HIV Diagnosis: Clinical Guidance

Debate between Lord Prior of Brampton and Baroness Walmsley

Thursday 1st December 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I am very happy to arrange a meeting of that kind. We are expecting an announcement very soon on the PrEP issue and it may be worthwhile having that meeting after that announcement.

[Baroness Walmsley (LD)]

My Lords, a high percentage of people living outside London compared to those in it are unaware of their HIV infection. It is 24% compared to 12% in London. Are the Government doing anything in the regions to replicate the good practice that we are beginning to see in London, so that that situation disappears?

[Lord Prior of Brampton]

My Lords, I think more is done in London simply because there is a greater incidence of HIV there. I was not aware of the difference between those two figures—the 12% and 24% which the noble Baroness referred to. I should like to look into that point and write to her.

Mental Health: Children and Adolescents

Debate between Lord Prior of Brampton and Baroness Walmsley

Wednesday 16th November 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, there is no doubt that whether it is housing for young people or loneliness for old people, many factors affect people’s mental well-being. The noble Lord may be interested to know, as I know that his particular interest is in looked-after children, that we have set up an expert working group to look particularly at that case. Interestingly, 85% of the local transformation plans that have been developed single out looked-after children as a group that requires special attention.

[Baroness Walmsley (LD)]

My Lords, I welcome the mental health dashboards, which allow people to hold their local clinical commissioning group to account for how much it spends on mental health, including on children, and on the quality of the services that it provides. However, can the Minister say how those dashboards are being publicised, and whether there is any way in which local people can benchmark the performance of their local CCG compared to others across the country?

[Lord Prior of Brampton]

My Lords, transparency is critical to this and every CCG will have its improvement assessment framework. Unless I am badly mistaken, they will all be in the public domain and it will be possible to look at the relative performance of each CCG. NHS England will also produce its own matrix and integrated dashboard, which will have all the key information about funding, the numbers of people accessing mental health provision and the improvements that those people achieve once they are in the system.

NHS Funding

Debate between Lord Prior of Brampton and Baroness Walmsley

Monday 31st October 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I will try to respond to those last three points. First, the noble Lord is right: the NHS is—and I would regard it still as—the highest-value healthcare system in the world. It does have fewer doctors and MRI machines—however you want to measure it—compared to many other OECD countries, but its outcomes, on the whole, are very good. I can, therefore, certainly confirm that the NHS is a very high-value healthcare system. As far as the involvement of the NHS in the plan is concerned, it was very much put together by the NHS and signed by all of the arm’s-length bodies at the time. This is a quote from Simon Stevens about the spending round settlement:

“This settlement is a clear and highly welcome acceptance of our argument for frontloaded NHS investment. It will help stabilise current pressures on hospitals, GPs, and mental health services, and kick-start the NHS Five Year Forward View’s fundamental redesign of care”.

This brings me to my last point, the fundamental redesign of care. That was possibly not really recognised at the time of the NHS review, because it is a fundamental redesign of care. As the noble Lord said, it means moving resources away from acute settings into community settings, very much as mental health care was restructured 20 or 25 years ago.

[Baroness Walmsley (LD)]

My Lords, the Secretary of State said that there were going to be another million over-75 year-olds in five years’ time, and I very much hope that I am going to be one of them. May I give the noble Lord a couple of other statistics? The King’s Fund quarterly monitoring report found that, for each month in the first quarter of this year, there were an additional 54,000 attendances at A&E departments and 14,200 emergency hospital admissions compared to the same time last year. All these emergencies are no way to run a health service.

The noble Lord and the Secretary of State pray in aid the five-year forward view as if it were a statement of fact. It is a plan; it is an aspiration, and at the time it was written, the hole in the funding of the NHS was not £4.5 billion, as the Select Committee says has been given to the health service; it was not £8 billion or £10 billion: it was £30 billion. The Government gave about a third of it and suggested, through the five-year forward aspirational plan, that the rest could be done by efficiencies. We have the STPs, which are supposed to find those efficiencies. We have heard many times in this House over the last few weeks about the shortcomings of those, so when will the Government respond to my right honourable friend Norman Lamb when he calls for a cross-party commission on proper funding of social care and the health service?

[Lord Prior of Brampton]

My Lords, I am sure that the noble Baroness will be here well past the age of 75, and that there are many years to come before she reaches that age.

The noble Baroness is absolutely right: for many elderly people, the worst way to be treated, frankly, is to be blue-lighted in an ambulance into an A&E department of a very busy acute hospital. The whole purpose of the five-year forward view is to deliver care to many more such people outside. I think we all agree with that. The noble Baroness’s party, like ours, agreed with the £8 billion of extra government spending over the course of this Parliament, and accepted the fact that very significant efficiencies could be generated from the NHS. We still subscribe to that view, and the STPs will be the right vehicle for delivering many of them.

Medical Students

Debate between Lord Prior of Brampton and Baroness Walmsley

Wednesday 26th October 2016 Lords Chamber

[Lord Prior of Brampton]

I respect the views of the noble Lord but I have looked very carefully at the number of applications coming into medical schools in 2016 compared with the previous year. In 2016, there were 20,100 applications for all medical schools, including in Scotland. The previous year the figure was 20,390, so there is no firm evidence to support the view that the noble Lord expresses. There were some rumours that St George’s was having trouble filling its places. I have investigated that and understand that it was a result not of any lack of demand but of the fact that it wanted to wait until A-level results had come through so that it could choose the best candidates based on those results. So I do not think there is any evidence to substantiate the noble Lord’s point.

[Baroness Walmsley (LD)]

My Lords, one of the objectives in Health Education England’s mandate is to reduce our dependency on temporary staff. However, the National Audit Office tells us that we are short of 50,000 clinicians, and that HEE is failing to be sufficiently proactive in addressing the,

“variations in workforce pressures in different parts of the country”.

Is the noble Lord’s department monitoring how well HEE is responding to these challenges?

[Lord Prior of Brampton]

My Lords, predicting the future requirement for doctors is extremely difficult. It is more a matter of prophesy than science. The fact that we are now going to fund an extra 1,500 doctor places a year, which is a 25% increase, should make a huge difference.

Breast Cancer: Innovative Drugs

Debate between Lord Prior of Brampton and Baroness Walmsley

Monday 24th October 2016 Lords Chamber

[Lord Prior of Brampton]

We received the report today. We warmly welcome its principles and believe that by combining the great depth of our research base in this country with the NHS, which is the largest single integrated provider of health services in the world, we can create a world-leading life sciences base in this country. The detailed response to the report and the costs attached to it will come in due course.

[Baroness Walmsley (LD)]

My Lords, repurposed off-patent drugs often fall in the cracks between the processes of NICE and the processes of NHS England, both of which organisations take the role of approving these drugs. The Accelerated Access Review recognises this problem and recommends that the new streamlined process involve both organisations talking to each other to make quite sure that that does not happen. What will the Minister’s department do to ensure that under this new streamlined process these drugs do not fall between the cracks, because many of them are very useful to patients?

[Lord Prior of Brampton]

My Lords, I need to consider the report in detail. I do not believe that repurposed generic drugs naturally fall within the AAR streamlined procedures, although it is very important that they do not fall between the cracks. The AAR is largely designed for new products rather than for repurposing old products.

Mental Health: Young People

Debate between Lord Prior of Brampton and Baroness Walmsley

Tuesday 11th October 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, in his recent national confidential inquiry, Louis Appleby reported that in 36% of all suicides of people aged under 20, family breakdown or family circumstances were part of the cause. My noble friend is absolutely right that families are critically important. That is very much part of the strategy in our Future in Mind paper. I was horrified by the figure that 43% of all people who took their own lives under the age of 20 had had no prior contact with any agency—no contact with GPs, no contact with CAMH units, no contact with schools—about their condition. Nearly half the people who took their own lives were completely below the radar. That is a shocking figure.

[Baroness Walmsley (LD)]

My Lords, I ask the Minister about young people with mental health problems in the criminal justice system, where they are particularly vulnerable to self-harm and suicide attempts. Recent draft NICE guidelines recommend that all staff working in the criminal justice receive training to recognise and respond to mental health problems. Although the NHS is not responsible for the physical or mental health of those in custody, the guidelines recommend co-operation between healthcare and the criminal justice system on mental health, so how will his department respond to them, and who will fund the training?

[Lord Prior of Brampton]

My Lords, I do not think I can answer the question about who will fund the training; I will write to the noble Baroness to answer it. She is absolutely right that a huge proportion of people who are in the criminal justice system, in prison, also suffer from mental health problems. Tackling the mental health problems of people in prison is just as important as tackling them outside. If I may, I shall write to the noble Baroness on this matter.

Junior Doctors: Industrial Action

Debate between Lord Prior of Brampton and Baroness Walmsley

Monday 5th September 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the noble Lord has raised many questions in his response to our Statement. He may well have read the article published earlier this week in the Times by Sir Simon Wessely, the president of the Royal College of Psychiatrists, which goes to the heart of what I would call the non-contractual issues that have bedevilled, coloured and provided the context for this dispute:

“Changes to the way that doctors are trained means that juniors face switching not just jobs but addresses every few months without much say about where they end up and when. Many seem condemned to spending years rootlessly shuffling from one place to another like lost luggage. Without any familiar faces, long hours are endured in relative isolation and managers who change all the time provide little or no recognition, let alone reward”.

This in a sense is what lies behind much of the dispute. The fact is that we had a contract that was wholeheartedly welcomed by Dr Ellen McCourt, now the president of the BMA, and by the association itself. The issues of difference in the contract were pretty small.

We have been discussing this contract for three years now and the Government have made 103 concessions. The Secretary of State’s door has been open throughout that time. The new contract is due to be introduced in October and at some point we really have to get on and introduce it. There is provision within it to review aspects as it goes forward. We have committed to looking at the gender pay issues that have been raised by the BMA and today HEE has published the work that it is doing on non-contractual issues with the BMA when the association is prepared to talk to it. The Government are bending over backwards to meet the BMA, but there comes a point where we just have to bite the bullet and go ahead with the contract that has been agreed, and that is the place we are in now.

The noble Lord referred to a lack of trust in local management and in the Secretary of State, but we now have the guardians of safe working hours built into the contract. They have a contractual commitment to report every quarter to the boards of trusts and to the GMC and the CQC every year. Plenty of independent safeguards have been built into the new contract. So while of course I understand many of the issues raised by the noble Lord, the Government have gone the extra yard every time they have been asked to do so and now we must get on and introduce this contract.

[Baroness Walmsley (LD)]

My Lords, I apologise to the Minister for not getting up quickly enough to add my questions from the opposition side before he gave his last response. We on these Benches welcome the fact that the strike planned for next week has been postponed. I think we have all taken very much to heart what was said by the GMC this morning. I hope the Minister can give an assurance that the Secretary of State will take this breathing space as an opportunity to get back around the table with the junior doctors not only to explore the details of the contract, which may not yet have been hammered out to everyone’s satisfaction, but to get to the core of the reasons why they are so up in arms.

I am very impressed by the fact that when junior doctors are marching along the street, they are not shouting, “Save our weekend pay” or “Save our training structure”, they shout, “Save our NHS”. That is what every single doctor in this country is committed to. The reason why doctors are so concerned is not the Government’s intention to make tests or more frequent investigations available on Saturdays and Sundays for patients in hospital, it is the fact that there are gaps in the weekday rotas now. The Minister is saying that there will be extra money and extra doctors. Where are they going to come from? Does he know how many doctors have investigated the possibility of emigrating or have even actually emigrated since the beginning of this dispute? I ask this because I am hearing about it all the time. I wonder where the new doctors will come from in order first to fill the gaps in the weekday rotas and then to provide extra services at the weekend. The £10 billion mentioned in the Statement is clearly not enough when we already have a £22 billion black hole in the NHS.

Over the Summer Recess we had so many news stories about units being closed, not just to reconfigure the services and provide better service for patients, but to save money, because the system is desperate to do that in the short term. The sustainability and transformation plans clearly do not have the confidence of the doctors, partly because they are very opaque and partly because they are very short term. They are picking up on any short-term economies they can make, rather than looking at the very long-term savings that might be made and bring better provision for patients. Will the noble Lord say where the extra doctors are coming from and how the Government plan to convince existing doctors in this country that they will be fully supported if they are to implement the Government’s policy?

