National Health Service: Missed Appointments

Debate between Lord Winston and Baroness Manzoor

Wednesday 30th January 2019 Lords Chamber

[Baroness Manzoor]

I am always happy to go back and shake the tree to find out the answers. I am a little bit like the Chief Medical Officer and believe that what you can measure you can manage. To that degree, I agree with the noble Lord that we need greater understanding of where patients are missed and exactly how that is managed. I also agree that there are rights but also responsibilities. However, some patients miss appointments for very good reasons, and we have to understand those reasons so that we do not just think it is irresponsible behaviour; I know it is not. I agree with the noble Lord that if somebody misses an appointment the GP could use the time to cover another issue. It is important if patients miss appointments because 70% or more of them will come back.

[Lord Winston (Lab)]

My Lords, some 15 years ago when I retired from the health service, we accurately costed how much the lost appointments in my out-patient clinic cost. The figure then was over £200 per patient in a clinic that was grossly oversubscribed, so we lost a lot of patients as a result. It is not good enough to say that we have looked at general practitioners. Can the noble Baroness answer the important question put by the noble Lord, Lord Dobbs? It is an effective drain on the health service and results in salaries being paid unnecessarily.

[Baroness Manzoor]

My Lords, I agree that it is a very important issue, and the NHS is looking at it. If you miss an appointment with a consultant or GP, the costs of that service are stated very clearly. We take this issue seriously and are tackling it.

Breast Cancer: Women Over 73

Debate between Lord Winston and Baroness Manzoor

Tuesday 15th January 2019 Lords Chamber

[Baroness Manzoor]

My Lords, I can only refer the noble Baroness to the answer that I gave previously, but I am delighted that her issue was picked up and dealt with effectively in routine screening—I am pleased to hear that. However, as I said, once we know the results of the AgeX trial we can consider any other issues that may emerge.

[Lord Winston (Lab)]

My Lords, for the second time in a week, the noble Baroness has denied evidence that exists. The evidence from New York—a recent study—clearly shows that screening of women over 75 is valuable. Moreover, most of those cancers—about 85%—are invasive. The problem, of course, is that all cancers are more common in older people. Is it worth while paying for mammography, or is it better to pay for the surgery afterwards?

[Baroness Manzoor]

My Lords, I agree entirely with the noble Lord, Lord Winston. It is always better to do preventive care. I am a passionate believer in that, and so is the department. As I said, however, the reality is that peer reviews in this country demonstrate different evidence. At the moment, we can only look at peer-based evidence and reviews undertaken by clinicians and researchers.

Human Tissue (Quality and Safety for Human Application) (Amendment) (EU Exit) Regulations 2019

Debate between Lord Winston and Baroness Manzoor

Wednesday 9th January 2019 Grand Committee

[Baroness Manzoor]

My Lords, the noble Lord does have a suspicious mind, and perhaps I was not clear. This is contingency planning and the agreements that will be put in place within the six months can continue after the six months. They are not just for six months. If there is a deal, then that is an entirely different matter.

[Lord Winston]

I hate to draw out proceedings longer than any of us wish to be here, but the Minister regrettably neglected to take on the points about research, which relate to all three SIs. I should not dictate how the Minister should think, but we have an excellent NHS because of its research base and the evidence it uses, unlike nearly any other country. We have promoted that and are desperate to maintain it in these difficult circumstances and the coming years, irrespective of Brexit. The problem is one which she may not have taken on board, intellectually. During the course of an experiment, things change. You realise that you need to do a slightly different procedure from what was originally planned. That requires a new ethical procedure, consideration by an ethics committee and, sometimes, patient consent as well.

Much of this research is done on a collaborative basis between two different nations. Noble Lords will see the problem I am trying to allude to. You may have researchers in, for example, Italy with whom you have been in close collaboration and they do something to the cells that we might receive but for which we have not received ethical consent in this country. It seems that that has not been fleshed out at all in our discussions. However, it is vitally important.

I have to tell the noble Baroness that listening to the debate in this Room is a senior medical researcher who has done excellent work with cell cultures. I do not think that she will be reassured by the discussions she has heard today. This is a serious problem for scientists. I am putting this on the record not because I expect a response—it is not fair to expect that—but so that when this instrument is put before the Chamber of the House of Lords, the issue is looked at seriously. It is fundamental to some of the things we are trying to say in the debate.

