Health: Tinnitus

Baroness Blackwood of North Oxford Excerpts

Wednesday 5th February 2020 Lords Chamber

[Baroness Thornton]

To ask Her Majesty’s Government what assessment they have made of the impact of tinnitus on the mental health of those affected.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, we recognise the debilitating impact that tinnitus can have on people’s lives and that for some the condition can lead to mental ill-health, including suicidal thoughts. That is why we have commissioned NICE to develop clinical guidance on the assessment and management of tinnitus. This is expected to be published in March and will help raise much-needed understanding about the condition.

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for that Answer. Given that this condition causes enormous misery and is, we are told, incurable, and given that research has shown recently what a detrimental effect it can have on the mental health of sufferers, I have two questions for the Minister. I am very happy if she needs to write to me with the answers. First, how much is the NHS spending on research into the causes and cures of tinnitus? Secondly, if there are cures—if you google tinnitus, you will see that many products out there on social media claim to cure it—have any of these been approved? Are they in the system for approval? If so, when will they be available on prescription?

[Baroness Blackwood of North Oxford]

I am happy to pay tribute to the British Tinnitus Association, which has raised the issues this week—it is Tinnitus Week—for its research. I thank the noble Baroness for her question. I will be happy to write to her on the specifics of the tinnitus treatments. Of course, tinnitus is often linked with acoustic neuroma, hearing loss and a number of other conditions, including mental ill-health. There are some treatable causes, which GPs look for, but there can be others related to mental ill-health. The cause of tinnitus is unknown; it cannot be treated. Talking therapy will be prescribed, and a lot of those treatments are already available on the NHS and on prescription. I am happy to send that information to the noble Baroness in writing.

There is obviously research available via the NIHR. We spend more than £90 million on NIHR research, and £15 million of this is spent via biomedical research centres at Manchester, UCL and Nottingham. Nottingham undertakes specific research into deafness and hearing problems, including tinnitus and hyperacusis. If the noble Baroness would like further detail, I am happy to write.

[Lord Berkeley of Knighton (CB)]

My Lords, does the Minister endorse the views of many researchers, some of whom she has just mentioned, in their warning that listening to loud music—for example, in amplification, in front of speakers at rock concerts or in ear buds—could be an explosion waiting to happen in future generations? Secondly—this may apply to some noble Lords not yet afflicted—any slight loss of hearing should be dealt with sooner rather than later, because that research has also discovered that if you do not do something about it, it can possibly lead to dementia.

[Baroness Blackwood of North Oxford]

The noble Lord is absolutely right that contact should be made with a GP regarding hearing loss as soon as possible, that links between hearing loss and dementia have been found and that it is extremely important that we increase research in this area. That is exactly why I have asked officials to get together a round table regarding hearing loss and dementia to drive up research in this area as soon as possible.

[Baroness Brinton (LD)]

My Lords, one in 30 children suffers from tinnitus. That is one child in every average-sized class, so there are a number of such children in every school. These children often say that their tinnitus sounds like a rushing train. They find it difficult to concentrate in school and often end up with problems. Some of these children will require mental health support. Can the Minister say what the current waiting time is for a CAMHS appointment for a child or young person suffering from life-changing tinnitus? It is a chronic condition. There is already a problem with the waiting list for children and young people with acute and life-threatening conditions, but what is the waiting time for these children to get in front of a doctor?

[Baroness Blackwood of North Oxford]

We are working hard to bring down waiting times across mental health, and the noble Baroness will know that we are bringing in waiting time standards. On mental health provision for those with tinnitus, she will know that we are working to bring in improved access to psychological therapies. Ninety-five per cent of those accessing such treatments and therapies are doing so within the time available. The most important issue is making sure that those therapies are available in an accessible way. Local commissioners have to pay due regard to equality legislation and make sure they provide those services either through BSL-trained therapists or interpreters locally, if necessary.

[Lord Elton (Con)]

My Lords, having suffered from tinnitus for some 30 years, I do not share the Minister’s enthusiasm for reminding people that they have it. The most effective survival technique is learning to ignore it. Mine is a mild case. If fellow sufferers turn their mind away from it regularly and as hard as they can at the beginning, it tends to become less of a curse. As to whether it affects one’s mental abilities, I leave your Lordships to form your own conclusions.

[Baroness Blackwood of North Oxford]

My noble friend has put it rather accurately. As he said, a lot of the talking therapies available for tinnitus, which has no known cause, are ways of coping with it, some of which have proven effective. On research, we need a better understanding of causes so that we can provide better treatments for a condition that, for some, can be pervasive, pernicious and hard to ignore.

Eating Disorders: Provision of Care

Baroness Blackwood of North Oxford Excerpts

Tuesday 4th February 2020 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, I thank noble Lords for their expert contributions. In particular, I thank the noble Baroness, Lady Parminter, for securing what has been a significant debate, and those noble Lords who spoke of their lived experience tonight. That is brave and an important contribution, both to inform policy and to let people outside this place know that there should be no stigma in speaking up. I wish to thank each and every noble Lord who has contributed tonight.

We know that eating disorders can be utterly devastating for the people suffering from these conditions and for those around them, including their families and friends. We know that they are not an aspect of vanity, as the noble Baroness, Lady Janke, said, but serious, life-threatening conditions with some of the highest mortality rates of any mental health disorder. They can have severe psychological, physical and social consequences—sometimes for a lifetime—and are more prevalent in young people but can occur at any time in life and in someone from any background. That is why we want to ensure that people have access to the right mental health support in the right place at the right time. We know that we have more work to do to ensure that we get there.

Improving eating disorder treatment services is a key priority for the Government; it is a vital part of our work on improving mental health services. As the noble Baroness, Lady Janke, rightly said, we know that the earlier an intervention is made and treatment provided, the greater the chance of recovery. That is why the Government set up the first standards to improve access to eating disorder services for children and young people, which will ensure that by 2020-21, 95% of children with an eating disorder will receive treatment within one week for urgent cases and within four weeks for non-urgent cases. We are on track to meet that commitment.

As raised first by the noble Baroness, Lady Parminter, and subsequently by others, in-patient treatment is also important, although we want it to be a last resort. That is why in 2014 we announced that we would invest £150 million to expand community-based care and why we are making good on that promise. It has resulted in 70 dedicated new or extended community services now either open or in development, which has led to faster access to eating disorder treatment in the community, with the number of children and young people accessing earlier treatment up from 5,234 in 2016-17 to 6,867 in 2017-18. The services are designed to give young people early access to services in their communities with properly trained teams. They include extended access to talking therapies, which, as the noble Lord, Lord Brooke, pointed out, are very important. In that way we can avoid extended hospital stays wherever possible.

Although eating disorders are commonly first experienced by people when they are young, conditions can continue into adulthood, as has been noted. Following the PHSO’s report, NHS England has convened a working group with NHS Improvement, Health Education England, the Department for Health and Social Care and other partners to address recommendations to take into account planning for improvements in adult eating disorder services.

As has been mentioned, there are currently 649 beds for treating eating disorders. We recognise that there is demand for extra beds, which is why we have developed a comprehensive activity dashboard—it is not very well named—which provides current and trend data regarding the use of in-patient services for adults with eating disorders. We shall use this to inform decisions regarding in-patient capacity requirements for local populations both in the short term and over the longer term to improve access.

In addition, for children and young people, the national accelerated bed programme for Child and Adolescent Mental Health Services is already supporting the delivery of care closer to home, and we hope that this is starting to improve the situation. Issues regarding geographical variation were raised by the noble Baronesses, Lady Murphy and Lady Thornton. We want to ensure that patients with eating disorders can receive treatment as close to home as possible. NHS England has recently created a review of NHS in-patient and community eating disorder services so that it can understand current provision, measure levels of geographic variation and allow the modelling of workforce implications to try to respond to those services.

I want to respond to the point raised by the noble Baronesses, Lady Hollins and Lady Brinton, as well as by others, regarding investment in mental health services. As I have already said, we have increased funding for eating disorder services, but we have also ensured that investment in mental health services must rise at a faster rate than in overall published funding. Each CCG must meet the mental health investment standard by which their 2018-19 investment in mental health rises, at a faster rate than the overall published programme of funding. CCG auditors will be required to validate their 2018-19 year-end position in meeting the mental health investment standard. In 2018-19, 100% of CCGs met that mental health investment standard. This is to ensure that we see an increase in the mental health investment standard, so that improvements can be made to access times, to the workforce and to all the other areas which have been referred to in the debate.

I would like to move on to the questions raised regarding access and waiting times for adult services. As the noble Baronesses, Lady Brinton and Lady Parminter, will know, we have brought in the eating disorder waiting time for children, but we are also trialling a four-week waiting time for adults and older people community mental health teams in local areas in order to understand how they should best be introduced. I understand the impatience for waiting time standards to be introduced immediately. Given the nature of our debate today, I ask for some understanding; we are building on a low base across the mental health system. We want to make sure that the waiting time standards we introduce are clinically appropriate, that the system is able to respond and that they are on track for delivery and sustained once brought in. I am happy to respond in a more detailed way subsequently if that is not a sufficient answer, but that is why we are bringing in the waiting time standards in that way.

On the question regarding transition that the noble Baroness, Lady Brinton, asked—rightly, given the questions identified across not only health but education and social care systems—two areas of the country with eating disorder services that are new care models, including West Yorkshire and Harrogate, are starting to make important progress in joining up young people’s and adults’ eating disorder services and improving the treatment and care received as close to home as possible. They are modelling services that, as we evaluate them, we hope could be rolled out in other parts of the country. I hope that answers the question of how we are trying to improve that.

On the question about workforce raised by a number of Peers—the noble Baronesses, Lady Thornton and Lady Hollins, and others—it is quite right that we recognise the need to recruit more mental health nurses and psychiatrists into the system. As was rightly said, there have historically been challenges in bringing in psychiatry trainees. We now have 300 more consultant psychiatrists than in 2010, so we are starting to make progress. We have focused on driving forward work to improve recruitment into psychiatry, working with the Royal College of Psychiatrists on its Choose Psychiatry campaign. To attract more junior doctors into psychiatry, the new junior doctor contract gives psychiatry trainees a £21,017 pay premium in addition to their normal pay. This is an additional £3,507 per annum for a typical six-year training programme. We also have additional support and similar additional payments in the nursing arena to attract nurses into specific specialties, because we recognise the need to do so.

