Health: Pancreatic Cancer Treatment

Debate between Lord Ribeiro and Lord O'Shaughnessy

Wednesday 19th December 2018 Lords Chamber

[Lord O’Shaughnessy]

I absolutely agree on that point. I hoped we would pass the “Lord Young test” with a jargon-free and, at least, succinct White Paper—the Life Sciences Sector Deal 2, which we published recently. It outlines some very important commitments to research in this area, including the creation of new early diagnosis cohorts, using a cohort of healthy people to look for early signs. That is one of the investments we are making, as well as investment through the National Institute for Health Research. We are looking for those exciting innovations, like liquid biopsies, that can help us get the signs earlier.

[Lord Ribeiro (Con)]

My Lords, as has been pointed out, it is not about the time to treatment but the time to diagnosis. Clearly, early diagnosis is the key. In Europe, the outcome for pancreatic cancer is often better than in the UK because patients have access directly to specialist care, whereas we rely on our GPs to be the gatekeepers, and that is where the problem lies. What measures will be taken to ensure that patients can have access to specialist care much earlier?

[Lord O'Shaughnessy]

My noble friend speaks with great wisdom on this topic, and he is absolutely right. I would point to two improvements that have happened in recent years. First, the NICE standard threshold for when GPs should make referrals has been lowered, so they ought to refer more often. Secondly, we are seeing a big increase in referrals to cancer specialists: there have been over 115% more referrals since 2010. We are starting to see much greater referrals from GPs to specialists.

Government Vision on Prevention

Debate between Lord Ribeiro and Lord O'Shaughnessy

Tuesday 6th November 2018 Lords Chamber

[Lord Ribeiro (Con)]

My Lords, the Statement makes reference to the use of predictive prevention to deliver more targeted interventions. At the recent meeting of the American College of Surgeons in Boston two weeks ago, the director of the National Institutes of Health—he likes to call them the national institutes of hope—said on targeted interventions that they are taking a new approach to disease prevention through the All of Us research programme and that, by taking account of individual differences in lifestyle, environment and biology, researchers will uncover paths towards delivering precision medicine. To date, since May this year, 100,000 people have signed up. What plans does the department have in the UK for a similar programme, and to use genomics for the benefit of all?

[Lord O’Shaughnessy]

I am very grateful to my noble friend for that question: he speaks with great wisdom and insight on this. The great promise of technology is to take all the information we hold about people—their health and care records, their genomic data, their lifestyle data—and use artificial intelligence to tailor health advice to them. There will be not just broadcast public health messages that everyone sees, but specific messages that will change my behaviour or your behaviour, to make sure that we live the kind of lifestyles we actually aspire to live, even if we do not always fulfil that.

I highlight three things we are doing. The first is our commitment to sequence up to 5 million genomes over the next five years. Secondly, we will try to make sure that AI is used in the right way to support healthcare and that relationships are entered into by the NHS and tech companies on a proper basis to bring the maximum possible benefit to the NHS and patients. Thirdly, we will try to take advantage of the enormous opportunity we have with the data that is available in a single-payer comprehensive health system by reassuring people that it is being kept and used safely and legally, but then utilising it so that it is joined up as a single integrated health and care data record, available for direct care and—critically—for research. Then we can start to tailor the medicine we deliver and move to a truly personalised NHS.

National Health Service: Assaults on Staff

Debate between Lord Ribeiro and Lord O'Shaughnessy

Wednesday 20th June 2018 Lords Chamber

[Lord O’Shaughnessy]

I will look into the specific issue that the noble Baroness mentions. I do not have the details in front of me. I know that all local authorities provide free, taxpayer-funded rehabilitation services for those who are suffering from alcohol addiction. I should also point out that this Government have increased progressive taxation on stronger alcohol, such as white cider, specifically to try to change people’s drinking habits and to reduce alcohol-related violence.

[Lord Ribeiro (Con)]

Following the theme of alcohol, the Minister was kind enough to meet me and members of the Alcohol Health Alliance on 30 April. We stressed that accepting a minimum unit price, as in Scotland, would do much to remove alcohol—and, particularly, cheap alcohol—from vulnerable people, some of whom are responsible for the attacks to which we are referring. When will England accept a minimum unit price and implement it?

[Lord O’Shaughnessy]

I was delighted to meet my noble friend on this topic. I know he cares passionately about it. We have said—and I have said in this House before—that we are looking at the Scottish example with interest now that Scotland has gone ahead with it. There is a growing evidence base to demonstrate the benefits of minimum unit pricing, but we want to see what transpires in Scotland before making any decisions about whether to move ahead.

Long-term Plan for the NHS

Debate between Lord Ribeiro and Lord O'Shaughnessy

Tuesday 19th June 2018 Lords Chamber

[Lord O'Shaughnessy]

I know that the noble Lord no longer serves the Labour Party, but he might be interested to know that the Labour leader said in February that,

“we will use the funds returned from Brussels after Brexit to invest in our public services”.

