that prisoners are more effectively engaged in drug treatment after release. As the noble Baroness, Lady Walmsley, said, when people have been off drugs and then come out and go back on to drugs, that can have very severe consequences.
As I mentioned earlier, engagement with good-quality drug treatment has a protective effect. It stabilises people and helps to improve their physical health and well-being. For example, people in treatment for their opiate use are less likely to inject drugs, experience overdose or transmit blood-borne viruses such as HIV and hepatitis C. People in treatment are also more likely to be tested and treated or vaccinated for blood-borne viruses. There were nearly 300,000 adults in contact with treatment services in 2014-15. Over half of the 130,000 patients who left treatment in 2014-15 had successfully completed their treatment free of dependency. This is an improvement on past performance and is helping people to achieve their potential and live a fuller, more rewarding life.
We have commissioned and received advice from the Advisory Council on the Misuse of Drugs about the contribution that opioid substitution treatment such as methadone can make to helping people recover. This is not in the least at odds with long-term prescribing of methadone to protect the health of those who are not able, or not yet able, to achieve full recovery. A question was raised as to whether at the time the policy was implemented—in 2010, I think—an assessment was done of the potential perverse consequences of that policy. I am not aware of whether such an assessment was done, but I can revert to the noble Lord about that afterwards.
Over the last decade, treatment outcomes have steadily improved, but have slowed in the past couple of years, most likely because the people remaining in treatment are those with more entrenched drug use and long-standing and complex problems. This is why recovery remains at the heart of our approach, with the key aim to support people to free themselves from drug dependency for good. We have moved our focus beyond the treatment system, to look more holistically and to include factors that help people recover from drug dependency and fully integrate back into the community.
We know that mental health can be a particular issue for many drug users. Some may use drugs as a form of self-medication for a mental health problem. Some will find that drugs exacerbate or cause mental health problems. PHE is encouraging substance misuse and mental health commissioners to work together at a local level to ensure that the services they commission are responsive to the needs of this client group, and there are clear specifications and transfer arrangements that describe how they will be effectively co-ordinated and delivered. I do not have time to talk about prevention; I thought I would have more time but I have only two minutes left.
The issue of funding is an important area. The noble Lord, Lord Patel, mentioned that the number of specialist mental health care nurses was down 10%. This reflects a more fundamental problem that over the past five to 20 years so much of the budget has gone into acute care. Community and mental health care has unquestionably suffered over that time. It illustrates a much broader problem. It is clear from the mandate of NHS England that parity of esteem is a key part of our policy over the next five years. Each clinical commissioning group’s spending on mental health will increase in real terms. There will be more money available for mental health care.
However, it will still be tough. There is not a lot of money in the system, but we are prioritising mental health care, and I think that, together with the public health grant, which is ring-fenced in local authorities, there will be resources available to tackle what I accept is a hugely difficult, complex and, as we have seen from the figures today, tragic area in which society, not just healthcare, has so dismally failed.
Briefly on the PBR point, the DH has done an evaluation on the payment by results pilots for drug and alcohol recovery, which will be published later this year. The preliminary evaluation, which is already published, suggests that the pilots did not lead to inappropriate pressure to discharge people from drug treatment—but it is preliminary and the full results will be published later in the year. I was going to say a little more about prevention but we can discuss that at another time.
Sugar Tax
Lord Prior of Brampton Excerpts(8 years, 3 months ago)
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Lord Clinton-Davis
To ask Her Majesty’s Government whether, in the light of the World Health Organisation’s analysis in the Report of the Commission on Ending Childhood Obesity, they support the proposal of the National Health Service to introduce a sugar tax.
The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, we are interested to see the results of the consultation on NHS England’s proposals for a sugar tax. Urgent action is needed to tackle obesity, particularly in children, which is why we will shortly set out a comprehensive new strategy to tackle the problem.
Lord Clinton-Davis (Lab)
The World Health Organization and the NHS, both distinguished bodies, have proclaimed that a sugar tax is desirable, necessary and should be introduced as soon as possible. In that light, do the Government have any plans to revise their previous position and introduce proposals for a sugar tax by no later than April of this year?
Lord Prior of Brampton
My Lords, the Government are considering a whole range of options for tackling the scourge of obesity in young people, which include portion control, reformulation, advertising and many others. One issue they are considering is a sugar tax, but we will announce the results of that strategy in the very near future.
Baroness Walmsley (LD)
My Lords, does the Minister agree that the key to weight management is correcting energy imbalance? Will the Government therefore consider forcing manufacturers of junk foods to put on their labels the number of hours of vigorous exercise that are equivalent to the contents of the packet?