In addition to this, questions were raised about prevalence. The important question was asked: how can we possibly make policy if we do not have up-to-date and accurate data on which to make that policy? As a data geek, I could not agree more. Therefore, while we have some useful data from the 2017 mental health of children and young people in England survey, which is helpful, we want to improve the information we have, so we have included—I am really sorry to use this acronym—the SCOFF eating disorder questionnaire in the 2019 health survey for England, due for publication in December 2020. We are working on securing a financial agreement for the next APMS in 2021. Content for the survey will be prioritised during the scoping phase, which I know will provide important prevalence data—something we want to see.

I have two final points regarding training and research funding, both of which are essential if we are to move forward. We certainly agree that mental health should be an integral part of medical education, and we thank the GMC for the work it has been doing to explain and illustrate by professional experience the principles of identification, self-management and referral of patients with mental health conditions. We are committed to providing the best training experience for all junior doctors. We will work with the GMC and relevant stakeholders to try to improve the training available. I know that the noble Baronesses, Lady Parminter and Lady Hollins, have been particularly involved in this. Perhaps we could take up this point afterwards.

When it comes to the questions of research raised in particular by the noble Lord, Lord Giddens, but also by the noble Lord, Lord Brooke, of course we need to understand these questions with much more granularity if we are to improve services, be more targeted with our policies and spend money more effectively. This year, we invested about £93.4 million in mental health research, which is up from last year. We are committed to having mental health research as a priority area. In particular, I was always very proud that the only biomedical research centre that focused on mental health was at Oxford Health. I was very proud to have opened that as the previous Mental Health Minister.

I am not aware of the specific research paper that the noble Lord, Lord Giddens, raised, but I am very happy to look it up after this debate and come back to him on it. When it comes to what I think he referred to as the ecological relationship between obesity and eating disorders, as a department we definitely consider that we must work very hard on making sure our prevention agenda works holistically across the entire addiction panoply. Indeed, we will be taking forward the prevention Green Paper in a way that ensures joined-up policy, not only in the department, but across government. I am very happy to follow up on the question regarding the 12-step approach.

I think I have touched on the majority of the commitments in the long-term plan, so I will not go into details because I have come to the end of my time, but I conclude by thanking all Members who contributed, in particular the noble Baroness, Lady Parminter. I hope I have reassured noble Lords about the Government’s commitment to improving eating disorder services, that we recognise the devastating impact of eating disorders and that we want to ensure that all those with eating disorders can access high-quality and vital mental health support much earlier, because we understand the impact this can have.

House adjourned at 8 pm.

Paterson Inquiry

Baroness Blackwood of North Oxford Excerpts

Tuesday 4th February 2020 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, with permission, I will now repeat a Statement made by my honourable friend the Minister for Mental Health, Suicide Prevention and Patient Safety regarding the Paterson inquiry. The Statement is as follows:

“This morning, the independent inquiry into the issues raised by the disgraced surgeon Ian Paterson published its report. The inquiry was tasked with reviewing the circumstances surrounding the jailed surgeon’s malpractice that affected so many patients in the most appalling way. As the report states, between 1997 and 2011, Paterson saw 6,617 patients, of whom 4,077 underwent a surgical procedure in the independent sector; and between 1998 and 2011, Paterson saw 4,424 patients at HEFT, of whom 1,207 underwent a mastectomy.

The report contains a shocking and sobering analysis of the circumstances surrounding Ian Paterson’s malpractice. It sets out the failures in the NHS, the independent sector and the regulatory and indemnity systems. As a result of these failures, patients suffered unnecessary harm. Their testimonies in the report make harrowing and appalling reading and, as such, it is with deep regret that we acknowledge the failure of the entire healthcare system to protect patients from Ian Paterson’s malpractice and to remedy the harms.

Nothing that I say today can lessen the horrendous suffering that patients and their families experienced and continue to go through. I can only start to imagine the sense of violation and betrayal of patients who put their trust in Ian Paterson when they were at their most vulnerable. That the inquiry reports today, World Cancer Day, makes this all the more poignant, and I apologise on behalf of the Government and the NHS for what happened, not least that Ian Paterson was able to practise unchecked for so long.

I would also like to pay tribute to the bravery of all those former patients who came forward to tell their stories to the inquiry and whose anonymised accounts have been recorded in the report. I know that this will make for difficult reading, as it highlights the human cost of our failure to detect and put a stop to Ian Paterson’s malpractice. A catalogue of failings resulted in harm to thousands of patients, causing devastation to countless lives. Some of these patients were let down several times, not least by the providers and the regulatory system that should have protected them, and by the failure of the medical indemnity system to provide any kind of redress at the first time of asking.

From the outset, Bishop Graham wanted patients and their families to be central to the inquiry’s work and to be heard. It was right, therefore, that patients and their families saw the report first—early this morning, shortly before it was presented to Parliament. Two aspects of the report are particularly striking: that the various regulatory bodies failed in their main tasks; and the absence of curiosity on the part of those in positions of authority in the healthcare providers, in the face of concerns voiced by other health professionals.

The report presents a tangled set of processes. Accountability was not exercised when it should have been, and some of the problems arose from not following through on established procedures, as opposed to insufficient procedures being in place, so we must take full responsibility for what happened in the past if we are to provide reassurance to patients about their protection in the future. I am therefore grateful that the suite of recommendations based on the patient journey presents a route map to government. The recommendations are extremely sensible and we will study them in detail; I can promise the House a full response in a few months’ time. That response will need to consider the answers to some very important questions that cut right across the healthcare sector. Unequivocally, regardless of where patients are treated and how their care is funded, all patients should be confident that the care they receive is safe and meets the highest standards, with appropriate protections, and that they are supported by clinicians to make informed decisions about the most appropriate course of care.

I am also very aware that it is not the first time that regulatory failure has been highlighted in an inquiry report. We have done much to make the NHS a safer system in recent years: revalidation, a reformed CQC and the work by the Independent Healthcare Providers Network to establish a medical practitioners assurance framework to oversee medical practitioners in the independent acute sector. However, in the case of Ian Paterson, the system did not work for patients and recent events at Spire show that there are still serious problems to address.

Patient safety is a continual process of vigilance and improvement. The inquiry does not jump to a demand for the NHS and the independent sector to invent multiple new processes, but to actually get the basics right, to implement existing processes and for all professional people to behave better and to take responsibility.

Last summer, NHSE/I published a new patient safety strategy, led by the national patient safety director, Dr Aidan Fowler. It focused on better culture, systems and regulation—very sensible but familiar words; all things that today’s inquiry says were not delivered. What we need now is action across the NHS and its regulatory bodies, and the same determination to change the independent sector.

We are absolutely committed to ensuring that lessons are learned and acted on from the findings of this shocking inquiry, in the interests of enhancing patient protection and safety in both the NHS and the independent sector. For today, I apologise again on behalf of the Government and the NHS, and send my heartfelt sympathy to the patients and their families for the suffering they have endured.”

--- Later in debate ---

[Baroness Brinton (LD)]

My Lords, I echo the points just made about the speed of the Government’s reporting. It is extremely helpful that the Minister in another place apologised clearly for the failures in the system and paid tribute to the victims. I too pay tribute to them and their families for their tenacity over many years, when it was clear that something was going wrong but the people who were in a position to gather information and do something chose not to.

The Statement says:

“I can promise the House a full response in a few months’ time.”


This public inquiry has rightly taken two years—it was slightly delayed by the general election and purdah—but it was clear in 2017 what many of the issues were. The excellent report from the Centre for Health and the Public Interest published in November 2017 entitled No Safety Without Liability: Reforming Private Hospitals in England after the Ian Paterson Scandal set out in a slightly different format many of the recommendations in front of us. I am sure that the Department of Health, the NHS and the independent hospitals will have looked at those recommendations.

I ask the Minister right up front: how long will it take before recommendations come back to the House from the Government on where they want to take things? After all, we have a Bill that is almost ready to go—or perhaps, as I said yesterday on the Second Reading of the Birmingham Commonwealth Games Bill, Groundhog Day is coming around again for us. Let us use that opportunity, at the very least, to remedy the obvious shortfalls in the system.

One of our major concerns is regulation of indemnity procedures for healthcare. There are serious shortcomings that must be dealt with as soon as possible. I was extremely concerned to read in the recommendations about the arrangements private hospitals have with clinicians to carry out their own activities that are rather like self-employed contractors almost renting an out-patient desk and in-patient beds. That is similar to renting a barber’s seat but without the overseeing regulations you need when people’s lives and health are absolutely at risk. That must be managed immediately.

Independent hospitals must take responsibility for their actions, so it is good that one of the key recommendations tries to focus minds on filling the gap between responsibility and liability. The report from CHPI two years ago said that this was vital and that independent hospitals must employ doctors and healthcare professionals, because without that responsibility on their behalf they will continue to wriggle out of liabilities and choose not to monitor clinical practice, missing either ill-meaning or incompetent surgeons. That cannot happen in the NHS and trusts have to take responsibility, as they do when things come to light. This hole in the current system needs to be remedied swiftly.

The inquiry also makes the important point that boards must apologise meaningfully and as early as possible. The UK health system, whether NHS or independent, has an extremely poor record of apologising, or of even commenting at all. Worse, it often tries to bury problems, denying whistleblowers any access. I am afraid that this is part of the systematic culture exposed in this very important inquiry—one that fears liability above apology and, equally importantly, does not learn well from mistakes, especially if through malpractice.

It is shocking that patients were often not guided to the Parliamentary and Health Service Ombudsman or the Independent Sector Complaints Adjudication Service. Compare that with the Financial Ombudsman Service: financial services companies must signpost access to the ombudsman at every step of the way when people buy financial products. A financial service problem could result in a loss of money, but a medical problem could end up changing lives for ever, as in the Paterson cases, so when will the Government deal with this issue? Will there be compulsory signposting for patients and clarity over whether all independent hospitals have to sign up to an independent complaints adjudicator—preferably just one, but I understood from what the Minister said in another place that they cannot regulate the independent sector completely? Frankly, as far as healthcare is concerned, my party believes we should.

