Primary and Community Care: Improving Patient Outcomes

Viscount Eccles Excerpts

Thursday 8th September 2022 Lords Chamber

[Viscount Eccles (Con)]

My Lords, it is a great privilege to follow those four opening speeches. However, I knew that I was getting myself into quite unnecessary trouble by putting my name down for this debate. Having had no internal experience of the National Health Service, I cannot follow the catalogue of problems which we have so far heard.

I start by declaring an interest: I am in receipt of community care. I will not go into detail, but I was in hospital two or three times and the NHS picked up that this would probably lead to the need for aftercare. Lo and behold, community care appeared. It has been very interesting and extremely helpful, but it raises two matters.

First, there was no explanation for why this was happening; it just happened. There has been no explanation which might lead one to understand the objectives or the value of the work, and possibly even the value for money of the work, being done in what is undoubtedly an endeavour to ensure independence—an endeavour for which I am very grateful.

The second matter that has arisen is that I cannot any longer understand whether there is a borderline—and if there is, where it is—between primary care and what might loosely be called hospital-based care. Because of my short stays, two hospitals have picked me up and are determined to monitor all sorts of aspects of what they found during their investigations. A lot of that work is what I would describe as primary care. I will not go into details, as that is not the point of such a presentation, but, for example, skin trouble, which has been persistent and different and has apparently quite complicated causes, seems to have moved away from primary care.

The other aspect of these experiences means that, for various reasons, I have not been able to create any personal relationship with a general practitioner. I have been responsible for some of the changes that have led to that, but so has the medical centre, where the people change quite rapidly.

When thinking about these experiences and about what I do not understand about the National Health Service and how it is organised and run, I am very thankful for what has happened in the delivery of my medical services; I have every reason to be grateful. There have been glitches along the way—a rare side effect, which affects only 1% of the population, but that just proves that I am an awkward person, as so many people are. I am truly grateful for the way in which the NHS has dealt with the various problems that I have had—and here I am, past my sell-by date.

When thinking about that, I reflect on my two grandfathers. They were both medical men, and they were both involved in the negotiations which led up to the Aneurin Bevan health service Acts. If they were with us today, they simply would not understand what is going on. The changes have been so radical—in society, in the behaviour and reaction of people in society, in the medical profession, and in the technology that has come over the past 74 years—that they would not understand what is going on and why it is going on in the way that it is. This leads me to think that we must be coming to a need to discuss, rethink and maybe alter the Aneurin Bevan settlement.

There have been so many efforts over that time, and yet we have heard the catalogue of the first four speeches of this debate. It is clear that something is amiss and that we need to think about this very big organisation, with its huge difficulties. The gearing in such a large organisation and the importance of that fact that, when medical services are delivered, it is very personal—they are essentially between two people; you and some medical practitioner who has been through a long training and has the knowledge—means that it will either work as it should or will run into troubles.

In thinking about where we are, I hope that the first thing that we will consider very carefully is the relationship between the political sector—this is a nationally provided service, funded from taxation and free at the point of delivery—and the medical profession. There is no natural fit between politics and medicine. There was not at the beginning of the health service, and indeed there were compromises made at that time which we still live with. In starting a discussion, we must go back to fundamentals, and we certainly need the medical profession to stand up and be counted on how it sees the way in which the delivery of medical services should be shifted. What is the borderline between primary care and secondary or hospital-based care? What are the fundamental questions which must be asked and answered if we are to go forward?

Covid-19: Vaccine

Viscount Eccles Excerpts

Tuesday 12th January 2021 Lords Chamber

[Lord Bethell (Con)]

Who can hold a torch to Professor Spiegelhalter and his analysis of the data? Although I did not hear him, I completely welcome his comments. I reassure the noble Baroness that enormous efforts are being put into the pharmacovigilance around this vaccine. Some of this is of a clinical and scientific nature, and it takes a while to read out. We have therefore put in parallel systems to get an early read-out on exactly the kinds of questions that she has asked.

[Viscount Eccles (Con)]

My Lords, as an interest, I can report that Lady Eccles and I have both had two Pfizer jabs, three weeks apart. At the planned rate of 2 million vaccinations a week, there will be the equivalent of 1 million people being fully vaccinated, whatever the gap. There will also be a continuing critical path through this rollout, which is complex. It may start by being vaccines, which are the limiting factor, but it could become otherwise. Can we be assured by my noble friend that the NHS is fully prepared to identify and deal with the critical path? Can we also be assured that we will get clear and full information on progress, and about the actions being taken to maintain that progress?