Lord Prior of Brampton
My Lords, as the noble Baroness will know, there are plans for later this year to have compulsory labelling of sugar content on packaging. However, I am not aware that there are any plans to have pictures of well-known athletes on the packaging as well.
Lord Robathan (Con)
My Lords, does the Minister agree that the issue of obesity, which is indeed a scourge, is largely one of individual and, in the case of children, parental responsibility?
Lord Prior of Brampton
My noble friend is partly right. It is of course a matter of individual and parental responsibility, but I think we have an obligation in our country to make the right choice as easy as possible, and for too many people the wrong choice is far too easy to make.
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.
Baroness Wheeler (Lab)
My Lords, Simon Stevens, the NHS chief executive, recently pointed out that obesity is the new smoking, and that Britain spends more on obesity-related healthcare than on the police, the fire service, prisons and the criminal justice service combined: £6 billion and rising. He has promised to raise the price of sugary drinks sold on NHS premises to staff, patients and visitors as another small step. Cannot the Government take steps to introduce this policy across all government departments and institutions?
Lord Prior of Brampton
My Lords, public procurement certainly has a role to play in tackling obesity. I am sure that that is one of the issues that will be addressed in the forthcoming strategy.
Lord Tugendhat (Con)
Does my noble friend agree that taxation, along with other measures, has played a significant role in diminishing the consumption of tobacco in this country over the years? Is it not therefore rather strange that the Government should be so reluctant to make more use of this weapon with regard to obesity?
Lord Prior of Brampton
My Lords, we have to be careful, or at least recognise, that if a sugar tax were imposed it would fall largely on those who are least able to afford it. There is of course a strong argument for a sugar tax, but there is also a case for making the argument against sugar consumption and making it easier for people not to consume sugar before we resort to taxation.
Baroness Jones of Moulsecoomb (GP)
My Lords, the Mayor of London, a well-respected member of the Conservative Party, has already put a sugar tax on sugary drinks at City Hall, so might the Government consider doing the same for the rest of Britain?
Lord Prior of Brampton
My Lords, what the Mayor of London has done at City Hall is similar to what Simon Stevens proposes to do within the NHS. The Government will watch both moves with great interest.
Lord McColl of Dulwich (Con)
My Lords, will the Minister give us an assurance that when the new policy comes out to tackle obesity we will not fall into the trap of saying that the answer is exercise? You have to run for miles and miles to take off a single pound of fat.
Lord Prior of Brampton
My Lords, exercise may be a part of our strategy to tackle obesity, but certainly not the major part.
Baroness Howells of St Davids (Lab)
My Lords, I am sure that the House is aware that sugar comes from many sources—sugar cane, sugar beet and in fruit. Which sugar would we tax?
Lord Prior of Brampton
The noble Baroness makes an interesting point. This is one of the difficulties with the proposal for a sugar tax. We must be very careful about which sugars we would tax. I cannot give the noble Baroness a proper answer save that where sugar taxes have been introduced, they apply to where sugar is added as part of the manufacturing process or where it is present in syrups and fruit juices, but not where it occurs in, for example, fruit or vegetables.
NHS: Trust Finances
Lord Prior of Brampton Excerpts(8 years, 3 months ago)
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The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, with the leave of the House, I shall now repeat as a Statement the response to an Urgent Question on NHS finances given in the other place by my honourable friend the Minister for Care Quality. The Statement is as follows:
“The House will know that in 2014, the NHS itself set out its plans for the next five years, which included a front-loaded funding requirement of £8 billion. Because of our strong economy, the Government have been able to honour that request and will be funding it in full, including a down payment of £2 billion in this financial year ahead of the spending review period. Next year, there will be an increase of £3.8 billion and, taken together, we shall therefore be providing £10 billion towards the NHS five-year forward view.
Within that context, a number of hospital trusts are running a financial deficit—in large part because of the need to staff wards safely after what was learned in the aftermath of the scandal of Mid Staffs. It is also the case that the best hospitals have begun to transform along the lines required by the NHS Five Year Forward View, but some have not, and this has made the management of their finances all the more difficult.
NHS Improvement expects that NHS hospital trusts will report an overall deficit for the current financial year, 2015-16. Savings achieved in the rest of the NHS have ensured that this overall deficit will be offset, so that the system as a whole will achieve financial balance. For the next financial year, NHS Improvement will continue to work with trusts to ensure that they improve their financial position. To help them in this endeavour, the department has introduced tough controls on the costs of staff agencies, a cap on consultancy contracts and central procurement rules, as proposed by the noble Lord, Lord Carter, in his review on improving hospital efficiency. The House should know that the savings identified by the noble Lord total £5 billion a year by 2020. The chief executive of NHS Improvement, Jim Mackey, is confident that, taken together, these measures will enable hospital trusts to recover a sustainable financial position next year”.