Once again, the Paterson case demonstrates the need for effective whistleblowing processes. Will the Government commit to an office of the whistleblower to, through legislation, give more protection to patients, whether they are in the NHS or the independent sector? Spire Healthcare has said that it has put more measures in place to encourage staff and patients to speak out since the Paterson case, but even the Statement refers to there still being problems in Spire Healthcare. This just demonstrates that this is not working. Paterson’s victims are very clear: we need a system within the NHS that protects patients and staff. That is equally true of the independent sector.

I end by repeating my initial question: can we please have a timetable for the Government to come back to Parliament with proposed changes, given that a Bill is waiting that could easily be amended for both Houses to attend to speedily?

[Baroness Blackwood of North Oxford]

My Lords, I thank the noble Baronesses for those very important questions on this very serious inquiry. I will try to respond to as many as I can in detail, bearing in mind that the Government are carefully considering the recommendations on an issue that deserves serious consideration.

I will reply first to the question on the Government’s responsibility for the independent sector. As I stated, patients in England have a right to safe and proper healthcare regardless of where it is provided and how it is funded. We are committed to ensuring that public and private sector providers adopt proper measures for protection of their patients, as was rightly raised by the noble Baroness, Lady Brinton. As she said, following a CQC report on acute care in the independent sector, my right honourable friend Jeremy Hunt wrote to the NHS Partners Network and chief executives, seeking their co-operation on a range of safety and quality issues, which will be followed up. Further, the independent sector has published a medical practitioner framework requiring consultants’ practising privilege to be reviewed regularly. Furthermore, the regulatory system has evolved since Paterson was practising, with fundamental standards of care, intelligence-led inspections and greater scrutiny of clinical governance as part of the well-led domain. However, this report is a rightful challenge to us to take a more strategic approach, and to regulate smarter and not harder when problems arise so that we can make sure these issues do not arise.

I would like in particular to pick up on the point made by the noble Baroness, Lady Brinton, that it is vital that the NHS has excellent directors to ensure that it can deliver the right standard of care. The Government have accepted in principle recommendations 1 and 2 of the Kark review,

“to develop specified standards of competence that all directors who sit on the board of any health-providing organisation should meet, and to create a central database of directors.”

The noble Baroness, Lady Harding, the chair of NHS Improvement, is taking this work forward as part of the people plan. This should also improve the standards available.

I must make the point that Paterson is in jail. This demonstrates that action has been taken. We have moved further from where we were. The GMC introduced revalidation in 2012 and the CQC started inspecting the independent sector in 2014. However, we will never be complacent because we recognise that there is much more to do, as the report makes clear. The staff and clinicians need to be more open, as has been stated. That is one reason why we introduced the 500 “freedom to speak up” guardians in 2015. When we speak to people, we know earlier where there are problems. As the inquiry says, we need better systems. I will go back to the national guardian, Henrietta Hughes, to ensure that she is as supported as possible in making these systems work effectively.

Regarding indemnity products, we understand how important it is, not only that patients are able to obtain compensation but that the process for assessing that compensation is easy to understand. We are considering this carefully as part of the response, and whether regulation is an appropriate means of addressing concerns about the indemnity cover of health professionals not covered by a state-backed scheme. This includes the consideration of clarity for patients seeking redress. I hope this reassures the noble Baroness.

There are widespread considerations about how cosmetic procedures not currently covered by the CQC are regulated. I hope I have answered most of the questions. We also recognise that while ISCAS is a second line of complaints system for independent patients, it may not be working for PPUs in the NHS. We will be considering that as part of our response. As for the timeframe for that response, we are looking at a three-month window, but want to ensure that we respond appropriately, carefully taking into account the points raised. As pointed out by the noble Baronesses, there are some quite knotty questions to take into account, which may require regulatory or even legislative responses. We must ensure that we get that right and respond in an appropriate timeframe.

The one further point to put into the mix is that it is still appropriate to take into account that there are many good-quality care providers in the private sector, so NHS commissioning through those providers is still appropriate. We must ensure that the regulatory system works in an appropriate manner and that, where there are concerns, people feel free to speak up and action is taken to protect any patients who may be at risk.

[Lord Ribeiro (Con)]

My Lords, as a past president of the Royal College of Surgeons, I wish to associate myself with the comments of the current president, Professor Derek Alderson. In response to the report, he said:

“The horrific experience of patients at Paterson’s hands is laid bare in today’s report. The healthcare system has failed hundreds of patients and their families, and we must learn from what went wrong. Following their thorough investigation, we welcome the inquiry’s recommendations today, designed to improve patient safety.


We have repeatedly called for the same safety standards to be enforced across both the NHS and private healthcare sector. The inquiry has also stressed this and agreed with our recommendation that a single repository of information about consultants’ practice should be created. We recommended this in our evidence to the inquiry because it allows the NHS and private sector to share information and raise any concerns about patient safety much more quickly.”


When the Bill comes before us, we will be discussing the health service safety investigation body—HSSIB. Can the Minister say whether, in the light of the Paterson inquiry, the Bill might be amended to ensure that HSSIB has the power to investigate all patient safety incidents that occur in the independent private sector as well as in the NHS, not just NHS patients referred to the private sector?

In his introduction, Bishop Graham says:

“It is wishful thinking that this could not happen again.”


Well, this week the British Medical Journal reports on an orthopaedic shoulder surgeon working in the same Spire Parkway Hospital who has had 217 patients recalled because of concerns about his practice. A solicitor for the patients involved said:

“The main concern seems to be that people were having unnecessary surgery under general anaesthetic.”


There are echoes of Paterson’s behaviour. Another recall at the same hospital suggests systemic failings. Given the outcome of the Paterson inquiry, which showed that lessons have still to be learned, how can we ensure that these lessons are learned?

[Baroness Blackwood of North Oxford]

I thank my noble friend for that question, and for his important contribution. He is of course very experienced in this area. Obviously we are looking for time in the legislative agenda to bring forward HSSIB. It is appropriate that we consider the patient safety elements of this report’s recommendations in the context of that Bill. In the previous Second Reading debate, which we look forward to repeating, we discussed the issues around the independent sector. But we will also separately, and perhaps in conjunction with that, consult on the key changes necessary to enable data on admitted patient care to be transferred from the Private Healthcare Information Network and independent providers directly to NHS Digital, which should start to take us in the direction of closing the gap, which I know that many noble Lords in the House are rightly concerned about.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I declare an interest as a board member of the GMC. I also chaired the Heart of England Foundation Trust from 2011 to 2014. Mr Paterson worked for the trust as well as in the private sector hospital that the Minister mentioned. I would like to add my personal apology to that of the Minister to the patients and families for the suffering that they endured. Mr Paterson was suspended shortly after I became chairman and we instituted Sir Ian Kennedy’s review. We now have a second inquiry and I pay tribute to Bishop Graham for his work. I have only had the chance to read the Statement quickly, but it seems a thorough piece of work and has many far-reaching lessons and recommendations for the health service.

I have a couple of suggestions for the Minister. First, one of the recommendations is around the way that regulators work together, or not. At the moment, legislation is rather out of date and sometimes gets in the way of collaborative working, although one should never use that as an excuse. As part of the legislative review, I wondered whether the need for reform of the whole regulatory system will be kept closely under review.

Secondly, I want to follow the Minister on this issue of NHS bodies being reluctant to own up to things that have gone wrong because of the potential legal liability. I have discussed this with bodies at the national level and they all say that that is nonsense and organisations should not fear apologising, but it is heavily in the culture of the NHS not to apologise because of potential liability. As part of the consideration of these recommendations, I suggest that the Government seriously look at giving an explicit statement to the NHS on the facts of this and encourage those working in the NHS always to be open about things that have gone wrong.

[Baroness Blackwood of North Oxford]

I thank the noble Lord for that important and knowledgeable contribution. His point about the sharing of lessons between regulators was well made. Part of the reason for proposing HSSIB is for systemic learning of lessons that might otherwise not be available because an inquiry might happen in one trust or group of trusts and lessons might not transfer across the entire system. The whole principle of HSSIB is cross-system learning. We already have evidence that that is working.

Furthermore, the principles at the heart of the patient safety agenda that my right honourable friend Jeremy Hunt put in place were to embed a culture of learning and not blame within the NHS so that apologies can be forthcoming. We have some way to go in achieving that change of culture, but the noble Lord is quite right that leadership starts from the top and having the right statements is a good start. The principles around the place of safety, the protection of whistleblowers and allowing people to come forward and say when they think that things are going wrong without fear of retribution are steps in the right direction. The right action after that is transparency and the recommendations in this report about transparency lead to the right actions being taken from that point.

Coronavirus

Baroness Blackwood of North Oxford Excerpts

Monday 3rd February 2020 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, with permission, I will now repeat a Statement made by my right honourable friend the Health Secretary regarding the ongoing situation with the Wuhan coronavirus:

“On Friday, the Chief Medical Officer announced that two patients in England who are members of the same family tested positive for coronavirus. They were transferred to a specialist unit in Newcastle, where they are being cared for by expert staff. Public Health England is now contacting people who had close contact with these two confirmed cases. Close contacts will be given health advice about symptoms and emergency contact details to use, should they become unwell in the next 14 days. These tried and tested methods of infection control will ensure that we minimise the risk to the public.

On Friday, a Foreign Office-chartered aircraft carrying 83 British nationals left Wuhan for the United Kingdom, and I thank all those involved in this operation, including staff at my own department, the Foreign Office, Border Force, the Ministry of Defence and military medics, as well as all the NHS staff, officials at Public Health England and many more who have worked 24/7 on our response so far.

Yesterday, we brought back a further 11 people via France, and returned UK nationals have been transferred to off-site accommodation within the NHS at Arrowe Park Hospital on the Wirral, where they will spend 14 days in supported quarantine as a precautionary measure. I thank all the staff there who have done so much to make this possible. There, they will have access to a specialist medical team who will regularly assess their symptoms. In addition, one British national has been taken to a separate NHS facility for testing.

We will take a belt-and-braces approach that puts public protection as the absolute top priority for a virus that is increasingly spreading across the world. As of today, there are more than 17,000 diagnosed cases in mainland China, with a further 185 in other countries, including France, Germany and the United States. There have been 362 fatalities so far. The World Health Organization has now declared the situation a public health emergency of international concern, and the UK Chief Medical Officers have raised the risk in the UK from low to moderate. We are working closely with the WHO and international partners to ensure that we are ready for all eventualities.

