General Practitioners: Appointments

Lord Rennard Excerpts

Thursday 17th March 2016 Grand Committee

[Lord Rennard (LD)]

My Lords, I declare my interests as in the register. There is of course much controversy at present concerning what I will call the Government’s preoccupation with the weekend working practices of junior hospital doctors but it seems to me that many people in need of medical support would have preferred the Government to keep concentrating on issues such as strengthening out-of-hours services for GPs and using modern technology to enable people more easily to interact with a GP.

Of course, much progress on these issues was being made prior to the general election and I am seeking some reassurance in this debate that that progress will continue. Just prior to the general election, it was announced that GPs in more than 1,400 practices across England would receive £550 million of government funding to reorganise their services so that surgeries could be open from 8 am to 8 pm, seven days a week. My good friend Norman Lamb, who was then the Care Minister, told me he hoped that some of this funding would lead to much greater use in those practices of patient consultations by videolink, email and telephone, together with a greater provision of online booking services. I hope that the Minister will be able to tell us about progress since that announcement last March.

That funding, however, was directed at slightly fewer than one in five GP practices in England so I hope that we might also hear more today about how the remaining 80% of GP practices can be supported in improving access for their patients. This is both very important in terms of improving patient care and essential if we are to avoid the crisis in our hospitals getting even worse. I would like to hear from the Minister about how the £250 million infrastructure fund, which was first announced in the 2014 Autumn Statement, is helping to improve and provide more integrated health centres and more use of technology. The Government’s press release at the time claimed that they would help to fund additional services, including on-site pharmacists, speech therapists, minor surgery and diagnostic tests. It was also intended to make it easier for GPs to return to the profession following a career break, encourage more medical students to take careers as GPs, and enable GPs considering retirement to work reduced hours in the interim. This timely debate will allow the Minister to describe, I hope, progress on these issues over the past 12 months.

However, we need to go much further and be much bolder in using new technology to improve access to GPs. Ten years ago I visited India and looked at the provision of health services in remote rural areas, where access to a GP, let alone a hospital, was bound to be extremely difficult. I was very impressed by the use of webcams in specially equipped vehicles that could tour rural areas and with the help of a trained nurse allow some basic tests to be undertaken and a face-to-face conversation to be held with a GP or even a consultant. This made me think about how we could do much more in this country, using new technology, to let people talk to a GP without necessarily visiting the surgery. As technology develops, those GPs or other people, including carers and family members, can monitor certain conditions remotely.

My own Fitbit tells me how many steps I have walked each day, and what my heart rate and my sleeping pattern are. While I do not wish to share this information with anybody else, it is easy to do so. I acknowledge at this point that it was active intervention by my own GP’s practice that led me to undertake a more active exercise regime and improve my own diabetic control. In time, I expect that my blood pressure and glucose levels will be monitored remotely by health professionals.

For some elderly or housebound residents, this could be a good way for GPs to help keep an eye on them without clogging up their surgeries, while enabling the professionals to determine properly whether or not an appointment is really necessary. At the moment, getting an appointment when needed is often very difficult. Getting access to a doctor at night is usually extremely difficult, but this was not always so. Something has gone wrong when people feel the need to turn up at A&E if they can or call an ambulance when they should really have been seen by a GP at a surgery or in their home.

These problems are well illustrated in the recent report by the Public Accounts Committee in the House of Commons, which highlighted the following facts. There are simply not enough GPs to meet demand. Deprived areas are particularly short of GPs and nurses. Finally, there is much variation in patients’ experience of getting and making appointments, with people who work full-time among those who are most disadvantaged.

It is also clear from that report that information about basic facts, such as services provided at GPs’ surgeries and the availability of those services, is sometimes difficult to obtain. The report also makes it clear that the Department of Health and NHS England do not have the data that they need to make well-informed decisions about how to improve access to general practice or where to direct their limited resources. In the long run, these issues come down to improving the way in which we try to do things, endeavouring to make efficiency savings. But without a doubt, funding is the major issue.