That concludes the Statement.
Lord Prior of Brampton
My Lords, the noble Lord asked a number of questions. Starting in reverse order, the Five Year Forward View was signed by not just the NHS Commissioning Board but also all the ALBs. Of course the £22 billion is a huge stretch. No one denies that and it requires a transformation in the way in which healthcare is delivered in this country. In terms of efficiency savings, the requirement for next year is 2%. We expect that to continue at around 2% to 3% over the five-year period.
I come to the noble Lord’s other questions. There is not a direct conflict between safe staffing levels, efficiency and financial balance. In good hospitals, the three go together. Of course I accept that there have been tensions and it is not surprising, looking back on it, that the reaction to what happened at Mid Staffs led to a number of hospitals increasing staffing levels very rapidly. I remember talking to the noble Lord when he was chairman of a trust—as I was at the time, or I might have been at the CQC—and of course I understand those pressures. All boards of all hospitals must live with those pressures and come to the right balance. I accept that the newly reinvigorated CQC has added to some of the pressures on hospitals to increase the level of staffing.
On the King’s Fund, I have not seen the report that the noble Lord mentioned and that reference to the “financial meltdown”. We expect to break even across the NHS this year. There is £3.8 billion extra spend going into the NHS next year and we hope that when all the plans have come in from the hospital trusts we will be in reasonable shape.
The noble Lord referred to the letter sent out, which I think was leaked in the Guardian, which led to this Urgent Question. I did not see the actual letter before it went out, but there is nothing in it that comes as a big surprise.
Baroness Walmsley (LD)
My Lords, a good example of NHS trusts doing what the Government have asked them to do and working together to deliver care more efficiently is the Uniting Care Partnership in Cambridgeshire and Peterborough, which collapsed after only eight months. We are told that the three NHS entities involved in the contract will continue to deliver care under the new model without disruption. If this is able to be done, why was so much money wasted in the bidding process? Could not they have worked together anyway? How much did the whole process cost and how much was paid to their advisers, the Strategic Projects Team, which did not seem to realise that the contract at the agreed price was simply undeliverable? Is not it clear that the CCG simply did not have enough money to deliver those services?
Lord Prior of Brampton
I think that the noble Baroness’s party was in government when that contract was negotiated, although it seems a bit churlish to remind her of that. The fact is that, as we move to these new ways in which to deliver care, risk is going to have to be taken. Some of the new ways in which we do it are not going to work. In this case, it clearly did not work. It was a very big project—£800 million in total value, I believe, over five years, for older people in Cambridgeshire. It was a highly complex contract and, tragically, it has not worked out. I shall have to come back to the noble Baroness if I can about how much it cost in fees.
Lord Warner (Non-Afl)
My Lords, the Minister mentioned the chief executive of NHS Improvement in very approving terms. Is he aware that that same chief executive told the House of Commons Public Accounts Committee that the sector’s deficit for the current financial year, 2015-16, looks,
“like it is heading towards £2.5 billion or perhaps even north of that”.
Capital to revenue transfers and “accounting adjustments” will kick in before April to bring the number down. Does that mean that the much-touted £3.8 billion that will come into the NHS next financial year, 2016-17, already has £2.5 billion to be offset against it before the financial year starts?
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.
Baroness Finlay of Llandaff (CB)
What are the Government going to do about the haemorrhage of finances into the PFI deals, given that £11.8 billion of buildings will have cost the country £79 billion by the time 31 years comes round? By then those buildings might very often not be fit for purpose because things have moved on so fast. Year on year there is a haemorrhage of money from the NHS to finance these deals. Last year, £2 billion went in that direction.
Lord Prior of Brampton
It is clear that a number of these PFI deals were massively expensive and have put huge pressure on a relatively small number of trusts. However, the fact is that we have entered into these long-term contracts and there is no way of getting out of them. I am afraid that it is a cost that the NHS will have to continue to bear.
NHS: Junior Doctors’ Pay
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Lord Harries of Pentregarth
To ask Her Majesty’s Government what assessment they have made of the remuneration of junior doctors.
The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, the review body on doctors’ and dentists’ remuneration stated, in its 2015 report, that total pay for junior doctors compares favourably with comparator groups. This will remain the case under the proposed new contract. Average total earnings range from £31,000 in the early stages of training to £53,000 for those in the later stages when they have specialised.
