NHS: Specialist Services in Remote Areas

Debate between Baroness Masham of Ilton and Lord O'Shaughnessy

Tuesday 11th December 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Lord makes an excellent point with great insight, as ever. We all want to move to an integrated care system which allows us to worry less about levels of care and think instead about patients and the care around them. We believe a lot can be done within the current regulatory framework but, when the Prime Minister asked the NHS to produce its long-term plan in return for the significant funding increase we are giving, she asked what legislation might be needed to complete that framework.

[Baroness Masham of Ilton (CB)]

My Lords, as president of the Spinal Injuries Association, I ask the Minister if he is aware of the terrible state of spinal injury specialised hospitals, which do not have enough beds. Is he aware that the association and our fundraisers have privately employed two specialised nurses to help the hospitals which do not have expert help available?

[Lord O’Shaughnessy]

I am of course concerned by the point the noble Baroness makes. She has raised it with me privately. I absolutely applaud the work that the association has done but I will come back to her about our specific plans on how to make improvements.

Government Vision on Prevention

Debate between Baroness Masham of Ilton and Lord O'Shaughnessy

Tuesday 6th November 2018 Lords Chamber

[Lord O’Shaughnessy]

We have said that we will clamp down on junk food advertising. Clearly we have cut down on the advertising of alcohol, smoking and many other things over successive Governments. This country has led the way in dealing with this sort of issue, so I am confident that we will have the necessary approach.

[Baroness Masham of Ilton (CB)]

My Lords, will the Minister assure us that some of the most important things that are not in the Statement are not downgraded? They are antibiotic resistance, vaccination and immunisation, drug misuse, the prevention of hepatitis C in prisons and sexually transmitted diseases which are becoming resistant.

[Lord O’Shaughnessy]

I can provide the noble Baroness with that reassurance. This is a vision document, not a plan. It does not go into detail in every area, but merely tries to set out an ambition for the kind of health service that we want. All the issues that the noble Baroness raises are incredibly important, and I promise her that they form a big part of the department’s agenda.

Gosport Independent Panel: Publication of Report

Debate between Baroness Masham of Ilton and Lord O'Shaughnessy

Wednesday 20th June 2018 Lords Chamber

[Lord O'Shaughnessy]

I thank the right reverend Prelate for his comments and for conveying those of his colleague, the right reverend Prelate the Bishop of Portsmouth. It is absolutely right that he is where he is today, ministering to that group of deeply affected people.

The facts as he set them out, and as are set out in the Statement, are truly shocking: hundreds of lives prematurely shortened because of these practices; institutional behaviour led by an individual but with others being complicit in it; cover-ups; whistleblowers being discouraged; and so on. It is hard to imagine a worse scenario. What the panel and Bishop James Jones have exposed through working so closely with families is the extent of the behaviour and the poor practice that went on.

The question now is, quite rightly, what we should do about it, and the right reverend Prelate quite rightly takes the pastoral position. There is counselling on offer and a helpline for those who think that their families may have been affected—there may be yet more people who come forward. There is also a commitment from the Secretary of State, and indeed all Ministers, to meet families to provide them with the support and information that they may need. There is an intention to meet those families at an event convened by Bishop Jones in October, and the panel secretariat is setting up specific conversations between the advisory clinicians on the board and individual families. One of the needs for counselling, sadly, will be after those conversations, when the truth about specific cases comes out—which is why it is about providing counselling not just today but on an ongoing basis. I can give the right reverend Prelate a commitment from the department that we will provide that for as long as necessary.

[Baroness Masham of Ilton (CB)]

My Lords, this tragedy has similarity to Shipman and Stafford Hospital. Does the Minister agree that there should be a far better and quick complaints procedure? This has been needed for years. Nurses should feel free and safe to bring up matters of worry concerning their seniors and colleagues, and relatives should have help to complain and be listened to.

