Health: Tick-borne Encephalitis

Baroness McIntosh of Pickering Excerpts

Tuesday 5th November 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Lord for that question, although I generally identify as a noble Baroness. We are continuing surveillance studies for TBEV in ticks and wildlife, and we plan to monitor its prevalence, distribution, maintenance and spread in the UK to ensure oversight of the situation. We have based our understanding of the risk assessment on recent experience in the Netherlands, where TBEV was recently identified. The estimated risk there of Lyme disease from a tick bite is 1:50, while the estimated risk of TBEV from a tick bite is 1:500,000. As regards us doing enough work, we have a national contingency plan written to deal with vector-borne diseases and understanding the effect of climate change, which gives us a sense of the challenges that we face.

[Baroness McIntosh of Pickering (Con)]

My Lords, will my noble friend recognise the work of the national Encephalitis Society, which is based in Malton in North Yorkshire, of which I have the honour to be a vice-president? Will she update the House on what work has been undertaken to help doctors identify the difference between meningitis and encephalitis so that the swiftest possible treatment can be given? My husband was one of those who suffered encephalitis in his 20s; many are less fortunate and do not make the recovery that he made.

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right, and I am happy to recognise the organisation that she mentioned. In the first place, the tick toolkit and the work of PHE is in place to raise awareness, and work goes into providing advice to professionals so that early diagnosis is possible.

GP Services in Rural Areas

Baroness McIntosh of Pickering Excerpts

Tuesday 2nd July 2019 Lords Chamber

Asked by

[Baroness McIntosh of Pickering]

To ask Her Majesty’s Government what measures they propose to take to ensure that there is adequate provision of GP services in rural areas.

[Baroness McIntosh of Pickering (Con)]

I beg leave to ask the Question standing in my name on the Order Paper and in doing so refer to my interests declared in the register.

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

My Lords, primary and community care will receive at least £4.5 billion more a year by 2023-24. Incentives have been in place since 2016 to attract GP training to hard-to-recruit areas, including rural areas. NHS England is consulting on allowing digital-first practices to be set up in under-doctored areas and everyone will have the right to digital-first primary care by April 2021, which will provide another way for patients in rural areas to access services.

[Baroness McIntosh of Pickering]

I thank my noble friend for that Answer. She might be aware of last week’s Telegraph report, which shows that almost 2,000 villages are at least three miles from their nearest GP practice. That figure would be higher were it not for the fact that rural practices can dispense medicine where community pharmacies are inviable. Will my noble friend take this opportunity to commit today to specific support for rural general practices over and above what is already in the NHS long-term plan, which has a particularly urban-centric focus? I remind my noble friend that we in rural areas are struggling to get 4G, let alone access to digital medicine.

Breast Scans

Baroness McIntosh of Pickering Excerpts

Monday 19th November 2018 Lords Chamber

[Lord O'Shaughnessy]

I am more than happy to do so. If the review is not the correct forum for consideration of such an issue, I will refer it to the advisory committee instead.

[Baroness McIntosh of Pickering (Con)]

My Lords, does my noble friend agree that, with mammography and all other forms of screening, the quality and availability of radiographers are important? Will he report to the House on the current status of radiographers in the country?

[Lord O'Shaughnessy]

I am happy to tell my noble friend that we are in the process of recruiting many more radiographers for the NHS, with a plan to recruit nearly 1,900 by 2021.

General Practitioners

Baroness McIntosh of Pickering Excerpts

Wednesday 17th October 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness raises what is unfortunately a sad fact. One of the areas I highlight is the increasing use of social prescribing, which uses means such as joining clubs and taking part in activities that often have a social dimension to alleviate the problems associated with loneliness. Our new Secretary of State has made social prescribing a priority, because clearly it enables us to change people’s lives for the better without resorting to appointments and medicines.

[Baroness McIntosh of Pickering (Con)]

My Lords, I declare an interest as an adviser to the board of the Dispensing Doctors’ Association. Will my noble friend address the very real issue of recruiting and retaining GPs in rural areas? I declare an interest in that both my father and brother have been dispensing doctors. It is not just an issue of 55 year-old doctors’ pension contributions; increasingly there is a problem of attracting young doctors in their 30s and 40s and retaining them, because of the poorer pension provisions we have now.

[Lord O'Shaughnessy]

My noble friend makes an important point, and obviously she has first-hand experience of that. I am pleased to tell her that there is a targeted recruitment scheme that offers a £20,000 salary supplement for those who serve in hard-to-reach areas. In 2016, 122 places were offered on that scheme, and that number has now more than doubled in 2018, so we are putting more and more emphasis on that.

NHS: Dangerous Waste and Body Parts Disposal

Baroness McIntosh of Pickering Excerpts

Wednesday 10th October 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness makes an important point about incinerator capacity; indeed, that was given as a reason by the company. However, we do not feel that that is a true reflection of incinerator capacity. There are 24 incinerators in the country and 30,000 tonnes of spare capacity which could be used, and we are talking about 900 tonnes of excess stockpiling that HES had taken care of—so we simply do not accept that there was not enough capacity. What there was not was a willingness on the part of HES to pay for that capacity, which is why we are in this situation.