Lord Harries of Pentregarth (CB)
My Lords, I thank the Minister for his Answer and declare a personal interest with a wife and son who are doctors. As the Minister will know, medical students do three years after they graduate before they obtain their first job at the age of 24, at which point they will have accumulated between £100,000 and £120,000-worth of debt, and their starting salary will be about £20,000 a year. I heard recently of somebody newly graduated being offered a job in computers for £60,000 a year, and another person newly graduated—at the age of 20 or 21—being offered £60,000 for a job in management consulting. Do the Government agree that there is something fundamentally out of balance in this system, and is the Minister convinced that the Government are doing all they can to ensure that junior doctors get a fair settlement, not just for themselves but for the whole future of the NHS?
Lord Prior of Brampton
My Lords, I should also declare a personal interest, as my son is in his fourth year as a medical student. It is actually two years after undergraduate training when you qualify fully. The base salary is about £23,000—the noble Lord said £20,000—but the average is more like £30,000, when you take into account the supplementary pay that they receive. I, too, see what other people are being paid in other sectors, but the fact of the matter is that, when a young man or woman opts to go into medicine, pay is not their main motivation: there are all kinds of other things as well. One has to take into account the whole package that is offered, not just the salary.
Lord Turnberg (Lab)
Is not the reason why young doctors and not-so-young doctors are threatening to go on strike not so much the pay but because this is the last straw in a continuing series of alienation, and of feeling undervalued and underappreciated by the management from the Secretary of State down?
Lord Prior of Brampton
I agree. I do not think that this dispute is fundamentally about pay; it is much more profound than that. It is about a feeling among many junior doctors, which is shared by many senior doctors as well, that they are not properly valued and fully appreciated. That is the underlying cause of the problems we are facing.
Lord Mackay of Clashfern (Con)
Can my noble friend say what the Secretary of State, his Ministers and the senior members of the department are doing to promote the morale of junior doctors in the light of what he has just said? There must be a very important job to be done in that connection.
Lord Prior of Brampton
My Lords, yes; the Secretary of State takes this matter incredibly seriously, and as part of the contract that is under negotiation with the BMA at the moment we are looking very much at the number of hours that junior doctors have to work. Many have worked for too many hours in the past and we want to put a cap on the number of hours they will work in future.
Lord Walton of Detchant (CB)
My Lords, I declare an interest as in 1950 I was elected chairman of the BMA’s Registrars Group, the predecessor of the present Junior Doctors Committee. I express the fervent hope that the current negotiations between the BMA and the Government will quickly be concluded to the satisfaction of both parties. In my view and in the view of many doctors it is a matter of considerable concern that there is a suggestion of further industrial action, which is inimical to the ethos of a caring profession. Will the Minister accept my view that the alleged threat by the Secretary of State to impose a new contract of employment on all junior doctors without agreement is outrageous?
Lord Prior of Brampton
My Lords, I think the whole House will agree with the noble Lord that we all very much hope to avoid another strike. The Secretary of State has asked David Dalton, the very distinguished chief executive of Salford Royal—the noble Lord, Lord Turnberg, will know him extremely well—to head up those negotiations with the BMA, and we are very hopeful that a conclusion to this dispute will be reached before there is any more strike action.
Baroness Brinton
I am very grateful to the noble Lord for giving way. Pay is only part of the problem for our doctors in this country at the moment. The NHS is increasingly kept afloat by overseas-trained doctors and over 40% of our hospital doctors are now from overseas. In certain specialities such as obstetrics and gynaecology the number is currently over 56%. Can the Minister say what the Government are doing to understand why some specialities struggle to attract enough UK-trained doctors, and, further, what they are doing to increase the number of medical training places for UK-based students?
Lord Prior of Brampton
The noble Baroness raises a very important point that we are highly dependent in a whole range of medical specialties on overseas doctors and of course overseas nurses as well. Health Education England is expanding the number of training places, in particular for GPs; we hope to have an extra 5,000 GPs in place by the end of this Parliament.
Lord Winston
My Lords, I apologise for interrupting the noble Baroness. The Government’s stated objective is essentially to cover NHS hospitals 24/7—that is, with weekend working. Many hospital managers—for example, those in Birmingham—have pointed out that they are perfectly able to staff their hospitals fully under the existing contract. Can the Minister tell us how many NHS hospitals in the United Kingdom have closed as a result of inadequate staffing at weekends?
Lord Prior of Brampton
My Lords, it is not a question of hospitals closing at weekends because of inadequate staffing; it is a question of whether hospitals are able to offer high-quality care throughout the weekend. Some hospitals can but some cannot. We have seen, for example, the reorganisation of stroke care in London. Providing high-quality seven-day services for stroke care can have a significant impact on the quality of patient care. This seven-day issue is not just about junior doctors by any means; it is a question of having diagnostics, senior doctors and a whole range of other specialties on duty over the weekend.
