Breast Scans

Debate between Baroness McIntosh of Pickering and Lord O'Shaughnessy

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

Debate between Baroness McIntosh of Pickering and Lord O'Shaughnessy

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

Debate between Baroness McIntosh of Pickering and Lord O'Shaughnessy

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

Debate between Baroness McIntosh of Pickering and Lord O'Shaughnessy

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

Debate between Baroness McIntosh of Pickering and Lord O'Shaughnessy

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

Debate between Baroness McIntosh of Pickering and Lord O'Shaughnessy

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

Debate between Baroness McIntosh of Pickering and Lord O'Shaughnessy

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?

General Practitioners: Workforce

Debate between Baroness McIntosh of Pickering and Lord O'Shaughnessy

Monday 5th March 2018 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I refer to my registered interest.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)]

My Lords, in the 2016-17 pension scheme year, 721 GPs took early retirement, representing 62% of all GP retirements. However, it should be noted that many GPs who take their NHS pension then return to service. Early retirement does not necessarily mean a loss of skills and experience to the NHS. We recognise, however, the need to increase the general practice workforce, which is why the Government remain committed to delivering an additional 5,000 doctors working in general practice by 2020.

[Baroness McIntosh of Pickering]

My Lords, we appear to be in a vicious cycle of doctors retiring early and then coming back and working part-time and fewer EU doctors coming to work here. What can my noble friend do to increase the number of doctors wishing to enter GP practice as opposed to other specialties, and what will the certification procedure be for EU doctors to be recognised as doctors to practise post Brexit in this country?

[Lord O’Shaughnessy]

I thank my noble friend for her question. It is interesting to note, looking at the figures, that the total number of retirees from general practice has been falling in recent years, which is very welcome, even though in the past few years there has been an increase in the number taking early retirement. As for entering general practice, that is how we need to get more GPs. The number of training places has increased to a record 3,250, which is an 18% increase over the past three years. Finally, on certification, mutual recognition of professional qualifications is of course a matter for negotiation as part of our future relationship with the EU. However, I can tell my noble friend that the Government are committed, under whatever circumstances, to recruit 2,000 international GPs in the coming years.

Alcohol: Minimum Unit Pricing

Debate between Baroness McIntosh of Pickering and Lord O'Shaughnessy

Wednesday 28th February 2018 Lords Chamber

[Lord O'Shaughnessy]

I do not recognise the picture of obstruction about tobacco and smoking. This Government have done a huge amount, and smoking levels have never been lower. In terms of increased pricing, history tells us, if you go back hundreds of years—think about “Beer Street” and “Gin Lane”—that taxation has a really important role to play in promoting better drinking habits. That is the approach that we have taken with changes in duty for drinks that are particularly problematic, such as white cider. As I have said, we will look at how minimum unit pricing in Scotland progresses.

[Baroness McIntosh of Pickering (Con)]

Is the Minister aware that Scotland has banned or tried to reduce BOGOF—buy one get one free—at supermarkets? That is the evidence that we heard on the ad hoc committee, which I had the honour to chair, on the scrutiny of the Licensing Act 2003. Changing behaviour is a good way forward, rather than the potentially regressive tax of MUP.

[Lord O'Shaughnessy]

My noble friend speaks with great wisdom about making sure, not just with alcohol but with other health issues around food and drink, that we have a look at making those kinds of promotions not possible.

Medicines and Medical Devices Safety Review

Debate between Baroness McIntosh of Pickering and Lord O'Shaughnessy

Thursday 22nd February 2018 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, I welcome the review that my noble friend has announced—I can think of no better person than my noble friend Lady Cumberlege to do it. One of the concerns of those who are campaigning and have received what they consider to be very inferior treatment is that when the mesh was originally introduced it was done, they think, without proper research, it was inserted with inadequate training, and inadequate warnings were given of the potential risks. Will my noble friend assure us that if an alternative is sought, that will not be the case but that it will be subject to rigorous testing, that there will be rigorous training of the medical professionals and that the risks will be explained to the patient?

