NHS: Long-term Sustainability

Lord St John of Bletso Excerpts

Thursday 18th April 2024 Lords Chamber

[Lord St John of Bletso (CB)]

My Lords, I join others in thanking and congratulating my noble friend Lord Patel on introducing this topical debate, and in congratulating the noble Baroness, Lady Ramsey, on her very moving maiden speech.

As the last to come to the crease before the closing speeches, I shall be very brief, and just make a few observations. I come to this debate not as a medical expert, though like my noble friend I suffer from peripheral neuropathy, but for the past 20 years I have been a company doctor, fixing companies large and small, though not on all occasions helping them to become more efficient and profitable. My first observation on the NHS is the apparent failure of effective leadership. I know many GPs, specialists and junior doctors, and one junior doctor I spoke to yesterday commented that he had been on strike not just because of the money but because he and others felt disfranchised.

We live in an exciting time of digital transformation and artificial intelligence, and we are seeing huge advances in quantum computing. By analysing vast amounts of medical data, including electronic health records and genetic information, we can uncover patterns, predict outcomes and improve diagnosis and treatment. Ultimately, however, the focus must be on effective, adaptable and accountable leadership. There is a danger that many in the medical fraternity are too focused on following protocols rather than guidelines and get bogged down in red tape.

I recently read the book, 2030: The Future of Medicine by Professor Richard Barker, a specialist in longevity research. I mention as an aside that it is my noble friend Lady D’Souza’s 80th birthday today—happy birthday. At 80 in your Lordships’ House, she is but a youngster. The observations that Professor Barker made when he wrote this book in February 2011 pertain as much today as they did then. In essence, he called attention to the need to re-architect the NHS and provide more effective time management to NHS GPs. Many GPs complain that they spend far too much time on administration and far too little time using their medical skills to diagnose and treat acute conditions. In this regard, a lot of elderly patients are not getting the treatments that they need and deserve. One of his observations was the need to focus on preventative medicine. We have seen huge advances in oncology and cardiology, but a lot more can and should be done on preventive medicine, including more focus on tackling obesity, on gut health and on lowering cholesterol.

The noble Baroness, Lady Blackwood, spoke very eloquently on the profound impact of genomics on personalised medicine. With the ability to sequence entire genomes rapidly and affordably, we are entering an era where treatments can be tailored to an individual’s genetic make-up, leading to far more effective, targeted therapies.

Time precludes me from debating the need for more effective procurement within the NHS. A huge amount could and should be done to save costs through shared services. I agree with my noble friend Lord Kakkar that the long-term sustainability of the NHS is a joint effort and requires commitment from all stakeholders—the Government, healthcare professionals, patients and the public sector. Will the Minister, in winding up, advise us as to what measures have been taken to conduct a global best-practice study on the long-term sustainability of public healthcare? I agree with the excellent suggestion of my noble friend Lord Warner of assimilating the Singapore healthcare system.

In conclusion, there are a lot of positive developments in the NHS and people should be congratulated and appreciated for their hard work, but my call is a simple one: we need to focus on effective and adaptable leadership, on effective procurement and on patient care; and to continue to focus on prevention. More funding in the NHS does not necessarily solve the problem. We need to get smarter.

Plastics: Health Research

Lord St John of Bletso Excerpts

Monday 19th December 2022 Lords Chamber

[Lord Markham (Con)]

Again, the research bodies are very happy to look at any good proposals. The only place I would disagree with this is on whether you would want to ring-fence a certain amount to a space when you do not know whether there is a health risk there. Therefore, if there are good research proposals, we are definitely ready to take that forward. I will caution against some of the quotes where they are based on a sample size of 22 people, in terms of the common-sense study. That is why we place caution on this, but if there are good research proposals, I say: absolutely, please bring them forward.

[Lord St John of Bletso (CB)]

My Lords, while welcoming the plastic packaging tax in April this year, I noted an alarming OECD report recently that plastic waste entering the oceans is set to treble in the next 40 years. What are our Government doing to fund credible plastic alternatives so as to mitigate the problems at source?

[Lord Markham (Con)]

I understand that this is part of the £500 million Blue Planet Fund that we put in place to help developing countries support the marine environment, and we are a contracting party to the OSPAR convention to participate in marine-limited monitoring programmes.

Health and Social Care Update

Lord St John of Bletso Excerpts

Monday 22nd March 2021 Lords Chamber

[The Deputy Speaker (Lord Haskel) (Lab)]

The noble Baroness, Lady Blackstone, and the noble Lord, Lord Lucas, have both withdrawn, so I call the noble Lord, Lord St John of Bletso.

[Lord St John of Bletso (CB)]

My Lords, I would like to probe the Minister outside the question of the vaccine supply and its admirable rollout. While welcoming the Government’s workplace testing scheme, in which lateral flow tests will be given to businesses until the end of June, what established workplace testing infrastructure is in place? What measures are being taken to ensure the high uptake of this strategy and that it is as safe and accurate as possible?