Health Ministers from G7 countries spoke this afternoon, and we agreed to co-ordinate our evidence and response wherever possible. The number of cases is currently doubling around every five days, and it is clear that the virus will be with us for at least some months to come; this is a marathon, not a sprint. On existing evidence, most cases are mild and most people recover. Nevertheless, anyone who has travelled from Wuhan or Hubei province in the last 14 days should immediately contact NHS 111 to inform it of recent travel, and should stay indoors and avoid contact with other people, just as they would with flu, even if there are no symptoms. Anyone who has travelled to the UK from mainland China in the last 14 days and is experiencing a cough, fever or shortness of breath should self-isolate and call NHS 111, even if symptoms are mild.

We will do all we can to tackle this virus. We are one of the first countries in the world to develop a new test for the virus. Testing worldwide is being done on equipment designed right here in the UK, in Oxford, and today I am making £20 million available to the Coalition for Epidemic Preparedness Innovations to speed up development of a vaccine. I can also announce that Public Health England has sequenced the viral genome from the first two positive cases in the UK and is today making that sequence available to the scientific community. Its findings suggest that the virus has not evolved in the last month. We have also launched a public information campaign, setting out how every member of the public, including Members of this House, can help by taking simple steps to minimise the risk to themselves and their families: washing hands and using tissues when they sneeze, just as they would with flu. That goes for all of us.

We remain vigilant and determined to tackle this virus, with well-developed plans in place. I commend this Statement to the House.”

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[Baroness Brinton (LD)]

I echo the thanks to medics, staff involved in logistics and especially the scientists working so rapidly to sequence the genome of the coronavirus. I support many of the points made by the noble Baroness, Lady Wheeler.

Our concerns are more about some of the very practical arrangements and the fact that the UK seems to be responding 24 or 48 hours behind some other countries. I note the Statement says that

“anyone who has travelled from Wuhan or Hubei province in the last 14 days should immediately contact NHS 111 to inform it of recent travel.”

It also says:

“Anyone who has travelled to the UK from mainland China in the past 14 days and is experiencing a cough, fever or shortness of breath should self-isolate”.


It is interesting that the Philippines, New Zealand, the USA, Singapore and Australia are now barring all foreign nationals from mainland China from entering their countries at all. I know that the World Health Organization is not yet saying that we should follow that, but I noticed that a report at the weekend said that about 340-odd people had come in from Wuhan just before the arrangements were put in place and that the Department of Health was now trying to track these people. Given that we now know that the disease can infect people prior to symptoms emerging, has the Department of Health been able to identify those people who arrived prior to the Government’s arrangements being put in place? Do the Government now have absolutely clear procedures to identify people coming not just from Wuhan and Hubei province but from mainland China so that they can contact them urgently if there are issues? Is everyone travelling in from China getting specific advice about who to contact and what to do?

Finally, what are the numbers of cases in regions outside Hubei? The press is reporting that at least 24 provinces, municipalities and regions in China have now told businesses not to resume work before 10 February at the very earliest. These account for 90% of exports from China. Given that many of our businesses rely on just-in-time manufacturing, I wondered whether the Government were assessing what the impact on our businesses would be if there was a gap in production and exports from China.

[Baroness Blackwood of North Oxford]

I thank the noble Baronesses for their comments and very relevant questions. The UK is of course very well prepared for these types of outbreaks. We have responded extremely well on previous occasions, so we should have confidence not only in the capability of Public Health England and the NHS to respond, but in the ability of our chief medical officers to assess the level of risk, which speaks to the point the noble Baroness, Lady Brinton, made about the pace and types of responses being put in place. This is clear medical advice based on the evidence and data available.

The advice available for travellers is obviously being kept under constant review and it has changed. Currently, there is advice against all travel to Hubei province and all but essential travel to mainland China. Essential monitoring has been put in place for all incoming flights from Hubei province, and for wider travel too. Public health officials are meeting all those flights and advice is being given as outlined in the Statement.

Rightly, a question was raised about the risk to the health workers who respond, as this is a virus that is spread by contact. Obviously, this speaks to the capabilities of NHS expert teams, who are accustomed to responding to any risk. As well as the expertise they already have, advice is being communicated from the CMO and others. The NHS expert teams are with every ambulance service and are in a number of specialist hospital units, where equipment and highly trained staff are ready to receive and care for patients with any highly infectious diseases. We have also provided an extra service on NHS 111, for public health advisers to triage people with specific queries or symptoms who have travelled from the region, so that they get to the right point. I hope that answers the question.

On the question of information to NHS staff across the system, a tripartite letter has been issued by the CMO, the NHS medical director and the director for the National Infection Service and PHE to all front-line clinical staff, so that they are aware how to respond and what steps to take when encountering patients arrived from overseas with respiratory infections. This was updated on 31 January in the light of the WHO’s declaration of PHEIC. I think we can be reassured on that point.

It is absolutely right that the evidence shows that the mortality rate of between 2% and 3% is mostly for older patients and those with pre-existing conditions. That is part of the data and the evidence which has been given to the NHS so that it knows how to provide appropriate care.

I would like to respond to the questions raised regarding the care provided for the confirmed cases. Public Health England is making good progress in identifying and contacting anyone who has been in close contact with those two confirmed cases. Thorough investigations will continue, to ensure that we take all possible actions to identify anyone who has come into close contact with them. They will be given health advice about symptoms, and emergency contact details to use if they become unwell within the 14 days. This is based on the CMO’s advice about tried and tested methods. Additionally, we are pursuing wider contact tracing across the country for all who have come in from Wuhan. We are confident in the progress that we are making.

Finally, I turn to the questions regarding vaccines. As I noted in the Statement, the Government have pledged £20 million to develop new vaccines to help to combat the world’s deadliest diseases. This will support work developing new vaccines for epidemics and includes three new programmes to develop vaccines against novel coronavirus. The project aims to advance vaccine candidates into clinical testing as quickly as possible. I cannot give an exact timeline to the noble Baroness today, but I shall endeavour to get her as much information as possible. I am sure that we shall have more discussion on these issues as we go through this, but I hope that I have answered her main questions. If I have missed anything, I will be very happy to write.

[Lord Birt (CB)]

My Lords, the Minister said that we were well prepared for this outbreak, but quite honestly it does not altogether appear so. We saw reports in the media of the first flights arriving from Wuhan. The passengers reported that there was no medical intervention and no advice offered of the kind that is in the Minister’s Statement. We are now asking people who have arrived in the last 14 days to contact the NHS immediately to inform them of recent travel, to stay indoors and to avoid contact. That advice was not offered to the first people who arrived. The delayed FCO chartered flight this week has quarantined people for 14 days, as we all know. These actions appear inconsistent. Can the Minister assure us that they are consistent and that there is some coherence and rationale behind them? There does not appear to be.

[Baroness Blackwood of North Oxford]

There is indeed. The first Urgent Question I replied to a few days ago was when we introduced the enhanced monitoring on planes, meeting each flight coming into Heathrow from Wuhan; they come in three times a week. That information and advice was given to individuals on those flights and public health officials met them from that day. If individuals came in before that day, they would not have received advice; contact tracing has been under way for those people. Subsequently, British nationals wishing to return home have been in contact with the Foreign Office and flights have been arranged to bring them home. I think that is the flight which the noble Lord is referring to. As a precautionary measure, quarantine has been arranged for those individuals for 14 days, to ensure that we manage any potential risk as effectively as possible. This is based on the advice of the Chief Medical Officer, from the data which has subsequently become available, since evidence is evolving regarding the risks associated with the Wuhan coronavirus.

[Lord Lea of Crondall (Non-Afl)]

It may seem rather indelicate at this stage to talk about the wider economic impact within China and on Chinese trade with the rest of the world, but, as was mentioned in Questions earlier, might it be useful if that dimension was included in future reports? A lot of businesspeople will be putting off trips and so on. There may need to be new lines of credit, especially at the present juncture. Of course, in China everything is coming to a halt in terms of internal transport and so forth. To show our interest in what we might call the economic and social developments in China, would it be useful to have some reporting on how the rest of the world is dealing with all these other non-medical dimensions? I think the Chinese and a lot of our businesspeople would appreciate that so that we do not jump the gun. People will be desperate to get back to business, which is not yet timely.

[Baroness Blackwood of North Oxford]

The noble Lord will not be surprised to hear that it is important to put the public health response first and foremost when it comes to a risk of this kind, and that is exactly what is happening in this case. The actions that the UK has taken in this regard have been appropriate, proportionate and commensurate with the data and evidence that have come forward, and they are based on clinical evidence. Having said that, he is absolutely right that an economic impact as a result of quarantine measures taken by China and others cannot be avoided, and it is right that we should consider the impact for UK businesses. I am sure that consideration will be given to what can be done about that.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister define what she means by mainland China? I asked a question about Hong Kong last week and I note from the Foreign Office website that the Hong Kong Government have announced that all border crossings with mainline China will close at midnight tonight, Hong Kong time, which is an excellent idea in terms of containment. I am also aware that people who work for international companies in Hong Kong have been told to work from home for a minimum of two weeks from last Friday—three days ago. What will we do about people coming to our borders from Hong Kong in the immediate future?

[Baroness Blackwood of North Oxford]

The noble Baroness asked that question last time and I did not forget. At the moment, Foreign Office travel advice is that anyone who has travelled to the UK from anywhere in China other than Wuhan or Hubei province, but not including Macau and Hong Kong, in the past 14 days and has developed symptoms should immediately self-isolate, even if symptoms are minor, and call NHS 111. Macau and Hong Kong are not included because those territories do not have evidence of sustained community transmission, as has been observed in mainland China, to date. They are therefore not currently included in the same travel advice as mainland China. However, the epidemiological situation in Hong Kong and Macau, as indeed in the rest of the region, is kept under constant review and will be considered in travel advice as we go forward, and reported to this House accordingly.

[Baroness Finlay of Llandaff (CB)]

My Lords, I am most grateful, as is everybody, to the Minister for updating us. She spoke about person-to-person transmission not having occurred in Hong Kong and those other areas. Will she confirm that to date there has been no evidence of person-to-person transmission outside China? That is, it has come from contact within China and people who have the virus leaving China. Do we have that information?