[Baroness Manzoor]

Perhaps I may respond briefly to the noble Lord, Lord Winston. I thought that I had made myself clear, but perhaps not clear enough. Research and clinical trials are outside the remit of these SIs.

[Lord Winston]

The issue is not about clinical trials; it is about collaborative research.

[Baroness Manzoor]

Research is also outside the scope of these SIs. The noble Lord has tremendous experience in this area, which we appreciate and value. We have a fantastic NHS based on world-leading research, working with our partners across the EU. That is right, but these SIs are not about that. These are matters for greater minds than mine to think about if we exit the EU. However, as far as these SIs are concerned, we want to maintain what we have at the moment. They cover a contingency plan to ensure that we have agreements in place. However, I understand the ethical issues and the points being made by the noble Lord, Lord Winston, regarding scientific research and close working collaborations, but I am not in a position to talk about them because they are not pertinent to the SIs we are discussing today.

Human Fertilisation and Embryology (Amendment) (EU Exit) Regulations 2019

Debate between Lord Winston and Baroness Manzoor

Wednesday 9th January 2019 Grand Committee

[Baroness Manzoor]

I hope the noble Lord feels I have been generous in giving way, but I really do need to make progress. I will answer the questions, but he must allow me to answer them before posing the same questions again.

The noble Lord asked about the impact cost for regulators and businesses, and I have already said these are to be low. He also asked what these costs are exactly. I do not have the figures, but they are expected to be very low, because for fertility clinics, it will be largely business as usual. Those importing from the EU already have import licences. The clinics will need written agreements and the regulator, the HFEA, will consider these at no cost.

[Lord Winston]

I am grateful to the Minister for giving way. This is a specialised area and it is quite understandable that the Minister is not fully apprised of the problems arising here. It is a question not merely of cost but also of ethical approval. For example, even for minor changes in a licence—and they can be minimal, such as a request for a three-month extension to a licence we have asked to be reviewed—it can take months just to get the approval. There are so many changes that need to be made when you do different research and find new things happening. This is a moving area of science. It is not static, and it is not like so much other regulation. Therefore, to take three completely different areas en bloc makes no sense. Each brings its own very different problems. I hope the Minister will recognise that as they need to be debated before they go to the Chamber.

[Baroness Manzoor]

I hear what the noble Lord, Lord Winston, says, but I want to reassure him that these instruments are about continuation of present practices, standards and patient safety. They are not introducing new ethical considerations. We are merely, if there is no deal, putting in place contingency plans so that for sixth months, new agreements can be put in place. The number of those agreements is not going to be significant.

A number of noble Lords raised issues about delays at ports. The noble Lord, Lord Adonis, in particular raised this on a number of occasions. I stress again, in the event of no deal, it is possible there may be delays for freight transiting via Dover, the Eurotunnel, and possibly Holyhead and other ports. The disruption to outbound traffic could have an impact on inbound traffic between EU and UK ports; I concede that. It could also lead to congestion on the road network in Kent, but we are planning for this situation and want to avoid any disruption to the supply of urgent material to hospitals in the region, and any congestion at ports or on the roads. Organs, particularly, are flown already, and that will continue. Where there is urgent need, they will be flown to the appropriate places, and those agreements will continue.

--- Later in debate ---

[Lord Winston]

Before my noble friend finishes, I should say that I really do not feel that that is a satisfactory point. I hope that I will be forgiven for saying this, but there are numerous examples of where the immediate relationship with Europe is important. Let me take one of those which I do not believe has been considered at all. We are aware that the Human Fertilisation and Embryology Authority undertakes to consider that no more than 10 attempts at sperm donation are made by individual donors, but we have increasingly been importing gametes from outside the United Kingdom because the regulations in this country have rather prevented males wishing, not unreasonably, to donate their sperm. As a consequence, we are importing sperm at an increasing rate and there is a great deal of evidence to show that there is an increasing risk of consanguinity in offspring because more than 10 children are produced as a result of one donor selling their sperm in different countries. That is the sort of thing which does in fact apply to the Brexit situation and it is a problem.

The three statutory instruments before us for discussion are so technical and so demanding that the suggestion which has already been made that we should perhaps withdraw them for the time being and have a proper consultation on what is important in the Brexit issues might be something that we should be thinking about today before accepting them en bloc and before we proceed any further.

