Children’s Health: Sugar

Lord Tomlinson Excerpts

Tuesday 12th September 2023 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is absolutely correct. What we give children in schools is a key thing that the Government can affect. That is why I am delighted that the level of free school meals, at 33%, is the highest on record, making sure that they have good nutritious food. But the noble Baroness is correct: there was a review taking place in 2019, which was one of the casualties of Covid. I know that it is now one of the things that we are thinking, as we recover from Covid, that we need to look at again.

[Lord Tomlinson (Lab)]

My Lords, the Minister has spoken passionately about reducing the intake of sugar by younger people. Are His Majesty’s Government intending to admit obese children with type 2 diabetes to the two-year pilot study of the new drug Wegovy?

[Lord Markham (Con)]

My understanding—and I will confirm this afterwards—is that, to begin with, always with these sorts of treatments, you want to make sure that you are doing it in a safer type of environment. Generally, having adults doing it is a better place to start. Clearly, if that works the way we think, and we can trust that it will work, then you have opportunities to expand beyond that. The other thing I would like to say on this is that, actually, an active life is very important—activity and sports are a very important component of this. Interestingly, it has been shown that an active life increases life expectancy by one to two years, so that is an important feature in all this as well.

Ambulance Delays

Lord Tomlinson Excerpts

Wednesday 9th November 2022 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend for probably the best advice and question I have received in my marathon series. I could answer her question at great length, because I agree that this is a whole-system issue and we need a whole-system response. I would happily talk about every aspect of that but I will pick up just a couple of the specific points that she made. Social care is clearly vital to this. That is what the £500 million discharge fund is for. We are all aware—noble Lords have probably heard me say it enough times—that 13% of our beds are occupied in this way. As my noble friend states, an ambulance will visit a home and 50% of the time will not end up conveying someone into hospital. Is having an ambulance there, with three people in it, the best use of our resources when perhaps a paramedic on a bike could solve it just as well? In a similar vein, my understanding is that roughly 50% of all A&E attendances are people who do not really need emergency treatment. Again, that goes to the point about making sure that they have opportunities to receive primary care appointments, which is what the pledge to increase appointments by 50 million is all about. This is a whole-system problem and something that we are working on with a whole-system approach.

[Lord Tomlinson (Lab)]

The Minister referred to the ABCD. I remember from when I read about it—it treats us rather like kindergarten children, does it not? —that “A” is for “ambulances”. But the big idea for ambulances in that document from the former Deputy Prime Minister was to create an auxiliary ambulance service. As the problem with the ambulance service at the moment is getting patients out of ambulances and into hospitals, what good will an auxiliary ambulance service do if it merely gets more people into hospital car parks, where more of them are waiting in more ambulances?

[Lord Markham (Con)]

The noble Lord is referring to the whole-system issue here, which I mentioned before. There is a £450 million investment to increase capacity in A&E facilities; that has already worked to upgrade 120 trusts to enable them to offload quickly. There are also 7,000 extra beds, and the £500 million social care discharge fund is all about freeing up more beds so that ambulances can discharge quicker.

NHS Dentistry Services

Lord Tomlinson Excerpts

Thursday 11th July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

My friend the noble Countess, Lady Mar, raises a vital area. Overall care for those in care homes, whether healthcare, mental health care or dental care, must be provided in a suitable manner. This is being considered in the social care Green Paper.

[Lord Tomlinson (Lab)]

My Lords, I declare an interest as a former chairman of the British Fluoridation Society. Does the Minister agree that prevention is much better than cure, and that you can prevent the need for dentists through a substantial increase in the use of fluoride in our water supplies? Is she satisfied with the progress being made on fluoridation of water? If not, what plans does she have to encourage it?

[Baroness Blackwood of North Oxford]

The noble Lord is quite right: prevention is always better than cure. That is why the programme for oral health improvement in both the NHS long-term plan and the dental contract being tested focuses on a more preventive approach to oral care. Water fluoridation is obviously a very effective way of improving oral health, particularly for children. According to the 2012 Act, it must be a local decision supported by Public Health England in the lead. We want to see more decisions. PHE’s guidance on delivering better oral health sets out clear expectations on this, but there are also other ways in which fluoride can get to children. One is through fluoride in toothpaste, which is now at effective concentrations; the other is that all dentists are expected to deliver fluoride to teeth directly, at clinically appropriate intervals, to all children in their care.