Also, in modelling for the worst-case scenario that might occur, how many negative pressure room beds do we have across the whole of the UK for those patients who develop severe acute respiratory infection and therefore have to be hospitalised and possibly ventilated in the event of this becoming severe? What evidence is there about the length of time that the virus survives on different surfaces outside the body? Because of the incubation and asymptomatic periods, when it appears that people are still infectious, there is a concern that the virus has quite a long survival time on surfaces, particularly those that may be warm and damp.

[Baroness Blackwood of North Oxford]

There were a few questions there. With regard to transmission, this is an evolving picture, so the best thing would be for me to send the most up-to-date information to the noble Baroness and put a copy in the Library, as I am sure it will be of interest to the whole House.

On ECMO beds, since April 2013, NHS England has commissioned a total of 15 adult respiratory ECMO beds from five providers in England. There is further provision in Scotland. But in periods of high demand, the capacity can be increased. For example, in the winter of 2018-19, when there was a significant risk associated with flu, the capacity was increased to over 30 beds and similar arrangements are in place for paediatric services. In addition, there are eight commissioned high-consequence infectious disease beds and around 500 infectious disease beds, and at the moment NHS England is confident that it has enough capacity, which I hope is reassuring for the noble Baroness. Obviously, we are keeping that under constant review as the situation evolves.

On the question about surfaces, that is one of the specific reasons why advice has been given regarding personal hygiene—washing hands and using tissues when sneezing—to avoid any forms of transmission that may create the kind of risks referred to by the noble Baroness.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, when the Minister repeated the Statement, she referred to the precautionary measures that people are being invited to remember when trying not to pass on infection. If I recall, the Statement said something to the effect of “as you would normally do with flu”. But does the Minister agree that that is not what people normally do with flu? People often do not take the symptoms seriously and transmit it before they have even decided to give into it themselves. I have one germane example in this context. A member of my family contracted flu a couple of months ago which became pneumonia, although fortunately not a serious case. He was advised to go to his GP and the GP referred him to A&E where he waited a long time with a lot of other people in what was clearly a highly infectious state.

Given the stringency of the measures taken to contain coronavirus, can the Minister say what wider public health lessons we might take from this in giving consistent messages to prevent people imagining that flu is a minor illness and it does not matter if you continue going to work or pass it on to other people? It does matter, and the mortality rate among vulnerable groups with flu can be quite high, as the Minister will know.

[Baroness Blackwood of North Oxford]

The noble Baroness has rightly raised this issue with me before. She is quite right that flu can and should be managed much more effectively in the community and by individuals. I think we have had an effective flu campaign this year. The flu vaccine has been offered to 25 million people. We have also extended the flu programme this year to children in year 6 to improve herd immunity and drive up its impact. We are seeing the number of those with flu declining, so we are starting to see some improvement. However, I completely recognise the noble Baroness’s point about public health lessons and improving public education on the management of infectious conditions, which we live with every winter, not just when we have an infectious situation such as this. I thank the noble Baroness for an important question.

[Lord Patel (CB)]

My Lords, in my view the measures the Government have taken are balanced so as not to cause a panic and unnecessary alarm. The important thing, though, is that the Government remain on top of developments. If the virus mutates and spreads rapidly from human to human, it will require much more draconian measures to be taken.

It has been reported that the virus transmits from human to human and to people who have not been in China, although the numbers are small. An index or measure of human-to-human transfer is known as R0. It currently stands at about 1 to 2. If it increases, that means the virus is spreading faster. Sequencing of all the known cases so far suggests that the virus has not mutated. It remains 99.98% the same sequence, including in the two patients known in the United Kingdom. I hope the Government have a strategy in place to keep on top of developments and that they will take the steps required to stop the spread.

[Baroness Blackwood of North Oxford]

I thank the noble Lord. He is right that there is a global effort to keep on top of the sequencing of the virus to track any evolution of it. As he said, the indications are that the virus has not evolved in the past month, which is encouraging. The rate of transmission is as reported. That means that the infection control measures in place, which are based on clinical evidence and the data, are proportionate and appropriate. Combined with the public health advice that has come out and the contributions each of us can make as individuals to manage the spread of infection, we believe that this is the responsible and appropriate route. However, as the noble Lord said, we will keep the developing situation under a close eye so that we can respond quickly and nimbly as the situation goes forward.

Wuhan Novel Coronavirus: UK Citizens

Baroness Blackwood of North Oxford Excerpts

Thursday 30th January 2020 Lords Chamber

[Viscount Waverley]

To ask Her Majesty’s Government what measures are in place to contain the Wuhan novel coronavirus (WN-CoV) in the United Kingdom and what plans are in place from British citizens returning from the China and other affected areas.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the NHS is always ready to provide world-class care to patients, whether they have a common illness or an infectious disease never seen here before. As a precaution, we are asking anyone in the UK who has returned from Wuhan in the last 14 days to self-isolate. The FCO is working to make available an option for British nationals to leave Hubei province.

[Viscount Waverley (CB)]

My Lords, I thank the Minister for her response and for attending the House at short notice. It is essential that the Government be robust in their messaging and that remedial actions be taken to reduce the possibility of fear through ignorance. They should consider all eventualities, including whether, in the extreme, core elements of government should be placed in lockdown. Would the Minister study and consider replicating the helpful advice that came out of the Canadian ministry of health regarding what citizenry should do in all circumstances, with dos and don’ts?

[Baroness Blackwood of North Oxford]

I am very happy to look at the advisory from the Canadian Government. I hold in high regard the CMO from that nation, whom I have met. The action that this Government have taken in putting in place enhanced measures at ports and giving advice to nationals has been proportionate but robust. So far, we can be pleased that all of the 131 cases tested for in the UK have been negative.

[Baroness Wheeler (Lab)]

My Lords, I underline the support from these Benches for the plans for organised quarantine. Both the medical evidence on the incubation period and the limited evidence of spread from people not yet showing symptoms highlight the need for this. Keeping evacuated people together is important. We also strongly support the recognition by government that dealing with this is a top priority, and give our praise and thanks to the medical, public health and NHS staff who are working hard to ensure that preparations are in place in the UK.

Can the Minister explain a little more about the evacuation arrangements and what discussions have taken place? What discussions has the UK had with the World Health Organization on difficulties with evacuation? Can the Minister advise what action the Government are taking to ensure the safety and welfare of British nationals stranded in Wuhan due to the delay in evacuation if they are unable to board a flight as they display symptoms of the virus? Those who make it on board will have to sign contracts agreeing to the 14-day quarantine at an NHS facility on their return to make sure that they do not have symptoms of the virus. What staffing resources will be available to carry out quarantine and screening procedures? What happens if various people refuse to sign the contract? Clearly, these teams will be of great importance in preventing the spread of the virus to the UK. I look forward to the Minister’s response.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her extensive questions. We are doing everything we can to get British people in Wuhan safely back to the UK. A number of countries’ flights have been unable to take off as planned. We will continue working urgently to organise the flight to the UK as soon as possible. We are working with British nationals who wish to leave and we are developing a package for them once they arrive. The plane will have medical staff on board to assess and manage the passengers; obviously, this is on the direct advice of and with support from our Chief Medical Officer, who has specific expertise in this area. A team from Public Health England and the NHS will meet passengers, and any passengers who have developed symptoms will be assessed and transferred to NHS care, as appropriate. Asymptomatic passengers will be transferred to an isolation centre; we do not want to provide details on that at this stage. We are working with the Chinese authorities to unlock the issues to allow the plane to take off.

[Baroness Manzoor (Con)]

My Lords, more than 120,000 Chinese students study in the UK. Can my noble friend the Minister say what support and advice the Government are giving to both students and universities?

[Baroness Blackwood of North Oxford]

Public Health England is doing a superb job in providing very clear advice for all those who may be concerned—either those who have relatives in China or those who feel as though they have been exposed. I encourage anybody with concerns to look to Public Health England for the most accurate and up-to-date advice; it is updated on a very regular basis. That is the place to go for the most accurate and clinically validated advice.

[Baroness Brinton (LD)]

My Lords, the Question from the noble Viscount, Lord Waverley, asked about British citizens returning from China and other affected areas. The Minister has concentrated her replies on Wuhan and Hubei province. Yesterday, Dr Michael Ryan, the executive director of the World Health Organization Health Emergencies Programme, said:

“The whole world needs to be on alert now, the whole world needs to take action and be ready for any cases that come, either from the original epicentre or from other epicentres that become established.”


What advice is being given to people coming from other countries where there are already reported cases?

--- Later in debate ---

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right. At the moment, there are 5,974 cases in mainland China and 6,064 cases globally, and there have been 132 deaths. It is important to understand that coronavirus is a large family of viruses, ranging from the common cold to much more severe diseases, such as MERS. The data we have puts the mortality rate at about 3%, so the risk is comparatively low compared with SARS and MERS. I just want to say that at this point.

In terms of wider travel advice, the FCO is now advising against all travel to Hubei province and all non-essential travel to China, and is advising British citizens to leave if they are able to do so. Wider public health advice for those travelling around the region can be seen on the Public Health England website. It is very clear and detailed. Any further advice on travel can be seen on the Foreign Office website. We are co-ordinating very closely; indeed, there was a COBRA meeting on this issue just yesterday.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister clarify that Public Health England is working closely with the other three public health departments in the UK and is taking the lead on this for people who are returning? Further, what is our strategy for Hong Kong, where nurses have said today that they will go on strike unless the borders between mainland China and Hong Kong are closed in order to protect the population?

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right: all the public health authorities across the United Kingdom will work closely together to ensure clear co-ordination, as always happens on public health issues. On Hong Kong, we will be discussing those issues through the WHO, which met yesterday to consider whether WN-CoV should be declared a public health emergency of international concern. It did not declare a PHEIC yesterday, but it will meet again. If it does declare a PHEIC, we will of course review our recommendations. However, we should be confident about the actions that we have taken. They are measured, proportionate and based on the highest level of scientific and clinical advice available at this stage of the outbreak from the Chief Medical Officer and Public Health England. We will keep the situation under continuous review and report to the House as it develops.

[Lord Woolmer of Leeds (Lab)]

My Lords, the Minister has emphasised that the arrangements will be for British citizens. If a British citizen is married to a Chinese citizen, perhaps with children who hold British passports, will the whole family, including the Chinese citizen, be eligible to come to this country?