The Lord Bishop of Chester
My Lords, I, too, declare that I have a daughter who is a junior doctor. She is in her fourth year since qualification. To get to the level of remuneration that the noble Lord mentioned—from £23,000—junior doctors have to work jolly long and unsocial hours. But my specific question is: what is the comparator with other developed western countries for the remuneration of our younger doctors?
Lord Prior of Brampton
My Lords, I cannot answer that question as fully as I would like but I shall certainly write to the right reverend Prelate on that. I think that from 2004 to 2007 British doctors were extremely well remunerated by any international comparison but that, over time, that has eroded. But I will write to the right reverend Prelate with those comparisons.
Baroness McIntosh of Hudnall (Lab)
My Lords, I think that the House will have been very interested to hear the Minister say, in terms, that seven-day working is not just about junior doctors but about a lot of other healthcare professionals who also need to be able to bring their services to bear at those times. Does he not think that it is a great pity that the dispute, as it has been conducted politically, has focused entirely on junior doctors and that this point has not been brought out? Will he do his best to make sure that it is brought out hereafter?
Lord Prior of Brampton
My Lords, discussions are going on with senior doctors and consultants at the same time, so I can assure the noble Baroness that it is not just with junior doctors that we are having these discussions.
National Health Service: Nurses
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Lord Clark of Windermere
To ask Her Majesty’s Government what plans they have to ensure that there are a sufficient number of nurses in the National Health Service.
The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, Health Education England is responsible for workforce planning in the NHS. In 2016-17, the HEE commissioning and investment plan forecasts an additional supply by 2020 of 40,000 nurses as a result of undergraduate and postgraduate commissions placed with universities between 2012 and 2016. Moving new nursing students on to the student loans system from August 2017 allows universities to offer up to 10,000 extra nursing, midwifery and allied health degree places by 2020-21.
Lord Clark of Windermere (Lab)
I thank the Minister for his answer, and we all wish the Government well in trying to make up the shortfall of nurses which is bedevilling our National Health Service at the moment. I am dubious about the abolition of the bursary scheme and think that the Government’s proposals are highly risky, but I wish the Government well. I ask the Minister for an assurance that if they proceed with the abolition of the bursary scheme, they will recognise that the cost to nurses at the end of their training will probably be approaching £50,000. Will the Government give a commitment that they will fund a payback or reward scheme so that those nurses who have spent a number of years in the National Health Service will have some of those debts written off?
Lord Prior of Brampton
My Lords, I thank the noble Lord for wishing the scheme well. It is intended to increase the supply of young men and women going into the nursing profession, with which I think everyone in this House would agree. It is true at one level to say that people receiving loans rather than bursaries will have a debt of about £50,000 at the end, but the repayment of that is, as the noble Lord knows, graduated, and only 9% of the excess over £21,000 a year will be payable, not the full amount, as he suggests.
Baroness Gardner of Parkes (Con)
My Lords, I have previously raised the question of the abolition of the SENs, and the Minister has told me that thought is being given to training which will not require university entrance. Are the Government making any progress on that, as there are many wonderful nurses—I am sure that we have all known some—who could never have got enough academic points to come in at the university training level?
Lord Prior of Brampton
My Lords, I completely agree with my noble friend’s sentiments. She will be pleased to know that from August of this year, Health Education England will be funding 1,000 new nursing associates, who will not be taking a degree but will effectively do a nurse apprenticeship, although they will be able to switch over to doing a degree later in their career if they so choose.
Baroness Walmsley (LD)
My Lords, given that hospital trusts are recruiting 5,600 nurses from outside the EU every year, that is surely much more of a pull factor than anything the Government might do with benefits. Given the fact that trainee nurses have to work on a clinical placement outside term time in which they add value to the NHS and take on responsibility, why are they not paid?
Lord Prior of Brampton
My Lords, I do not entirely follow the noble Baroness’s question. All I can say is that we are all pleased that we are able to attract nurses from overseas, but that cannot be the right long-term policy for this country. We must train our own nurses and not rely upon recruiting nurses from overseas.
Baroness Watkins of Tavistock (CB)
My Lords, what consideration have the Government given to enabling people who want to study nursing as a second degree to have loans in the way that they will allow for those studying some STEM subjects? We have traditionally had mature entrants who are already graduates.
Lord Prior of Brampton
My Lords, we are still consulting on the details of this scheme, but I assure the noble Baroness that the loan scheme will be available for mature students doing their second degree as it is for those doing their first degree.