[Lord O'Shaughnessy]

I completely agree with the noble Baroness. Clearly, improvements have been made—freedom to speak up guardians came out of the Francis review into the Mid Staffs tragedy—but I reiterate the point that I made earlier: we cannot be complacent and just assume that what exists now is up to the task, as the noble Lord, Lord Hunt, said, of guaranteeing that this will not happen again. Looking at complaints procedures, protections for whistleblowing and so on will be part of the investigations that we make.

Breast Cancer Screening

Debate between Baroness Masham of Ilton and Lord O'Shaughnessy

Thursday 3rd May 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness makes an incredibly important point. To refer back to the Statement, I think that the word used was “may” and that an upper range was given. I want to distinguish between two things. The first is the national campaigns that take place—I think there were 14 in the past eight years—to encourage women to check for their own symptoms and take up opportunities for screening programmes. Those will continue; that is part of the overall programme. In terms of writing to the women who are still alive who may have been affected, that is a separate and discrete process. It will start with a letter. It is easy for us to track down those who are registered with a GP in England and we are working with colleagues in the devolved Administrations, as noble Lords would expect, to make sure that we can write to those who have moved to those countries, and to provide resources to those countries so that they can provide screening. A helpline is also included that has been publicised.

On the point about the number of deaths that may have occurred, it is a difficult issue. On the one hand, we have received advice that that may be the case and we felt that it was wrong not to be honest and transparent about it. At the same time, there is not a clinical consensus about the benefits of breast cancer screening for women aged 70 and over—that came as something of a surprise to me—because of the non-malignancy or low malignancy of some tumours that can be spotted and the harms that can follow from treatment.

So we need to be cautious. What we have projected as a range is based on statistical modelling and not based on scrutiny of actual case note reviews. Of course, we deeply hope that the number will come down as we carry out that inquiry.

[Baroness Masham of Ilton (CB)]

My Lords, why is there the magical cut-off point of 72? In the paper the Minister just read, what are the non-threatening cancers in older people and what are the harmful tests and treatment? If they are harmful for older people, what about younger people?

[Lord O’Shaughnessy]

The noble Baroness asks an excellent question. The clinical advice that we received, which is the reason for the extension of screening from up to the age of 70 to up to the age of 73, is part of a clinical trial. There is no evidence that screening necessarily benefits women in general; of course, it will benefit some women in particular. There are breast cancers—I cannot claim to be able to describe them because that is well beyond my clinical knowledge—that women can have at that age and live with, and, indeed, they can die of something else at a later age. The treatment process, whether it is chemotherapy, radiotherapy or surgery, can be very debilitating, harmful and in some cases unnecessary, although, having found a tumour, a woman may well want to progress with that treatment. We have been driven by that age range, with 72 as the cut-off, and the wider description of this lack of clinical consensus. I assure the noble Baroness that we have been informed by a clinical advisory group throughout the process to make sure that we are as accurate and effective as possible.

[Baroness Masham of Ilton]

I am glad it is not the case that older people are not worth treating.

[Lord O'Shaughnessy]

Certainly not.

NHS: Winter 2017-18

Debate between Baroness Masham of Ilton and Lord O'Shaughnessy

Wednesday 18th April 2018 Lords Chamber

[Lord O'Shaughnessy]

I shall certainly look into that issue. We are reviewing insurance across primary care, as my noble friend might know, and I shall look into this specific issue.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister agree that one of the problems is the shortage of intensive care beds, which holds up operations in hospitals so that there is a queue?

[Lord O'Shaughnessy]

The noble Baroness is quite right. That is one of the reasons we have taken some big decisions over the winter, one of which is to reduce the amount of delayed discharges. I think it has been reduced by about 1,500 beds. It was also the reason behind what was undoubtedly an unpopular decision and one that we did not want to take: to suspend and postpone some elective surgeries during January. That freed up a number of beds, which helped us to cope with the emergency admissions. Happily, it has not had to be reinstated since the end of January.