[Lord Prior of Brampton]

My Lords, the noble Baroness made a valid point when she said that when she meets junior doctors on their demonstrations or marches, they are concerned about the NHS—rightly so; it will be a sad day when doctors are not concerned about the future of the NHS—but that is no reason for going on strike over this contract. We are perfectly happy to have a debate with them. We will disagree and agree on some things, but to launch a wave of strikes over this cannot be right. As the noble Baroness indicated, it is not the contract that they are worried about at all; they are worried about much more general things than the state of the contract.

Staffing is a big issue. There is no question but that after the Mid Staffordshire tragedy, we saw a huge increase in agency staffing. We saw that increase because we did not train enough of our own doctors and nurses. That is a long-term issue about increasing training numbers, but, in the meantime, part of the £10 billion of extra money we agreed to put into the NHS, which the noble Baroness’s party agreed to do at the last general election, has to go towards increasing staffing in our hospitals.

Bread and Flour Regulations (Folic Acid) Bill [HL]

Debate between Lord Prior of Brampton and Baroness Walmsley

Friday 8th July 2016 Lords Chamber

[Baroness Flather]

What amazes me is that we are talking about nudging and not doing this or that, but we often have research on issues which are of great importance not only to the individual—as we have been talking about—but to the family and to the country. When a child needs lifelong care, surely it is not a good idea to not do anything about that. We seem to be going round and round, saying that we cannot be led by research, while the Government must have their policy. But what is the policy based on?

[Baroness Walmsley]

The noble Lord has just read out a list of the functions of government. Would he not add protection to that? We chlorinate all our water to protect people from water-borne diseases. Why not put folic acid in flour?

[Lord Prior of Brampton]

I will continue with the example that the noble Lord, Lord Hunt, gave, of alcohol. Clearly, the Government have the responsibility to put the science into the public domain. But should they ban people from drinking more than 14 units of alcohol a week or should they leave it to people to make that choice themselves, on the basis of the information that they have? That is the philosophy that lies behind the Government’s position on folic acid. It is also our thinking on how we address the scourge of obesity and lies behind the way we deal with our smoking and alcohol problems and behind all our prevention strategies. It is about doing all we can to help people make the right choice, but ultimately accepting, outside of extreme circumstances, that the final choice has to be made by them and not by the Government.

This is why the Government agree with the statement made by my honourable friend in the other place, Jane Ellison, when she said that the Government consider that a broad approach to the promotion of good pre-conception health needs to be taken to make sure every child gets the best start in life. On balance, the Government have decided that mandatory fortification is not the right way forward and therefore have no plans to introduce it in England.

We know that good pre-conception health, of both future mothers and fathers, can lead to healthier pregnancies and good infant health. By contrast, poor pre-conception health—for example due to diabetes, poor diet, obesity or smoking—can lead to poor pregnancy outcomes, including gestational diabetes, NTDs, premature births, and poor perinatal and infant mental health.

Many parents make few preparations to improve their health before pregnancy. That is why a more proactive approach which promotes good pre-conception health to reduce the risk of poor pregnancy outcomes for women and their families should be adopted. This is why my colleague Jane Ellison has set up a ministerial round table. She held her first meeting with interest groups on 13 June to help identify additional measures to promote good pre-conception health.

I recognise the tragedy of neural tube defects. I recognise the urgency and passion that lies behind this Private Member’s Bill but, at this time, the Government have decided that, on balance, we are against mandatory fortification of white bread with folic acid and therefore have no plans to introduce it in England. Instead, all our efforts will be directed at promoting good pre-conception health. I realise that that is a disappointing but probably not unexpected reply to the noble Lord, Lord Rooker, and to his colleagues who support the Bill. Of course, that balance may change over time. As the noble Baroness, Lady Hayman, said, he is a formidable opponent and I have no doubt that he will carry on pushing the case for fortifying with folic acid. In time, who knows where that argument will go but, for the time being, the Government’s position is that we will not support the Bill.

NHS: Junior Doctors’ Contract

Debate between Lord Prior of Brampton and Baroness Walmsley

Wednesday 6th July 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, it is certainly a matter of regret on all sides that this dispute has not been resolved in an amicable, satisfactory way; I agree with the noble Lord on that. The Secretary of State plans to introduce the new contract with NHS employers in a phased way beginning in November. He has said that in terms of how the contract is implemented and any extra-contractual issues that arise, his door is always open; he is willing to talk to the BMA and junior doctors.

[Baroness Walmsley (LD)]

My Lords, is it not entirely inappropriate for the Secretary of State for Health to claim that a 16% majority on a 68% turnout is undemocratic, especially when he represents a Government who are in power with the votes of less than one in four of the electorate? Has he now become a supporter of proportional representation? Is it not entirely irresponsible to try to impose on junior doctors this contract, which they are so against, at a time of great danger to the NHS because of the referendum result?

[Lord Prior of Brampton]

My Lords, 40% of junior doctors voted against this contract. That is a fact, but it does not alter the fact that it is disappointing and sad that so many junior doctors feel obliged to vote against. I am not downgrading that at all. I have not heard it said that it is not democratic. A significant minority of junior doctors have voted against the contract. We have a huge need to rebuild trust between the Government and the junior doctors. The vast majority of junior doctors are committed to their profession and the NHS and we want to rebuild with them the level of trust that always existed in the past.

Health: HIV

Debate between Lord Prior of Brampton and Baroness Walmsley

Monday 4th July 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the judicial review is being held next Wednesday, which is only 10 days from now, at which point we will know the exact legal position. I really cannot comment further on it today. As far as this drug being widely available as a prophylaxis, it is widely available only in some countries for very specific groups of people. If we commission it in the future, it is important that we are clear about where we can get the most benefit from it.

[Baroness Walmsley (LD)]

My Lords, the PROUD study reported in the Lancet last year showed that the PrEP use of Truvada in high-risk groups reached nearly 100%. Are there any other preventive treatments for life-threatening diseases which are 100% effective but for which NHS England is refusing to take responsibility?

[Lord Prior of Brampton]

It is true that in the control group used in the PROUD trial there was a very high level of success—85% or 87%, I think—but it is critical to identify the right group of people. That is why NHS England is providing £2 million to test Truvada as a prophylactic among a wider group of people to see whether it is equally efficient.

NHS: Unsafe Hospital Discharges

Debate between Lord Prior of Brampton and Baroness Walmsley

Wednesday 15th June 2016 Lords Chamber

[Baroness Walmsley]

To ask Her Majesty’s Government what action they are taking, in the light of the report of the Parliamentary and Health Service Ombudsman, to prevent unsafe discharges of frail and elderly people from hospital.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, unsafe discharge of frail elderly patients is unacceptable. Discharge can be very complex, and the integration of health and social care is vital for safe, joined-up care. We are using sustainability and transformation plans to promote integration, supported by the better care fund, creating a seven-day NHS and supporting local systems to develop integrated discharge systems and new models of care.

[Baroness Walmsley (LD)]

I thank the Minister for his reply, but is he aware that the ombudsman reports patients being discharged before they are clinically ready, without being assessed or consulted and without a care plan or their family being told that they are coming? Does he know why this is still happening 12 months after Healthwatch England’s report on the same issue? Does he agree that this not only puts an enormous financial burden on the NHS but is an appalling way to treat vulnerable people?

[Lord Prior of Brampton]

My Lords, there are millions of interactions between patients and consultants and doctors every day of the year, and there will be some mistakes. We cannot draw conclusions from one or two desperate situations. In so far as they reveal systemic problems, it is valid to draw attention to individual cases of this kind, and there are some systemic issues lying behind the PHSO’s report. In particular, it states:

“We are aware that structural and systemic barriers to effective discharge planning are long standing and cannot be fixed overnight … health and social care … have historically operated in silos”.

That is the issue on which we should be focusing.

National Clinical Director of Adult Neurology

Debate between Lord Prior of Brampton and Baroness Walmsley

Thursday 9th June 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I am of course very happy to meet the Neurological Alliance with the noble Baroness. I just say this: if the medical director and board of NHS England cannot make decisions about where they should get their clinical advice, one is bound to ask what on earth the point of them is. There are certain decisions that must be made by NHS England and Bruce Keogh, its medical director, came to this decision. I think it is a decision that he should make, not politicians.

[Baroness Walmsley (LD)]

If three years has been long enough for NHS England to decide that the national clinical director and the regional clinical networks are not working well enough for neurology, how long is it planning to give the new system to prove that it is better for patients?

[Lord Prior of Brampton]

I do not think that anyone is saying that the system was not working well enough. The argument that NHS England put was that it had to focus its resources on a smaller number of key national priorities—for example, mental health, cancer and learning disabilities—and that is what it is doing. It is poking the resource into a smaller number of well-focused and well-defined areas, but it can still get all the advice that it needs on neurology from the clinical reference groups and other sources.

NHS England: Pre-exposure Prophylaxis for People at Risk of HIV

Debate between Lord Prior of Brampton and Baroness Walmsley

Tuesday 7th June 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I am not going to proffer the argument that it is too expensive, because that is not the issue today. The issue today is that NHS England feels that it does not have the power to commission this particular drug. Whether or not it has that power may well be judicially reviewed, so I cannot comment on the outcome of that judicial review.

The PROUD study produced strong evidence of the effectiveness of Truvada as a preventive drug. The work that NICE is going to do, and the pilot scheme to look at the effectiveness of this drug—it will cost £2 million and will be funded by NHS England and PHE—will ensure that when the question whether NHS England has the power to commission this drug is resolved, there will be the evidence on which to make that decision.

[Baroness Walmsley (LD)]

My Lords, are the Government simply delaying until Truvada comes out of patent and becomes cheaper? Can the Minister say whether NHS England has taken into account the protection from HIV infection of the whole community that would result from a reduction in infection of high-risk groups? Can he also explain why the Government see infection prevention as a local authority responsibility in this case, given that other forms of prevention, such as vaccination, are the responsibility of the NHS nationally? This is not consistent.

[Lord Prior of Brampton]

As I said in response to the earlier question, this is really not about the efficacy of the drug. There is evidence that it is very efficient; that will be confirmed or otherwise by the extra work done by PHE. It is purely a question of the independent legal advice given to NHS England that it does not have the power to commission this drug.

Dental Health: Children

Debate between Lord Prior of Brampton and Baroness Walmsley

Tuesday 7th June 2016 Lords Chamber

[Lord Prior of Brampton]

I agree with my noble friend. Fluoridisation has a huge and direct impact on oral hygiene. It will be up to Manchester to make that decision in due course. To pick up a point made by the noble Baroness, Lady Benjamin, social deprivation also plays a big part in the variation in the quality of people’s teeth. Interestingly, 75% of all children have no tooth decay now, but in some parts of the country—Blackburn, for example—the figure is as low as 40%.

[Baroness Walmsley (LD)]

My Lords, does the Minister agree that a healthy diet, including milk, fruit, vegetables and enough vitamin D, is as important to the development of children’s teeth as not eating too much sugar? The Healthy Start programme provides those eligible with free vitamins and vouchers to buy those healthy foods but I understand that the uptake is poor. What are the Government doing to improve the uptake of this programme and to ensure that the lessons learned by those authorities that choose universal distribution of vitamins are spread throughout the country?

[Lord Prior of Brampton]

My Lords, there is no question but that a low-sugar, healthy diet is good for people’s teeth. The noble Baroness will have to wait until we produce the children’s obesity strategy later in the summer, in which we will reveal the full strategy.

Obesity

Debate between Lord Prior of Brampton and Baroness Walmsley

Thursday 26th May 2016 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, is the Minister aware that some food manufacturers and supermarkets are delaying their reformulation programmes in anticipation of the strategy? Is he also aware that they would welcome mandatory industry standards for potentially harmful ingredients so that they do not lose competitiveness when they do the right thing?

[Lord Prior of Brampton]

My Lords, I think that the announcement of the sugar levy on sugary drinks has meant that that part of the industry has been forewarned of what is coming in the strategy. Already there are signs from some of the manufacturers that they are reformulating their products—which is the whole purpose of a levy rather than a tax.

NHS: Bursaries

Debate between Lord Prior of Brampton and Baroness Walmsley

Wednesday 25th May 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, all the evidence is—not just from nursing but from other university courses—that loans have not reduced the numbers of people wishing to go to university: indeed, quite the contrary. The number of people going to university has gone up since student loans were introduced. The demand from young men and women who wish to go into nursing is very strong. The noble Lord will know that 57,000 people apply every year to become nurses and there are only 20,000 places, so we are confident that this will result in more, not fewer nurses.