Lord Hunt of Kings Heath (Lab)
My Lords, last night in the education regulations debate, the noble Baroness, Lady Evans, said from the Dispatch Box that last year the cap on applications for nursing students meant that 37,000 applications were rejected, yet today the Minister quoted the figure of 10,000 extra places by 2020, which I take to mean 2,000 places a year. What about the other 35,000 a year who are presumably rejected for a nursing place? If there are ways of getting rid of the cap, why on earth are the Government not allowing many more nurses to be trained? Is it actually because they have cut the budget of Health Education England which would have to finance the placements of those student nurses in NHS trusts?
Lord Prior of Brampton
My Lords, I think the noble Lord is wrong in what he says, but I will double check. I believe that there will be an additional 10,000 placements per year, but I will check that afterwards. That is not until 2021 because the new scheme will not come into place until August 2017, which means that the first students will come out of the new scheme in 2020. We are estimating that there will be 10,000 in that year.
Baroness Finlay of Llandaff (CB)
Do the Government recognise that the retention of nurses is also extremely important and that the loss from the profession later in life may reflect difficult working conditions and lack of support? Will the Government also note that nurses in the hospice world and specialists in palliative nursing tend to be older nurses who have left NHS employment and gone to the charitable sector precisely because they feel that they can work as they want to, fully and professionally, and have a supported working environment?
Lord Prior of Brampton
My Lords, retention and return to practice are crucial. The noble Baroness may be interested to know that Health Education England has up to 90, I think, courses that have so far attracted just under 1,000 nurses back to practice. The cost of attracting someone back to practice is some £2,000 each compared with some £50,000 for a new nurse.
Baroness Wall of New Barnet (Lab)
My Lords, the noble Lord will be aware of the pressure that is quite rightly on trusts to reduce their agency spend. How can we cope with doing that when we are also still trying to get in nurses whose visas are being stopped, despite the fact that that restriction was supposed to have been lifted?
Lord Prior of Brampton
The cost of agency spend has risen from around £2.8 billion a year to some £4 billion this year. It is far too high. There is recognition that reliance upon agencies to this degree is also not good for quality of care. On grounds of both care and cost, we wish to reduce the spend on agencies.
Failures of the 111 Helpline
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The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, with the leave of the House, I shall repeat as a Statement the Answer to an Urgent Question given in another place by my right honourable friend the Secretary of State for Health on NHS England’s report into the death of William Mead and the failures of the 111 helpline. The Statement is as follows.
“Mr Speaker, this tragic case concerns the death of a one year-old boy, William Mead, on 14 December 2014 in Cornwall. While any health system will inevitably suffer tragedies from time to time, the issues raised in this case have significant implications for the rest of the NHS which I am determined we should learn from.
First, though, I would like to offer my sincere condolences to the family of William Mead. I have met William’s mother Melissa, who spoke incredibly movingly about the loss of her son. Quite simply we let her, her family and William down in the worst possible way through serious failings in the NHS care offered, and I would like to apologise to them on behalf of the Government and the NHS for what happened. I would also like to thank them for their support and co-operation in the investigation that has now been completed. Today, NHS England published the results of that investigation—a root-cause analysis of what happened. The recommendations are far-reaching, with national implications.
The report concludes that there were four areas of missed opportunity by the local health services where a different course of action should have been taken. These include primary care and general practice appointments by William’s family, out-of-hours calls with their GP and the NHS 111 service. Although the report concluded that these did not constitute direct serious failings by the individuals involved, had different action been taken at these points, William would probably have survived.
Across these different parts of the NHS, a major failing was that in the last six to eight weeks of William’s life the underlying pathology, including pneumonia and a chest infection, was not recognised and treated. The report cites potential factors such as a lack of understanding of sepsis, particularly in children, and pressure on GPs to reduce antibiotic prescribing and acute hospital referrals. Although this was not raised by the GPs involved, the report also refers to the potential pressure of workload.
There were specific recommendations in relation to NHS 111 which should be treated as a national, not a local, issue. Call advisers are trained not to deviate from their script, but the report says that they need to be trained to appreciate when there is a need to probe further, how to recognise a complex call and when to call in clinical advice earlier. It also cites limited sensitivity in the algorithms used by call handlers to red-flag signs relating to sepsis. The Government and NHS England accept these recommendations, which will be implemented as soon as possible.
New commissioning standards issued in October 2015 require commissioners to create more functionally integrated 111 and GP out-of-hours services, and Sir Bruce Keogh’s ongoing urgent and emergency care review will simplify the way the public interacts with the NHS for urgent care needs.
Most of all, we must recognise that our understanding of sepsis across the NHS is totally inadequate. This condition claims around 35,000 lives every year, including around 1,000 children.
I would like to acknowledge and thank my honourable friend the Member for Truro and Falmouth, who, as well as being the constituency MP to the Mead family, has worked tirelessly to raise awareness of sepsis and has worked closely with the UK Sepsis Trust to reduce the number of avoidable deaths from sepsis.