The results of the most recent general elections show people’s reluctance to pay higher levels of taxation and politicians’ reluctance to ask them to do so. This is in spite of the fact that people now expect a pension from the state for a much greater proportion of their lives than ever before; with this comes the probability of them needing greater provision of health and social care. Improving access to GPs and funding the health and social care services that we need may require the introduction of a hypothecated tax in future. I believe that all parties should be considering this option if they are to be honest about addressing these problems. I would welcome the views of the Minister on that.

NHS: Hospital Overcrowding

Lord Rennard Excerpts

Tuesday 15th March 2016 Lords Chamber

[Lord Prior of Brampton]

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

[Lord Rennard (LD)]

My Lords, does the Minister agree with the president of the Society for Acute Medicine that there are no more efficiencies to be made and that we must now start to invest in care again to bring us on a par with other developed nations? Does he accept that the planned increases in expenditure for the NHS will not be adequate to deal with the crisis in it, and that we need to consider a hypothecated tax to fund health and social care?

[Lord Prior of Brampton]

My Lords, a lot of what was said by the person, whose name I cannot remember, to whom the noble Lord refers, was absolutely right, but when he said that there were no more efficiencies to be gained he was completely wrong. We can still achieve huge efficiencies throughout the whole healthcare system, in the context that the NHS is one of the most efficient systems in the world, but it can be better. It would be completely wrong to say that no more efficiencies can be achieved.

National Health Service: In-Patients with Learning Disabilities

Lord Rennard Excerpts

Monday 18th January 2016 Lords Chamber

[Lord Prior of Brampton]

My noble friend makes a number of very good points. I will draw them to the attention of Mike Richards, the chief inspector for acute care in England, who is about to embark on a thematic review of avoidable deaths. He will look in particular at those with learning difficulties and I am sure that he will take into account the words of my noble friend.

[Lord Rennard (LD)]

My Lords, does the Minister accept that something is seriously wrong when two-thirds of the unexplained deaths of these highly vulnerable people with learning difficulties who die in NHS hospitals in England are not properly investigated? Does he accept that this is a much more serious scandal than that based upon some highly dubious statistics used by the Secretary of State for Health to talk about unexplained deaths in hospitals at weekends?

[Lord Prior of Brampton]

I tried to explain the difference between avoidable deaths and excess deaths earlier in my answers, without trying to make any political point about it. There is an important distinction to be made, and I hope that I made it. I agree with the noble Lord that this is a very serious issue, and the Government are approaching it in a very serious way.

National Health Service

Lord Rennard Excerpts

Thursday 14th January 2016 Lords Chamber

[Lord Rennard (LD)]

My Lords, I draw the attention of the House to my entry in the Register of Lords’ Interests. Last autumn, the Chancellor secured some good headlines by promising an extra £10 billion in real terms for NHS England by 2020, representing an annual increase in NHS spending of 1.75%. But beneath those headlines, NHS cost and demand rises by 3.5% to 4% a year. When trying to explain the problems of the rising cost of pensions and healthcare, I often begin by saying that when I was at school, 40 years ago, male life expectancy was just 67. A man approaching retirement then might well have worked and paid taxes since he was 15. After 50 years of contributions, he would retire at 65 with a pension and the health service would have to provide for him and look after him for just two years. A man who retires this year at 65 will probably live another 20 years. His state pension will have to be paid for from general taxation for 20 years, not two years, and towards the end of his life there will be, on average, a period of eight years when he will be in poor health and in need of greater health and social care support.

In providing for women and men like him, the NHS delivers good value for money compared to healthcare systems in other countries. We achieve a lot by spending just 8.5% of GDP on health compared to the OECD average of 8.9%, but our figure is due to fall to 7.8% by 2020.