[Baroness Blackwood of North Oxford]

We are currently holding discussions on this point and the Foreign Secretary has made representations.

[Lord Trefgarne (Con)]

My Lords, has any progress been made in developing a vaccine against this dreadful disease?

--- Later in debate ---

[Baroness Blackwood of North Oxford]

My noble friend has raised an important point. While the UK is one of the first countries outside China to have developed a prototype laboratory test for this novel disease, there is as yet no vaccine. The WHO is co-ordinating the research effort in this area and is producing an R&D road map. As a nation we are actively involved in this because we have particular capabilities here. We will be contributing to a co-ordinated global effort not only to improve the diagnostics but to develop vaccine capabilities.

[Lord Alton of Liverpool (CB)]

My Lords, has the Minister seen the report this morning from the AFP saying that Russia has closed its borders with China? Does that not add to the need for the World Health Organization to declare this a world health emergency? Are we in discussions with it about that?

[Baroness Blackwood of North Oxford]

I think I have already made the point that we are in constant dialogue with the World Health Organization regarding all aspects of the response to this outbreak. That dialogue includes the declaration of a PHEIC, which would include a number of different elements, and the organisation is meeting on that today.

Nursing and Midwifery

Baroness Blackwood of North Oxford Excerpts

Thursday 30th January 2020 Lords Chamber

[Lord Crisp]

To ask Her Majesty’s Government what plans they have to celebrate Florence Nightingale’s bicentenary and the World Health Organization’s Year of the Nurse and the Midwife in 2020.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the Government are working with the Chief Nursing Officer for England on plans to celebrate the bicentenary of Florence Nightingale and those in the nursing professions. Plans includes supporting the Nursing Now campaign across the NHS in England. The Chief Nursing Officer is also working in partnership with the Florence Nightingale Foundation to plan many activities, culminating in an international conference organised by the foundation and the Burdett Trust for Nursing in October 2020.

[Lord Crisp (CB)]

My Lords, I thank the Minister for that reply. This year is a chance to celebrate the legacy of great nurses and midwives of the past such as Florence Nightingale, notably, but also great figures such as Mary Seacole and others in this country and elsewhere. It is also a chance to celebrate today’s nurses and midwives, and thank them for what they do. In passing, I am delighted to be wearing a piece of the new nursing tartan, designed by Scottish nurses and commissioned just last month. However, this is also an opportunity to look again at nursing and midwifery, recognising how far the professions have developed in recent years and that they perform a very wide range of roles, all with customary care and compassion.

Nurses are true health professionals in their own right, no longer handmaidens to doctors—if they ever were—and have the potential in the future to do even more. With that in mind, I ask the Minister two questions. First, what plans do the Government have for investing in training and increasing the numbers of advanced nurse practitioners? Secondly, what plans do they have for reversing the decline in community nurses, school nurses and health visitors in this country, who will play such a vital role as services move more towards the community?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his important question. I am envious of his tartan and I definitely identify with his praise for nurses, who work long hours and serve the most vulnerable at the moments of their greatest need. To answer his specific questions, as part of the NHS people plan, we are committed to supporting career development for nurses, which includes supporting a diverse range of careers. An example would be the advanced practitioners within multi-professional teams. This is an important point that the noble Lord raises. We are also developing a plan for district and community nurses to work with healthcare providers, practitioners and higher education institutions. The plan will set out how we will grow the community nursing workforce, which includes mental health and learning disability nurses, and it is expected to be published later this year.

[Lord Forsyth of Drumlean (Con)]

My Lords, might my noble friend not mark this important bicentenary by enabling those nurses who have been in the profession for, say, five or 10 years to have their student loans written off, given that the cost to the taxpayer of not doing so will be greater? The write-off in 30 years’ time for the taxpayer will be £1.2 trillion in cash terms, so why not help the profession and the taxpayer by doing this now?

[Baroness Blackwood of North Oxford]

The noble Lord has made this point before and I have taken it back to the department before. He will know that we are providing additional financial support to nurses, including the maintenance grant of £5,000 in non-repayable funding, with specific targeted support of £3,000. However, I am very happy to take back his proposal once again, as we have an upcoming Budget.

[Baroness O’Neill of Bengarve (CB)]

My Lords, is the Minister aware that the Royal Statistical Society is celebrating the election of its first woman fellow, Florence Nightingale, and that nurses play a very considerable part in the collection and processing of data that matter for public health, and all our health?

--- Later in debate ---

[Baroness Blackwood of North Oxford]

Yes, indeed. As the noble Baroness will know, Florence Nightingale was perhaps one of the earliest and most notable statisticians. She is a great role model for those young women who wish to go into STEM careers. One way in which we wish to mark this bicentenary is with the Nightingale Challenge, which calls for every employer of nurses globally to provide leadership and development training for young nurses and midwives in 2020. The aim is to have at least 20,000 nurses benefiting from it in 2020, with at least 100 employers taking part.

[Baroness Brinton (LD)]

My Lords, it is right that we have congratulated nurses and celebrate them but it is also the year of the midwife. It is important that we celebrate the progression in midwifery. Midwives are often much less publicised for the work they do within the community. What plans are there for celebrating midwifery specifically during this year?

[Baroness Blackwood of North Oxford]

We are of course conscious that we need to support midwives, especially as we look to raise standards in midwifery. Specific plans are being developed by the Chief Nursing Officer, Ruth May, which will ensure that all parts of the nursing profession, including midwives, will be focused on. These will be brought forward shortly.

[The Lord Bishop of Carlisle]

My Lords, given Florence Nightingale’s genius for exploring and combining very disparate fields of study and practice, including the worlds of healthcare and faith, will Her Majesty’s Government and the Minister join me in commending the work of parish nurses, who now bring health and healing to more than 100 communities around the country, complementing the work of both the NHS and social care agencies?

[Baroness Blackwood of North Oxford]

I absolutely agree with the right reverend Prelate on this issue. He will know that the long-term plan is committed to supporting and developing community care. Parish nurses are a key part of that, but so is the development of social prescribing, which we have committed to rolling out. I know that parish nurses work hand in hand with this programme, so I am pleased to agree with the points that the right reverend Prelate has made. We will also want to think carefully about how we can support the work that he is doing.

[Lord Clark of Windermere (Lab)]

My Lords, the Minister mentioned the reimbursement of fees, which has been reintroduced. For non-mental nurse training, is this scheme as generous as that which was discontinued a couple of years ago, or do we reimburse only about 50% of the fees?

[Baroness Blackwood of North Oxford]

The scheme is more generous than the previous scheme.

[Baroness Greengross (CB)]

My Lords, until a few years ago, community nurses looked after the whole population in the area in which they worked. Lately, they have looked after only children up to the age of about five. Is it planned for them to go back to looking after the community as a whole, which is an important part of their work?

[Baroness Blackwood of North Oxford]

The noble Baroness is very knowledgeable about this. She is right that when we strengthen community practice, it is important to have a holistic approach. That is exactly what underpins the ICS having a much more joined-up approach to social care, general practice and mental health. It is what lies behind developing a holistic people plan. Such an approach will come forward when this is published.

Major Trauma Centre: Westminster

Baroness Blackwood of North Oxford Excerpts

Thursday 30th January 2020 Lords Chamber

[Baroness Masham of Ilton]

To ask Her Majesty’s Government whether they have any plans to establish a major trauma centre in the immediate vicinity of Westminster to treat casualties in the event of any terrorist attack in the area.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the NHS has well-tested plans and capability for responding to a terrorist attack and treating casualties. The attacks in London and Manchester in 2017 tested our capability. London has four major trauma centres where casualties will be triaged and treated, and this will include casualties from an attack in the vicinity of Westminster.

[Baroness Masham of Ilton (CB)]

My Lords, I thank the Minister for her reply. Is she aware that thousands of people come into Westminster, including tourists from all over the world, people coming to work here, the police, demonstrators and both Houses of Parliament? Are we not a special case? Would it not be very good to have a special trauma unit at St Thomas’ Hospital? When there is a lockdown, we cannot move in Westminster.

[Baroness Blackwood of North Oxford]

My Lords, I pay tribute to all the brave members of the public, the NHS and Members of this place who so often have responded incredibly bravely when terrorist attacks occur. We owe a great debt of gratitude to all those individuals who do not think of their own lives in responding to protect others.

On the noble Baroness’s specific question about our capabilities in responding to risks that occur, we have a specific arrangement that has been put forward with the trauma network. The decision about the location of the trauma centres allows full geographic coverage while ensuring that the full package of care is available for patients when they come forward, which includes treatment for burns, orthopaedic injuries and neurosurgery. I know the noble Baroness knows there are four major trauma centres located in London at St Mary’s Hospital, St George’s Hospital, the Royal London Hospital and King’s. They are all adult and children’s major trauma centres and are all approximately three miles from Westminster.

More importantly, we have specialist ambulance capability in responding wherever an attack may occur in London. We can be very proud of the response that we have seen not only from the hazardous area response teams but from the tactical response units. Those responses have been in very short order and have meant that, although these were appalling incidents, their impact was much reduced.

[Baroness Thornton (Lab)]

My Lords, a study published in the Emergency Medicine Journal found that NHS hospitals seem in many ways unprepared for terror attacks, with half the doctors unaware of emergency plans and just over one-third aware of what to do personally if a major incident is declared. I thought the Minister’s answers were brilliant and very reassuring, but what action are the Government taking to ensure that all doctors receive education on their hospital’s major incident plan as well as an abbreviated version of their own particular role?

[Baroness Blackwood of North Oxford]

The NHS develops its plans in each hospital according to the Government’s national risk register and its planning assumptions underpin this. The security services then evaluate and publish the current threat level to the UK from terrorism and the NHS is made aware of any change to this, so that it can react accordingly. In addition, we provide training for paramedics for terrorist attacks, as I have mentioned. We have the hazardous area response team, comprising specially trained personnel to provide ambulance response to particularly hazardous or challenging environments, including following a terrorist attack. London also has the tactical response unit, which is designed to work as part of a multiagency team with police and fire services to respond to firearms incidents. In the most recent attacks, the response time for paramedics was within seven minutes. We have recently agreed to increase the number of marauding terrorist attack and chemical, biological, radiological and nuclear trainee paramedic responders, and we will have a minimum of 240 responders in each ambulance trust.