[Lord Bethell (Con)]

I congratulate my noble friend and Lady Eccles on their double vaccinations. It is one of the most heartening experiences of a pretty dreadful year to witness the rollout of this vaccination and the joy and reassurance it brings to those who have been vaccinated. I reassure my noble friend that the NHS is absolutely putting the resources in place not only to roll out the single and second vaccinations to everyone over 18 who will step up for those but also for the pharmacovigilance to ensure that any adverse effects are recorded through the Yellow Card scheme and that those records are analysed and acted upon so that any changes or tweaks, as sometimes happen, are enacted by the NHS to get the best possible outcome for as many people as possible.

Health Protection (Coronavirus, Local COVID-19 Alert Level) (Very High) (England) Regulations 2020

Viscount Eccles Excerpts

Wednesday 14th October 2020 Lords Chamber

[Viscount Eccles (Con)]

My Lords, I fully support the local approach to this very difficult situation. We have learned a lot since the virus came and hit us. We could do with being told more about what has been learned, particularly by the front line.

We need to remember that we live in a democratic society governed by consent, and we are facing unprecedented circumstances. In these circumstances, how do we assess the Government’s response? This regulation makes some claims—that it will simplify matters for the public, contribute to controlling the virus and stopping its spread, and prevent the NHS being overwhelmed. It is quite difficult to be too confident about any of those statements, and much else. Cases lead by arithmetical progression from hospital admissions to death.

In all of this, where is the statement about the balance being struck between all the competing economic and social issues, along with the virus? We keep being told that there is a balance being struck, but we do not know what it is. Can we confidently expect to be told about this assessment, certainly in time for the four-week review of this regulation, so that we can all see how the balance is being reached and all do our own assessment of our responses to it?

Health Protection (Coronavirus, Local COVID-19 Alert Level) (Medium) (England) Regulations 2020

Viscount Eccles Excerpts

Wednesday 14th October 2020 Lords Chamber

[Viscount Eccles (Con)]

My Lords, in expressing my gratitude to my noble friend on the Front Bench, I reflect that in this very complicated situation it cannot always be easy to convey the messages that go from this House to the other end of the Corridor. Messages are coming from a multitude of directions, and we must be very grateful for my noble friend’s diligence and persistence and for the calm presentations that he makes to us in this House.

This virus is, regrettably, proving to be very efficient. What assumptions can we reasonably make? There are not many, but perhaps there are two. The first is that it will be here for a long time, and the second is that it is almost certain that it will cause excess deaths, although of course some of them, equally regrettably, will probably be due to other, more conventional reasons because of the burden laid on our institutions—notably, the NHS.

At the same time, the social, economic and financial effects are huge, and they have been discussed many times in this House. They go all the way from the national debt to the individuals who decline to self-isolate for their own reasons, some of which are very compelling.

Therefore, a balance needs to be struck, with a comprehensive approach to how we deal with the future. In approaching that, it is very welcome that the Government have made the greater involvement of local institutions—local government, the NHS and Public Health England, to which I would add charities and local groups—a part of the programme. However, at the moment it is described as “working with”, and I am not sure that that is yet an adequate way of approaching local involvement. The nearer the action, the greater the knowledge of what is happening and of the people to whom it is happening and their circumstances. Indeed, I would say that our best chance of controlling, reducing or suppressing this virus lies with individual behaviour. Knowledge of what is happening is growing all the time and people’s response to that is critical.

However, I come back to these regulations and the others that we have considered today. They all need to be reviewed in 28 days. The 28th day is 11 November—a date of some significance. I think that this House and the public need to know more about the criteria that will be applied to those reviews—the assessment that has been made and how the balance, with all the competing matters that face us, is being approached and reached. May we please have some days before 11 November to debate the matter?