Abortion: Misoprostol

Debate between Baroness Masham of Ilton and Lord O'Shaughnessy

Tuesday 20th March 2018 Lords Chamber

[Lord O'Shaughnessy]

The importance here is making sure that, under the auspices of the Act, women have access to safe and legal abortion, and that is what they have a right to do. An important point here is that, the earlier these abortions happen, the safer they are. The proportion of abortions under 10 weeks has risen from 68% to 81% in the last 10 years. At the moment, both courses of treatment for early medical abortion should take place in a clinical setting approved by the Secretary of State.

[Baroness Masham of Ilton (CB)]

My Lords, has any research been undertaken on the psychological feelings of people who have had abortions in their own homes?

[Lord O'Shaughnessy]

I am not aware of any research, but I shall ask the department to see if there is any. If there is, I shall write to the noble Baroness.

Medicines and Medical Devices Safety Review

Debate between Baroness Masham of Ilton and Lord O'Shaughnessy

Thursday 22nd February 2018 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Countess for raising that point. We have met to discuss this issue and she has been a great campaigner on medicine safety issues. That dialogue is going on. As she knows, that view concerning the safety is not currently shared by the regulators. But I want to stress that the work that my noble friend Lady Cumberlege will be leading will try to set up a process which deals equitably, objectively and compassionately with these concerns when they arise. One of the problems in the past has been, frankly, that we have not dealt with these things in the same way. It is dependent on the strength of the lobby group, the type and strength of the Government and what is on their agenda at any one time. That is not good enough. We need a consistent and compassionate approach to listening to concerns, scrutinising them properly and dealing with the consequences, which may entail no further action or could be anything up to a full public inquiry. That is what my noble friend will be dealing with and that will be a huge step forward. It will be precisely that kind of process to which any concerns about HPV or anything else should be directed.

[Baroness Masham of Ilton (CB)]

My Lords, I thank the Minister for the support he has given to the epileptic women who have taken valproate, resulting in them having children with autism. The marking and the advice were not there for them. Does the Minister realise that many people are concerned about the European Medicines Agency, which deals with safety in medicines? It was housed in London at Canary Wharf but has now gone to Amsterdam. Will we still be involved in that agency? We were leaders when it was here in London and we still have a lot to offer.

[Lord O'Shaughnessy]

The noble Baroness makes an excellent point. Specifically on valproate safety, the MHRA has taken a leading role in pushing all the time for stronger responses to the concerns. We are pleased to see that other European countries are responding. That highlights a bigger issue, which is if you look across the entire continent and the work that our agencies do—whether it is the MHRA, the GMC or others—we are seen as a leader across Europe, and indeed globally, on patient safety issues. That is one reason why it is our desire that in our future relationship with the European Union, the MHRA and other agencies continue to play that role, for the good of patients not just here but across Europe.

NHS Winter Crisis

Debate between Baroness Masham of Ilton and Lord O'Shaughnessy

Monday 5th February 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord raises a very interesting issue. As he rightly points out, that number has been dropping over a long time. It has plateaued in recent years, but it has been falling. This is a difficult situation. We all agree that more care should be delivered in the community, but we also understand that at certain times of year you do need beds in hospitals. I will point to two things: first, making sure that bed capacity is more efficient so that people can stay safely for less time and can spend more time being treated in their homes—which often is where they want to be, and that is why the extra funding for social care is important; and, secondly, the reconfiguration test that has been introduced by NHS England, which is about stopping reductions in bed numbers—which, as the noble Lord said, has happened under successive Governments—where it cannot be proven that any reduction is for the benefit of patients in terms of their overall care.

[Baroness Masham of Ilton (CB)]

My Lords, I declare an interest as president of the Spinal Injuries Association. Is the Minister aware that at Stoke Mandeville’s national spinal centre, a ward that is absolutely necessary has been taken away from the spinal unit and used for general patients? There are waiting lists in the seven spinal units all over the country, affecting seriously ill patients who need specialised treatment. Will the Minister look into the situation?