Nurses and Midwives: Numbers

Lord Tomlinson Excerpts

Monday 4th December 2017 Lords Chamber

[Lord O'Shaughnessy]

Retention is critical. A number of nurses have gone through return-to-practice programmes to make sure they can come back into the profession. I recognise that today’s UCAS data show that while the number of applications has risen among the under-21s, it has fallen among the over-21s. It is important to point out that financial support is available for those people, in terms of both help with childcare and extra financial support. Now, for the first time, we are providing funding for second degrees if they are in nursing.

[Lord Tomlinson (Lab)]

The Minister said clearly that he never misses an opportunity to say how much we value our nurses. Does he accept that “value” is best recognised in a tangible form rather than in words that have no meaning?

[Lord O'Shaughnessy]

I think that words do have meaning, and it is important not to miss the opportunity to say how much we value those nurses who have come from the European Union as well as all staff in the NHS. One example of the value with which we hold them is the announcement in the Budget that the Chancellor will fund an Agenda for Change pay settlement for nurses.

NHS: Junior Doctors’ Contract

Lord Tomlinson Excerpts

Wednesday 6th July 2016 Lords Chamber

[Lord Prior of Brampton]

One fact that has come over very loudly to me during the past year is that the whole definition of “junior doctors” is an absurd one. Many junior doctors have been in training for many years and we rely on them to deliver much of our front-line care. It is just another reason why it is so important, as other noble Lords have mentioned, that we rebuild the trust of junior doctors.

[Lord Tomlinson (Lab)]

My Lords, will the Minister reflect that there is not a great deal of merit in telling us that the Secretary of State’s door is always open if his mind remains closed?

[Lord Prior of Brampton]

I do not agree with the noble Lord. There has been considerable movement on the part of the Secretary of State between the contract that was originally put to the BMA in March and the one that was agreed with the BMA in May. There is plenty of evidence to suggest that the Secretary of State’s mind has been open.

NHS: London

Lord Tomlinson Excerpts

Wednesday 30th October 2013 Lords Chamber

[Earl Howe]

The noble Lord is absolutely right. These solutions should not be imposed from above. Indeed, the Shaping a Healthier Future proposals were designed by local clinicians in consultation with their patients. It was not a prescription dreamt up in Whitehall. We are very clear that the local NHS should continue to feel local ownership of these ideas as it takes them forward. I have no doubt that, if it feels it necessary, it will turn to the royal colleges for particular kinds of advice. It is free to do that as it wishes.

[Lord Tomlinson (Lab)]

Is the noble Earl aware that on this side of the House he is very highly regarded as a model of clarity? However, in the second part of his answer to the noble Lord, Lord Hunt, today, he was somewhat equivocal in relation to the future of Lewisham Hospital. I hope that he will accept an invitation to visit Lewisham Hospital. I declare an interest as somebody who lives in that area and has opposed the closure. Does he also realise that such is the strength of feeling in Lewisham, he had better have read the whole judgment carefully and cleared all his lines before he goes there? The threatened closure created such community anger as I have never seen before and he would be most unwelcome unless he were able to give a clear and unequivocal response about its future.

[Earl Howe]

My Lords, I certainly understand the noble Lord’s strength of feeling on this. It is certainly my intention to read the judgment when we receive it in full. Nothing is closing in Lewisham. The service remains as it has been. There is nothing that Ministers intend to do to change that situation. However, as I mentioned earlier, there is an issue to be addressed in Lewisham and indeed in Greenwich. It is a pressing financial issue that commissioners as well as the hospitals themselves have to face. I have no doubt that a visit to Lewisham would benefit me enormously and I shall await an invitation to that effect.

NHS: 111 Telephone Service

Lord Tomlinson Excerpts

Monday 13th May 2013 Lords Chamber

[Earl Howe]

I am very glad that my noble friend has raised that issue. Sir Bruce Keogh is indeed looking across the piece at urgent and emergency care services, and that will include the way in which 111 is working.

[Lord Tomlinson]

Does the Minister accept that Sir Bruce looking at these questions is not necessarily a comfort? Sir Bruce looked at accident and emergency services in south London but, based on what the Minister has said today about the pressure on accident and emergency services, Sir Bruce came to the wrong conclusion about Lewisham accident and emergency.

[Earl Howe]

My Lords, I hope the noble Lord will understand that I cannot comment on Lewisham because it is sub judice. I do not accept that the advice that Sir Bruce gave was ill founded.