If we want a better health service, we have to look at the fact that France, Germany and Holland all spend about 11% of GDP on health. We will certainly never match those levels if the Chancellor is to succeed in his aim, set out in the Autumn Statement, of reducing the overall level of government spending from about 41% of GDP to just 37%. It would, however, be a very brave politician who argued for more than a very modest increase in the basic rate of taxation, even though it is now 15p in the pound lower than in 1975-76, 10p in the pound lower than in 1979-80, 5p in the pound lower than in 1988-89 and 2p in the pound lower than in 2000-01. It may be politically unacceptable to reverse those income tax reductions, made for political advantage, but the time must have come for a hypothecated health and social care tax. I hope that this idea will be considered further by the cross-party commission being launched by Norman Lamb.

Sugar Tax

Lord Rennard Excerpts

Wednesday 13th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, reduction of sugar is a critical part of the Government’s obesity strategy. It has been made clear by the reports of Public Health England, the McKinsey institute and others that there is no silver bullet. It is not just a question of passing a tax and getting the results that you wish to have. If a tax were to come in, it would be part of a whole range of other measures.

[Lord Rennard (LD)]

My Lords, does the Minister accept that the introduction of a modest sugary drinks tax should be a win-win policy in that, if it works, people would be deterred from consuming those drinks, switch to alternatives and lead healthier lifestyles, and, if it does not work, it would raise money much needed by the NHS to deal with the problems of the obesity and diabetes epidemics?

[Lord Prior of Brampton]

My Lords, as I said earlier, the Prime Minister and the Secretary of State for Health are thinking long and hard about what should be part of the obesity strategy. I am not sure that the noble Lord is right when he says that a modest tax would have much of an impact; it would have to be a significant tax to have a major impact on the consumption of sugary drinks.

Alcohol

Lord Rennard Excerpts

Wednesday 9th December 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I am not sure who considers alcohol to be habit-forming and hallucinatory—whether it is my noble friend or others. I think it depends very much on the quantities in which it is taken.

[Lord Rennard (LD)]

My Lords, does the Minister accept that the 1.3 billion unit reduction in alcohol consumption of which he spoke represents a reduction of only 2%, and that the alcohol industry itself cannot be relied on to assess objectively the scientific evidence that points strongly towards the need for things such as minimum unit pricing and for alcohol taxation to be proportionate to the alcohol content of drinks?

[Lord Prior of Brampton]

My Lords, as I say, an independent assessment of the responsibility deal will be done by the London School of Hygiene and Tropical Medicine. It is important that the assessment is independent and certainly is not undertaken by the industry or, indeed, by the Department of Health. It is worth noting that the consumption of alcohol seemed to peak in 2005 and has declined slightly since then. I am not in any way minimising the appalling damage that alcohol does to the lives of many people, but consumption is coming down slowly.

Atrial Fibrillation

Lord Rennard Excerpts

Wednesday 4th November 2015 Lords Chamber

[Lord Rennard (LD)]

My Lords, I draw the attention of the House to my entry in the Register of Lords’ Interests. I also congratulate the noble Lord, Lord Black of Brentwood, on securing this important debate. Approximately 900,000 people in England have been diagnosed with atrial fibrillation, or AF, and there are perhaps half a million people here with the condition who have not yet been diagnosed. The condition causes an irregular heartbeat and it is one of the most important risk factors for stroke, contributing to one in five strokes. If left untreated, AF increases the risk of stroke fivefold.

AF-related strokes are often more severe, with higher mortality and greater disability arising from them than from other strokes. The Global Burden of Disease Study in 2013 suggested that atrial fibrillation and atrial flutter resulted in 112,000 deaths in 2013, compared to 29,000 in 1990. So it is a growing problem. Treatment with anticoagulants significantly reduces the risk of stroke in people with AF, but according to the Stroke Association, almost half of all the people in the UK with AF are not receiving the full anticoagulation treatment which significantly reduces the risk of stroke.

The issues for us to consider, and for the Minister to respond to, must therefore begin with the question of whether greater attempts at screening, which could enable early diagnosis, could be justified in terms of lives saved. Patients often do not feel any symptoms when their heart rate changes. There are many causes of this but not all of them are obvious. Can we simply rely on many people turning up at their doctors with other concerns leading to the identification of this condition? For those who are diagnosed, is enough being done to promote these anticoagulation treatments, including those most recently developed?