[Lord O’Shaughnessy]

I was not aware of that but I shall certainly investigate and write to the noble Baroness.

NHS: Nurse Retention

Debate between Baroness Masham of Ilton and Lord O'Shaughnessy

Wednesday 17th January 2018 Lords Chamber

[Lord O’Shaughnessy]

The point about understanding the reasons that people leave is very important. Some hospitals use exit interviews for that; I do not know if it is a nationwide programme but I shall certainly write to the noble Lord about that as it is a good idea. As for attracting staff back, I mentioned the return-to-practice programme. I think my noble friend Lady Chisholm took advantage of a similar programme when she returned to work after having children. I come back to the issue of pay. We know that pay is important, which is why lifting the cap will make an important difference to showing how much we value these staff.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister agree with me that, if the National Health Service provided reasonable housing for nurses and flexible working for those with children, it would help to retain them?

[Lord O’Shaughnessy]

The noble Baroness is quite right. We know that housing costs are an issue, particularly in the south of England and cities, which is why we want to use the sale of surplus NHS land to deliver more homes specifically for nurses and other similar professionals. She is also right to talk about flexible working, which comes up time and again in staff surveys. The use of nursing banks can be very helpful in that regard, and we have seen a big switch away from agencies towards using such banks for those places that need to be filled temporarily.

Agency Nurses

Debate between Baroness Masham of Ilton and Lord O'Shaughnessy

Wednesday 10th January 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is quite right that agency staff are sometimes used to fill vacancies—about nine out of 10 vacancies are filled in that way. The key is to make sure that they are used in a proper, planned way that is not expensive. The point about the “break glass” clause is that the rules that exist to cap agency spend can be broken where there is a need and where that need is approved by the trust for patient safety purposes. That is an important feature of the system.

[Baroness Masham of Ilton (CB)]

My Lords, in this present crisis, are more nurses taking advantage of the “break glass” clause?

[Lord O'Shaughnessy]

The number of uses of the “break glass” clause has actually fallen since April 2016, which was the peak. This shows that there has been a much more planned use of bringing in extra staff as they are needed, rather than an ad hoc response, which was what it was designed to address.

Brexit: Health Policy

Debate between Baroness Masham of Ilton and Lord O'Shaughnessy

Wednesday 6th December 2017 Lords Chamber

[Lord O’Shaughnessy]

The Secretary of State has set out very clearly that patients should not be disadvantaged as a result of the new arrangements, whatever they may be. Clearly, those new arrangements will be a matter for negotiation, but we will make sure that patients are not disadvantaged and that the industry can continue to get its drugs and devices to the UK market as quickly as it does now.

[Baroness Masham of Ilton (CB)]

My Lords, how many people from Europe who are in the medical field have already left because of insecurity and not knowing what is happening?

[Lord O’Shaughnessy]

I recognise that there is uncertainty. That is why we have set out our intention of offering a route to settled status for those people working here, and why we want the issues of citizens’ rights to be dealt with as soon as possible in the next phase of talks. The noble Baroness and other noble Lords will be interested to know that, if you compare June 2016 to June 2017, there are more EU workers working in the NHS from one year to the next.

HIV Prevention Services: Public Health Funding

Debate between Baroness Masham of Ilton and Lord O'Shaughnessy

Thursday 30th November 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is quite right to point out the difference. If you look at the performance in London against the UNAIDS 90-90-90 targets, you will see that they have been met. However, England as a whole is at least slightly behind on at least one of those factors—people with HIV not being diagnosed—which points to the fact that out of metropolitan areas there is more work to do, as she says. One of the ways in which local authorities meet that challenge is through offering home testing kits, which are being sent out and which are now seeing the kind of return and diagnoses levels that you would see in sexual health clinics.