On the frequency of inspections, the Environment Agency has issued a series of notices, and that has escalated over the summer to the situation that we are in now. That is the proper regulatory response. I reiterate the point that there is no established threat to public health or continuity of service, which hopefully answers her last question. From an NHS point of view, neither clinicians nor patients will have noticed any impact on the level of care as a consequence of what I absolutely agree with her is completely unacceptable behaviour by this company.

[Baroness McIntosh of Pickering (Con)]

The Minister mentioned 30,000 tonnes of spare incinerator capacity. Is that for general waste or exclusively for medical waste? Will the Minister encourage the Department for Environment, Food and Rural Affairs to engage with the public on the importance of incineration as a means of disposing effectively of both household and medical waste? We are currently exporting a massive amount of household waste from the city of York and north Yorkshire to Holland, where it is put back in the community as energy from waste. I would like to see more of that occur in this country.

[Lord O'Shaughnessy]

I thank my noble friend for her question. I will certainly take up the issue of waste disposal in general with my colleagues in Defra who, as she knows, are responsible for it. On the specific question of incineration capacity, Defra calculated that in 2017 there was a total of more than 30,000 tonnes of spare capacity for clinical and hazardous waste incineration. That was across a year, but we know that the NHS has identified more than 2,000 tonnes of incineration capacity this month. So the capacity is there; the point is that it should be used to get rid of the stockpile. As I said, the contracts are now in place to ensure a continued flow of service to NHS trusts.

Brexit: Food Standards Regulations

Baroness McIntosh of Pickering Excerpts

Tuesday 4th September 2018 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, the noble Lord said that regulations will be required. It will be of interest to the House to know what the timetable for those regulations will be.

[Lord O'Shaughnessy]

My understanding is that they will be laid, subject to clearance, before the end of the year.

General Practitioners: Indemnity Scheme

Baroness McIntosh of Pickering Excerpts

Monday 16th July 2018 Lords Chamber

[Lord O’Shaughnessy]

No, it is not.

[Baroness McIntosh of Pickering (Con)]

My Lords, I declare the work that I do with dispensing doctors. A particular barrier to retaining and recruiting GPs in rural areas is the pension provisions, which is the case for all professions. Will my noble friend make representations to the authorities that be in this regard as that would be a major step forward for those now coming into the profession in their 30s and 40s?

[Lord O’Shaughnessy]

My noble friend makes an excellent point and I will certainly do so. There is an attempt not just to recruit many more GPs into service but to recruit them into hard-to-reach areas, such as rural areas, through a targeted recruitment campaign. I am sure that that is one of the areas that we will want to look at.

Carers: Back Pay Liability

Baroness McIntosh of Pickering Excerpts

Wednesday 16th May 2018 Lords Chamber

[Lord O'Shaughnessy]

I recognise the concern expressed by the noble Baroness, which the Government share. Even though the position on the change of the status on paying sleep-in payments changed in October 2016, we understand the size of civil liabilities for some providers who, of course, are, in many cases, providing for some of the most vulnerable people in society. That is why this HMRC scheme was set up. It gives providers extra time—up to 15 months—to get their house in order, understand their liabilities and pay them. That comes to an end in March 2019, which is why we are working on looking at other interventions and talking to the European Commission about the legality and state-aid rules in relation to that. I am afraid that I cannot give her any more detail at this stage, but I can tell her that it is a priority.

[Baroness McIntosh of Pickering (Con)]

My Lords, this is particularly about the retrospective nature of this award. I contacted my noble friend, who was kind enough to take up the case of the Wilf Ward Family Trust, which provides for the care needs of young people with learning disabilities and which will be affected. Is he able to contest the retrospective nature of this decision and ensure that no similar back pay will be awarded in the future? County councils are completely incapable of making up this shortfall.

[Lord O'Shaughnessy]

I thank my noble friend for raising the issue, which we are looking into. The point here is that the change in policy has come about because of decisions made by employment tribunals and a clarification of the law, and the job of government is therefore to help providers to comply with the law. That is how the scheme has come about, and why extra support is being looked into. We are working closely with providers to try to understand the scale of the liability and how it affects organisations differently—we think that up to two-thirds are affected. We will also make sure that any intervention that might follow—I stress “might”—is proportionate, fair and legal.