Covid-19 Update

Viscount Eccles Excerpts

Monday 14th September 2020 Lords Chamber

[Viscount Eccles (Con)]

My Lords, last week I pursued the question as to whether there were precedents for using emergency powers under an old Act—this is an Act from 1984—and also whether the Government had any plans to change the procedure to one that is more like what we have come to expect over many years, so that we debate these regulations before they came into force. Many of the questions that are asked would be much sharper if the debate was before the regulations came into force. It would be better, because the future is more interesting than the past—and doubly so in these hybrid days, when debate is not as easy as it is in normal circumstances. Indeed, one reason for thinking that we should change is that there must be an impression that the Executive are riding roughshod over us, when what is actually needed is consensus—as has been indicated by the two Front-Bench speeches today—and I think that consensus is available. Will the Government have another think, decide it is better to be in front and implement some changes that will make Parliament’s job easier?

[Lord Bethell (Con)]

I thank my noble friend for his comments, but my perspective is slightly different. The fact is that this disease is incredibly aggressive and nimble; we sometimes have to turn decisions around literally within hours. I cannot think of another situation, other than war, where the decision-making has to be quite so quick. I would love to be able to bring regulations to this House for full debate in advance of their implementation, but no human institution can move at that kind of speed—it is just not possible. In answer to his question, we have no plans to switch horses at the moment. We are working as hard as we can to bring regulations here as quickly as we can, and I pay tribute to the House authorities for doing everything they can to put regulations in front of the House as quickly as they can.

Health Protection (Coronavirus, Restrictions) (England) (No. 3) Regulations 2020

Viscount Eccles Excerpts

Thursday 3rd September 2020 Lords Chamber

[Viscount Eccles (Con)]

My Lords, I will follow the thrust of the speeches made much earlier by the noble Lords, Lord Hunt of Kings Heath and Lord Scriven. In this intervention, I am questioning not the policy but its legislative implementation. In the early days when things were very hectic we could understand why the policy was being implemented in the way that it was, but now, when we know much more, it must be a matter of doubt.

The policy is being implemented under a 36 year-old Act, the Public Health (Control of Disease) Act 1984—I apologise to all noble Lords who know this story very well—including the emergency powers in that Act. The Act imposed duties upon bodies such as the Port of London, port health authorities and aerodromes controlled by the Secretary of State, and their duties were to report notifiable diseases. The powers in the Act were designed to make sure that they carried out their duties in a proper manner. There were even duties about the conditions in which people might live in canal boats.

My question to the Minister is: is there a precedent for picking a conveniently drafted set of powers and using them for a very different purpose? Will the Government, with their much greater knowledge, continue to use this, or do they intend to change the way in which they implement the legislation to give much more scope to Parliament for scrutiny and even possibly amendment?

Covid-19: Response

Viscount Eccles Excerpts

Monday 27th July 2020 Lords Chamber

[Lord Bethell [V]]

The noble Baroness is entirely right that track and trace on its own, with or without an app, is not enough to prevent a second wave. The only thing that can do that is the behaviours of the British people themselves. Commitment to hygiene, distancing and isolation is the best bulwark we have against this horrible disease. In terms of community testing, given the current level of technology, mass testing of the entire nation on a weekly basis is beyond the resources of our technology, testing capabilities and, frankly, the tolerance of the British people. However, as I said in answer to an earlier question, the technology is moving incredibly quickly. It has already moved a long way in the last few months, and I am hopeful that technologies such as—but not only—the OptiGene technology may offer new opportunities. However, they have to be validated, invested in and developed: they are not on the near-term horizon.

[Viscount Eccles (Con)]

My Lords, I am sure my noble friend is well aware of the importance of the use of language in Statements and careful use of language. Given the importance of the working relationships between national and local authorities, will my noble friend expand on the assertion that the new powers delivered last Saturday will enable local authorities to “act with more vigour”? It seems a strange phrase to me, and I would welcome some expansion on how those relationships are going.

[Lord Bethell [V]]

My Lords, the relationship with local authorities is extremely good, and I recommend that noble Lords do not believe everything they read on this subject. I completely commend those who work closely with PHE, the test and trace programme, the joint biosecurity team and all the sectoral parts of government that reach out to local authorities, DPHs and local infection teams. A very strong bond is forming, and we have a very large number of outbreaks up and down the country that you never read or hear about, and which are not celebrated either for being good or bad because that partnership works well. The intelligence and data are put into the hands of the people who need them, and the teams move quickly and effectively to deal with the outbreak. I am extremely grateful for this; a huge amount of progress has already been made, and we continue to invest in those relationships.