Surveys suggest that patient access to novel oral anticoagulants is lower than should be expected, highly variable across the country and much lower than in other European countries. The National Institute for Health and Care Excellence produced an excellent atrial fibrillation quality standard in July, which was endorsed by the Department of Health. But there is real doubt over whether that standard is being properly applied uniformly and in a timely fashion. The evidence suggests not.

An NHS Improving Quality report estimates that just over half of people with AF are getting drug treatment in line with the recently updated best practice guidelines. A year ago, it produced a report which suggested that better care of people with AF could help prevent an additional 11,600 strokes and save the NHS as much as £124 million per year. It also suggested that full implementation of new best practice guidelines could prevent almost 28,000 strokes each year and lead to overall savings of £293 million for the NHS in England.

I hope the Minister will respond positively by telling us that there will be rapid progress towards full implementation of these best practice guidelines.

Smoking: E-Cigarettes

Lord Rennard Excerpts

Tuesday 3rd February 2015 Lords Chamber

[Earl Howe]

My Lords, the noble Lord is correct. The Cochrane review concluded that the quality of the evidence overall is low because it is based on only a small number of studies. The National Institute for Health Research has recently commissioned a large randomised control trial to examine the efficacy of e-cigarettes compared with nicotine replacement therapy when used within the UK’s stop smoking services. That project is due to end in 2018 and will certainly improve our current understanding.

[Lord Rennard (LD)]

My Lords, does my noble friend agree that we need a public health education campaign to persuade people that there are absolutely no health benefits whatever, or indeed any merit, in becoming addicted to nicotine, and that the promotion of devices such as e-cigarettes should be purely for the purposes of encouraging people to be weaned off their addiction to tobacco with nicotine, as tobacco is still killing nearly 300 people every day in this country?

London Health Commission: Smoking

Lord Rennard Excerpts

Thursday 15th January 2015 Grand Committee

[Lord Rennard (LD)]

My Lords, I, too, congratulate the noble Lord, Lord Darzi, on initiating this opportunity to debate the important issue of the harm done by smoking, and the best ways for it to be eradicated.

In recent weeks, the world has been shocked by the loss of life in events such as the terrible murders in France, and in Nigeria, and by accident in the recent AirAsia plane crash. Approximately 2,200 human beings lost their lives in those events. People have rightly been outraged by the murders, and anxious to prevent such loss of life, whether caused by evil people or air accidents, in future.

Today we are discussing how we can prevent many avoidable deaths and much suffering resulting from a legal product, but one which we now know to be anything but safe. I have drawn attention to the approximate number of people who lost their lives in those terrible events because it is a comparable figure to the number of people who in the UK alone lose their lives each week as a result of smoking-related diseases. Despite many years of progress, smoking-related disease still claims 272 lives prematurely every day in the UK, causing approximately 100,000 deaths annually. This is something about which we can take action—to reduce the loss of life; to create substantial health benefits that will raise the quality of life for many people; and to reduce poverty and increase opportunity for many of the least well-off people in our country.

The tobacco industry works furiously hard to avoid erosion of its profits because its products result in the early death of one in two of its customers. It needs to continually recruit new smokers to maintain its profits. However, its new customers are nearly always children or young people. Two-thirds of regular smokers start before the age of 18 and two-fifths of them start before 16. I wholeheartedly welcome the recommendations made in the London Health Commission’s report. It is clear from the findings of the noble Lord, Lord Darzi, that London needs to do more to tackle smoking, which is the major cause of preventable premature death in the capital. Measures such as smoke-free parks and a strengthening of work on illicit tobacco are very welcome, but many other important measures must be implemented if we are to continue to drive down smoking prevalence in the future, as we have done so successfully in the recent past.

This House took important steps, tabling amendments to the Children and Families Bill, subsequently taken up by the Government, to prohibit smoking in cars with children and to require all cigarettes to be put in plain, standardised packaging. However, while the regulations on smoking in cars have been laid and, once voted on, will be implemented this year, there remains a silence from the Government about standardised packaging. I hope that the Minister will break that silence this afternoon.