[Baroness Masham of Ilton (CB)]

My Lords, is it correct that six clinics have closed in London recently? Is he aware that other infections, such as gonorrhoea, have become drug-resistant? Many people from ethnic minorities need to know where to go, and communication is so important.

[Lord O'Shaughnessy]

I did not know about the closures that the noble Baroness mentioned. I reiterate that more tests are taking place. Indeed there has been a substantial decrease in the amount of new diagnoses, which is good news because it means that transmission is falling. We want to focus on the outcomes here, which are positive, particularly in London. She is of course quite right about other STIs being important. There is good news there as well, because diagnosis is falling, so some of the public health plans being put into place are starting to pay dividends.

Health: Sepsis

Debate between Baroness Masham of Ilton and Lord O'Shaughnessy

Thursday 14th September 2017 Lords Chamber

[Lord O'Shaughnessy]

That is absolutely right but I draw the attention of the noble Lord to a couple of things. First, in the NICE quality standard published yesterday there are some very clear statements about the speed with which people suspected of these symptoms should be treated. Those are quite robust in terms of getting intravenous antibiotics to people within an hour, being reassessed by a senior clinician if they then fail to improve within an hour and so on. That is very clear and there is implementation guidance going through. Another thing announced yesterday is quite important. It is a slightly odd phrase but “safety netting” is where someone has been assessed on whether they have sepsis, does not have it but is sent away with materials that show what the symptoms might be and how to report back if their condition deteriorates.

[Baroness Masham of Ilton (CB)]

My Lords, as has been said, sepsis can be a big killer if the correct antibiotics are not given. Should it not be conditional to report sepsis so that more research can be done? Should there not be a very quick test for it?

[Lord O'Shaughnessy]

The noble Baroness is quite right. Trusts are now incentivised to report incidences of sepsis and their performance against these quality standards. That is happening. Unfortunately there is still variation within the system. That is why the documents that came out yesterday are so important. For the first time, we have an operational definition of adult sepsis. Clearly, that is critical to making sure that it is spotted in time.

National Stroke Strategy

Debate between Baroness Masham of Ilton and Lord O'Shaughnessy

Wednesday 5th July 2017 Lords Chamber

[Lord O’Shaughnessy]

My noble friend is quite right to highlight that issue. I must congratulate him on the progress made in stroke treatment during his time as Secretary of State for Health. I shall certainly look at whether the better care fund can be used in the way that he has described.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister agree that there is fragmentation across the country and that care differs in some areas? Did the strategy not pull it together and pass on good practice to those less experienced?

[Lord O'Shaughnessy]

The noble Baroness is of course right that the strategy had that galvanising effect. As I said, it has been superseded by a broader cardiovascular strategy, which is leading to some of the improvements that I have discussed. The other thing to focus on is the fact that stroke is now being included in the new urgent and emergency care standards that are being introduced, which will ensure, and indeed require, that all stroke patients are seen within 14 hours by consultants who are stroke specialists. That is precisely about ironing out some of the discrepancies in actual practice that happen across the country.

Brexit: Nursing Staff

Debate between Baroness Masham of Ilton and Lord O'Shaughnessy

Tuesday 27th June 2017 Lords Chamber

[Lord O'Shaughnessy]

The critical point is to have enough nurses and, indeed, enough medical staff. Of course, where they come from is going to be dictated by various circumstances. As I have discussed already, language controls have been introduced in order to focus on patient safety. We do need to increase the number of nurses in the health sector. That has happened since 2010. There has been an increase. There are more in training. But clearly there need to be more as we have a growing and ageing population.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister know how many unfilled vacancies there are at this time for nurses?

[Lord O'Shaughnessy]

I do not have that information at my fingertips. Of course, at any time there will be unfilled vacancies as nurses move around. As I said, we know that recruiting more nurses into the health service is an important priority for the years ahead, which is why we are undertaking the programmes that I mentioned.