[Baroness Manzoor]

I thank the noble Baroness, Lady Thornton, for her intervention; I very much appreciated it. I also thank the noble Lord, Lord Winston, for his suggestion. But as I have already indicated, we are considering the SIs here today, and it will be a matter for the Grand Committee how it chooses to proceed. I say again that we are not talking about changing legislation; rather, it is about maintaining the standards that we currently have. In terms of tracing organs, sperm and cells, the regulators will keep the same standards and provisions of traceability. They will not change. As the noble Lord will know, these agreements are not only in place with the EU; the regulators have agreements with other countries around the world.

I conclude with a clarification. It was either the noble Lord, Lord Adonis, or the noble Lord, Lord Foulkes, who said that we are changing primary legislation. They were right, but only to the extent that it is within the powers in the European Union (Withdrawal) Act. We are amending primary legislation in relation to HFE because the EU directives in this area were implemented by primary legislation. I just wanted to clarify that. I beg to move.

Folic Acid

Debate between Lord Winston and Baroness Manzoor

Wednesday 9th January 2019 Lords Chamber

[Baroness Manzoor]

My Lords, I pay tribute to the noble Lord, Lord Rooker, for raising this issue. I am delighted that the consultation will take place, so there has been movement, as he rightly said. I place on record that I had a meeting with the Secretary of State this morning to raise this issue with him personally. Like me, he is passionate to ensure that the consultation happens as soon as possible, but it is important that we undertake the impact assessment. On the question that the noble Lord just put to me, due to the milling process it is of course important that we have a UK-wide consultation.

[Lord Winston (Lab)]

My Lords, the Minister said that this is not a straightforward matter, but actually it is. If noble Lords read the paper by Dr Crider from the United States, they would see that folic acid compounds had been given prophylactically in this way for 40 years. That has shown a reduction in neural tube defects of up to 30%. What is also important is that at least four other papers show that the worst cases are where underprivileged people are not taking these supplements. So far, no side-effects of any seriousness have been noted. Is it not about time that the Government took responsibility for the pain and suffering of these families?

[Baroness Manzoor]

Of course the Government are taking responsibility, and I have just said that we are having this consultation. When I say it is not a straightforward matter, I mean in relation to the impact assessment. I agree that a number of countries—I think around 40—are putting folic acid on a mandatory basis. However, the noble Lord will appreciate that SACN and COT have issued guidelines that we will need to take into consideration in the consultation, and the Secretary of State has assured me today that we will make a decision as soon as possible.

Human Fertilisation and Embryology Act 2008: Frozen Eggs Storage

Debate between Lord Winston and Baroness Manzoor

Thursday 12th July 2018 Lords Chamber

[Baroness Manzoor]

My Lords, the noble Baroness makes an important point, and I recognise her argument. As an ex-chairman of the HFEA, she will know that the law is not set in stone. I am not aware that there is any consensus on what a more appropriate maximum storage limit should be, but if a strong case can be made for a new maximum limit, the Government would certainly consider a change in the law if it was needed.

[Lord Winston (Lab)]

My Lords, I declare an interest as the chairman of the Genesis Research Trust, which funds research into reproductive medicine. Is the noble Baroness aware that the Minister on the Front Bench who answered my Written Question at the end of last year showed that the figures for egg freezing were as follows: at that time, 4,841 eggs had been thawed for the process of making a pregnancy, 93 pregnancies had resulted, and there were 41 live births—that is to say, even the miscarriages are not properly represented—but the overall success per egg per freezing was less than 1%. Of course, I absolutely support what the noble Baroness, Lady Deech, is saying about having earlier freezing, but if freezing is left too late, this is the despicable result. Can the noble Baroness ensure that the Department of Health does something about the many private clinics that charge thousands of pounds to women who have their eggs frozen and claim a 40% to 60% success rate, and that is on record?

[Baroness Manzoor]

My Lords, of course, I recognise the tremendous, world-renowned expertise that the noble Lord, Lord Winston, has in this area. He asked a number of questions, and I cannot comment on the Written Answer on the numbers and figures that were given on the eggs that were frozen and thawed. However, I was interested to see the data published by HFEA in March on the ages of women freezing their eggs in 2016, which showed that roughly 67% were 35 or older. I recognise the argument that, as with every aspect of our body, eggs also get older, so the earlier they are frozen, it is potentially better. For those women freezing eggs for non-medical reasons, the 10-year storage limit would appear to provide a reasonable period for them to decide if they wish to go forward with fertility treatment. On the question of private clinics, the noble Lord is absolutely right. I am aware that clinics are advocating three or four cycles of treatment to freeze eggs. That can be very expensive, so it is important that women who want to go down that route regard the issue seriously because at the end of the day only 26% are successful.