The Tobacco Advertising and Promotion Act has been effective in reducing children’s exposure to promotional activity and has brought about a consequent reduction in awareness of tobacco marketing among young people. Between 2003 and 2013—very much contrary to the arguments put by the noble Lord, Lord Naseby, when he opposed restrictions on tobacco advertising—regular smoking among young people declined from 10% to 3% in the UK. However, we must do much more.

Tobacco packaging is now the most prevalent form of tobacco advertising. Smokers display the branding every time they take out their packs. In doing so they are making a statement about how they want to be seen by others as they display, and endorse, the brand that they have chosen. The arguments put forward by the tobacco industry to oppose plain paper packaging are completely undermined by the vehemence of their opposition to it. The industry’s credibility was undermined long ago by its denials about the link between smoking and lung cancer, the addictiveness of nicotine and the effects of passive smoking. The tobacco industry now claims that standardised packs will lead to an increase in tobacco smuggling.

The hypocrisy of the industry on this issue was well exposed by the disclosures about its own role in organising tobacco smuggling. I noted that the noble Lord, Lord Naseby, was reading from the brief of the Tobacco Manufacturers’ Association, which can hardly be considered to be objective in this matter. The association claims that there has been an increase in tobacco sales in Australia since the introduction of standardised packaging, but it ignores the increase in population in Australia in that time. Adjusted for population, tobacco sales per person in Australia have in fact fallen since the introduction of standard packs.

The strong cross-party support for the tobacco control measures contained in the Children and Families Act amply demonstrates the strength of feeling of parliamentarians on this issue. I know that my party wants to see that time is allocated for the required debate and a vote on the introduction of standardised packaging before Parliament rises for the general election.

There is a choice ahead of us between promoting public health or rewarding the tobacco lobbyists. It will be greatly to the discredit of this Government if they do not ensure that the necessary regulations for plain paper packaging are laid before Parliament, in time for the regulations to be voted on as soon as the notification to Europe process comes to an end on 2 March. It would be a public health disaster if the views of the tobacco industry and a small minority of parliamentarians sympathetic to it stopped the clearly expressed will of Parliament on this issue from being implemented.

Health: Sugar Consumption

Lord Rennard Excerpts

Wednesday 6th February 2013 Lords Chamber

Asked By

[Lord Rennard]

To ask Her Majesty’s Government what plans they have to help people reduce their sugar consumption.

[The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)]

My Lords, we have challenged business, through our responsibility deal calorie reduction pledge, to take action to help people eat fewer calories. This can include helping reduce sugar consumption. Businesses are already taking action; for example, soft drinks manufacturers which are signed up to the calorie reduction pledge are reducing sugar and calories in their drinks, and we are looking to others to join force.

The Government are also helping consumers to reduce their calorie intake by providing practical advice through NHS Choices and via the Change4Life campaign.

[Lord Rennard]

My Lords, does the Minister agree with the Secretary of State for Health that legislation may be required in this area if other measures do not succeed? In the mean time, does he think consideration needs to be given to changing tax regimes so that the tax may be rather higher on very sugary soft drinks, and rather lower on drinks that are less full of sugar? Does he also think that we may need to restrict the amount of sugar provided in some products, such as breakfast cereals targeted at children, so that parents either as consumers themselves or watching their children can see how many spoons of sugar are going on to their cereal, rather than simply accepting the amount of sugar already produced by the manufacturers?

[Earl Howe]

My noble friend asks a number of questions. I am sure he will have welcomed, as I did, the announcement a few days ago by two major manufacturers of sugary drinks that they were substantially reducing the sugar content of their drinks. This is in part a result of the engagement that we have had with the food industry, which, in public health terms, is taking on responsibility for the products that it makes.

While there are advocates for taxation, in 2012 my department reviewed the international evidence of the effect of taxation on people’s consumption of food and drink. There is very limited empirical evidence, certainly from literature, but also in practice that that has an effect on body weight or health outcomes. There is a range of possible unintended consequences, including swapping for other foods which may be even less healthy than the ones that we are trying to cut out.