In January last year I announced a package of measures to help improve diagnosis of sepsis in both hospitals and GP surgeries, and significant efforts are being made to improve awareness of the condition among both doctors and the public. But the tragic death of William Mead reminds us there is much more work to be done”.
Lord Hunt of Kings Heath (Lab)
My Lords, I am very grateful to the noble Lord for repeating that. I start by paying tribute to Melissa Mead and her husband Paul, who have fought to know the truth about their son’s death and who are now campaigning to raise awareness about the care of sepsis and how we can improve it.
Clearly, the key is to learn lessons and take action in the immediate future. Ministers were warned about poor sepsis care back in September 2013 when an ombudsman report highlighted shortcomings in initial assessment and delay in emergency treatment that led to missed opportunities to save lives. Can the Minister say what action has been taken by the Government? Will he urgently meet the UK Sepsis Trust to discuss what needs to happen to raise awareness among GPs, the NHS and the public?
The Minister outlined the failures in the 111 response. He will know that the replacement of NHS Direct, which was predominantly a nurse-led service, with NHS 111 means that the service now relies mainly on call handlers who receive as little as six weeks’ training and where turnover among staff can be very rapid. Is he going to review the training that call handlers receive and will he consider increasing the number of clinically trained staff available to respond to calls?
The Minister will be aware that there are two other inquiries into NHS 111 failures at the moment: in the east Midlands and on the south-east coast. Can the public have confidence that the 111 service is fit to diagnose patients with life-threatening conditions?
Lord Prior of Brampton
My Lords, I echo the tribute that the noble Lord paid to the Mead family and their recognition that we can only learn from these terrible tragedies. The fact that they are prepared to make available the report to other parts of the NHS will help in that learning process. I, or one of the other Ministers concerned, will certainly undertake to meet the UK Sepsis Trust.
The noble Lord raised the issue of the 111 service. It is worth making the point that, in this case, the call handler took the call and referred it to a GP who was part of the out-of-hours service. The GP then spoke directly to William’s mother and decided on what the right course of action was. However, I take on board exactly what the noble Lord said about training and the mix between clinicians and non-clinicians in 111 call centres. It will become a better service when the out-of-hours service and the 111 service are integrated.
One point that came out of the report was that had there been an electronic patient record indicating the evidence of the time that William had spent with GPs in the preceding six weeks, the GP who took the call might possibly have come to a different decision. This was a tragic case of all the holes in the Swiss cheese lining up to cause this awful tragedy. Therefore, I take on board what the noble Lord said about 111 and will pursue that with NHS England.
Baroness Walmsley (LD)
My Lords, I share the concerns of the noble Lord, Lord Hunt, about 111, but does this not go much wider? On the issue of medical and public education about sepsis, what are Public Health England and Health Education England going to do about this? We cannot rely on the BBC1 programme “Trust Me, I’m a Doctor”, which this week has certainly increased my understanding of the symptoms of sepsis. But that needs to be spread to the wider public. I recommend that people go on iPlayer and watch that programme if they want to know about this. Does this not also indicate that this very conscientious and determined mother was not listened to? She knew her child was behaving abnormally and all the people who talked to her—from GPs through to everyone else—just did not listen.
Lord Prior of Brampton
My Lords, the facts of this case demonstrate that a lot of things went wrong. That is the real tragedy of it. Had one of those things not gone wrong, the tragedy may not have happened. The noble Baroness referred in particular to medical education but it is wider than that. As I said, a whole stream of things went wrong and we must learn from that.
Baroness Masham of Ilton (CB)
My Lords, does the Minister agree that confusing messages are coming out? One is that antibiotics are being given too liberally. The other is that they are desperately needed for serious chest infections—and this boy had pneumonia, which was missed. Cases of meningitis are also missed. Such illnesses really need antibiotics. Does he agree?
Lord Prior of Brampton
My Lords, in a sense there are mixed messages—but there is a common-sense message here as well. We do not want to overuse antibiotics but, on the other hand, clearly where there is a serious infection, antibiotics are absolutely necessary. At one level it is a mixed message but there is a common-sense way through the two.
Baroness McIntosh of Hudnall (Lab)
My Lords, the noble Lord has pointed out—as those of us who have read about this case are aware—that the patient was a very young child. One thing that I find troubling about this whole history is that that fact appears not significantly to have influenced the way in which his case was handled. Is it not the case that there should be a default position in respect of very young children exhibiting symptoms where the precautionary principle should apply, whether in respect of prescribing antibiotics, referring to hospital or any other kind of presumption of the possibility of acute illness?
