Electricity Supply: International Interconnectors

Debate between Lord Prior of Brampton and Lord Elton

Thursday 26th January 2017 Lords Chamber

[Lord Prior of Brampton]

My Lords, I have an app on my phone through which I can tell exactly where all the electricity is coming from at any time. That 2% from renewables is very low; obviously, the wind was not blowing that day. The noble Lord is absolutely right that our baseload is provided by gas, coal and nuclear and I assure him that, in its Winter Outlook Report of October 2016, the National Grid said that we had an electricity margin of 6.6%, compared to 5.1% for the same period last year. There are no current concerns about security of supply.

[Lord Elton (Con)]

My Lords, my noble friend has repeatedly said that the current can flow in both directions. Can he tell us in which direction it will flow when both the continent and this country are in the grip of acute conditions? Will that be determined by market forces, by contractual decisions or by political agreement?

Dental Health: Children

Debate between Lord Prior of Brampton and Lord Elton

Tuesday 7th June 2016 Lords Chamber

[Lord Prior of Brampton]

The best way of addressing social deprivation is to have a strong economy. As I am sure the noble Baroness will agree, the Government have the perfect economic strategy to address that issue.

[Lord Elton (Con)]

My Lords, my noble friend emphasised the fact that sugar is bad for teeth and that the Government are trying to reduce the intake of sugar by private individuals. What is the effect on teeth of the substitutes that will be introduced into many products to replace sugar?

[Lord Prior of Brampton]

I am afraid that I cannot answer that question as I simply do not have the knowledge. I will research it and write to my noble friend.

NHS: Bursaries

Debate between Lord Prior of Brampton and Lord Elton

Wednesday 25th May 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I think that the Royal College of Nursing, Unison and other unions have concerns about moving from bursaries to student loans; it would be idle to pretend otherwise. But we are convinced that the demand for young people to go into nursing is very strong and that the availability of more money through the loan system to nurses at university will therefore encourage more people to go into nursing.

[Lord Elton (Con)]

My Lords, I am sure that there is a simple answer to my question that everybody else knows. My noble friend said that there were 20,000 nursing places available for training and more than 50,000 people wishing to fill them. But we also read that there is a shortage of nurses such that there are very heavy demands made for agency nursing. What explains that discrepancy?

[Lord Prior of Brampton]

My Lords, the reason for the discrepancy is that at the moment the bursary system effectively caps the number of student places for nursing. One of the purposes of moving to the loan system is to remove that cap and our estimate is that by so doing an additional 10,000 places will be created between 2017 and 2020.

Sex-selective Abortion

Debate between Lord Prior of Brampton and Lord Elton

Monday 7th December 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, my noble friend makes an important point. Gender-based abortion, female genital mutilation, honour crimes and various other issues still take place in some ethnic communities in England. Across the board, we have to be vigilant about all of these issues and make it clear that they are not acceptable. They are against the law and anyone aware of these practices going on should report them to the police.

[Lord Elton (Con)]

My Lords, my noble friend has twice referred to evidence on a population basis, which I take to mean that the evidence is taken without distinction of which part of the country it comes from. Has any effort been made to correlate the evidence with clusters of cases, which might point to some social activity that would be possible to countermand?

[Lord Prior of Brampton]

My Lords, the statistics are collected on the basis of birth across the population. They are then analysed in 500 different ways. In only one of those 500, which concerned the third or further child given birth to by women from Nepal, was there any variation from what one would expect. I can assure noble Lords that the statistical analysis is very robust.

Access to Palliative Care Bill [HL]

Debate between Lord Prior of Brampton and Lord Elton

Friday 23rd October 2015 Lords Chamber

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

My Lords, first, I join with everybody else in thanking the noble Baroness, Lady Finlay, for raising this issue and bringing the Bill before us. She has a long history of passion, commitment and experience in this area, and we all recognise that. There seems to be violent agreement from all sides of the House on the substance of her Bill, and so I congratulate her on the support that she has garnered, which of course goes way beyond noble Lords in this House.

Before I address the Bill directly, I want to draw out three themes that have emerged out of the debate today. The first is that, despite the report from the ombudsman and some very upsetting individual stories, the UK does pretty well in this area. My noble friend Lord Howard referred to the report in the Economist. For the second time—the first being five years ago—out of all 80 countries surveyed, the UK came top, and that includes all the richer nations. We come significantly higher than most other European countries. In part, that is because the hospice movement in the UK has been extraordinarily successful. My noble friend Lord Howard referred to the CQC report. It is quite extraordinary that 90% of all hospices inspected have been “good” or “outstanding”.

However, in praising the hospice movement and the care that it delivers at home, let us reflect for a minute on how difficult it is to provide good-quality palliative care in a very busy acute hospital. It is true that they probably do not do it as well as it is provided in hospices, but, given the circumstances, they often do a remarkable job. My noble friend referred to the bowl of porridge that was provided in a hospice. I refer him to the Wrightington Hospital, where a lady coming near to the end of her life said that her one last wish was to see her horse. They brought the horse to the hospital and wheeled her down to see it. We do see these extraordinary acts of kindness and compassion in NHS hospitals as well. That is the first point that I would like to make: the UK does this pretty well.

Secondly, the most important point to come out of today’s debate is the patchiness of how we do it. Variation, I am afraid, is a problem that runs right through the NHS. The noble Lord, Lord Davies, went right back to 1946. Whether it is in end-of-life care, orthopaedics, stroke care or cancer care, there has been this level of variation since the inception of the NHS in 1946. The way that this Government have decided to try to confront this level of variation is through transparency.