[Lord Bethell (Con)]

The noble Lord is entirely right to emphasise this incredibly important aspect of our toolkit to manage infection rates down. The workplace is an area of infection threat and asymptomatic testing is a way to keep workplaces safe. We have put in place until the summer the free provision of lateral flow tests for those who wish to do workplace testing, and we are looking at ways in which we could potentially extend that, particularly in circumstances where the infection rate crept up again. We are working very closely with BEIS colleagues to look at the kind of regime that would be necessary. I pay tribute to DfT colleagues who have trail-blazed this area with the test to release programme, which uses private testing capacity for that important transport corridor, and to colleagues at UKAS who have put in place the accreditation necessary to create an independent, private ecology of the kind that the noble Lord refers to.

Health Protection (Coronavirus) (Restrictions) (England) (No. 4) Regulations 2020

Lord St John of Bletso Excerpts

Wednesday 4th November 2020 Lords Chamber

[Lord St John of Bletso (CB)]

My Lords, I am in favour of the amendment moved by the noble Lord, Lord Robathan. I seriously question why it is necessary to have a nationwide lockdown when the three-tier system was working well in many regions. Clearly, the Government were put into an impossible predicament by the dire warnings from SAGE and several scientific institutions that base their conclusions on worst-case scenarios. As the noble Lord rightly mentioned, there have been many disagreements among the scientific community. The fear and hysteria were hyped up by many in the media. Why, as the noble Lord, Lord Forsyth, has asked, was there not a cost-benefit and risk analysis?

As several noble Lords have mentioned, the King’s College Covid symptoms app, based on 4.3 million contributions, shows clearly that while cases are still rising across the UK, they have not spiralled out of control and the R value is just above one. There is clear evidence that the tier 3 restrictions in Liverpool and in the north-east have had a positive impact. Why did we not have tier 4 restrictions and regional lockdowns, which have been highly effective in other parts of the world such as Australia?

Businesses both large and small have acted responsibly in respecting social distancing, the wearing of face masks and strict hand-washing measures. This second lockdown will devastate many businesses and, inevitably, take us into a double-dip recession, destroying jobs and adding to the problems of anxiety, depression and domestic abuse.

I dread the long-term repercussions of the huge debt that will have to be repaid, predominantly by the younger generation. What will this lockdown cost? We seem to be reacting purely to bad news. In most cases, except long Covid, the recovery period is a matter of a week. I say this having had Covid. Apart from a dry cough for a few days, I recovered in no time at all. My 93-year-old mother-in-law has just recovered from Covid within two weeks. The treatment of Covid patients has hugely improved. We have over 250 vaccines under development globally.

While death rates are running at 10% above the seasonal average, death rates from Covid compared with earlier in the year have come down considerably. We all knew there would be a second wave. The NHS had seven months to prepare for it. What evidence does the Government have that the NHS cannot cope? The Government are using a sledgehammer to crack a nut and allowing the tail to wag the dog.

NHS: Healthcare Data

Lord St John of Bletso Excerpts

Thursday 6th September 2018 Lords Chamber

[Lord St John of Bletso (CB)]

My Lords, I join in the thanks to my noble friend Lord Freyberg for introducing this very topical debate. I am grateful to the Library for the very useful research note we received. I also join in the congratulations to the noble Lord, Lord Bethell, on a fine maiden speech. We all respected his late father for his many campaigns.

I was fortunate, like the noble Baroness, Lady Rock, to be a member of your Lordships’ Select Committee on Artificial Intelligence. A major conclusion of our report was that one of the biggest beneficiaries of the effective use of AI and data will be the healthcare sector and obviously the National Health Service.

As my noble friend Lord Mitchell mentioned, data is the new oil and is the fuel of artificial intelligence and the fourth industrial revolution. Clearly, the considerations of privacy, public trust and recent breaches of data security are of widespread concern and need to be properly addressed. But big data, if it is fully embraced, has the potential to provide huge advances in improved treatment, risk mitigation and—a point that has not been mentioned by other speakers—cost savings to the National Health Service.

It is encouraging that the Government have identified AI and data as one of the United Kingdom’s four great challenges in the industrial strategy. Today, we measure the human body in several metrics: heart rate, blood pressure, temperature and glucose levels. I do not profess to have any medical expertise, but it is well known that we have about 10 trillion cells in the human body and, with the advances in AI and technology, we can now measure the quantified self with data streams using wearables such as Fitbits and Apple watches, heart rate monitors and others. Many believe that, within 10 years, we will be able to instrument almost every cell in the body in real time.

We are increasingly moving from a world of reactive health to preventive health. Analysing much of the healthcare data from the NHS offers huge opportunities in preventive medicine. It is well known that there is no central database for medical records within the NHS, which highlights the need for more interoperability of health information systems. I was interested in the GMC report last year which highlighted a significant step change in the UK healthcare data landscape from the 26 research centres. While identifiable medical records are rightly strictly regulated, there is potential—a point made by the noble Viscount, Lord Bridgeman—to anonymise more data, which would prevent data scientists from breaching privacy laws. We have the biggest pool of healthcare data possibly in the world within the NHS. Apart from the obvious benefits of the primary use of healthcare data within the NHS, there are the secondary uses outside the NHS. We could radically reduce the cost of healthcare using preventive diagnosis—a very important point. By way of example: within five years, many believe that, with the effective use of data, we could tackle almost every type of cancer through early detection. Yesterday, I had lunch with Salim Ismail, the founding chief executive of Singularity University, which brings together the top experts in the fast-moving technologies around the world. He believes that the NHS could go from spending an average of £250,000 per patient down to £50,000 in the next 10 years. This is profound.