Medical Innovation Bill [HL]

Debate between Lord Winston and Baroness Manzoor

Friday 12th December 2014 Lords Chamber

[Lord Winston]

My Lords, I apologise for my infelicity in getting the groupings wrong. I am very grateful to the Front Bench for making their proposal, which is very helpful.

I realise that I have been in your Lordships’ House since 1995 and this is the first time that I have ever proposed amendments at a Report stage. I should have learnt by now how to handle a Report stage, but I have to admit that, due partly to inexperience and partly to lack of attention to your Lordships during other Report stages of different Bills, I do not. Be that as it may, I shall not go on for long.

I was pleased to hear a degree of support for my Amendment 1, about emergencies, because I think that that approach is necessary. If the noble Lord, Lord Saatchi, is prepared to talk to me about that and see what we might do perhaps at Third Reading, I would be very happy to see how we might get more effective wording for some of these ambiguous areas in the Bill.

I am disappointed that we are not defining “innovation”. That is important because, clearly, these are issues which doctors will need to consider. It is clear from a large number of responses from doctors that there is very considerable confusion about the Bill. What is extraordinary is the number of bodies that show this confusion and say how right doctors are to be confused. Although the Royal College of Ophthalmologists is apparently worried about a particular drug—I bow to the knowledge of the noble Lord, Lord Saatchi, about this; I did not know that it was—the list of concerned bodies includes the Academy of Medical Sciences, of which I have the honour to be a fellow, the Academy for Healthcare Science, the Medical Research Council, the Wellcome Trust, the British Medical Association, the Royal College of Physicians, of which I am also a fellow and therefore I have an interest, the Royal College of General Practitioners, the Royal College of Radiologists, the Royal College of Psychiatrists, the Royal College of Surgeons of Edinburgh and, to some extent, the Royal College of Surgeons of England, the Association of Medical Research Charities, Action Against Medical Accidents, the Medical Defence Union and the Medical Protection Society. I know that it has been suggested, rather irrationally, that somehow the lawyers want to leave things as they are so that they can make more money but, in fact, the Medical Defence Union and the Medical Protection Society are most involved in litigation and they clearly want a reduction in litigation, which is why they are not in favour of the Bill.

Also concerned about the Bill are the British Pharmacological Society, the NHS Health Research Authority and the NHS Litigation Authority—I checked its website this morning to confirm that—Healthwatch and, rather importantly, Cancer Research UK, which raises about £700 million a year for the treatment of cancer in this country. Also concerned are the Motor Neurone Disease Association and, to some extent, the National Institute for Health and Care Excellence. They are mostly concerned about the confusion to doctors, but some would go further than that. They say that the Bill is unnecessary and, as I shall seek to explain, may endanger patient safety.

The reason why I tabled the two amendments about medical practitioners is that it is fair to say that, in future, the National Health Service will have to rely more and more on people who are graduates other than medical graduates. Therefore, the Bill should recognise that they will sometimes need to innovate. It may be worth clarifying their position at this stage.

For the moment, I will not divide the House on Amendment 1, but I would very much value further discussion with the noble Lord, Lord Saatchi.

[Baroness Manzoor (LD)]

My Lords, before the noble Lord sits down, will there be any consideration of the nursing profession and others to be included when he is thinking of medical practitioners who are not qualified?

[Lord Winston]

I personally think that that is very important. That is why I tabled the amendment, because I wanted discussion on the issue—in particular, for health visitors and more senior nurses, whose position means that they often have to be innovative. The real issue here concerns midwives, because midwives—particularly district midwives, when they do not have a medical practitioner with them—are often presented with horrendous situations where they have to act innovatively. We hear from the Department of Health that it would like to extend home delivery. That may be a very good thing—I do not know; although I am a qualified obstetrician, I have concerns about that—but if that extension happens, as seems likely given that the health service is strapped for income, it is important to consider other health professionals who may be confronted with those problems. At the moment, the Bill does not do that, and I think that that will cause problems in future.