It is a fact that, outside healthcare, the only way to drive out variation is through a market—we all know that. If you have choice and competition, they will drive out variation. It is much more difficult in an area such as healthcare, where there is such imperfect information and such imperfect choice. Our approach is to try to confront this issue of variation through transparency. It is not just through CQC reports but through having a much more open culture within the NHS. I say to the noble Lord, Lord Warner, that choice is also a key factor in that, where it is possible.

The third key theme to emerge from this debate is the importance of out-of-hospital care. Where we can deliver good-quality, safe care outside hospital, it tends also to be at lower cost. If it is at lower cost, we have more resources to spend elsewhere in the system. I say in response to my noble friend Lord Howard that I know that Hospice UK is in discussions with NHS England about whether it can help us deliver more care outside hospital. Other noble Lords referred to the huge importance of district and community nurses. Delivering out-of-hospital care to people who are at the end of their lives requires considerable expertise; you need district and community nurses on hand to administer pain relief and the like. In the case of my own mother, who died very recently in an NHS hospital, it was essential to have people there all the time who could adjust the level of pain relief, oxygen and the like.

Those were the three general points that I wished to make. I am afraid, however, that the Government cannot support the Bill and I will set out the reasons why. The most important reason is not that we disagree at all with the underlying intention of the Bill—we are in full agreement with it—but that we do not feel that primary legislation is the right way of tackling the issues raised because it could lead to unintended consequences. Most importantly, we feel that it attempts to deal with issues that, in the main, are best tackled by clinicians, ideally together with patients, carers and loved ones, based on a combination of the patient’s individual condition, preferences and the clinician’s professional expertise.

There is no other part of the healthcare system, be it cancer, stroke, maternity—the beginning of life as well as the end of life—where we have the mandated system that is proposed in the Bill. I will withdraw the following analogy if it is not fair. When the Liverpool care pathway was introduced—I was a huge supporter of it—there many parts of the country and many hospitals where it was implemented sensitively and where it contributed greatly at the end of many people’s lives. Yet, because in some parts of the system it became a tick-box solution where people were ticking the box and missing the point, I sometimes feel that a top-down, central directive, be it through legislation or from another source, can interfere with best-practice decision-making. That is the primary reason why we oppose the Bill.

However, there is a second reason—it is probably less strong, but it is strong nevertheless. It is that we feel that the Bill goes against the whole concept and principle of local autonomy that was established in primary legislation through the Health and Social Care Act 2012. I accept that clinical commissioning groups are still in their infancy—they have only been there for just over two years—but they are bound by a duty to commission health services based on the assessed needs of their local population, and palliative care is included in that stipulation. There is also concern that legislation on this issue as set out in the proposed Bill could stifle local innovation by NHS bodies, including commissioners, as they seek to improve the quality of care and provision.

As well as the responsibilities given to the local commissioning bodies, the 2012 Act also enshrines specific responsibilities for health education and training on Health Education England. This Bill would supersede those provisions, thus undermining the role and responsibilities of Health Education England, which works in partnership with local training and education boards to commission and deliver appropriate training and education.

I could go on and talk about what the Government are doing in this area, but that is the fundamental point and I should probably leave it there. We have huge sympathy for the underlying intent of the Bill.

[Lord Elton]

My noble friend has put local autonomy at the centre of his argument. If local autonomy results in unacceptable variations between localities, will the Government be on the look-out for this? It has only been running recently, as my noble friend says, but will he keep it at the forefront of his watch? If it increases or does not diminish, then something will have to be done about local inequalities.

[Lord Prior of Brampton]

My noble friend makes a good point. There is tension in the health service between local autonomy, local accountability and the National Health Service. There has always been this tension. We believe that in driving up standards it is best to have the local autonomy. However we must also have transparency so that we know who is falling behind and who is forging ahead. As to transparency at a clinical level, I was talking to a former president of the Royal College of General Practitioners recently—she comes from a different political background from myself—and she said that within the DNA of all doctors is a huge sense of competition: they want to deliver better care than the next-door doctor. That is true of surgeons probably more than anyone, but also true of GPs, physicians and hospitals, and increasingly it will be true of CCGs as well. My response to my noble friend is that we are embedding a much higher degree of transparency into the system and it is through that transparency that we will drive improvement by highlighting the best and the worst.

Mental Health Services: Young People

Debate between Lord Prior of Brampton and Lord Elton

Tuesday 23rd June 2015 Lords Chamber

[Lord Prior of Brampton]

The use of police cells for anybody suffering a mental health crisis, but particularly for children, is wholly unacceptable. Last year, the number of children who were held in a police cell was 160. That has come down from a much higher number. The Government and my right honourable friend the Home Secretary are determined to stop this happening—indeed, legislation is about to go through the other place to ensure that it does not happen. But that leads to the question of where, if not to a police cell, they should go. I have been told that there is a risk that young people going through a mental health crisis might actually be arrested to make them eligible to come into a police cell, which would of course be equally unacceptable. The number is getting much smaller and I hope that if I am here in a year’s time it will be down to zero.

[Lord Elton (Con)]

My Lords—

--- Later in debate ---

[Lord Elton]

My Lords, the previous answer made it clear that a significant proportion of the pupils and young people the Question refers to are in custody. Can the Minister assure us that there is equality of treatment, within both the spend and the survey he referred to, for those children in these dire circumstances?

[Lord Prior of Brampton]

I thank the noble Lord for that question. I am not sure that I totally got the question, but I can say that keeping a young person in custody is the absolute last resort. The police do not wish to do it and do so only when there is no bed available in an appropriate, safe setting. The issue is the availability of beds. It is better for a child to be in a single room on an adult psychiatric ward than in a police cell.