Taylor Review of Modern Working Practices

Debate between Lord Prior of Brampton and Lord Naseby

Tuesday 11th July 2017 Lords Chamber

[Lord Prior of Brampton]

Possibly it trivialises the issue, but it does reflect the fact that these new, app-based jobs are different. I suppose that “gig” is possibly an unfortunate word.

[Lord Naseby]

Is the Minister aware that I had the privilege of working with Matthew Taylor on the child trust fund? I put it to the Minister that this report is excellent. Do the Government recognise that there are three levels—or parties—involved, and that, as the noble Baroness, Lady Hayter, said, the consumer is one? Clearly the workers are absolutely fundamental as well, but fair competition among employers is the third dimension. Is this not an opportunity for Her Majesty’s Government to act almost as a referee by looking at all these aspects and making sure that at every single level there is now fair competition, fair wages and a fair opportunity for all parties to work together?

[Lord Prior of Brampton]

My Lords, as the noble Lord said, there are three parts to this. The report focuses very much on workers and business, and, as the noble Baroness, Lady Hayter, said, we ought possibly to look at this issue also through the eyes of the consumer. This is an ideal opportunity for the Government to act, if you like, partly as a referee: ultimately, we do have a clear responsibility in this area and when we have had a chance to consider the report I am sure that we will not disappoint my noble friend.

Medical Students

Debate between Lord Prior of Brampton and Lord Naseby

Wednesday 26th October 2016 Lords Chamber

[Lord Naseby (Con)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and, in doing so, declare an interest in that my wife is a retired full-time GP practitioner.

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

My Lords, my right honourable friend the Health Secretary announced on 4 October that the Government plan to increase the number of medical school places by up to 25%. From September 2018, the Government will fund up to 1,500 additional medical school places each year. Students will be able to apply for the extra places from 2017 in order to take them up from the academic year 2018-19.

[Lord Naseby]

Is my noble friend clear that the Secretary of State is to be congratulated on beginning to grasp this nettle? In the last three years, we have lost 3,500 medical students, but the problem goes deeper, does it not? Today, 56% of the intake of medical students is female. Furthermore, 70% of female GPs today work part-time, and a recent survey by the King’s Fund says that 90% of all medical students in training want to work part-time. Given that it costs £200,000 to train anybody as a medical practitioner, surely the time has come to consider a minimum full-time commitment of at least four years after qualification, similar to what they do in Singapore and, indeed, in our own Armed Forces.

[Lord Prior of Brampton]

My noble friend is absolutely right that more than 55% of those who go to medical school are now women; that is a fantastic change that has happened over the past 20 years. It is true that more women than men tend to work part-time, as they have children and bring them up, and that is taken into account in the planning done by HEE. When my right honourable friend the Health Secretary made his announcement, he said that we will be looking in our consultation at requiring people whom we have paid to go through medical school to give at least four years back to the NHS, which I think is reasonable. The figure is actually six years if you become an Army doctor, so four years is not unreasonable.

Junior Doctors: Industrial Action

Debate between Lord Prior of Brampton and Lord Naseby

Monday 5th September 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the noble Lord makes a very good point. The changes that are coming upon the NHS, whether from technology or forced upon us, in a sense, by demographic change in the UK— meaning that much care that has traditionally been delivered in hospitals will need to be delivered outside hospitals in people’s homes and much care will be delivered by technology rather than directly by people—are all going to have a huge impact on a whole range of different staff levels, not just junior doctors.

[Lord Naseby (Con)]

Is my noble friend aware that I am in a doctors’ family? My wife worked full-time in a big practice. She worked every weekend and did her share of out-of-hours work. My son is a doctor. I hope some of the grandchildren will be. These young men and women volunteer to enter this profession, do they not? They take an oath, do they not? What the public find incomprehensible is that after several years of negotiation, they understood there to be an agreement and a recommendation from the then leadership of the junior doctors—agreed to by even the present leadership of the junior doctors—but once again the public are back on the rack. Is that not totally unacceptable?