[Baroness Walmsley (LD)]

My Lords, will the Minister say how much the Treasury will save by shifting this debt from the Government to low-paid nurses? Given the demographic of nurses, who are overwhelmingly female and, as I said, relatively low-paid, surely quite a lot of that student debt will never be repaid. Is this really such a good deal for the Government?

[Lord Prior of Brampton]

I think that it is a good deal for the Government—as the noble Baroness puts it like that—on a number of fronts. It is good for patients because there will be more nurses. It is good for the Government because there will be less need to recruit overseas nurses and agency nurses. Of course, the noble Baroness is right that for mature students coming in, the time to repay the student loan debt will be shorter than for younger people, but the Government will still make a return on that.

Health: Alcohol

Debate between Lord Prior of Brampton and Baroness Walmsley

Thursday 12th May 2016 Lords Chamber

[Lord Prior of Brampton]

Public Health England is conducting an evidence review of the harm done by alcohol, and minimum unit pricing will be an aspect that is addressed. To express a personal view, if we are going to address alcohol consumption by increasing the price, is it best that the benefit of that should go to the drinks companies through charging higher prices, or is it better that it should go to the Government through taxation? That is a question that the House might want to ponder.

[Baroness Walmsley (LD)]

My Lords, does the Minister agree that compelling public information is key? Does he recall that the last time we talked about the sugar tax I recommended that manufacturers of sugary products should label them showing how much exercise would be required to burn off the contents? Is he aware that that is exactly what the Drinkaware website does? Would it not deter noble Lords, when considering ordering a glass of wine in the Bishops’ Bar, if they knew that they would have to run up and down Whitehall for 16 minutes in order to burn it off?

[Lord Prior of Brampton]

I am sure we will all be following in the noble Baroness’s wake when we do that. It is worth making the point that one of the benefits that came out of the responsibility deal, which I know not everyone in this House thinks was successful, is that the labelling on alcoholic products has got much better.

Care Quality Commission (Fees) (Reviews and Performance Assessments) Regulations 2016

Debate between Lord Prior of Brampton and Baroness Walmsley

Tuesday 10th May 2016 Grand Committee

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, I first acknowledge the fact that any increase in fees, at a time when providers of adult social care, the NHS and elsewhere are going through a very tough time, is clearly very unwelcome. So perhaps it was not surprising, in a sense, that in the consultation when given the choice of spreading the increase over four years or two years, everyone voted for four years rather than two. I think everyone knows that, over time, it was the intention of the previous Government, as well as this one, to have full cost recovery. In the end, that must be right, but it is a question of how long it takes to get from where we are to where we need to be.

Most people will understand why the scope of the CQC’s work has developed over the past three or four years. The origins of the new CQC lay in what happened in Mid Staffordshire, Morecambe Bay and Winterbourne View, and a feeling that those tragedies could not be allowed to happen again. A much more comprehensive, expert-led inspection regime was the right way to try to unearth those awful things.

I totally understand what has been said by my noble friend Lord Lindsay and the noble Baroness, Lady Walmsley, about moving towards a more risk-based form of inspection. In the CQC’s strategy, which will be announced in a week or so, I hope there will be some reference to it having a more risk-based inspection regime. Of course, that has to be based, as my noble friend Lord Lindsay mentioned, on good intelligence. Over the past three years, the CQC has been able to collect intelligence, particularly on NHS trusts, where there are much better data—we are also using soft data as well as hard data—and that does enable one to put in place a more risk-based system of inspection. It has already said that it will re-inspect institutions that have a “Good” or “Outstanding” rating after a longer period of time than the ones with “Requires improvement” or “Inadequate”. But we will see when it produces its strategy next week exactly what it is planning to do.

On the comments of my noble friend Lord Lindsay, we did have some discussions when I was at the CQC, but I have to accept that they did not get very far. However, I would encourage him to meet the new chairman of the CQC, Peter Wyman, as well as David Behan, whom he already knows, to see whether or not there is any way that UKAS accreditation can help not just in adult social care but in aspects of clinical care as well.

On the points made by the noble Lord, Lord Hunt, about the consultation, the consultation period did go from 21 December 2015 to 1 February 2016. There was a reasonable period of consultation, but I accept that the implementation of the increase was much quicker. I also know that, although it did not sound very much in the context of the whole, for individual trusts this was just another cost increase that they had to bear. It is worth noting that the total cost of the CQC as a proportion of the whole that is expected for adult social care and the NHS is around 0.19%—very similar to the cost of Ofsted in education. So it is not as though it is expensive; it is just that the level of cost recovery has been ordained to be over a shorter time.

It is also worth noting that, for domiciliary care, the period of time is over four years and not two years. For GPs, where it was felt that the cost increase was the straw that might break the camel’s back, the baseline funding has been increased to allow for the extra increase.

[Baroness Walmsley]

My Lords, am I right in thinking that the help for GPs will be over just one year?

[Lord Prior of Brampton]

I believe that it has gone into the baseline funding of the GP contract, but if I am wrong about that I shall write to the noble Baroness.

More generally, the CQC’s scope and the way that it does its inspections is just much broader than it used to be. They are done in more depth and detail. This statutory instrument was introduced to Parliament so that it would reflect what the CQC is now doing and recognise its enlarged scope. The regulations do not extend the remit of the CQC’s activity or the scope of reviews or performance assessments to additional providers or services; neither does it change the fees actually charged.

The CQC, like every other aspect of the NHS, is going to have to save a considerable amount of money over the next five years, which the noble Lord, Lord Hunt, referred to in his speech. This means that the kind of inspections which we have seen in some NHS trusts, where a large number of very expensive people descend upon a trust, will have to be scaled back to some extent. As the noble Baroness intimated, I think that we will see a more risk-based inspection model—a bit more like the Ofsted model. I suspect that we will see more unannounced inspections as well, because a large part of the cost of the CQC is not just its direct cost but the indirect costs on the trusts preparing for the inspections. Sometimes the degree of preparation undermines the validity and insightfulness of the actual inspection.

I take on board entirely the strictures of the noble Lord, Lord Hunt. This is another expense when times are extremely hard, but it reflects the fact that the scope of the CQC is now broader than it was three years ago, and the need to have full cost recovery over a fairly limited time.

National Health Service Trust Development Authority (Directions and Miscellaneous Amendments etc.) Regulations 2016.

Debate between Lord Prior of Brampton and Baroness Walmsley

Tuesday 10th May 2016 Grand Committee

[Baroness Walmsley (LD)]

My Lords, I have no intention of detaining the Committee, as I agree with everything that the noble Lord, Lord Hunt, has said. I look forward to hearing the Minister’s reply. I am particularly concerned that a very complex system of governance will not produce transparency and accountability, and I look forward to reassurance on that score.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, that was a short intervention from the noble Baroness. I was very struck by the noble Lord, Lord Hunt, saying that, when the 2012 legislation went through Parliament, it took 85 days and 85 of the Bill’s clauses dealt with Monitor alone. I am afraid that that is part of the response that I shall give him today. We did not have 85 days—or maybe 165 days, if we take into account the TDA and the restructuring—because matters are too urgent. However, the noble Lord is right to bring this issue up today, because I do not think that there has been enough scrutiny around Monitor, the TDA and NHS Improvement.

Responding to the points that he raised about foundation trusts will perhaps in part answer both questions. The distinction between foundation trusts and trusts has been eroding over time—there is no question about that. The roles of Monitor and the TDA were becoming more duplicated over time. It is interesting that, when David Bennett was at Monitor, he saw the need to develop an improvement agency within Monitor, almost mirroring the TDA. Simply being a financial and economic regulator was clearly not enough at a time of such huge stress and pressures within the system.

However, there are two other important factors that I should mention. At the time, I agreed that the principle of foundation trusts—I think it was called “earned autonomy”—was absolutely right, as was the governance structure, with clear accountability through locally elected and appointed governors to the local population. But when the King’s Fund says that what we now have is the end of competition and autonomy, it is partly right. Using competition as a means of driving improvement through the NHS has been tested almost to destruction. It started back in 2005-06, with the new Labour Government and ISTCs, foundation trusts and the like. Increasingly, we are of the view that competition has a role to play but a pretty limited one, and we cannot rely upon competition—or the market, if you like—to drive the kinds of improvements and change that are needed within the system.

Junior Doctors: Contract

Debate between Lord Prior of Brampton and Baroness Walmsley

Thursday 5th May 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, given that we have the opportunity over the next five days to try to find a resolution to this dispute, it is probably not helpful now to talk about the “what ifs”. My experience of these situations is, the least said in public, the soonest mended. If the noble Baroness does not mind, I will not answer her question directly today.

[Baroness Walmsley (LD)]

Does the Minister accept that what he has said this morning, welcome thought it may be, is really rather too late? Trust is the most important element when it comes to the provision of medical services. The Secretary of State has already lost the trust not only of junior doctors but of a very large percentage of the general public. It has to be said that the BMA has also lost the trust of a certain percentage of the public. Trust is also important in political matters. We all accept the Government’s intention in their manifesto to provide more services seven days a week—of course, most junior doctors work seven days a week anyway—but does the Minister accept that imposing this contract at the end of the pause period is not the only way of achieving the Government’s objective? Further discussions with those who provide the services may very well find an even better way of providing these seven-day services to patients.

[Lord Prior of Brampton]

My Lords, I am not sure where that question ended up, to be honest. All I will say for today is that we have an opportunity over the next five days for the BMA and the Government to find a resolution to this issue. If we can, it will make the implementation of seven-day working across the NHS much easier.

Health: Hepatitis C

Debate between Lord Prior of Brampton and Baroness Walmsley

Thursday 28th April 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, there are many people who suffer from hepatitis C who are asymptomatic and do not know that they have hepatitis C, so I do not know if the figure of 220,000 is true or not. But people with it can have treatment using the drug interferon—which is an extremely unpleasant treatment that can take up to a year and has some very horrible side effects. This new drug is, in many ways, a miracle drug. It is a fantastic drug, but it is incredibly expensive. We have to accept that, not just for hepatitis C but for many cancer treatments, there are going to be some drugs that are too expensive to spend on huge numbers of people.

[Baroness Walmsley (LD)]

My Lords, if there are budgetary constraints, surely those victims who were infected by state action should have priority. Is the Minister aware that there are many Welsh patients who were infected with contaminated blood in English hospitals and are now being used in a game of pass the parcel between the UK Government and the Welsh Government? Can he say what was agreed at the meeting on 24 March between his officials and officials of the Welsh Government? Patients in Wales have not been able to get an answer from the acting Chief Medical Officer of the Welsh Government on this. Perhaps he could write to me.

[Lord Prior of Brampton]

My Lords, this new drug for hepatitis C is made available on the basis of clinical need, not the route of infection. There is a consultation going on about whether a special fund might be established for those who have received infected blood. I cannot answer specifically on the issue of the Welsh people but I will write to the noble Baroness on that matter.

Healthwatch England

Debate between Lord Prior of Brampton and Baroness Walmsley

Tuesday 26th April 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I should make it clear that the advert said that someone with a private sector background was desirable, not essential. No one else on the committee of Healthwatch England has a private sector background, so to have that kind of mix would seem common sense to me. Maybe it is particularly the case in that role, following someone such as Anna Bradley, who is very much a champion of consumers. Having that sort of championship of consumers on the board of Healthwatch England is important. With regard to the line of responsibility of the chair of the CQC, she is still ultimately appointed by the Secretary of State for Health.

[Baroness Walmsley (LD)]

My Lords, what precisely is it that somebody with a private sector background could bring to this organisation that somebody without a public or voluntary sector background would not bring? Should not the criteria be much more about understanding how best to undertake public engagement and an ability to shape services that reflect public priorities and concerns? Does this Question not raise a more general one about the politicisation of public appointments?

[Lord Prior of Brampton]

I disagree. I had a private sector background when I became chairman of the CQC, I might add, so perhaps I am slightly biased in this regard. Having a mix of people from all different backgrounds, whether private, public or voluntary sector, is a very good thing.

Junior Doctors: Industrial Action

Debate between Lord Prior of Brampton and Baroness Walmsley

Monday 25th April 2016 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, instead of reeling off the litany of justifications and figures that we have just heard, is it not really time for the Secretary of State to put aside his pride, stop being pig-headed and listen to people in the national interest? He is clearly not listening to the junior doctors but will he not now listen to the sensible compromise proposal from other parties, including my own, which, I point out, does not undermine the Government’s objectives in the long term?

