NHS: Junior Doctors’ Contract

Debate between Lord Turnberg and Lord Prior of Brampton

Wednesday 6th July 2016 Lords Chamber

[Lord Prior of Brampton]

Safety was clearly a major consideration in the minds of junior doctors when the original contract was negotiated, but the leadership of the BMA agreed with us that their safety concerns had been fully taken into account in the new contract. As far as numbers of doctors are concerned, we have plans to train a further 5,000 GPs over the next four years, but unquestionably there are gaps in many rotas around the country, and we do rely heavily on doctors from overseas to fill those gaps.

[Lord Turnberg (Lab)]

There has been much made of the fact that the junior doctors are extremely disillusioned. I think that is undeniable. It is perhaps not so well recognised that “junior doctors” includes a large number who are well into their 30s, who are very well trained and on whom the NHS relies entirely.

[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.

NHS: Bursaries

Debate between Lord Turnberg and Lord Prior of Brampton

Wednesday 25th May 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the reason for the discrepancy is that at the moment the bursary system effectively caps the number of student places for nursing. One of the purposes of moving to the loan system is to remove that cap and our estimate is that by so doing an additional 10,000 places will be created between 2017 and 2020.

[Lord Turnberg (Lab)]

My Lords, if you go to any nursing graduation ceremony you will see lots of 30 and 40 year-old women who have been carers and who now wish to retrain as nurses. This is a very valuable asset for the health service, and yet they are just the people who may be disenfranchised by this policy. Is it not crazy to do this?

[Lord Prior of Brampton]

My Lords, the loan will be available to mature students as well as to students taking their first degree. The loan structure is such that if someone will not be working for as long as a younger nurse they will not in all likelihood repay the whole of the loan, which will be written off at the end of the period. I agree entirely with what the noble Lord says; we depend heavily on mature students coming into nursing. Our view is that this will not put off those people.

Health: Neural Tube Defects

Debate between Lord Turnberg and Lord Prior of Brampton

Monday 21st March 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I cannot answer the latter question, but I will try to find out and write to the noble Baroness. She is right that Scotland is considering this and looking at the practical issues around implementation. She is right that other countries in the world—I think 50—have done this, but many others have not, including all European Union countries.

[Lord Turnberg (Lab)]

My Lords, I realise that the noble Lord is in the hands of his scientific advisory committee and cannot say anything without it, but I ask him to draw to its attention the fact that it may be using outdated research evidence if it believes that adding the small amounts of folic acid to bread has the same metabolic effect as taking 1 milligram of tablet a day. It does not. The very remote possibility that there is danger in taking 1 milligram of tablet a day is eliminated completely if you add it to food and take it during the day. Will he draw that to the committee’s attention and ask it to think again?

[Lord Prior of Brampton]

I will certainly draw that point to the attention of the SACN. It would be surprising if it was not already aware of that fact, but as I said I am addressing not really the science but whether it is right or proportionate to fortify bread for everybody to reach such a small number of people.

E-cigarettes: Regulation

Debate between Lord Turnberg and Lord Prior of Brampton

Monday 7th March 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, as I said, these new products are not perfect but are substantially better than smoking cigarettes. One of the purposes of the new directive is that there should be proper labelling on the products.

[Lord Turnberg (Lab)]

My Lords, the noble Lord dismissed the idea of an excise tax, but there is a strong rumour that the EU intends to impose a tax on these products. Will the Government do everything they can to counteract this counterproductive suggestion?

[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.

NHS: Junior Doctors’ Pay

Debate between Lord Turnberg and Lord Prior of Brampton

Wednesday 27th January 2016 Lords Chamber

[Lord Turnberg (Lab)]

Is not the reason why young doctors and not-so-young doctors are threatening to go on strike not so much the pay but because this is the last straw in a continuing series of alienation, and of feeling undervalued and underappreciated by the management from the Secretary of State down?

[Lord Prior of Brampton]

I agree. I do not think that this dispute is fundamentally about pay; it is much more profound than that. It is about a feeling among many junior doctors, which is shared by many senior doctors as well, that they are not properly valued and fully appreciated. That is the underlying cause of the problems we are facing.