They have also raised concerns about potential trade under any future trade agreement with the United States, where I understand a lot of the mesh comes from. They are concerned that we will not just waive any suspect mesh through but will ensure our own rigorous testing so that it meets the highest requirements of the UK.

[Lord O’Shaughnessy]

I thank my noble friend for those points; she highlights some very important issues. Medical devices are regulated differently from medicines: they have to go through a safety procedure and they are not licensed in the same way as medicines are. They come onto the market, they are used and safety assessments are made as time goes on. We are now in the position with mesh that we will have a registry, so that every time it is used we will know what the consequences are. That will also give us a comparator, as will the audit, for effectiveness against alternative procedures. As I have said, there is still a view in the medical and regulatory communities that, when used according to guidelines in the appropriate way, it can be transformative for women. However, it can also be the wrong thing and NICE has been very clear that in some cases, in some surgeries, the risks outweigh the benefits, in which case it should not be used. It is important that there is absolute conformity with those guidelines and that is part of what the registry will ensure.

On the issue of trade, under no circumstances will our trade relationships with any country in the future dilute the regulatory rigour that we apply and have always applied in this country. We have a very well regarded regulatory system in this country but we also know that we can do better and it is absolutely our intention to continue to strengthen it.

Health: Pelvic Mesh Implants

Debate between Baroness McIntosh of Pickering and Lord O'Shaughnessy

Tuesday 6th February 2018 Lords Chamber

[Lord O'Shaughnessy]

I am grateful to the noble Lord for raising this issue, because there is certainly a complication rate. I know that a lot of women are suffering as a result of complications from this procedure. As he will know, we have asked the MHRA, NICE and NHS England to have a look at the correct use of this kind of mesh. They have all concluded that they do not support a complete ban. They propose a range of restrictions on usage. Indeed, the most recent interventional procedure from NICE on prolapse said that it should be used only for research purposes and not as a front-line treatment. However, I am aware that Australia and New Zealand are implementing bans for particular usage. I have asked NICE and MHRA to investigate why they have done that and to report to me urgently so that I can see the grounds for the ban. We have different regulatory systems, but I want to know what is happening there.

[Baroness McIntosh of Pickering (Con)]

My Lords, will my noble friend explain to the House what the alternative might be if pelvic mesh implants were to be stopped? Is it not appropriate to be absolutely sure that any alternative is fool-proof and that there are no consequences?

[Lord O'Shaughnessy]

My noble friend makes an excellent point. This is one procedure, and for some women it can be positive and life-enhancing. But we also know that it carries a risk of complications. That is one reason why we wanted to carry out the audit, because it will look not only at areas and procedures where there have been problems and complications but at where it has been successful, so that we can have a proper understanding of what the complication rate is and therefore what the safety concerns are.

Nurses and Midwives: Numbers

Debate between Baroness McIntosh of Pickering and Lord O'Shaughnessy

Monday 4th December 2017 Lords Chamber

[Lord O'Shaughnessy]

I think that words do have meaning, and it is important not to miss the opportunity to say how much we value those nurses who have come from the European Union as well as all staff in the NHS. One example of the value with which we hold them is the announcement in the Budget that the Chancellor will fund an Agenda for Change pay settlement for nurses.

[Baroness McIntosh of Pickering (Con)]

My Lords, I congratulate my noble friend on the increase in the number of training places, but can he give the House an assurance today on the figures for recruitment and retention of nurses in rural areas and, in particular, that their travel is fully paid for when they drive round remote parts of the country such as North Yorkshire and other isolated areas that they have to cover?

[Lord O'Shaughnessy]

Yes, absolutely—travel costs should be accounted for, as long as they are incurred in the course of an ordinary working day. I should also point out that extra travel costs are now supported as part of the student finance package for those who need to travel for study.