There are two big differences between the euphemistic “gradual introduction” that he is proposing and the pilot projects proposed by other parties. The first is that of course a pilot scheme can be independently evaluated. If the Secretary of State is so confident that this scheme will not damage patients or doctors, why is he afraid of proper evaluation? The proper and safe implementation of the new contract is surely worth a very small delay. Secondly, a pilot would mean that all junior doctors evaluated in a hospital would be on the same contract, whereas piecemeal introduction, which he is proposing, could mean that two doctors working side by side in the same department were on totally different contracts. Does the Minister not agree that this would be deeply divisive, as well as very difficult practically?

I am also very concerned about the idea of consultants manning A&E departments this week. While I am grateful to them for being willing to step forward in the interests of patient safety, I am concerned that it might work in the opposite direction in their own departments. Who will take the difficult decisions in, for example, cardiology or vascular medicine when urgent cases come up and the consultant is setting somebody’s broken finger in A&E? Has the Minister thought about that?

Should not the Secretary of State consider his position? Is he really the right person to solve this dispute? Patient safety, not the future of his own job, should be his prime consideration. This week, that will be at risk—website or no website.

[Lord Prior of Brampton]

My Lords, I am personally massively sympathetic to the concerns expressed to me by many junior doctors over the last three or four months, and in fact over the last 12 or 13 years. For family and personal reasons, too, I feel hugely in sympathy with the situation in which they find themselves. There is no doubt that the training of junior doctors is wholly inadequate. Their placements are short term and they move from one rota to another, with many rotas unfilled. There is a lack of teamwork now that the old firm has gone and nothing has replaced it. There is also a lack of leadership and mentorship for juniors.

When I compare the training and TLC that junior doctors get with that received by those going into accounting, law, big corporates, investment banking or other areas like that, I think that the lot of the junior doctor is not a good one. I remember reading a paper, probably 10 years ago, by Dame Carol Black when she was president of the Royal College of Physicians. She talked about the deprofessionalisation of the profession, and that really will come to pass if we are not careful. So I am hugely in sympathy with many of these issues and I have particular sympathy for women—especially young women with families and so on.

But let us be honest about this. That is not what this contractual dispute is about. Those are the big issues but this dispute is about pay on Saturdays. That is the issue that the contract fell down on. The noble Lord and the noble Baroness opposite talked about a pilot—but are we really talking about piloting a different Saturday pay structure? Everything else was agreed between the BMA and Sir David Dalton. To be honest, it is disingenuous to say that we could pilot something like that. Fundamentally, this is about pay, and I think that the junior doctors have got it wrong when they go on strike and withdraw emergency cover over an issue related to premium pay on Saturdays. It is simply not a big enough issue to cross the threshold of withdrawing emergency cover. They must recognise that. There will be a time to address the more fundamental issues affecting the training of junior doctors, and they must be addressed for the sake of the profession, of patients and of hospitals—but, sadly, that is not the issue that we are confronting today.

Two other important issues were raised. In answer to the noble Baroness, not all cardiologists and cardiac surgeons are rushing off to an A&E department. They will cover urgent and emergency cases in their own specialties as well.

Although in a way it is not for debate today, the noble Lord, Lord Hunt, raised the very fundamental, long-term problem of whether there are the resources within the system to deliver the ambitions that we all have for a world-class health service. Maybe today is not the time to answer that: we should probably focus on the matter in hand.

NHS: New Junior Doctor Contract

Debate between Lord Prior of Brampton and Baroness Walmsley

Monday 18th April 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the noble Lord has raised two substantial points. The first is the difference between introduction and imposition. The fact is that, in the context of the NHS, where there is really only one offer, the difference between introduction and imposition is very small. Technically, it is true that individual employers are responsible for its imposition, but in reality, as the noble Lord will know from all his years in the Department of Health, the Secretary of State has considerable powers in this matter. I do not think the noble Lord would want all trusts to cut their own deals locally—there has to be an actual contract. It is true that when the legislation for foundation trusts was brought forward by the noble Lord’s Government a few years ago, they were given the power to negotiate their terms and conditions locally but, with the exceptions of, I think, Southend and possibly Guy’s and St Thomas’, they have chosen to stick with the national contract.

On the noble Lord’s last point about a way through, there are no winners from this dispute. The patients are very clear losers, and it is tragic that we have got to the situation that we have. The threshold for withdrawing emergency cover from hospitals needs to be a lot higher than the one the junior doctors are adopting on this occasion.

[Baroness Walmsley (LD)]

My Lords, this Statement comes at a time when the latest figures for A&E performance are the worst ever—1% lower, we were told last week, than the figure for January, which was the previous worst ever. The staff are very close to exhaustion. Thirty-five per cent of the doctors in this country were born abroad—the highest level in the OECD. With this very long-running dispute, many junior doctors are now saying that they are going to go abroad, and the Government have not told us whether they will increase the number of places for trainee doctors to try to compensate for that. We, and the doctors themselves, really need to know.

I would also like the BMA to tell us what percentage of its members now want to strike, because I think that it has given us old figures. However, if the Government want a seven-day NHS, this is absolutely the wrong time to target the junior doctors. They need to do some proper negotiation and not hold the sword of Damocles over the heads of some of the most important public servants we have.

[Lord Prior of Brampton]

My Lords, the noble Baroness talks about a proper negotiation. This negotiation has gone on for three years and there have been 75 meetings about this contract. It is hard to know what a proper negotiation is when you have that number of meetings over that period of time. The junior doctors may not recognise this but the Government feel that 73 different concessions were made during that period. In many ways this has gone on for too long, and that is why, when Sir David Dalton got involved towards the end of the contract negotiations, his advice was, “You’ve got to settle this”. We cannot go on and on negotiating and discussing these matters.

On the other point that the noble Baroness raised, the pressure on our emergency services is huge at the moment. She is right that the A&E performance in January was very poor, but it is simply the case that demand on our A&E departments is huge.

E-cigarettes: Regulation

Debate between Lord Prior of Brampton and Baroness Walmsley

Monday 7th March 2016 Lords Chamber

[Lord Prior of Brampton]

I also congratulate the noble Lord on giving up cigarettes and taking up these other products. I do not know whether he has tried unicorn blood or crab leg flavours, but a multitude of flavours is available on the market. The directive has come about purely because of the feeling that although nicotine is better than smoking, it is not perfect.

[Baroness Walmsley (LD)]

My Lords, although these products are clearly much less harmful than smoking tobacco, they are not entirely harmless. They have a lot of noxious chemicals in them. What are the Government doing to inform people about the research on the potential hazards of these products, including the reduction in resistance to infections, reduction in fertility and changes in behaviour patterns?

[Lord Prior of Brampton]

My Lords, as I said, these new products are not perfect but are substantially better than smoking cigarettes. One of the purposes of the new directive is that there should be proper labelling on the products.

Pharmacies: Funding

Debate between Lord Prior of Brampton and Baroness Walmsley

Wednesday 2nd March 2016 Lords Chamber

[Baroness Walmsley]

To ask Her Majesty’s Government what steps they will take to ensure that every community continues to be served by a local pharmacy, in the light of their plans to cut funding to pharmacies in October.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, community pharmacies are a vital part of the NHS. The Government believe efficiencies can be made without compromising the quality of services or public access to them. Our aim is to ensure that community pharmacies upon which people depend continue to thrive. We are consulting on a pharmacy access scheme which will provide more NHS funds to certain pharmacies compared to others, considering factors such as location and the health needs of the local population.

[Baroness Walmsley (LD)]

I thank the Minister for his reply. Has he made any assessment of the value of the services provided by pharmacies to the NHS, local communities and local authorities in assisting with their public health responsibilities? In light of the importance of all these services and the potential for expansion in future, is it not rather arbitrary of the Government to make these cuts that I understand could cause the closure of 3,000 pharmacies? Then they will sit back and wait for the survival of the economic fittest.

[Lord Prior of Brampton]

My Lords, it is important that we recognise the fundamental changes happening in the market that community pharmacies operate in. With the growth of online ordering of prescriptions, the large-scale automation of dispensing and the integration of health services within which community pharmacies are absolutely vital, the industry will have to change.

National Health Service: Workforce Race Equality Standard

Debate between Lord Prior of Brampton and Baroness Walmsley

Wednesday 24th February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the whole purpose of the WRES is to shine a light on the performance of each trust in the country. The CQC will be including it in its well-led domain from March of this year and has already begun to incorporate it into its inspection processes. As the noble Lord knows, in Bradford where he is the chairman of a trust, we have a huge amount of progress to make.

[Baroness Walmsley (LD)]

My Lords, what is being done to ensure fair career progression further down the ladder? Unless we get people moving up, we will never have BME medical directors. Further, is he prepared to comment on diversity among the personnel in the recruitment agencies themselves that work for the NHS?

[Lord Prior of Brampton]

My Lords, the noble Baroness makes a good point. In a way the WRES focuses very much on the more senior grades in the NHS, but we need to focus on progression from band 4 into 5 and 6 as well. It is an important point that needs to be taken on board. As far as recruitment is concerned, it is very important that we have people from BME backgrounds on the recruitment panels. Getting the right people is crucial, and if that means going to external recruitment agencies when we have to, we should not rule that out.

Accident and Emergency Services: Staffing

Debate between Lord Prior of Brampton and Baroness Walmsley

Tuesday 23rd February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, seven-day working clearly goes far beyond junior doctors; it requires senior doctors, pharmacists, social workers, and primary care as well as acute care if we are to deliver a full seven-day service. As my noble friend knows, that is our objective over the next five years.

[Baroness Walmsley (LD)]

My Lords, does the Minister endorse the principle of Kirsty Williams’s Private Member’s Bill in the Welsh Assembly, the Safe Nurse Staffing Levels (Wales) Bill, which, having passed with all-party support, now ensures safe staffing levels in all wards in Wales? Will the UK Government follow the example of the Liberal Democrats in Wales?

[Lord Prior of Brampton]

My Lords, I can perhaps be excused for not following all that carefully Private Members’ Bills in the Welsh Assembly promoted by the Liberal Democrats. Safe staffing is obviously very important. I quote Mike Richards on this, who says that it is,

“important to look at staffing in a flexible way which is focused on the quality of care, patient safety and efficiency rather than just numbers and ratios of staff”.

That is extremely important.

Junior Doctors

Debate between Lord Prior of Brampton and Baroness Walmsley

Monday 8th February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the noble Lord said he had three questions; I think there were only two questions there, which is unusual, if I may say so. We do not want to impose a contract. We want the BMA to come back and continue the talks and we still hope that that will happen. Clearly, imposing a contract is not what we ever wanted to do when this whole process started. As was said in the Statement, the Secretary of State’s door is open and we hope that we can resolve these difficult issues in a negotiated, consensual way.

On the noble Lord’s second question, he rightly said that this is an appalling situation, but actually I describe it more as a tragedy. Let me quote from a trainee doctor:

“I feel undermined and not valued at work and I have seen how this flagging morale among colleagues has caused more than ever to leave the profession. It is a hard job that takes dedication and stamina to continue. But as we are criticised and treated as ‘cogs in a wheel’ rather than as individual professionals, I think we will see ever increasing numbers of people leaving this profession”.

That was in 2005, after the contract came in. The issues facing the junior doctors go back a long way. It is not just about plain time on Saturdays or this particular contract but about how we value, reward, train and trust junior doctors. That is the issue we must come to when the current dispute is resolved.

[Baroness Walmsley (LD)]

My Lords, I think that the Minister did not answer the question from the noble Lord, Lord Hunt, about which hospital chief executives believe that the junior doctors’ contract is what is getting in the way of seven-day services. Surely the state of primary care, which is stretched all over the country, and the lack of diagnostics, laboratory services, X-rays and so on in hospitals are much more significant.

My own question is about plain time, which I believe is the sticking point. It occurs to me that the best way of ensuring patient safety is to make sure that we do not have tired doctors. Can the Minister convince me about the fact that we are being told that junior doctors will not have to work any more hours than they do now? If you are extending plain time from 8 am until 10 pm, instead of 7 pm, and into Saturdays, then it strikes me as quite possible that they will work much longer hours. I would be very interested to know what the average working week of a junior doctor is now compared to 20 years ago, because it strikes me that we are in danger of going backwards.