Brexit: Food Standards Agency

Baroness McIntosh of Pickering Excerpts

Thursday 26th April 2018 Lords Chamber

[Lord O’Shaughnessy]

I can certainly reassure the noble Baroness that the Food Standards Agency is getting the resources it needs, as well as a stable funding settlement across the spending review period. The Chancellor announced £14 million more for it for 2018-19. That money will also beef up—excuse the pun—the National Food Crime Unit to make sure that it can investigate the kinds of cases that she has highlighted. As for the ongoing relationship with the EU, it is important to recognise that during the implementation period we will continue to access food information-sharing systems. We will continue to have food risk assessments carried out on our behalf by the European Food Standards Authority, and the Commission will make risk-management decisions that affect the UK. We will continue to be part of that system until the end of the implementation period. Naturally, what happens after that is a matter for negotiation.

[Baroness McIntosh of Pickering (Con)]

Will my noble friend commit to setting out the timetable for all the implementation regulatory statutory instruments that are required to enhance the powers of the Food Standards Agency, given the role that it will be required to play not just in domestic food production but in relation to all imports from 29 March next year?

The Long-term Sustainability of the NHS and Adult Social Care

Baroness McIntosh of Pickering Excerpts

Thursday 26th April 2018 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, it is a pleasure to follow the noble Lord. This is a wide-ranging debate and touches on a number of major issues. We are greatly indebted to the noble Lord, Lord Patel, and his committee, and I congratulate him on securing this debate. My father and my brother were country GPs and my uncle was a surgeon. They devoted their working lives to the health service. My father was one of the first NHS GPs in 1948. In the days when home visits were the norm, he worked on duty, on call every second night and every second weekend. Whatever the weather, Dr Mac would be there to look after the patient. I yield to no one in my admiration for those who work at every level in the health service.

I would like to look at ways of enhancing the long-term sustainability of the NHS, particularly in rural areas. I work with the board of the Dispensing Doctors’ Association. Its national headquarters are in Kirkbymoorside in North Yorkshire. I recognise the great work that such doctors do dispensing in sparsely populated rural areas that are not well served by community pharmacies. Undoubtedly, providing all public services, not least healthcare, in rural areas is more challenging and more expensive, and it is not generally recognised in NHS funding.

There are further challenges, such as the lack of good access to rural broadband. It is important to acknowledge that it is very difficult for those practising in rural areas to access NHS Digital. I refer, for example, to the electronic prescription service, which is a particular challenge in rural areas. It seems bizarre that at the moment the health service seems to be putting more money into allowing patients to access wi-fi in the waiting room before a GP consultation than into beefing up the broadband available to rural GPs.

Historically, Conservatives in government have always emphasised rurality and sparsity factors in both funding and delivering healthcare. Given the vast areas that GP practices cover and the often long distances patients have to travel to general hospitals, community hospitals play a central role in delivering healthcare in rural areas. It is a matter of anger tinged with sadness that a decision was taken by the local clinical commissioning group to close the Lambert hospital temporarily, then permanently. More recently, NHS Property Services has decided to sell the site on which the hospital is situated. In terms of delivering healthcare locally, this is a retrograde step. To the local community, selling a facility that was gifted to the people of Thirsk and surrounding villages in perpetuity by the Lambert family is ethically and morally questionable. In my view, it is indefensible. It was a fantastic facility, offering step-up, step-down rehab after a fall, stroke or operation, making patients safe before they returned home. I take this opportunity to seek an assurance from the Minister that he will either intervene, block the sale of the site and permit the Lambert site to be converted into a health hub for the local community, which is what GPs in Thirsk are requesting, or ensure that the proceeds of the sale are returned and used for healthcare in Thirsk.

Primary care is currently the less-favoured arm in NHS funding compared with secondary care. This point was made by the noble Baroness, Lady Tyler. This imbalance needs to be addressed. The idea of hypothecating national insurance contributions to pay for the NHS has some merit but, as I mentioned in my earlier intervention, taking 1% out of the health service by increasing this charge is immediately to remove funding that would normally go to front-line care, so that potential gap in the finances has to be filled.

I welcome the idea of a royal commission to look at sustainable, long-term funding for the NHS, particularly if it were against a background of cross-party consensus. Such a commission would be a wonderful opportunity to review the balance of spending in favour of primary care, particularly in rural areas where costs are higher owing to rurality and the sparsity of the population, which I mentioned earlier.

I favour the model of GPs working in partnership, but we face a ticking time bomb. A number of GPs face retirement over the next five to seven years, and fewer GPs want the responsibility of being partners. It is not just that positions are difficult to fill in London, which the noble Lord, Lord Winston, referred to; they are difficult to fill in rural areas too.

My question to the Minister today is: where is the parliamentary scrutiny and accountability of NHS England and NHS Property Services? They operate independently of government and appear totally unaccountable to Parliament. I am aware of the mandate agreed between the Department of Health and Social Care and NHS England, but I question where the adequate parliamentary scrutiny is. For the sustainability of general practice and with a view to allocating more funds to delivering healthcare in rural areas, the balance between rural and urban areas should be addressed as a matter of urgency. Enabling GPs to treat patients swiftly after appointments at their surgery would prevent an increasing dependence on admissions to accident and emergency departments and prevent a troubling ailment becoming acute.