Lord Prior of Brampton
My Lords, one would expect the doctors concerned to make that presumption in the case of a very young child. But the noble Baroness makes a valid point and I am sure that NHS England will take it on board.
Baroness Meacher (CB)
My Lords, does the Minister agree that this tragic case occurred in an environment of incredible pressure on GPs and others within the NHS, with a growing blame culture and huge numbers of patients—they have to see 60 to 70 in a day very often? We all have to accept that things will go wrong if we leave GPs, in particular, working under those sorts of personal pressures and so on. We know that 30% or so will leave the profession in the coming years. Will the Minister meet with me to discuss what he might do to alleviate some of those problems? That could be very helpful.
Lord Prior of Brampton
My Lords, unquestionably there are huge workload pressures on GPs. There is no doubt about that. I do not think they were a primary cause of this particular tragedy, but I will be happy to meet with the noble Baroness to discuss that.
General Dental Council (Fitness to Practise etc.) Order 2015
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Lord Prior of Brampton
Moved by
That the draft order laid before the House on 18 November 2015 be approved.
Relevant document: 11th Report from the Joint Committee on Statutory Instruments. Considered in Grand Committee on 18 January.
Health: Hormone Pregnancy Tests
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Lord Kennedy of Southwark
To ask Her Majesty’s Government what is the timeframe for the inquiry into the safety of hormone pregnancy tests, and when they expect the report to be published.
The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)
My Lords, an expert working group of the Commission on Human Medicines has been convened to review all available evidence on whether use of hormone pregnancy tests may have been associated with adverse outcomes in pregnancy. The group met twice in 2015 and a number of further meetings will be held in 2016. A report of the group’s findings will be published once the review is complete, which is expected before the end of the year.
Lord Kennedy of Southwark (Lab)
My Lords, the terms of reference of the inquiry still do not include past regulatory failures and the campaigners fear a veil of secrecy and an inability to get to the truth. What can the Minister say today to alleviate people’s fears? Will he agree to meet a delegation of campaigners and interested Peers to discuss how we can shine a light on what happened to learn the lessons of the past so that they are there for the future?
Lord Prior of Brampton
My Lords, this issue goes back to the 1950s, so trawling back over that period may not be that helpful. What is helpful is that we learn lessons from the past so that the existing regulatory system can learn from those errors. I am, however, very happy to meet the noble Lord and others who are interested to discuss this further, if they wish to do so.
Baroness Walmsley (LD)
My Lords, given that many of the survivors of Primodos, the drug in question here, were not told that they were taking part in a clinical trial, will the noble Lord assure us that today nobody would take part in a clinical trial without their knowledge?
Lord Prior of Brampton
My Lords, I understand that to be the case but I will double-check and, if it is not, I will of course write to the noble Baroness.
Lord Hunt of Kings Heath (Lab)
My Lords, is it absolutely clear that there will be full disclosure of all public documents and the regulators’ documents for this review?
Lord Prior of Brampton
I understand that all the relevant documents are being made available to the expert working group. The chair of the association looking after the children who have been damaged by these pregnancies is an observer on that committee.
Lord Winston (Lab)
My Lords, with deference to my noble friend’s Question, is it not a fact that 40 years on—it is actually more than 40 years because the last letter in the British Medical Journal was in 1977 on things that had happened previously—it is now really impossible to decide the precise nature of what happened after the dosage of Primodos? While an inquiry might be helpful to some people, it is very unlikely that we will uncover anything that will be really useful in the future. Is not the message to pregnant women that they are not advised to take any kind of drug during pregnancy?
Lord Prior of Brampton
My Lords, the noble Lord is clearly an expert in this field. If the advice is that pregnant women should not take any kind of drug during pregnancy, that must be the right advice. I agree with him that many of these documents go right back to the early 1950s and many are in German rather than English. The quantity of documentation is enormous. That is one reason why this review has taken so long. However, the people on the expert working group are very distinguished clinicians and are doing the best they can in very difficult circumstances.
Baroness Gardner of Parkes (Con)
My Lords, will the Minister confirm the reply he gave that no one will be asked to take any of these experimental things without being aware of doing so, because pregnancy is a time of great anxiety, particularly in view of the accidents that have happened in the past?
Lord Prior of Brampton
All I can do is entirely agree with what my noble friend says. That must be right.
Baroness Deech (CB)
My Lords, there has been great fuss about the Prime Minister’s wish to ensure that all women, particularly Muslim women, learn English. What steps can the Government take to make sure that all pregnant women receive directly the medical advice that they need during pregnancy?
Lord Prior of Brampton
Much advice is available on NHS Choices and elsewhere. Clearly, GPs have a primary responsibility in giving initial advice to women, of whatever nationality, when they become pregnant.