[Lord Prior of Brampton]

My Lords, I apologise for not replying to the question earlier about the number of chief execs. The point is that this is not just about junior doctors; I think we all understand that totally. We are hoping to have more primary care, more social care, more diagnostics and more senior consultant cover at weekends, which will support junior doctors and make their lives better at night time and over the weekend. As far as the hours are concerned, the new contract proposal puts far greater safeguards over the amount of time that junior doctors will be working. I think that is largely accepted by the junior doctors. Going forward, the maximum number of consecutive nights will be down from seven to four; the maximum number of long shifts—that is, over 10 hours—will be down from seven to five; the number of consecutive late shifts will be down from 12. We are putting in those safeguards to ensure that we do not go back to the bad old days of very long hours. They were the bad old days on one level but if you actually talk to most doctors, they did get tired and it affected safety but it built a sense of teamwork, camaraderie and purpose in hospitals. We need to be careful about rubbishing the old days when they built up a lot of really serious, good professional work.

Allied Health Professionals: Training

Debate between Lord Prior of Brampton and Baroness Walmsley

Monday 8th February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, as I said, overall there is a small net increase of 334. That is largely for paramedics, where HEE believes that there is a more serious shortage than for other allied health professions. As I said, we have seen a significant increase in AHPs of more than 16% over the last five years and we expect that growth to continue after 2017.

[Baroness Walmsley (LD)]

My Lords, how will the Government achieve their objectives in relation to modernised cancer treatment and an enhanced role for radiographers when Health Education England is cutting the number of training places for therapeutic radiographers by 4.3%?

[Lord Prior of Brampton]

Actually, I think the number of radiographers is going up slightly. I will check, if I can, and write to the noble Baroness. It is also worth mentioning that the number of medical endoscopists is planned to go up by 200 over the next three years.

Sugar Tax

Debate between Lord Prior of Brampton and Baroness Walmsley

Wednesday 3rd February 2016 Lords Chamber

[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.

NHS: Trust Finances

Debate between Lord Prior of Brampton and Baroness Walmsley

Monday 1st February 2016 Lords Chamber

[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.

Failures of the 111 Helpline

Debate between Lord Prior of Brampton and Baroness Walmsley

Tuesday 26th January 2016 Lords Chamber

[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.

National Health Service: Nurses

Debate between Lord Prior of Brampton and Baroness Walmsley

Tuesday 26th January 2016 Lords Chamber

[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.

Health and Social Care: State Pension

Debate between Lord Prior of Brampton and Baroness Walmsley

Thursday 21st January 2016 Lords Chamber

[Lord Prior of Brampton]

The right reverend Prelate is right to remind the House of the report by the Commonwealth Fund which indicated that the National Health Service is the most efficient and overall the best healthcare system in the world. He also referred to prevention. The childhood obesity prevention strategy is due to be announced by the Government in the next couple of months. We have made huge progress on reducing smoking and in other areas of prevention, but I agree with the right reverend Prelate that prevention is a critical part of our long-term approach to healthcare.

[Baroness Walmsley (LD)]

My Lords, the Minister talks about the support for the five-year forward view, but is he aware that more than 80% of finance leads within the health service do not believe that the five-year forward view can achieve the savings that it says it can? It just cannot be done without extra resources. Surely, particularly with the state of affairs in social care, where the Government’s extra money is being back-loaded, not front-loaded, we need to take an overall holistic look at health and social care and how much we should be spending as a country and how we are prepared to raise that money fairly.

[Lord Prior of Brampton]

My Lords, I think that the same question is being asked in slightly different terms by many different noble Lords. I cannot really add to what I said before. We are supporting the NHS’s plan. By the end of this Parliament we will be putting another £3.5 billion into social care through the social care precept and an extra £1.5 billion into the better care fund. We believe that we have a plan for social care and healthcare over the course of this Parliament.

Health: Hormone Pregnancy Tests

Debate between Lord Prior of Brampton and Baroness Walmsley

Thursday 21st January 2016 Lords Chamber

[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.

Health: Red Cell Folate

Debate between Lord Prior of Brampton and Baroness Walmsley

Tuesday 19th January 2016 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, is the Minister aware that, as I was told this morning by three neural disease specialists, the danger of overmedication with folic acid by fortification is absolutely minuscule—you cannot measure it? In addition, they suggested to me that it is vital that we reduce the number of babies with neural tube defects because, due to our success in the past in reducing the numbers, the specialists and services for such babies are very thin on the ground. We really need to do something about this now.

[Lord Prior of Brampton]

My Lords, the danger of overmedication with folic acid is small, I accept that. It is not non-existent but it is small. Just so that the House knows the numbers, the number of babies aborted because of neural tube defects is about 400 a year; the number who are born with neural tube defects, alive or not alive, is about 60 a year. It is a very serious issue and one that the Government are taking extremely seriously, but we have to weigh that against the other issues of medicating the entire population.

Sugar Tax

Debate between Lord Prior of Brampton and Baroness Walmsley

Wednesday 13th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I think that the noble Lord is right; indeed, the Prime Minister has called this the new smoking. Obesity is as important to public health as smoking has been in the past. We have to build a much stronger case among the public at large before we can start to introduce the full range of tax and other measures that we have had for cigarettes and alcohol.

[Baroness Walmsley (LD)]

My Lords, has the Minister tried the Sugar Smart app on his mobile phone, which can be found on the Change4Life website? I tried the app this morning—it is very clever; it reads a barcode and tells you how much sugar is in a product. Unfortunately, however, I tried it on five sugary products and it did not have any of them in its database. Has this very good idea been under resourced?

[Lord Prior of Brampton]

My Lords, fortunately I, too, tried the Sugar Smart app this morning. Interestingly, 600,000 people have downloaded that app and the PHE Change4Life programme has had considerable success in raising awareness of the amount of sugar that you consume when you buy a product in the supermarket.

Children: Obesity

Debate between Lord Prior of Brampton and Baroness Walmsley

Tuesday 12th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, my noble friend is right that we have to involve all departments. For example, she mentioned the environment. There is plenty of evidence to suggest that urban and educational environments can be designed so that children spend more time walking. The development of cycleways in London is another example of how we can design our environment to improve the level of physical exercise that we take.

[Baroness Walmsley (LD)]

My Lords—

[Baroness Finlay of Llandaff (CB)]

Can the Minister outline what is being done specifically in relation to women in pregnancy, given that excessive weight gained in pregnancy, which is often linked to the phrase “eating for two”, is very difficult to lose afterwards, particularly if women do not breastfeed? Moreover, postnatal depression can itself be a cause of excessive eating after delivery of the baby, causing the maintenance or even aggravation of obesity. That requires specific services to target these women.

[Lord Prior of Brampton]

The noble Baroness will know that the report of the Chief Medical Officer which came out two or three weeks ago laid particular stress on the importance of women who are pregnant because of the impact of obesity not just on themselves but on their children as well. Advice is available through NHS Choices, Start4Life and Healthy Start; we have various schemes that are focused on pregnant women. I am sure that we can do more, and perhaps when the government strategy on obesity is announced in the near future, it will address that issue as well.

[Baroness Walmsley]

My Lords—

[Lord Winston (Lab)]

My Lords, given that homo sapiens is a species that is programmed to eat carbohydrate and fat, what estimate have the Government made of how much childhood obesity is due to epigenetic factors rather than simply eating sugar and carbohydrate later on in life? Might this not be programming earlier in the generation perhaps as the result of previous generations’ environment? This is an essential point in understanding obesity.

Pregnancy: Neural Tube Defects

Debate between Lord Prior of Brampton and Baroness Walmsley

Monday 21st December 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I pay tribute to the noble Lord for the extraordinary work that he has done in this field and for giving this very important and tragic issue a greater degree of public awareness. My honourable friend in the other House, Jane Ellison, the Minister for Public Health, is considering her response to the report that the noble Lord referred to and to the report by the SACN, the committee on nutrition, published on 20 October. I expect that she will come to a decision early in the new year.

[Baroness Walmsley (LD)]

My Lords, given the importance for the health of the foetus of folic acid being taken by women before they are pregnant, will the Minister work with his colleagues in the Department for Education to ensure that all young women—and young men—know the importance of taking folic acid long before they even think of becoming pregnant?

[Lord Prior of Brampton]

The noble Baroness is absolutely right. When you know you are pregnant, it is too late to start taking folic acid, and that is the fundamental reason why the noble Lord, Lord Rooker, is pushing for fortifying flour with folic acid. However, she is absolutely right that education is fundamental to this as well.

Down’s Syndrome: Do Not Resuscitate Orders

Debate between Lord Prior of Brampton and Baroness Walmsley

Tuesday 15th December 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, perhaps I could address first the particular issue of Andrew Waters. The doctor who signed the DNR order was a junior doctor who made a mistake. It was a misjudgement, he apologised for that mistake, and he has learnt from it by using his experience to teach other doctors how to deal with similar issues. It is important to make that statement first—the reaction of that junior doctor was the right one, having made that mistake. The noble Lord mentioned the Blue Apple Theatre company. He was kind enough to send me a copy of some of the work that it does, which illustrates that people with Down’s syndrome can have a very full, useful, good and happy life, and their lives should be valued just as highly as the life of any other person.

[Baroness Walmsley (LD)]

My Lords, does the Minister know how widespread such discrimination is against people with learning difficulties? What reassurance can he give to parents such as those I met recently in the House of Commons Dining Room, who were terrified to allow their disabled son to go into hospital because they knew they were going to be put under pressure to sign a DNR notice? They were also afraid that, even if they refused but were not at his bedside 24 hours a day, it would happen anyway.

[Lord Prior of Brampton]

My Lords, the noble Baroness has just made a truly shocking statement. If indeed this practice was systemic and widespread, it would be a matter of huge concern and I think all of us in this House would be appalled by it. I have no evidence that this is a systemic problem, but it is absolutely the case that this group of very vulnerable people have been let down not just by doctors and clinicians but actually by all of us—the whole of society, for ever. The report produced three weeks ago called Building the Right Support recognised that we have let down this group for decades, and I hope that over the next five years we can start to make amends.

Southern Health NHS Foundation Trust

Debate between Lord Prior of Brampton and Baroness Walmsley

Thursday 10th December 2015 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, our hearts go out to the family of Connor Sparrowhawk and all the other families who have struggled so hard to get investigations of the unexpected deaths of their loved ones. On many occasions they have struggled to find the financial support required to make that investigation. That is quite wrong. In this particular hospital’s case, the percentage of unexpected deaths that was investigated is pretty scandalous. In fact, across the board, only 1% of unexpected deaths of those with learning disabilities are investigated.

I very much welcome the Minister’s saying that a light will be shone on this, but will the investigation bear in mind the possibility that it should not be the hospital trust itself that decides which of its unexpected deaths should be investigated? Police forces no longer investigate themselves—that is done by another police force. Should that not be the case with hospitals too? My second question is about timeliness. The report is not the first indication we have had of problems with this trust. The coroners have complained on numerous occasions, and over a long period, about the timeliness and quality of the reports received by them on cases that were investigated. Surely this indicates that there have been problems with the administration, the collection of evidence and the systems of this trust. Why was that not picked up earlier?

[Lord Prior of Brampton]

My Lords, the noble Lord, Lord Hunt, gave two very important figures: 1% of these incidents involving people with learning difficulties were investigated and 0.3% involved people with learning difficulties who are older. We have not got it right in this country when it comes to people with learning difficulties. We have not fully learnt the lessons of Winterbourne View. However, NHS England has now published this new strategy for people with learning difficulties and mental health problems. We will hold it to account for delivering that. I think that represents a step change in trying to get as many of these people out of hospital settings—“from hospital to home” is the line in the report—which is so important. That is the fundamental issue that we should not lose sight of.

NHS England received the report in September. It has not yet been published because it had to give the trust a chance to comment on it, and the methodology has to be fully sorted before it is published. However, Jane Cummings has given a commitment to the Secretary of State that the report will be published before Christmas. So does NHS England have a grip? I think it does.

On the question of an independent investigation, which the noble Baroness, Lady Walmsley, raised, the trust has to be the first line in this. It is up to the trust to have the right culture within it so that these incidents come to the surface. We now have a much more empowered CQC providing independent inspection, and of course the Secretary of State has agreed to set up an independent investigation branch, on the recommendation of the PASC, which will be operable from March.

Health: Liver Disease

Debate between Lord Prior of Brampton and Baroness Walmsley

Wednesday 9th December 2015 Lords Chamber

[Lord Prior of Brampton]

I have read the Lancet report and I noted this rather unusual omission in the north-west. I do not understand why the north-west does not have a specialist liver facility. It is something that I will follow up and find out. I will write to the noble Lord if I can.