NHS: Mid Staffordshire NHS Foundation Trust

Viscount Eccles Excerpts

Monday 11th March 2013 Lords Chamber

[Viscount Eccles]

My Lords, it is a great pleasure to follow the noble Lord, Lord Patel. Of course, I must defer to him, as he knows far more about the National Health Service than I do. I have been a patient but do not have anything like his depth of knowledge.

There is not much that we do not know about Mid Staffs. A lot of it dates back a fair number of years. The Francis findings were amazing, and the taking and recording of the evidence was truly a wonderful job done. There was a complete failure of management. Nobody had any confidence in anybody else there. However, time has gone by and things have been done since, and I feel quite cautious about how much we should generalise out of the experience of one hospital. I think we should treat this with caution.

Much has been done since. There have been changes in the management and governors of the trust. It is well recorded that there have been significant improvements from a very bad position. Of course there is always more to be done, but that is a condition of all our lives; there is no end to continuous improvement and never will be.

This takes me to the 290 recommendations in the Francis report. I do not feel at all capable of dealing with those. As the noble Lord said, we await the Government’s response. In fact, there are rather more than 290 recommendations, if you add in the bullet points. There are some 10 bullet points within some recommendations. To me, the trust’s most important decision and most important choice is who to appoint as its chief executive, with the necessary knowledge and the team-building skills that go with that knowledge. Hospitals are complicated and continuous operations. No two patients present in the same way. Mid Staffs provides 48 distinct services.

The new chief executive has her chairman and his governors, six executive directors and four heads of clinical directorates: 10 people in executive positions. Of these 48 services, 40 are medical and the other eight finance, administration, and so on. I must be careful to point out that the trust and Mid Staffs are not exactly the same thing. The trust employs close to 3,000 employees, so the 48 services, with the 3,000 employees, are the management responsibility of the 10: the executive directors and the heads of the clinical directorates. Clearly with that number of employees and that number of services, there is a need for a detailed and well understood middle management structure. After all, there are 120 consultants, all professionally qualified and all of a certain seniority.

I will end with one example of how one needs to look at the middle management—the 800 in admin and estates—and the person within that system who is responsible for bed linen. That person needs to hold a budget, and needs to be sure that the supplies of bed linen are as they should be, that the laundry works as it should, and that the linen is available. If one looks back to the Francis report and tries to find how the reports that have been done have tackled these very detailed problems of middle management—MRI, ultrasound, X-ray, or what you will—there is not much to be found. I therefore urge us to concentrate our minds on the management, the staffing, and the leadership of individual hospitals, and not to widen our look too greatly.

Public Bodies Bill [HL]

Viscount Eccles Excerpts

Monday 28th March 2011 Lords Chamber

[Viscount Eccles]

My Lords, the first three amendments in this group are very welcome. Going right the way back to Second Reading, I remember the suggestion that Schedule 7 be dropped from the Bill being made right at that time. The dropping of Schedule 7 makes the arrangements for sunsetting a great deal easier to agree than they would have been if that schedule had stayed in. These two amendments are rather a subtle way of agreeing to a sunseting procedure, but they are none the less very welcome. I also remember that at Second Reading there was a suggestion that if this was the way that we were going and Schedule 7 were dropped, perhaps we would need Public Bodies Bill (No. 2). I am sure that my noble friends on the Front Bench and, particularly, my noble friend Lord Taylor are very pleased that he has found a way of avoiding Public Bodies Bill (No. 2), and I think we should all be very grateful for that. Finally, we have made a long journey and a lot of progress, which is extremely welcome.

[Lord Taylor of Holbeach]

I thank noble Lords for the general welcome given to these amendments. I thank those on the opposition Benches for their positive engagement on finding these solutions. For that, I am extremely grateful. I thank my noble friend Lord Goodhart for the gracious way in which he bowed to the consensus building on Amendment 72 and my noble friend Lord Eccles for the recognition he gave to the difficulties this Bill faced and for his part in overcoming those difficulties.

Public Bodies Bill [HL]

Viscount Eccles Excerpts

Wednesday 9th March 2011 Lords Chamber

Debate on whether Clause 12 should stand part of the Bill.

[Viscount Eccles]

This clause covers the procedure for orders made under Clause 11, so I imagine that it must go. It is about orders made under Clause 11(1). If Clause 11 has gone, Clause 12 must go, too.

[Lord Taylor of Holbeach]

Having just been speaking, it was quite difficult to get order into my papers, but I am there now.