[Baroness Walmsley (LD)]

My Lords, I welcome the Minister’s reassurances. Is she aware that in London last year 265 fewer members of the public attempted CPR on people nearby whose hearts had stopped? Does that not suggest that it would be more help to the people who work in and visit this building if we invited St John Ambulance to come to us again to deliver training on CPR and wider first aid interventions?

[Baroness Blackwood of North Oxford]

As ever, the noble Baroness makes a very sensible suggestion about wider CPR training. I will take up that point.

[Lord Flight (Con)]

My Lords, with the closure of the fire stations in Victoria and across the river in Lambeth, is the Minister comfortable that the firefighting support for Westminster is adequate?

--- Later in debate ---

[Baroness Blackwood of North Oxford]

My noble friend raises an important point. Ambulance and specialist response teams have very tried-and-tested ways of working with the fire and rescue and police services to make sure that they preserve life during potential terrorist attacks. We can be very confident in that response, especially given their performance during recent events.

[Lord Jordan (Lab)]

My Lords, London has some of the finest emergency services and best-equipped trauma centres in the world. The real problem is the deadly vacuum between the terrorist attack and the arrival of paramedics. Specialist and military experts have developed citizenAID, a free app with a proven record that gives ordinary people the ability to give life-saving first aid without prior training or equipment. Will the Government promote citizenAID nationally? London needs it now, as does the Parliamentary Estate.

[Baroness Blackwood of North Oxford]

The noble Lord makes a very sensible suggestion to look at ways in which we can encourage individuals to save lives. It may be appropriate in situations other than terrorist attacks and I am happy to look into it.

[Baroness Masham of Ilton]

My Lords, many people think that St Thomas’ has a trauma centre and are very surprised when they hear that it does not.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her comment. I think I have made the point that there is a trauma network across London to ensure full coverage for trauma across the city and enable individuals to get the best trauma service, wherever they may be.

Health: Sepsis

Baroness Blackwood of North Oxford Excerpts

Wednesday 22nd January 2020 Lords Chamber

[Lord Grade of Yarmouth]

To ask Her Majesty’s Government, further to the University of Washington’s Global Burden of Disease Report, published on 16 January, what steps they are taking to address incidents of sepsis in the United Kingdom which is ranked 132 out of 195 countries for deaths caused by sepsis.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, over recent years the NHS has become much better at spotting and treating sepsis quickly. This means that more people are being identified as at risk of sepsis and mortality rates are falling. While we welcome this report’s attempt to advance knowledge of worldwide deaths from infection and sepsis, we are confident in our own data, which puts UK deaths from sepsis as significantly lower than reported in the study.

[Lord Grade of Yarmouth (Con)]

I thank my noble friend for that Answer. The House will not need reminding that some 50,000 people a year die in this country from sepsis, far too many of them unnecessarily. I declare my interest as an unpaid adviser to the UK Sepsis Trust, which has done remarkable work to improve awareness. Members of the trust, including clinicians and so on, have had many meetings at different levels within the department, begging for a registry of all sepsis cases in the UK. We have had a very sympathetic hearing but it is a bit like dealing with the laundry— nothing ever comes back. Can the Government make a commitment to introduce a registry which will help greatly to improve the targeting of the right antibiotics for the right cases?

[Baroness Blackwood of North Oxford]

I thank my noble friend for this Question and I pay tribute to his work on it, and the work of the UK Sepsis Trust. I am aware of the calls for a national sepsis registry for patients. It is important that we understand the data; we are confident that it provides an accurate indication. We think that UK data is as good as it can be at the moment but that there is a clear need for better data on sepsis. The problem with the registry as proposed is that it would use retrospective data collection. We want to go beyond this with the UK’s five-year national action plan for AMR, which includes a commitment to develop the real-time patient-level data of individual patients for infection, treatment and resistance history. Work is already under way by NHS England and NHS Improvement. I hope that is the kind of answer my noble friend was looking for.

[Lord Patel (CB)]

My Lords, as a country our record for the number of deaths due to sepsis is pretty abysmal, as stated already. Most of that is due to late diagnosis of sepsis. One-third of patients die and for every hour that a diagnosis is delayed, the death rate rises by 8%. Last year, on a visit to a biotechnical company in Northern Ireland, the Secretary of State commended the development of a quick diagnostic test, which will give a result within two hours so as to start appropriate antibiotics. Will the Government make a commitment that when this molecular test is available, which is likely to be soon, it will be immediately available to the whole of the NHS?

[Baroness Blackwood of North Oxford]

The noble Lord, as always, speaks with great expertise in this area. I emphasise the work that has been ongoing to improve the picture on sepsis. Since 2015, screening for sepsis in emergency departments has improved from 52% to 89% and timely treatment for sepsis from 49% to 76%, but the noble Lord is absolutely right that we need to improve the outcomes. Early and accurate diagnosis is at the heart of this. I shall keep an eye on innovations in diagnostics. The noble Lord knows that innovation in this area is right at the heart of what I do, and I think that his proposal is very sensible.

[Baroness Thornton (Lab)]

My Lords, the Government seem to be complacent about this. I know that the Minister has given us lots of facts and statistics, but the number of deaths from sepsis in the UK is five times higher than in the country in the European Union that has the best performance. Only two EU countries have a higher number of deaths, so it is a very serious problem. Why are only 70% of acute trusts in England using the national early warning score system? Why are they not all using it?

[Baroness Blackwood of North Oxford]

I am not quite sure which data the noble Baroness was referring to. The study stated that the number of UK deaths was at 48,000. This was a modelled estimate; it was inaccurate. Our data, published by the Office for National Statistics, states that the figure is 22,341 and puts the UK’s performance at a better rate. We are not complacent in any way. This is why there has been concerted action through a number of routes not only to improve the performance in sepsis diagnosis and screening but to make sure that we raise public awareness and provide training for NHS staff. The early warning system has been introduced as the revised national early warning score. As the noble Baroness said, it is intended to improve and standardise the process of recording, identifying and responding to patients at risk. It was introduced as a CQUIN incentive and included in the 2020-21 scheme which was published yesterday. This means that it will be in every hospital across the country.

[Baroness Walmsley (LD)]

My Lords, it can be difficult to diagnose sepsis in people with learning disabilities and difficult for them to realise that they may have it. The NHS has a very good little video prepared by and for people with learning disabilities and their carers. Is there anything the Minister can do to make sure that that helpful video is disseminated more widely?

[Baroness Blackwood of North Oxford]

That is an extremely helpful and constructive proposal. If the noble Baroness would like to raise it with me outside the Chamber, I will take it up as a matter of priority.

[Lord Forsyth of Drumlean (Con)]

My Lords, does my noble friend accept that public education has an important role to play here, so that people are aware of the symptoms—following the question asked by the noble Lord, Lord Patel? Can we congratulate the BBC, those of us who are fans of “The Archers”, on the work it has done in this respect?

[Baroness Blackwood of North Oxford]

I am very happy to congratulate the BBC. I do not know that I heard “The Archers” storyline in question, but I shall make sure that I update my education in this respect. I want also to congratulate Public Health England on its national Start4Life information service for parents. It has worked with Mumsnet to make sure that awareness is spread to those most likely to need it, because those most at risk are the young, the elderly and those who have underlying conditions. Targeting the messaging at those who need it most is very important.

[Lord Winston (Lab)]

My Lords, the noble Lord, Lord Grade, raises a very important point. Can the Minister tell us what percentage of patients with sepsis have the DNA profile of the bacteria recorded?

[Baroness Blackwood of North Oxford]

The noble Lord, Lord Winston, always raises very specific questions requiring statistical answers which are not necessarily at my fingertips. I shall write to him on that point.

Wuhan Novel Coronavirus: Threat to UK Citizens

Baroness Blackwood of North Oxford Excerpts

Wednesday 22nd January 2020 Lords Chamber

[Lord Patel]

To ask Her Majesty’s Government what is their strategy for protecting UK citizens from the threat posed by the spread of Wuhan novel coronavirus (WN-CoV).

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, we are monitoring closely the development of this virus. Advice from Public Health England and the Chief Medical Officer is that the risk to the UK is currently low. The UK is well prepared for the emergence of novel viruses. As part of our preparedness, we have introduced enhanced monitoring of direct flights from Wuhan to the UK and updated our travel advice for Wuhan. We continue to update health workers on how to identify, treat and contain any possible cases.

[Lord Patel (CB)]

My Lords, I thank the noble Baroness for her reply and commend the Government for publishing tomorrow initial measures for controlling the spread of this virus, if it comes to the United Kingdom. This is a newly identified virus, which probably originated in animals, particularly in the seafood markets in Wuhan. None the less, it is 80% genetically identical to the SARS virus, which killed a significant number of people. We now understand that, although the Chinese have sequenced the genome of the virus, it has mutated and can now spread directly from human to human, which raises the likelihood that it will spread more widely. The initial illness can vary and is sometimes very mild, hence the case in the United States where the diagnosis was not made on arrival at the airport in Seattle by the authorities, even though they had procedures in place. Will the Government keep a watch out and update the advice depending on how the virus develops? Secondly, will there be procedures for quarantine and follow-up contact if a case is identified, particularly if the virus mutates and becomes highly virulent?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his important and timely Question. I am happy to update the House that, from today, enhanced monitoring is in place for all direct flights from Wuhan to the UK. Public health officials will meet every direct flight from Wuhan to the UK and will be on hand to provide information about symptoms. Mandarin and Cantonese speakers will be on hand and leaflets will be available in several languages. We will also roll out enhanced monitoring of all flights arriving in the UK from China. Leaflets and information will be available across all UK airports, advising travellers from China on what to do if they feel unwell. The enhanced monitoring of direct flights will obviously be kept under continuous review and expanded if necessary. The risk to the public is low and the NHS is well prepared but, to answer the noble Lord, any patients assessed for this new disease would be isolated under standard procedures if necessary. There are a number of infectious disease units around the country that would be able to respond appropriately.

[Baroness Brinton (LD)]

My Lords, it is good that the Chinese Government, and indeed our Government, are responding better than has perhaps happened in some past incidents, including over SARS. The BBC has reported today that a number of Chinese cities are now reporting that there are people with this condition. When will flights from those cities, and not just Wuhan, be monitored? Also, will there be specific traveller advice for UK citizens travelling into China who have chronic and underlying conditions that mean they may need to take more care?