[Baroness Walmsley (LD)]

My Lords, the Lancet said that the majority of people with obesity have non-alcohol related fatty liver disease. Does the Minister agree that we need restaurants and takeaways to publish the calorie, fat, sugar and salt content of their dishes? Some of the best do it, but not many do. Will he also consider further restrictions on the advertising of high-calorie junk food to children?

Health: Adult Pneumococcal Vaccination

Debate between Lord Prior of Brampton and Baroness Walmsley

Tuesday 8th December 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, there is a huge and growing role for community pharmacy in delivering services that have traditionally been supplied by the NHS. If we were to discuss this in five years’ time, I am sure that we would see a far greater role played by community pharmacy. I am not sure that I can give the noble Lord a specific answer on vaccinations. I can just say that the flu vaccination rate so far this year to date is 66%. Last year, by the end of the winter, it was 72%, so we are roughly on target to do the same as last year.

[Baroness Walmsley (LD)]

My Lords, the service standards say that local authority directors of public health have a key role to play in ensuring good coverage of vulnerable groups in their area. Given that fact, what assessment has the Minister’s department made of their ability to carry out that role, given the recent large cuts in public health budgets?

[Lord Prior of Brampton]

My Lords, the principal role for pneumococcal vaccination—the subject of the Question—lies with GPs. Take-up of the PPV for those aged over 65 is 70%; for those aged over 75, it is 80%. For young children, the rate is more than 95%.

Sex-selective Abortion

Debate between Lord Prior of Brampton and Baroness Walmsley

Monday 7th December 2015 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, with which stakeholders are the Government working in order to fulfil their commitment to explore pressure and coercion on women in relation to boy preference and its possible link with domestic violence?

[Lord Prior of Brampton]

My Lords, I have a long list of stakeholders, which covers all the usual suspects in this area, if I can put it like that. In the way that the methodology was developed to assess whether there was a population basis for gender abortions taking place, we took advice from the Office for National Statistics and a number of the royal colleges.

Junior Doctors Contract

Debate between Lord Prior of Brampton and Baroness Walmsley

Monday 30th November 2015 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I, too, thank the Minister for repeating the Statement. I, too, understand that the junior doctors have now agreed to call off tomorrow’s strike. Will the Government therefore apologise to the 4,000 patients whose treatments tomorrow will have been delayed by this going right up to the wire and the Government being so reluctant to go to ACAS for negotiation?

I understand that more detailed negotiations will now take place. Will the Government be entering those negotiations without prejudice and with the well-being of patients—and the well-being of doctors, upon which the well-being of patients depends—in their minds as they negotiate? Will they take very seriously the concerns that have been put to them by conscientious junior doctors, who work very hard for us?

I, too, have some scepticism about the data in relation to the so-called weekend effect. I echo the call of the noble Lord, Lord Hunt, for some independent research into the causes of the less good outcomes that undoubtedly occur in some places—to what degree, we do not know. I am quite sure that the junior doctors and their contract are not the only cause of any such weekend effect.

[Lord Prior of Brampton]

My Lords, first, I am very pleased to confirm to the House that in the past few minutes the BMA and the Government have reached an agreement, which will allow time for negotiations to take place. The BMA has agreed to suspend industrial action, including that planned for tomorrow, and the Government have agreed not to proceed unilaterally with implementing the new contract. By any standards, that is very good news.

The noble Lord referred to the brain drain. The best thing we can do in the short term is to sort out the contractual dispute with the junior doctors. That is absolutely fundamental to restoring morale among doctors. There is a feeling among some junior doctors that they are not properly valued. This goes way beyond some of the issues being discussed on the contract. It is about their training and a lot of other issues that bear on this.

There have been, I think, two studies published in the BMJ now about the weekend effect, along with studies in other parts of the world as well, such as the US. There is no doubt that there is a weekend effect. It is to do with lack of senior cover at the weekends, diagnostics and all those kinds of issues. This is a broad issue, which can be addressed only if we have a seven-day service. It is certainly not just about junior doctors.

We do not have much time but I will say this about the Secretary of State: patient safety is his motif. If he wishes to be remembered for anything, it is patient safety. That is why he agreed to go to ACAS when the BMA suggested it. He was absolutely right to do so and I congratulate both the BMA and the Secretary of State for coming to this agreement just in time.

Accident and Emergency Departments

Debate between Lord Prior of Brampton and Baroness Walmsley

Monday 30th November 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I thank RoSPA and the Royal College of Emergency Medicine for the important work they have done in producing this report, and the work done by Queen Mary’s College in substantiating it. The Government’s policy is to put the main responsibility for children under the age of five in the hands of local authorities in the belief that they, by knowing the local conditions better than central government, can have a greater impact.

[Baroness Walmsley (LD)]

My Lords, given that 15 to 24 year-olds are another of the three most vulnerable groups that are liable to have accidents, will the Government consider looking carefully at the national curriculum and ensure that PSHE, including personal safety and accident prevention, is taught in every single maintained school?

[Lord Prior of Brampton]

That is an interesting question. However, the report shows clearly that the main problem exists with the under-fives. Of course, there are issues at all ages, including falls and other aspects of accident prevention at the end of life. The interesting work that LifeForce has done in Birmingham shows that, for not very much money, we can have a big impact. Using the health visitors who are now employed by local authorities is a very important way in which we can address this important issue.

NHS: Food Banks

Debate between Lord Prior of Brampton and Baroness Walmsley

Thursday 26th November 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, the people running the schemes in the two hospitals in Birmingham and in Tameside are to be congratulated. I am not sure that there is a similar scheme in Newcastle. I know from experience of homelessness how difficult it is, for example, to discharge patients when they have nowhere to go, with the risk of discharging people onto the street who will then come back into hospital. The work they are doing in those two hospitals is to be applauded. We have a welfare safety net in this country. Tragically, anywhere around the world there will be some people who fall through that net. The fact that there are voluntary groups and charities prepared to help pick those people up is a cause for celebration. It is that combination of a state welfare net with an active civic society which makes this country as good as it is.

[Baroness Walmsley (LD)]

My Lords, does the Minister agree that the location of food banks should not be at the top of the priority list of cash-strapped NHS hospitals, most of which are in deficit at the moment? Does he also agree that food banks need to be conveniently located so that those who need them can visit them regularly? I would rather hope that those people would not have to visit hospitals regularly.

[Lord Prior of Brampton]

I do not think that anyone is saying that the food banks in the hospitals in Birmingham and Tameside are their top priority, I just think that it is a very human reaction of people working in those hospitals who want to help very vulnerable people who are being discharged.

Gender-based Violence: Women with HIV

Debate between Lord Prior of Brampton and Baroness Walmsley

Wednesday 25th November 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness raises the very profound point about stigma. Where people suffer from both HIV and domestic abuse, they are extremely vulnerable and feel it very difficult to raise these issues. The Government have done a lot to try and remove the stigma and make it easier for these very vulnerable women to come forward. I am sure that the noble Baroness is aware of the sexual assault referral centres. There are now 43 of those, funded by NHS England, the police and local authorities. They are a good example of cross-government support.

[Baroness Walmsley (LD)]

My Lords, in 2012 the coalition Government set up a new research and innovation fund to collect information about violence against women in 10 African and Asian countries with the view to setting a new prevention strategy. Could the Minister tell us anything about how that strategy is progressing? Given the risk of HIV to many of these women, will that issue be covered in the strategy?

[Lord Prior of Brampton]

I think I am right that there are some 16 million women worldwide who suffer from HIV/AIDS so it is a huge problem, particularly in sub-Saharan Africa. I am not familiar with the innovation fund to which the noble Baroness referred, but I will investigate that and write to her.

NHS: Costs of Operations

Debate between Lord Prior of Brampton and Baroness Walmsley

Monday 9th November 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, hospitals do know their costs; they know their reference costs and their HRGs. Increasingly, we will want to get patient-level costing into all our hospitals, as is already the case in some hospitals. If you know the actual cost by patient, the hospital management can have a much better discussion with hospital clinicians. Patient-level costing is important going forward in hospitals. For GPs, we have a calculated payment, as my noble friend will know: currently £75.77 per capita on the list, adjusted for various matters. A capitated figure for GPs is probably better than a much more detailed breakdown of costs.

[Baroness Walmsley (LD)]

Do the figures for hospitals discriminate between those that have to service expensive PFI contracts and those that do not? If so, and if the former are more expensive than the latter, is the department funding them appropriately to enable them to pay those costs?

[Lord Prior of Brampton]

The noble Baroness makes an important point. We have what we call a “market forces factor”, which is applied to the tariff to make adjustments for unavoidable differences in costs—for instance, providing care in London compared to providing it in a cheaper place. The way we measure the cost of capital is not entirely satisfactory, though, and if an individual trust has a very expensive PFI, that is not properly compensated for by the market forces factor. We should spend some more time looking at that issue.

Health: Post-polio Syndrome

Debate between Lord Prior of Brampton and Baroness Walmsley

Tuesday 20th October 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Lord is much better informed about this than I am, and of course I agree with him 110%. However, there are other aspects to treating this pernicious illness; clearly pain relief is important. It raises the issue that GP practices having a multidisciplinary team—physios and people who are experts in mobility, orthotics, pain relief and exercise—is very important.

[Baroness Walmsley (LD)]

My Lords, people with post-polio syndrome often require the care of a wide range of different specialists, which makes the linking up of their care and treatment particularly crucial. What are the Government doing to ensure that these can be linked up? Could the Minister say whether any of the vanguard sites are working on partnerships that will enable this to happen?

[Lord Prior of Brampton]

NHS England’s approach to most people who are suffering from long-term conditions is best summed up through its House of Care programme, which is very much based around the individual and their carers and so is personalised. Of course, personal health budgets can have a big role to play for people with long-term, complex, chronic conditions.

Primary Care: Targets

Debate between Lord Prior of Brampton and Baroness Walmsley

Tuesday 13th October 2015 Lords Chamber

[Baroness Walmsley]

To ask Her Majesty’s Government whether they will encourage general practitioners’ practices to employ nurse prescribers, nurse practitioners and pharmacists in order to achieve their seven day target for primary care.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, broadening the skill mix within general practice is an important part of improving access for patients. General practices are including nurse prescribers, nurse practitioners and clinical pharmacists in their multi-disciplinary teams and experience suggests that this results in significant benefits for patients. Earlier this year, NHS England launched a £15 million scheme to fund, recruit and employ clinical pharmacists in GP surgeries.

[Baroness Walmsley (LD)]

I thank the Minister for that reply, but is he aware that the GP shortage is made worse by the fact that a declining number of young doctors want to go into GP practice for various reasons, including pay, working hours and the volume of consultations? At the same time, we have a surplus of excellent young pharmacy graduates looking for jobs who would be very happy to go into clinical general practice. Is it not time for a new initiative to bring these two things together and ensure that doctors get the assistance of all these excellent young graduates?

[Lord Prior of Brampton]

The noble Baroness makes a very good point. There is plenty of evidence to suggest that where general practices employ clinical pharmacists, it relieves GPs of a considerable burden. Interestingly, the NHS Alliance produced a report last week called Making Time In General Practice. It identified that up to one in six patients seen by GPs could in fact be seen by someone from a broader skill mix within general practice, so what the noble Baroness says makes a lot of sense.

NHS: Financial Performance

Debate between Lord Prior of Brampton and Baroness Walmsley

Monday 12th October 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I thank the noble Lord for those helpful comments. His first question was: what is the updated estimate for the full year? There is a general figure out there that the King’s Fund, the Health Foundation and others have come up with—£2.1 billion—as the underlying provider deficit for the year. That figure is largely based on the first quarter’s results because you cannot annualise the first quarter’s results; the first quarter is often much worse than the subsequent three quarters. We believe we can manage that £2.1 billion down quite significantly; interestingly, last year the underlying provider deficit was £1.2 billion. We have other ways of managing that deficit through the surpluses that may arise on the commissioning side and other sources of revenue.

The noble Lord talked about agency staff. I recognise some of what he says but there is no doubt that in the aftermath of the tragedy at Mid Staffordshire, the strengthening of the CQC when I was there has led to greater pressure to increase staffing numbers. I heard the noble Lord say, I think when he was chairman of the Heart of England trust, that if you are going to get shot it is better to get shot for not hitting your financial budgets than for not having enough staff on the wards. There has been a much greater emphasis on higher levels of staffing and that has put pressure on agency staffing. There are actually 8,000 more nurses and 9,000 more doctors in the NHS since 2010.