In the history of mankind, we have never seen so much intensity of innovation—from solar energy, autonomous cars to drones to biotech and genomics, to neuroscience breakthroughs and many other disruptive technologies. With access to more data we are now on the brink of understanding and solving some of the major mental diseases such as Alzheimer’s, Parkinson’s and dementia. Using technologies with the benefit of large datasets, such as FUS—focused ultrasound—could revolutionise the treatment of many illnesses non-invasively. We need to shift legacy mindsets to embrace new ideas. By embracing blockchain technologies we could dramatically reduce the cost to the public sector of healthcare. Time restricts me from elaborating on the benefits of blockchain, but I was encouraged by the recent reply that the Minister gave me to an Oral Question that the Government were embarking on a number of pilot studies looking at these benefits.

I hope that more can be done to promote and accelerate the analysis of large datasets within the NHS. By doing this, the United Kingdom has the potential to be a global leader in health and wellness in the 21st century.

NHS: Equitable Access

Lord St John of Bletso Excerpts

Thursday 5th July 2018 Lords Chamber

[Lord St John of Bletso (CB)]

My Lords, will the Minister elaborate on how the forthcoming NHS digital innovation hubs, combined with the Data Saves Lives campaign, can deliver a fairer distribution of excellence in the regions with the greatest health and social care needs?

[Lord O'Shaughnessy]

One thing that has become apparent to me in 18 months of being a Minister is that the data in the NHS about patients and their needs, diseases and care is a unique asset. We have to ensure that patients trust the way that the NHS uses that data, which is why we have created things such as the national data opt-out, cybersecurity and so forth. If we can bring that public trust, that data can be used for research through these digital innovation hubs to develop new treatments and make sure that they are available for NHS patients first.

Health: Cancer Drugs Fund

Lord St John of Bletso Excerpts

Wednesday 13th March 2013 Lords Chamber

[Earl Howe]

My Lords, when the arrangements for the cancer drugs fund pass to the NHS Commissioning Board in April, there will be standard operating procedures for the fund, which will provide greater consistency of access across the country while also preserving the right of clinicians to request any drug that they think will help a patient. The standard operating procedures will be published very shortly, and the noble Lord will then receive a fuller answer to his question.

[Lord St John of Bletso]

My Lords, can the Minister elaborate on what reports, if any, have been produced from the Chemotherapy Intelligence Unit in Oxford on the efficacy of the cancer drugs fund? What will be done for those patients who have received relief from this fund for their treatment in future?

[Earl Howe]

My Lords, the noble Lord raises a very important point because clinical audit of the drugs in the cancer drugs fund and their use will be extremely important in informing the use of these drugs going forward and, indeed, in determining their price under a value-based pricing scheme. As yet we have not heard from the Oxford Cancer Intelligence Unit although I understand that we will receive a preliminary report quite soon. However, as I mentioned earlier, when the current fund comes to an end we will ensure that those patients who are receiving drugs under it will continue to do so.

Health: Pancreatic Cancer

Lord St John of Bletso Excerpts

Monday 23rd April 2012 Grand Committee

[Lord St John of Bletso]

My Lords, I am grateful to my noble friend Lord Aberdare for giving us the opportunity for this important and very topical debate. At a time when there have been so many dramatic improvements in the cure and treatment of cancer, it is sad and very alarming that there have been little to no such improvements as regards pancreatic cancer. As my noble friend mentioned in his alarming statistics, the situation has not improved for almost 40 years.

It is also very concerning that the National Cancer Patient Experience Survey in 2010 showed that pancreatic cancer patients have some of the worst overall experiences of all cancer patients. In my allotted few minutes today, I want to touch on just two issues: diagnostics and research. There is currently no screening test for pancreatic cancer and, given that we now know that the disease takes 10 to 15 years to progress and that there is significantly more understanding of the biological and genetic makeup of the disease, what assurance can the Government give that more funding will be made available to provide this effective test?

Secondly, I understand that most drug trials for pancreatic cancer in the UK are currently focused on testing combinations of existing drugs. Given that there have been significant developments in the understanding of the biology of pancreatic cancer in recent years, what actions can the Government take to ensure that more trials are conducted on new drugs which build on the existing research? Essentially, we need a far more radical and creative approach to pancreatic cancer. Time restricts me from speaking on the scope for more surgery, but I cannot understand why, when 20 per cent of patients are eligible for surgery, only 10 per cent have the opportunity of having it.

In conclusion, I applaud the tremendous work of the charity Pancreatic Cancer UK and its Campaign for Hope. I sincerely hope that today the Minister can give us all some encouragement that more financial research and support can be given to address this important campaign so that the UK can achieve its potential for doubling survival rates.