Clearly, we are not alone in believing that, once we leave the European Union—and, as a party, we are committed to leaving the European Union—we will no longer be sending subscriptions to Brussels but using them for the NHS. For further detail on the funding settlement, the noble Lord will need to wait until the Budget, when the Chancellor will outline the plans.

[Lord Ribeiro (Con)]

My Lords, I welcome this report, but note that the Statement refers to the number of over-75s increasing by 1.5 million, which will prove a challenge in the future. One of the recommendations of the long-term sustainability report was that we should look at other methods for ensuring funding. I was very pleased to hear the noble Baroness, Lady Thornton, say that the review suggests that the public are prepared to pay more towards the NHS. I suggest that if we look at the experience of Japan, where people over the age of 40 start making contributions towards their long-term care, we may well have an opportunity to resolve this problem. If the public are willing, the Government should look seriously at this in the context of social care.

[Lord O'Shaughnessy]

We have in this debate just started the lively conversation that we will be having on taxation in the next few months. Clearly there are a number of ideas; they have been voiced by Members on the Liberal Democrat and Labour Benches as well as those on my Benches and the Cross Benches. We know that there are a number of ways that this could be done; the Prime Minister has shown incredible leadership to admit that this is necessary. These are very difficult decisions: in polls, people say that they want to pay more tax but when it comes to the crunch they often feel slightly differently. True leadership is being able to take us through that situation, and that is what the Prime Minister is showing.

Alcohol: Minimum Unit Pricing

Debate between Lord Ribeiro and Lord O'Shaughnessy

Wednesday 28th February 2018 Lords Chamber

[Lord O’Shaughnessy]

As I said, the Government are looking at this issue and, following the Supreme Court judgment, the Scottish Government can move ahead with their plans. The issue is not about the lack of evidence on whether reducing drinking has health benefits, but about making sure that any new system is implemented in a way that is fair on those who drink sensibly, particularly those on low incomes. The approach we have taken up to now is to use the tax system judiciously, including high duty levels for drinks such as white cider. As we move ahead and look at the evidence, we have to consider not just the health benefits but the economic costs that could be imposed on perfectly sensible drinkers.

[Lord Ribeiro (Con)]

My Lords, liver disease, unlike cancer, is the only major cause of premature death that has increased since 1970. As the Minister rightly says, the Scottish Government have this week introduced minimum unit pricing. Would the Minister be willing to meet me and the chairman of the Alcohol Health Alliance to discuss what we in this country can do to follow the Scottish lead?

[Lord O’Shaughnessy]

I would be very happy to meet my noble friend and the colleague he mentioned.

NHS: Clinical Negligence

Debate between Lord Ribeiro and Lord O'Shaughnessy

Wednesday 31st January 2018 Lords Chamber

[Lord O'Shaughnessy]

I completely agree with the noble Lord and make two points in response. He will know of the Secretary of State’s great passion for this area and of the maternity safety training funding and other training funding. From April, we will introduce the healthcare safety investigation branch, which will investigate each of the 1,000 incidents noted by the Each Baby Counts project which occur at birth, whether brain damage or neonatal death, precisely so that we can learn from that experience and make sure that those who provide these services are properly trained to avoid these incidents wherever humanly possible.

[Lord Ribeiro (Con)]

My Lords, we need to do something to tackle this issue much more urgently as the total cost of the litigation in the pipeline is some £65 billion—half the NHS budget. Until and unless we do something about changing Section 2(4) of the relevant Act we will have a continuing problem with patients claiming for private care when they should have their care provided by the NHS.

[Lord O'Shaughnessy]

I agree with my noble friend; this is an issue, not least because, when that Act was brought in, the NHS was a very different creature and did not offer the extensive range of care that it does now. We need to make sure that we are not effectively paying twice. However, this is a difficult and complex legal issue. It is important that we take our time to investigate how we tackle it properly so that those who are unfortunately affected by poor care are not put at a disadvantage for the rest of their lives.

NHS: Winter Staffing Levels

Debate between Lord Ribeiro and Lord O'Shaughnessy

Thursday 26th October 2017 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord knows that winter is always a more difficult time for the NHS. I hope he also knows that there are 11,000 more nurses on wards than there were in 2010. Indeed, I was looking at the data on doctors. There has been a 30% uplift in emergency doctors in that time as well. So there are more staff in the NHS—but, of course, there is much more need for winter preparedness. The NHS feels that it is better prepared than ever for winter.

On the issue that the noble Lord refers to—I assume he is talking about the story in the press today—that is, I stress, a local pilot that is being explored. I do not think it is even under way. It is being proposed by a local doctor—indeed, an emergency registrar. For it to go ahead, it is clear that any such pilot would have to abide by the very strict rules that exist on safety, safeguarding quality and so on for any care setting. The head of Age UK said that any new innovation—I think we want to encourage innovation—needs to pass the mum or grandma test. I think that is a very reasonable test to apply to something such as this.