The noble Lord mentioned the cost of consultants. I recognise the strength of what he says—that it is a bit rich for us to complain about the cost of consultants when, through our arm’s-length bodies, we have been responsible for recruiting them. We expect much of the improvement methodology that has been provided by independent consultants to be provided by NHS Improvement; for example, the fact that we have now taken on Virginia Mason to help us spread best practice in running hospitals in the NHS is a model for things to come. I also hope that chains of hospitals will emerge and develop some of the best practice from hospitals such as Salford Royal, Frimley Park, the Royal Free and others, so that we can spread best practice without relying so heavily on external consultants.

Unfortunately, I have not read the article by Tom Hughes-Hallett. I would say to Tom, who I know, that he might spend more time focusing on his own hospital, which got a “requires improvement” notice from the CQC, than on spreading his views to all and sundry, although I recognise the strength of some of them. Sorry, I am running past my time. I had not realised that time was of the essence.

[Baroness Walmsley (LD)]

My Lords, quite clearly there is a crisis of funding in the NHS on an enormous scale and nothing I have heard from the Government indicates that the problem is going to be solved by any single party. This should be of cross-party concern. During the election, my right honourable friend Norman Lamb asked the Secretary of State for Health if he would co-operate with a cross-party commission to look at a cross-party solution to a new settlement for the NHS. He agreed, as did the Labour spokesman, yet five months later nothing has happened. Can the Minister tell me when it will?

In Scotland health and social care have been integrated and are already showing successes because of that. When will that happen in England? The situation in Scotland illustrates the fact that the challenges to the NHS are never going to be solved by the NHS alone. This is a whole-government issue. When will the Government beef up the Cabinet committee on health so that every department can be held to account for whether its policies contribute to the greater health of the nation or not? Until that is done, the NHS alone cannot be expected to solve the looming problems.

[Lord Prior of Brampton]

My Lords, it is worth reminding your Lordships that there was considerable consensus around the five-year forward view. I think that the noble Baroness’s party wholly signed up to it and, along with the Conservative Party, to committing £8 billion of extra money to the NHS over the lifetime of this Parliament. We stand by that. The NHS, in its turn, agreed to find £22 billion-worth of efficiency savings, which I think the noble Baroness accepted when she was part of the coalition Government. That is still the situation so I do not think that we need a new settlement. There is a settlement: it is called the five-year forward view and we are fully committed to it.

The noble Baroness raised the issue of integration. I agree 100% with her and it is an essential part of the five-year forward view—the vanguards are based on it. I remind noble Lords that the spending in the UK per capita on health is $3,200. In France it is $4,100 and in Germany it is $4,800. The NHS does a remarkable job in delivering world-class healthcare, which is rated by the Commonwealth commission and other independent agencies as among the best in the world, with considerably fewer resources than any other developed system in the world.

NHS: Mental Health Patient Assessment Needs

Debate between Lord Prior of Brampton and Baroness Walmsley

Monday 12th October 2015 Lords Chamber

[Lord Prior of Brampton]

It is obviously not possible for me to comment on an individual case but it sounds like a very tragic and a very difficult case. Of course, someone in that kind of position ought to have access to normal NHS facilities and care, and I am at a loss to know why my noble friend’s grandson has not been able to get proper access. The fact that a general anaesthetic is required, and has been said to be required by a clinician, should not make it any more difficult to access that kind of care. I am very happy to look at this as an individual case and, if it is not just an individual case but an example of a broader problem, I shall be very happy to meet my noble friend outside the Chamber to pursue the matter with her.

[Baroness Walmsley (LD)]

My Lords, is the Minister aware that NHS staff are a very resourceful group of people and that in the past many of them have found ways of helping patients through these scans and so on when they have found them very difficult? What are the Government doing to ensure that these creative responses to patients’ individual needs can be shared with other members of NHS staff? Will the Government consider some kind of restricted-access online resource centre, through which NHS staff can share their good ideas and what they have found to work?

[Lord Prior of Brampton]

My Lords, I think spreading best practice is a perennial problem in the NHS. The noble Baroness gave an example of that but I could give many, many others: we are not good in the NHS at spreading best practice. I hope that the newly reformed combination of the TDA and Monitor into NHS Improvement will be a very useful repository of good practice, in the same way as the IHI is in the USA.

Health: Detection Dogs

Debate between Lord Prior of Brampton and Baroness Walmsley

Thursday 17th September 2015 Lords Chamber

[Lord Prior of Brampton]

Clearly, molecular diagnostics is a growing field and will have a hugely important role to play in diagnosing many cancers. This was certainly a recommendation of the cancer task force led by Harpal Kumar. We are not by any means saying that we should pursue dogs at the expense of molecular diagnostics, just that we should try every opportunity. There seems to be some evidence regarding the number of false positives—for example, the use of dogs to sniff urine is considerably more accurate than more conventional forms of detecting cancer. We would not therefore want to rule out the use of dogs by pursuing solely molecular diagnostics.

[Baroness Walmsley (LD)]

My Lords, is the Minister aware that many diabetes patients who would like a dog and feel that they would be helped by one but cannot get one through the NHS are paying for dogs from unlicensed trainers? However, they are of variable quality and may not be as good as properly trained dogs. Will the Minister look into this to see what can be done about it?

[Lord Prior of Brampton]

The decision on whether to supply dogs locally must be left with clinical commissioning groups.

NHS: Clinical Commissioning Groups

Debate between Lord Prior of Brampton and Baroness Walmsley

Wednesday 16th September 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness raises a very important issue. I think that she is raising issues not about the actual formula but about the speed at which NHS England reached the target levels of the formula. She points to the discrepancy of west London, which is 31% over the formula. I can tell her that NHS England is committed by 2017-18 to bringing all those under the formula by more than 5% up to that level. It will also be encouraged to address the issue of CCGs that are above the formula.

[Baroness Walmsley (LD)]

My Lords, given that the expertise of the CCGs is also very variable, in some areas the commissioning support groups are particularly important. Is the Minister satisfied that both the expertise and the funding of the commissioning support groups is appropriate?

[Lord Prior of Brampton]

The noble Baroness is right that there is considerable variation in the performance of CCGs and, indeed, commissioning support groups. In an effort to address that variation, we are in discussions with the King’s Fund to publish in a very transparent and open way the performance of individual CCGs.

--- Later in debate ---

[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.

[Baroness Walmsley]

My Lords, the criteria that the Minister mentioned sound all very well, but they do not take account of existing levels of ill health in the most disadvantaged areas of the country. The criteria he quoted do not take account of the need for catch-up for those populations.

[Lord Prior of Brampton]

The report by the Public Accounts Committee raised the issue of whether deprivation was properly taken into account by the formula used by ACRA, and ACRA has agreed that in its new formulation it will look again at the adjustment it makes to the formula for deprivation.

Health: Children

Debate between Lord Prior of Brampton and Baroness Walmsley

Thursday 10th September 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, access to health services is not just a rural issue; it relates also to deprivation, be it urban or rural. I would point out to the House the increase in the number of health visitors, which has gone up from 8,000 to nearly 12,000 over the past five years, and also to the Family Nurse Partnership scheme, which now has 16,000 places on it for younger and teenage mothers. So the Government are doing a lot to improve access. I guess they could always do more.

[Baroness Walmsley (LD)]

My Lords, is the Minister aware that in some areas fewer than half the five year-olds reach a good level of development? Given how important this is for their health, education and future employment prospects, why have the Government decided that from next year, the collection of early years foundation stage profile data is no longer to be statutory? How are the Government going to monitor how well children are developing across the piece, and how individual nursery settings are doing?

[Lord Prior of Brampton]

I am not sure that I can give that question a full answer. I am aware of the early years programme and I think that it is largely up to schools to monitor the development performance of children when they come into reception classes, which they are doing. I have seen the figures that the noble Baroness refers to—the 40% figure of children who have not reached the right development age by the time they come into reception class. It is a serious issue and I will take her words on board.

Health: Skin Cancer

Debate between Lord Prior of Brampton and Baroness Walmsley

Wednesday 22nd July 2015 Lords Chamber

[Lord Prior of Brampton]

The NICE guidelines are due to come out at the end of July or in August. I believe that they are guidelines, not mandatory, although they should be read in the context of the report by Harpul Kumar, Achieving World-Class Cancer Outcomes. Cancer is a very high priority for this Government, and this may come out in further questions. In commissioning these services, we have to be very careful that we do not disaggregate dermatology services in hospitals; the provision of routine and complex emergency dermatology services and, of course, the training of dermatologists should be commissioned as a whole.

[Baroness Walmsley (LD)]

My Lords, is the Minister aware that consultant dermatologists often see patients who have been told by their GP that their mole was benign and did not require a biopsy? In the UK, the mortality rate is 20% compared with 12% in Australia for a similar number of cases. Given that outcomes are so closely linked to the thickness of the lesion and early diagnosis, what are the Government doing to make sure that GPs are trained to recognise the benign skin lesions and to refer the more dubious ones to consultants? I am aware that we ask a great deal of GPs, but what matters is training them to recognise these things and not wasting money and compromising patients by not referring them early enough.

[Lord Prior of Brampton]

Health Education England is aware that insufficient time is spent on dermatology issues in the training of junior doctors, and it is considering that very seriously.

NHS: Reform

Debate between Lord Prior of Brampton and Baroness Walmsley

Thursday 16th July 2015 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, I, too, thank the Minister for repeating the Statement. It reflected much of what I heard this morning from the Secretary of State at the King’s Fund. It is a brave and realistic approach but there are some yawning gaps in it compared to what I should have expected in a major statement about NHS reform. However, I welcome several points.

The focus on culture change and nurturing staff is absolutely right. The NHS is the best and most cost-effective service in the world only because of the skills and commitment of its staff, yet we are told that in some places staff morale is poor. This is very sad to hear. It was good to hear earlier this morning about the beneficial effect on morale in those hospitals that are responding positively to being put in special measures.

I welcome the new personnel, processes and training that are being put in place to ensure that staff can safely express concerns about the quality of care, so that each member of staff can take part meaningfully in the improvement pathway of his organisation. We could do with ditching for all time the expression “whistleblower” with all its negative connotations. I welcome what the Secretary of State called “intelligent transparency”, a no-blame focus on what went wrong and how to put it right. In common with the noble Lord, Lord Hunt of Kings Heath, I think that merging the TDA and Monitor could be a good thing, with this focus on no-blame improvement. That should help, but we still need more signposting for patients and service users about how and where to complain if they have poor care in what is a very complex system.

I of course welcome the focus on better data-gathering, especially in the field of mental health, where we are rather short of it. Managers cannot make good financial decisions without the facts about what everything costs. Businesses could not survive like that and neither can the NHS.

I welcome the long-awaited publication of the Rose report and the acceptance of its recommendations. I look forward to seeing what they are. We need a new focus on the quality of NHS management. If we are to rise to the challenge of the £22 billion of efficiency savings, we need excellent managers and finance directors as well as excellent doctors and nurses. I welcome the fact that the noble Lord, Lord Rose, extended his remit to CCGs.

I also welcome the new requirement for hospitals and groups of doctors to provide a seven-day service but I share some of the concerns of the noble Lord, Lord Hunt, about how it will be delivered. People do not get sick to order just on weekdays, so that is important. I should, however, like assurance that this does not necessarily mean putting any further burden on individual hard-working doctors, nurses and laboratory staff. Good planning is needed to avoid further burdens. However, this will certainly mean the recruitment of more trained staff. We need assurance that they are in the pipeline. Can the Minister say, for example, what the Government are doing to stem the flow of staff, trained by the NHS at a cost to the taxpayer, who leave the country as soon as they qualify?

What was missing from the Statement and the speech this morning was context and understanding that filling the £30 billion black hole in the NHS requires a whole-Government response. If patients are to be in charge, they need good health education so that they know what a healthy lifestyle means. They need access to sports and leisure facilities and nutritious food, and they need warm, dry homes. Integration needs to be a lot broader than just integration between health and social care. Unless social care is properly funded, the NHS will not be able to find its expected £22 billion of efficiency savings while making the improvements outlined in the Statement because of the knock-on effect on acute hospital beds. Yet while there has been more money for the health service, there has been nothing but cuts in social care.

The thrust of the Statement was about getting it right first time and, if not getting it right the first time, then certainly the second and subsequent times. This has to be right for patient safety and confidence but also for cost-effectiveness. If we are to rise to the increasing demand on the health service, we must get it right as near as possible every time and we must support the staff in doing so.