Pregnancy: Neural Tube Defects

Debate between Lord Turnberg and Lord Prior of Brampton

Monday 21st December 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, when my noble friend says that this House is almost unanimously agreed she may well be right. However, the decision on this matter has to be taken in the other House. As I said, my honourable friend Jane Ellison, the Minister for Public Health, is going to come to a decision very quickly.

[Lord Turnberg (Lab)]

My Lords, we seem to have been for ever on this particular question. There is an irrational fear that somehow it is dangerous to fortify flour, and this has held up people in some way or other. But scientifically that does not bear fruit. It is clear from all the experience around the world of many years of fortifying flour with folic acid that it does work. We should be doing it here now.

[Lord Prior of Brampton]

My Lords, I am certainly not going to argue on clinical grounds with the noble Lord, who knows far more about this than I do. However, the issues are not purely clinical; they are to do with the mass medication of the whole population to reach a very small minority of women of child-bearing age. There are also some administrative issues to do with making sure that people do not take too much folic acid, as some cereals have folic acid added to them. However, I understand exactly what the noble Lord is saying, and can only repeat that the Minister for Public Health is reviewing this now.

NHS: Reform

Debate between Lord Turnberg and Lord Prior of Brampton

Thursday 16th July 2015 Lords Chamber

[Lord Turnberg (Lab)]

My Lords, I, too, welcome the Statement and many of the things in it. We accept that higher mortality rates at weekends in hospital are unacceptable, so we have to try to think of ways of reducing them. Seven-day working for consultants is just one element. Consultants are important, of course. The Minister is probably aware of Brian Jarman’s publication some years ago which showed that there was an inverse correlation between the number of doctors in a hospital and the mortality rate; that is, a hospital with more doctors had a lower mortality rate. There are lessons to be learned there, especially as we in the UK seem to have fewer doctors per head of population than almost any other OECD country, and fewer beds come to that—so we are starting from a low ebb, and the points made by noble Lords about where we are going to get the extra people from are important.

However, the consultant element is just one part. The noble Baroness, Lady Finlay, made a very good point about the need for radiologists, physiotherapists and pathology laboratories. All the machinery of the hospital has to be there. Equally, there is the whole business of general practice and community care. Primary care at the weekend is poor, by and large; that is one of the major problems. Patients are not getting into hospital until they are in greater extremis, so they are more ill when they get there: then they require more service, and once they are there, they cannot get home because there is no one to see them home. Concentrating on consultants is just one element. What is the Minister’s response?

[Lord Prior of Brampton]

The noble Lord, Lord Turnberg, knows the situation on the ground as well as anybody in this House and, of course, he and the noble Baroness, Lady Finlay, are absolutely right that this will not be solved just by having more consultants in acute hospitals. We have to look right the way across social care, primary care, community care, mental health care and acute care. We are talking about a system. In many ways, one of the reasons why we find ourselves in the position we find ourselves in today is that we have not had a system for some time. We have deliberately broken up the system for good reason.

I was very much in favour of foundation trusts having their own balance sheet and their own profit and loss account because of increased accountability, but disadvantages have flowed from that. Chief executives in acute hospitals look after their own. They have treated themselves as an island. We are not part of an island. Rebuilding the system will take some time. It is not going to happen tomorrow, and there is no silver bullet. All I can say is that the Government are committed to the five-year forward view, the new models of care and joined-up care. We are committed to experimenting with accountable care organisations, integrated care organisations and all kinds of joined-up models. We are seeing exciting developments in Manchester and possibly, in time to come, in Cornwall and other parts of the country where we will have pooled budgets between social care and healthcare. I am confident that over the next five years we will if not solve these problems, at least go a long way to doing so.

Local Authorities: Public Health Budget

Debate between Lord Turnberg and Lord Prior of Brampton

Wednesday 15th July 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Lord makes a good point that goes considerably broader than the Question. I accept that many of these things are inextricably linked.

[Lord Turnberg (Lab)]

My Lords, does the noble Lord accept the report from NICE, which showed that investment in public health improves not only the health of individuals but the economy? Can I tempt him to agree that cutting funding by as much as—I think—7.5% is counterproductive in trying to improve the nation’s health?

[Lord Prior of Brampton]

The noble Lord may be interested to know that the McKinsey institute assessed that the cost of obesity to the British economy was some £46 billion. I am under no illusion about the importance of proper prevention.