I am afraid that I draw an analogy with the three-day week. I was the director of an advertising agency, responsible for the standby advertising. The miners’ strike required the Government of the day to publish the terms that they were offering to the miners on that occasion. I urge my noble friend to consider whether the time has not come for the public—the people, the patients—to be told exactly what was agreed in the summer and what additional benefits will be put forward to the junior doctors; I understand there are some. The public are the ones who will suffer. I do not want—as I am sure the rest of the House does not—to see patients suffer.

[Lord Prior of Brampton]

My Lords, the contract that has been offered to the junior doctors is not confidential. It can be made available to the public. Indeed, I think the main terms of that contract have been made available to the public. My noble friend is absolutely right that members of his family—and, indeed, my family and others we know—enter the medical profession as a vocation or a calling. It is an awful shame that that seems to have been lost in the dispute that has been happening over the past few months.

Junior Doctors: Contract

Debate between Lord Prior of Brampton and Lord Naseby

Thursday 5th May 2016 Lords Chamber

[Lord Prior of Brampton]

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

[Lord Naseby (Con)]

Is my noble friend aware that the public will greatly welcome the magnanimity of Her Majesty’s Government in willingly moving forward and having further discussions over a short period? At the same time, though—I can only speak from having talked to some of my former constituents in Northampton—the public want to know what the benefit is to both the public and the junior doctors from this new contract. Maybe the time has come to publicise, through the standby agency of the COI, in an advertisement, exactly what the benefits are to both parties.

E-cigarettes: Regulation

Debate between Lord Prior of Brampton and Lord Naseby

Monday 7th March 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, as I said, there is no proposal for an excise duty as part of the tobacco directive, as I understand it. I would agree entirely with the intent behind the question, which is that we should be promoting this product not discouraging it.

[Lord Naseby (Con)]

My Lords, is my noble friend aware that, following on from what my noble friend said at the beginning, these vapers ensure that there is no harmful effect from passive smoking, which you normally get from cigarettes? In addition, research in New Zealand shows that they are a far better way to come off smoking than placebos or patches, which saves the NHS money. Is this not just another example of a badly thought through draft directive?

[Lord Prior of Brampton]

My Lords, I think there is evidence that e-cigarettes are more effective than, or as effective as, nicotine replacement therapies, and that my noble friend is right that there is no danger from passive smoking, which is why the inability to smoke in public places does not apply to e-cigarettes.

NHS: Costs of Operations

Debate between Lord Prior of Brampton and Lord Naseby

Monday 9th November 2015 Lords Chamber

[Lord Naseby]

To ask Her Majesty’s Government whether the National Health Service will publish the average cost of all operations and procedures undertaken (1) by general practitioners, and (2) in hospitals.

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

My Lords, the department has published the average cost of operations and procedures in hospitals for the past 17 financial years. These reference costs are the average unit costs to NHS hospital trusts of providing acute, ambulance, mental health and community services, covering £58 billion, or 55%, of revenue expenditure in 2013-14. Reference costs for 2014-15 will be published this month. There are currently no plans to collect similar information from general practitioners.

[Lord Naseby (Con)]

Does my noble friend recall that one of the features of GP fundholding was that GPs had a budget, the patient could choose what hospital they went to and the hospital to which they were referred then sent a bill to the GP? If we introduced a new system whereby GPs and hospitals actually knew the cost of what they were or should be charging, would that not enable GPs and hospitals to stick to their budgets, and some of the overspend would then disappear?

[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.

Primary Care: Targets

Debate between Lord Prior of Brampton and Lord Naseby

Tuesday 13th October 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, the short answer is no. I do not think that I could stand here and promise funding for artists in GP surgeries, but I do have an open mind. If the noble Lord would like to talk to me about it outside the Chamber, I would be very happy to do so.

[Lord Naseby (Con)]

My Lords, as the NHS has a problem with its cost base, rather than load GP practices with even more overheads, would it not be wiser to follow what a number of us experience in our own practices: much closer liaison between GP practices and local chemists, which account for only a partial amount of the NHS’s overheads?

[Lord Prior of Brampton]

My noble friend makes a very good point. There is an increasing and important role for high-street and community pharmacists in delivering healthcare.