[Lord Prior of Brampton]

My Lords, I thank the noble Lord and the noble Baroness for their comments. I was quite depressed listening to the noble Lord opposite. We had a debate in this House last week and we talked about a sense of political consensus on the NHS. I start by saying—rather personally—that, having listened briefly this morning to his right honourable friend Andy Burnham in the other place misquote me out of context from the debate that we had last week, I thought that there was no hope of a non-partisan approach to the NHS. For the avoidance of any doubt from anybody, and as I think I made pretty clear in last week’s debate, I believe fundamentally and passionately in a universal, tax-funded healthcare system—the NHS—that is free at the point of delivery and based on clinical need, not ability to pay. Having looked back on it, I do not remember uttering a word in that debate that would question that statement. Therefore, I hope the noble Lord opposite might have a word with his right honourable friend in the other place to make it absolutely clear that playing cheap party politics has no place in our discussions about the NHS.

Turning to the comments about my right honourable friend the Secretary of State for Health’s Statement today, seven-day services are in many ways at the heart of it. Thousands of people are dying because we do not provide seven-day services in hospitals. We cannot carry on with a system with thousands of people dying. It is not just that thousands of people are dying. The health of thousands of people is deteriorating in our hospitals over the weekend.

This is an anecdote, which may be unfair. However, two years ago, I met a radiologist walking down the corridor in an NHS hospital on a Friday morning. His wife had been admitted through A&E. She had abdominal pains. He could not get her a scan. She was going to have to wait in that hospital until Monday. Had it been a bank holiday, she would have had to wait in that hospital until the following Tuesday before she had that scan. That is an anecdote, but we know that it is happening all the time. It is unacceptable.

So I ask the noble Lord opposite to be more enthusiastic about this. Of course it will be difficult. This Government are putting in £8 billion of new money. This is more money than his party was prepared to offer before the election. It is the same amount of money that the noble Baroness’s party was offering to put in. This is £8 billion of additional money that we are putting into the NHS. It is a critical part of our strategy. It was laid out in our manifesto and is in the NHS Five Year Forward View that we would make seven-day services a main plank of these reforms. For those people who think that this cannot be afforded, put yourself in the position of a chief executive of an NHS hospital that works four and a half days a week because theatres stop work at lunchtime on Friday. Often, they do not start again until Monday lunchtime because every bed is taken up when they come in to work on Monday morning. Across the country, thousands of consultant surgeons, theatre staff and anaesthetists are hanging about on Mondays because they cannot start their work. This is because there is not a bed in the hospital because the flow of patients through that hospital came to a grinding halt on Friday. The noble Baroness is right that this is not just a hospital issue but about joined-up care. You cannot get the discharges out of the hospital unless social care, the physios and the OTs are working—the whole system needs to be working. Seven-day working is not only right for patients but will enable our hospitals to work much more efficiently.

I will pick up a few other issues. I remember when the 2003 contract was voted on by consultants. In my view, it was a disastrous contract, which deprofessionalised many professional consultants. They voted against it the first time and voted for it, grudgingly, only the second time. They voted for it because their pay went up by 28% as a result of it and they could opt out of providing care over weekends and outside normal hours—of course they voted for it. Looking back on it, some of the noble Lords and Baronesses opposite will maybe accept that it was a disastrous contract. It deprofessionalised a deeply vocational profession and fundamentally changed the culture of the NHS—a culture that we are now trying to change once again.

I welcome the comments of the noble Lord and the noble Baroness about Sir Robert Francis’s report on whistleblowing. We want an open culture, in which whistleblowing is a thing of the past. I agree with the noble Baroness that whistleblowing is not a great name. It would be great if we never heard about whistleblowing ever again because people felt able to raise their concerns in a proper, central and safe way and knew they could raise them without fear of any detriment to their employment prospects. The proposals put forward by the Public Administration Select Committee, which have been taken up by the Secretary of State for Health, are absolutely right. We need a safe place for when things go wrong.

I turn to the Rose report. Leadership is fundamental. Around a hospital, one ward will be doing well and one will not because there is a good ward sister in the first one; one hospital will be doing well and one will not because of good local leadership in the former. Leadership is absolutely fundamental, and I subscribe to all the comments that my noble friend Lord Rose has made in his report.

The noble Lord’s comments about the TDA and Monitor are harsh. David Bennett and others in those organisations have done a very good job in very difficult circumstances. We are fundamentally changing the roles of TDA and Monitor. Together, they are now, as the name suggests, an improvement agency first and a regulator second. The new role of the TDA and Monitor in NHS improvement will fundamentally change the way we approach performance management and improvement. The Secretary of State for Health alluded to the contract that the TDA recently signed with Virginia Mason, one of the safest hospitals in the world, which is one way of bringing best world practice into the NHS.

I will conclude on the context. Times are difficult in the NHS and we should not pretend differently. This Government are absolutely committed to seeing this transformation programme through. The noble Lord opposite said he did not know anybody who thought that we could achieve the £22 billion in savings that are set out in the NHS Five Year Forward View—he knows me.

Local Authorities: Public Health Budget

Debate between Lord Prior of Brampton and Baroness Walmsley

Wednesday 15th July 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I am hesitant to disagree with the noble Lord in view of the fact that he told me earlier that he qualified as a doctor in 1945, which was nine years before I was born. However, the devolution of responsibility to local authorities has been fairly universally welcomed. They are better able to take into account local priorities. I should also add that just over £2 billion of the public health budget is held centrally as well.

[Baroness Walmsley (LD)]

My Lords, is the noble Lord aware that many of the local authorities commission these important prevention services from NHS providers? Has any impact assessment been made of the effect on the NHS of this loss of income?

[Lord Prior of Brampton]

I think that the noble Baroness will know that we are due to go out to consultation on this matter, and that is an important issue that will be taken into consideration.

National Institute for Health and Care Excellence

Debate between Lord Prior of Brampton and Baroness Walmsley

Monday 13th July 2015 Lords Chamber

[Lord Prior of Brampton]

I am sorry—I did not quite understand the question. I realise that I cannot ask my noble friend to repeat it, so I wonder whether I could pick it up with her outside the House.

[Baroness Walmsley (LD)]

Is the Minister aware that in Wales 12% of NHS staff have made complaints about staffing levels in the past few years? Will the Minister join me in welcoming the fact that the Labour Government of Wales will be held to account for that next year?

[Lord Prior of Brampton]

From what I understand, the problems in Wales mean that there is a lot more for the Government to be held to account for there.

Health: Multiple Pregnancy

Debate between Lord Prior of Brampton and Baroness Walmsley

Monday 13th July 2015 Lords Chamber

[Lord Prior of Brampton]

The Government may have figures on this. I do not have figures here today, but I shall certainly endeavour to find them as soon as I can and perhaps follow it up with the noble Lord in a meeting outside this House.

[Baroness Walmsley (LD)]

My Lords, given that mothers expecting multiple births need the expert care of qualified midwives and yet we have quite a shortage, and given that the Government are considering giving golden hellos to GPs, what about midwives?

[Lord Prior of Brampton]

My Lords, we are not considering golden hellos to midwives. There are, I think, some 6,400 extra midwives in training at the moment and some 2,100 more midwives today than there were in 2010.

Health Funding

Debate between Lord Prior of Brampton and Baroness Walmsley

Thursday 9th July 2015 Lords Chamber

[Baroness Walmsley]

To ask Her Majesty’s Government whether they carried out an equality impact assessment before deciding on the recent in-year budget cut to public health funding.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, we pay close attention to equalities considerations when deciding how to distribute the public health grant between local authorities. The Department of Health is about to consult on how to implement the savings and we will address our equalities duties in full when announcing our final decisions.

[Baroness Walmsley (LD)]

My Lords, I thank the Minister for his reply, but given that these cuts will impact on teenage pregnancy programmes for the young, domestic violence programmes for women, HIV prevention programmes for gay men and some members of the BME community and TB prevention programmes for the poor and homeless, will he say where the equality is in that?

[Lord Prior of Brampton]

The noble Baroness will know that decisions on these matters are left to local authorities, and we wish to give them as much discretion as we can.

NHS: Whistleblowing

Debate between Lord Prior of Brampton and Baroness Walmsley

Tuesday 30th June 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Lord makes a very important point. There are many junior doctors from BME backgrounds who do indeed feel that it is difficult to raise concerns. One recommendation in Sir Robert Francis’s report is that every NHS organisation should have a local freedom to speak up guardian, which I hope will help. But whatever we do to change the law or codes from the GMC and others, it will not replace the need to have an open, transparent and learning culture in all NHS organisations.

[Baroness Walmsley (LD)]

My Lords, would it not be more likely that such discrimination as mentioned by the noble Lord, Lord Desai, would be stamped out if there were more black and ethnic minority members of staff at senior levels in the NHS? Is he aware that the proportion in London NHS trusts of those from a BME background is only 8%, compared to 45% in the general population and 41% among NHS staff?

[Lord Prior of Brampton]

The noble Baroness has probably read The “Snowy White Peaks” of the NHS, which sets out very clearly for all to see the really shocking lack of representation of people from BME backgrounds at senior levels of the NHS. This is an absolute priority. NHS England has appointed Yvonne Coghill to look at all the racial inequality issues, and she and NHS England have my full support in their endeavours.

NHS: GP Clinics

Debate between Lord Prior of Brampton and Baroness Walmsley

Thursday 25th June 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness is quite right. We do need GPs, and they will be at the heart of the renaissance in general practice. The Government are committed to recruiting an extra 5,000 GPs into general practice over the next five years—that figure is net of people retiring. We accept entirely the noble Baroness’s proposition that we must persuade more newly qualified junior doctors to opt for general practice rather than for working in hospitals.

[Baroness Walmsley (LD)]

My Lords, what discussions have the Government had with the Royal College of Emergency Medicine about the idea of collocating GP clinics in A&E departments? Surely such a strategy has the potential for killing two birds with one stone.

[Noble Lords]

Oh!

NHS: Immigration Rules

Debate between Lord Prior of Brampton and Baroness Walmsley

Wednesday 24th June 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I agree with my noble friend; it cannot be right for a rich country such as ours to recruit nurses from much poorer countries. I will just say that the Philippines, for example, produces more nurses on a deliberate basis than it needs for itself, so that they can go overseas, usually for temporary periods, not permanently. Interestingly, over the last five years, the number of non-EU overseas nurses working in this country has reduced by 41%.

[Baroness Walmsley (LD)]

My Lords, if we need more home-grown nurses, what are the Government doing to address the flood of nurses leaving the profession, and the appalling attrition rate during training? My noble friend Lord Willis’s report on the Shape of Caring review showed that every year 20% of student nurses do not complete the year, and 40% of nurses do not complete the first five years in the profession. Since it costs £78,000 to train a nurse, is that not a terrible waste of money, and could we not do more to support student nurses to finish their training?

[Lord Prior of Brampton]

The noble Baroness makes a strong point. The drop-out rate of nurses is between 20% and 30%; it varies hugely from one nursing school to another. I am told that the peak of the drop-out rate is after their first clinical placement, which indicates that the way some nursing schools recruit their students is far from satisfactory. I hope that Health Education England will change the way it remunerates some nursing schools to ensure that they recruit the people with the right qualifications, temperament and vocation before they offer them places.

Health: Palliative Care

Debate between Lord Prior of Brampton and Baroness Walmsley

Tuesday 23rd June 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I thank the noble Baroness for those comments. Over the years I have spent quite a lot of time with nurses who are specialists in palliative care and I have always been hugely impressed by their work. I have not seen the booklet produced by the RCN to which the noble Baroness refers and I would certainly like to do so.

[Baroness Walmsley (LD)]

My Lords, was the Minister as shocked as I was, when reading some of the case studies in this report, to realise that the problems did not require further legislation or regulations but required staff who would follow guidelines and who had common sense, compassion and good communication skills? Why are people who lack these skills and attributes not being weeded out at the training stage, before they get anywhere near a patient?

[Lord Prior of Brampton]

My Lords, if Members of this House have not read the report by the ombudsman, I recommend it. It consists of 12 short, fairly straightforward case histories, which make for appalling reading. There are many nurses in hospitals and community settings who deliver wonderful care. The issue is their ability. The CQC is now making regular inspections of end-of-life care in all its hospital visits. It is one of the eight core services that it looks at. It has found that in the vast majority of cases, end-of-life care is caring. The noble Baroness asked why such care is so variable. I think that in hospitals it is partly because they are often busy places. They are not ideal places to die in. Who would wish to die in a clinical setting in a very busy ward unless they had to? That may be a part of the explanation.