--- Later in debate ---

[Baroness Blackwood of North Oxford]

I have a list of the current confirmed cases, which I am happy to place in the Library—it is probably not constructive to read it out—although the numbers are changing regularly. We are keeping travel advice and the monitoring of flights in and out of other Chinese cities under constant review. The advice at the moment is against all but essential travel to Wuhan. We will keep travel to other Chinese cities under close consideration.

[Viscount Ridley (Con)]

My Lords, does my noble friend agree with one of the precepts of Darwinian medicine that there is generally a trade-off between virulence and contagiousness and that, in the world of viruses, if you want to spread by casual contact, it tends to help to keep the patient healthy and standing on their feet—as indeed I am with a cold at the moment? If this virus does spread from man to man—sorry, person to person—there is a chance that it may reduce in virulence and it is, therefore, important to keep in perspective the warnings that we give people. While we must not underreact to this, it is also important that we do not overreact and cause major disruption to the economy, as has occasionally happened with responses to previous incidences of influenza.

[Baroness Blackwood of North Oxford]

That was well put. Our view is that this is a proportionate and sensible response that is scalable and appropriate according to the evidence available. We will obviously be reviewing what is a new and emerging infection. Scientific understanding of the disease is evolving rapidly—essentially on a daily basis. We will obviously review the measures set out regularly.

It is important to set out what the symptoms are, in case anybody listening needs to understand. This is essentially a bad respiratory tract infection that could turn into pneumonia. At this stage around 2% of known cases have died. To compare mortality rates, SARS had one of 10% and Ebola 70%. That gives a level of perspective, but the picture is evolving and we will keep this under close review as the situation develops. Unsurprisingly, of course, within that context those at greatest risk are the vulnerable, the elderly or those with underlying health conditions, so the advice is to come forward if such symptoms occur.

[Baroness Thornton (Lab)]

Notwithstanding the noble Baroness’s remarks, I am pleased and reassured that the Government have implemented the measures outlined and welcome the precautionary approach taken to the arrival of passengers from the Wuhan region of China. Can she confirm that the Government have assessed whether adequate resources are available in the PHE port health teams to carry out screening procedures and any further screening procedures that might be necessary?

[Baroness Blackwood of North Oxford]

We have indeed. First, three direct flights from Wuhan arrive into Heathrow and a team of public health experts, which will include the principal port medical inspector, the port health doctor, the administrative support and team leader and a translator, will meet every direct flight from Wuhan. We believe that this is a scalable solution, which could respond to a developing health challenge. In addition, before a flight lands a message will be broadcast to passengers in several languages to encourage them to report illnesses to flight staff and the captain will be required to provide an early warning of any illnesses on the aircraft one hour before arrival, which allows a much more appropriate response on landing. We believe that this is a manageable and effective response. The NHS has a very good record of responding to similar situations, whether with Ebola or monkeypox. We can be very proud of our public health record in these areas and can be confident in how bodies will respond to this incident.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister agree that this has come at a very difficult time, because we are the middle of the flu season and this is difficult to diagnose? Does she realise that 15 health workers have been diagnosed in China? Therefore, will all health bodies be told to be aware?

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right: there is great pressure on the NHS and we need to make sure that the appropriate information is given to the system so that there is no undue anxiety in that regard. As I said, the NHS has a tremendous record in responding to similar incidents. Clinicians in primary and secondary care have already received advice covering initial detection, investigation of possible cases, infection prevention and control and clinical diagnostics. NHS England and NHS Improvement have developed an algorithm to support NHS 111 to identify suspected cases and a central alerting system alert will be issued to the front line by the Chief Medical Officer, the medical director of Public Health England and the medical director of NHSE and NHSI to increase awareness of the situation and actions if potential cases present.

As I said to the noble Lord, Lord Patel, there are a number of infectious disease units around the country that can take suspected patients and are accustomed to responding in this way. Of course, the UK is one of the first countries outside China that has a prototype specific laboratory test for this novel disease. I want to emphasise, though, that there are no confirmed cases in the UK.

[Lord Campbell-Savours (Lab)]

My Lords, I listened closely to what the Minister said. She seemed to be referring to post-flight monitoring. Would it not be possible to have some sort of pre-flight monitoring process at the point where people depart from China? I say that as someone who has half a lung and is therefore very vulnerable.

[Baroness Blackwood of North Oxford]

As someone who has my own health condition, I share the noble Lord’s attitude to exposure to infection. The Chinese Government are taking strong measures in Wuhan to try to control the outbreak, including reports, confirmed by post in Beijing, that they are advising their own citizens against travel to and from Wuhan. Measures are in place there. We would welcome more timely sharing of epidemiological data on the spread of diseases from China via the WHO, and we are working through those routes to try to improve it. However, I made the point that, where we have the ability to do so, we seek to put in place the earliest possible control measures, including on-flight, so that by the time there are issues at the border we are able to intervene.

NHS: A&E Waiting Time Target

Baroness Blackwood of North Oxford Excerpts

Tuesday 21st January 2020 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what plans they have, if any, to change the four hour accident and emergency waiting time target.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the existing standard is still in place. NHS England and NHS Improvement are reviewing access standards in four key areas, including urgent and emergency care. The Government will respond to recommendations from the review once it is concluded.

[Lord Hunt of Kings Heath (Lab)]

My Lords, in December, for 68.6% of patients the four-hour target was met, against the actual target of 95%. That is the worst month ever. The Government’s response, behind the warm words of the Minister today, is that they want to get rid of the target, yet research published last week by Cornell and the IFS shows that the current target saves at least 15,000 lives a year. The Royal College of Emergency Medicine has said that there is no viable alternative to the current target. The college says that the Government should get on with getting this target back on track. Will the Government do that?

[Baroness Blackwood of North Oxford]

The noble Lord always asks astute questions. Winter is a challenging time. Over 2 million people attended A&E last month, and we have to pay tribute to the dedicated NHS staff for seeing over 70,000 people every day—the highest number in December ever. Although we have more NHS beds open this winter than last, our A&Es have had to treat more people. The A&E waiting standard is being looked at by clinicians, who are considering whether it is appropriate, given the changes that have occurred in clinical standards. The five key reasons considered for moving away from the standard include: the standard does not measure total waiting times; the standard does not differentiate between the severity of conditions; the current standard measures a single point in an often very complex patient pathway; and there is evidence that processes, rather than clinical judgment, are resulting in admission or discharge in the period immediately before a patient breaches the standard, which is a perverse incentive. The Government will not do anything without public consultation and clinical recommendation. We will wait to see that, and no decision will be made until that comes forward.

[Baroness Fall (Con)]

My Lords, let us not get distracted from the key issue here, which is that our A&Es are under enormous pressure. One reason is that people find it very difficult to see a GP, and that is why I think we can all welcome the announcement that we will see some more GPs. When might we see some progress on the ground?

[Baroness Blackwood of North Oxford]

My noble friend is absolutely right. We need to improve access to community care to make sure that people are diverted away from inappropriate visits to A&E. We have said that we will recruit over 6,000 doctors in GP practice, and we are working on that as we speak. We are also increasing the number of GP practices within A&E so that people can be diverted into appropriate care when they go to A&E inappropriately. The evidence is that already around 10% of those attending A&E are streamed into those GP practices, and we are currently trying to increase that provision.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my interest in relation to the Royal College of Emergency Medicine. Do the Government recognise the data from the weekly monitoring of 50 EDs that report to the Royal College of Emergency Medicine that shows that, in the first two weeks of January this year, an average of almost 6,500 people waited more than 12 hours in emergency departments, the figure having risen from just over 3,800 in October? These long waits represent risks to the health, and indeed to the very lives, of these patients. The president of the college, Dr Katherine Henderson, has urged:

“Rather than focus on ways around the target, we need to get back to the business of delivering on it.”

[Baroness Blackwood of North Oxford]

I emphasise that the review of clinical waiting times has been ongoing since 2018. The issues this winter are being addressed with urgent action in this winter. That includes: increasing the provision of same-day emergency care, so that patients can be seen as quickly as possible and are not admitted overnight, if that is inappropriate; reducing the number of patients who have unnecessarily lengthy stays, so that beds are available for those who need to be admitted; continuing to increase the number of urgent treatment centres, with a standardised level of care, so that those who do not need it can be diverted away from A&E—there are now over 140 urgent treatment centres, which can be booked from NHS 111 in most places; increasing the number of GPs in A&E, so that patients can be streamed to appropriate care; and enhancing NHS 111, so that patients can be booked into GPs locally or diverted to pharmacists.

[Lord Clark of Windermere (Lab)]

My Lords, regarding the increase in the number of GPs, bearing in mind that the coalition Government cut the training of doctors by thousands upon thousands and that the Government have announced that they are going to increase the number of GPs by 6,000, will the Government produce a timeline of when they are going to meet that target of 6,000 extra doctors?

[Baroness Blackwood of North Oxford]

My Lords, I know that the timetables are going to come forward in the people plan, so I cannot give you that in detail today. What I can tell you is that we have announced that we are investing an extra £4.5 billion in primary and community care by 2024 to fund a good amount of this. The five-year GP contract was agreed between NHS England and the BMA last January, which makes the job much more attractive. In addition, salaried GPs will receive at least a 2% increase and there are incentives to attract them into rural areas, which are struggling the most with recruitment. We have also announced that we want to recruit staff into support services around GPs so that GPs are not focusing on administrative tasks, which has been a disincentive to recruitment over the last period.

[Baroness Brinton (LD)]

My Lords, in addition to the importance of having more GPs to help relieve pressure on the service, there is still the continuing problem of social care, where many people are ending up in A&E or being returned to hospital after a brief stay back at home, or in a home. When will the Government publish their review on social care? We need to make sure that social care is absolutely understood and refunded properly in the future.

[Baroness Blackwood of North Oxford]

The noble Baroness, Lady Brinton, is right to hold the Government’s feet to the fire on this issue. I know the strength of feeling in the House on this matter. She will know that we have provided councils with an additional £1.5 billion to make sure there is short-term funding to address the challenges. Also, of course, the better care fund has provided some winter funding to address some of the challenges. But she is right that there needs to be sustainable funding for the long term. We look forward to the SR for that. Regarding the long-term solution, the Prime Minister has been clear that he wants to bring that forward within this year.