South London Healthcare NHS Trust

Lord Tomlinson Excerpts

Thursday 31st January 2013 Lords Chamber

[Lord Tomlinson]

My Lords, I join in the thanks offered to the noble Earl for repeating the Statement. One has the feeling that, for someone so highly respected in this House, his heart was not really in the repetition.

Lewisham hospital is a local hospital which produces excellent local care—and I declare an interest as someone who uses its services. What the Minister has announced today is that he is not going to make the cuts quite as bad as they were—not quite as extensive. But, in effect, we are still having a very good service penalised in order to provide resources for the failures. Can I ask two specific questions arising from the Statement? At one point it states that,

“a non-admitting Urgent Care Centre at Lewisham may not lead, in all cases, to improved patient care”.

How does the Minister square that with some of the other statements made about the principles on which this reorganisation is based? With two further tranches of money—£36 million and £37 million—provided to the other sites which need to be improved, I ask him to comment on what the Secretary of State said at the end, namely that,

“there is a significant level of risk associated with achieving the identified savings. I recognise that the additional clinical safeguards I have put in place will marginally increase these financial risks but on balance”—

basically, “I think it might be all right”. Is this not another example of wishing being given a higher priority than factual decision-making?

[Earl Howe]

My Lords, perhaps I may put on the record my own recognition that Lewisham hospital is an excellent hospital. There is no question about that and there has never been any question about it. The hospital provides good care for local people and it is highly valued. Only this afternoon I had one noble Lord from my own Benches telephoning me to tell me of his personal experience of Lewisham hospital and its excellent maternity care.

The noble Lord asked me two specific questions. He quoted the Statement where at one point it was made clear that a non-admitting urgent care unit at Lewisham would not improve patient care. That is the precise reason why Sir Bruce Keogh recommended something different; namely, an admitting A&E unit with 24/7 cover. He looked at the recommendation and was not satisfied with it in terms of risks to patients. I hope that that is helpful to the noble Lord because I think he misconstrued what I was saying.

On the question of risk, any set of assumptions that relies on hypotheses around patient flows in the future and clinical referral decisions has to be, by its very nature, uncertain. It is the view of the trust special administrator and the review of my right honourable friend that the assumptions underpinning these decisions are reasonable, and that was backed up by Sir Bruce Keogh. But the noble Lord has a point because the implementation of these recommendations is going to be key, and that is why the TSA has recommended a programme board to oversee the implementation of these recommendations over the next few years. It is absolutely essential that commissioners and the providers in that area buy in to these proposals. We believe that they will, but it is important that if the financial risk is to be minimised, we get as close as possible to the forecast and predictions that the TSA has set out.

NHS: Hospital Beds

Lord Tomlinson Excerpts

Thursday 6th December 2012 Lords Chamber

[Earl Howe]

My Lords, it is questions of that kind that we expect the clinical commissioning groups to examine because they will become responsible for out-of-hours primary care. Therefore, it is incumbent on them to ensure that that service not only is a good one but does not lead to unwanted consequences in terms of unplanned admissions to hospital.

[Lord Tomlinson]

My Lords, does the Minister accept that his usual clarity has deserted him somewhat today as he has indicated that money which is underspent is returned to the Treasury but on the other hand he has said that it is not lost to the National Health Service? Does he agree that this gives a completely new meaning to double-entry bookkeeping?

[Earl Howe]

I shall be happy to write to the noble Lord to explain why my answers have been absolutely correct and the situation that I have described is nothing new. However, we are in a new situation in the sense that it appears that the supplementary questions can be extended at will over any other Question on the Order Paper, but I am happy to take questions from the noble Lord at any time.

Health and Social Care Bill

Lord Tomlinson Excerpts

Thursday 19th January 2012 Lords Chamber

[Lord Tomlinson]

Is the Minister aware that his message about the imperatives of health service reform does not appear to have reached the Royal College of Nursing and the Royal College of Midwives, based on statements that they made yesterday? Does he share the view of his right honourable friend the Secretary of State in another place, who has stated that these are not disputes about the health service but politically motivated strikes?

[Earl Howe]

I do think that the objections that the Royal College of Nursing has raised have very little to do with the Health and Social Care Bill. They are much more about what may or may not be happening in certain hospital trusts, which are matters that, in general, the Bill does not affect.