[Lord Ribeiro (Con)]

My Lords, the only way in which to increase staffing levels in anticipation of the flu epidemic is through agency staff, which is going to cost a huge amount of money. Surely, the better thing to do would be to ensure that all health staff are vaccinated so they are at least healthy when the epidemic hits us—if it does.

[Lord O’Shaughnessy]

My noble friend talks with great authority on this issue and he is quite right. The NHS is offering all front-line health staff free vaccinations. NHS England has confirmed that it will also be paying for care workers in social care settings to get free jabs. Furthermore, we are now, for the first time, inoculating in school children aged between two and eight, who are sometimes known as “superspreaders”. This is to ensure that, if such an epidemic were to happen, we would be as well prepared as ever.

Tobacco Control Plan

Debate between Lord Ribeiro and Lord O'Shaughnessy

Thursday 23rd February 2017 Lords Chamber

[Lord O’Shaughnessy]

I will certainly look at what they are doing in Finland. I was not aware of that, and it is a very ambitious goal. As a former smoker, I have to say I know the benefits both in health terms and in my pocket from reducing smoking. It is essential that we continue on the trajectory of reducing smoking that has been going for a long time. England is a world leader in this area, and we should recognise that. There has been huge success but clearly there is a lot more to do.

[Lord Ribeiro (Con)]

My Lords, in a recent survey the British Thoracic Society found that 72% of hospital patients who smoked were not asked if they wanted to quit. Will my noble friend assure me that the promised tobacco control plan will ensure that hospital patients who smoke will get the support they need to quit?

[Lord O’Shaughnessy]

My noble friend makes an excellent point. Indeed, the Royal College of Surgeons of Edinburgh has just started a campaign to encourage clinicians to help their patients to stop smoking, and making sure that that happens is clearly going to have benefits for the kind of major surgery that some of the people who are suffering severe effects of smoking will need to have.

National Health Service: Nurses

Debate between Lord Ribeiro and Lord O'Shaughnessy

Wednesday 22nd February 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness makes a very good point. In fact, the workforce figures out today, which show the increases I have described, also show an increase in the number of nurses with general qualifications who are capable of working across multiple specialties and different sectors.

[Lord Ribeiro (Con)]

My Lords, mindful of the fact that we have taken the decision to leave the European Union and realising that many of our nurses come from overseas, and more recently from Europe, surely the time to start increasing nursing numbers is now, to make sure that we deal with any shortfall that may come after 2020.

[Lord O'Shaughnessy]

My noble friend makes an excellent point. Currently, around 7% of nurses are EU nationals. There has not been a drop-off in the number of EU nationals joining the NHS workforce since the referendum; nevertheless, it is clearly sensible to reduce our reliance on overseas nurses each year. We are doing that through additional training places and through retention and return to work schemes.

Mental Health and NHS Performance Update

Debate between Lord Ribeiro and Lord O'Shaughnessy

Monday 9th January 2017 Lords Chamber

[Lord Ribeiro (Con)]

My Lords, from these Benches I welcome my noble friend to his new position on the Front Bench and pay credit, as he did, to the work that the noble Lord, Lord Prior, did before him.

The Statement suggests that, during this period of exceeding challenge to the hospital sector, with clinical leaders attempts will be made to,

“suspend elective care, including, where appropriate, suspension of non-urgent out-patient appointments”.

I was rather distressed to hear on the “Today” programme of a patient with oesophageal cancer having either his treatment or his admission delayed—it sounded like it was his admission. As a surgeon, I felt particularly uncomfortable about that. I hope that the Minister can give some reassurance that when it comes to treating patients with cancer, irrespective of the pressures a hospital is under, provision must be made to admit those patients, because any delay can have a long-term effect on them.

Although I accept that there have been 11,400 more doctors since 2010—and that is a very reassuring figure—we must also remember that the intake into medicine has changed significantly over the past 10 or 20 years. There is now probably a majority of female doctors coming into medical school, so the workforce is feminising and changing. Whether we like it or not, many of them will have children, will have family commitments and will wish to work part-time, or less than full-time. When we talk about numbers, it is important that we talk about whole-time equivalents rather than the ballpark figure. It looks like a lot of doctors coming into the system, but we must take into consideration that many of them will work less than full-time, so we may well need to increase the medical workforce, perhaps asking them to work in a different way than they do currently.

I would be grateful if the Minister would comment on that, but I welcome his comments about mental health. I hope that greater provision will be made to ensure that patients with mental health issues have as much support as possible, as he said.

[Lord O'Shaughnessy]

I am grateful to my noble friend for his kind words of welcome. On the specific issue raised on the “Today” programme, which I believe is the subject of a documentary, and how it relates to the Statement made by my right honourable friend, there is an important distinction, which is that it is at the discretion of local clinical leaders. It is not a blanket mandate to delay treatment where the ethical and clinical responsibilities of those treating a given patient require it to be done speedily.

On the issue of the workforce changing, I take my noble friend’s point about what in the education world we called FTEs—full-time equivalents—and will make sure that the workforce figures I use are always expressed in those terms.