Mental Disorder: Autism and Learning Disabilities
Baroness Thornton Excerpts(4 years, 6 months ago)
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Baroness Blackwood of North Oxford
I thank the noble Lord for raising this very important Question today. I should like to be clear that the Government are committed to ensuring that people with learning disabilities and autistic people have the best quality of life and live a full life in the community. A lot of the work that has been done recently, including reviewing and replacing the autism strategy and doing case reviews of every individual who has a learning disability or autism and is in in-patient care, is designed to ensure that we deliver that. I shall take back to the department the noble Lord’s specific point about a hotline for families and ask what can be done.
Baroness Thornton (Lab)
My Lords, as my noble friend has rightly highlighted, neither autism nor learning difficulties are mental health conditions. These children should not be in wards which are likely to be noisy, bright and unpredictable. Noble Lords may have seen the report on Sky News about Jeremy, whose autistic daughter Bethany is being held in a mental health unit. He has been campaigning about her inhuman treatment for a long time—too long. He says of the proposed review: “There are 600 people whose care plan says that they should not be in hospital, and for half of them, their local authorities do not even know that”. Those are the Government’s own figures. We have had one review after another since Winterbourne View, nine years ago. I agree with Jeremy— we need action not reviews.
Worse, Matt Hancock, the Secretary of State, is apparently sitting on a report about Jeremy’s daughter and said that it will be released before Parliament rises. Can the noble Baroness ensure that Bethany’s report is released to her parents this afternoon and tell the House when we will see action, rather than reviews, for this vulnerable group of young people?
Baroness Blackwood of North Oxford
We absolutely agree with the noble Baroness’s point. We need to ensure that everybody who can be cared for in the community is able to be cared for. That is why we have reduced the number of people in in-patient care by 22%; we have set a target to reduce that number by 50%. We are driving that forward as quickly as possible.
On the matter of the serious incident review of Bethany’s case, we have received the report and are working to release it as soon as possible. NHS England is taking action to improve Bethany’s situation and secure an alternative, more suitable, provider in the community as quickly as possible.
Regarding the case reviews of every individual, the Government have committed to providing each patient with a date for discharge or, where that is not appropriate, with a clear explanation of why and a plan to move them closer to being ready for discharge in the community. This significant commitment from the Government should be welcomed.
Health and Social Care: Malnutrition
Baroness Thornton Excerpts(4 years, 6 months ago)
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Baroness Blackwood of North Oxford
The noble Lord is absolutely right that this is an issue which is on the rise. The causes are complex and can be clinical, social or economic, but we are committed to improving this situation. That is why we have brought in the hospital food review, to ensure the safety of the food available for patients, visitors and staff, but also to look at how we can provide the highest level of care possible for patients, which includes the quality and nutritional value of the food served to them. The review will also look at the best possible methods of screening and training staff.
Baroness Thornton (Lab)
My Lords, in a rich country such as ours, it is shameful that anyone does not have enough to eat. Yet over £3 billion is spent on managing malnutrition and its effects. NHS trusts already have a duty to ensure that they meet patients’ nutritional and hydration needs. However, the Campaign for Better Hospital Food has said that, despite the introduction of food standards, at least half of all hospitals are not complying and the current Government are failing to encourage progress. Labour has committed to mandatory nutritional standards being regulated. I invite the Minister to join us in supporting this sensible policy.
Baroness Blackwood of North Oxford
The noble Baroness is absolutely right that it is critical that people have good and healthy food in hospitals. That is exactly why there are very strict food standards in hospitals and health and care settings which are already enforced by the CQC. It is also why we appointed the former head of the Hospital Caterers Association, Philip Shelley, to look at what more could be done to improve the situation with the hospital foods review, to look at the safety of food available to patients, visitors and staff, improve nutrition and make available healthier choices, and ensure that we can improve the expertise of caterers, suppliers, staff and those who work in hospitals, to ensure that we raise standards and reduce the incidence of malnutrition across the system.
Health Service Safety Investigations Bill [HL]
Baroness Thornton ExcerptsTuesday 29th October 2019
(4 years, 6 months ago)
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Baroness Thornton (Lab)
My Lords, I am resisting using words such as “zombie” in this debate, particularly so close to Halloween. Given the debate taking place in the Commons right now and the fact that a decision might be taken as we speak to dissolve Parliament, this debate may come to naught. However, it seems likely that we will find ourselves discussing this issue again after a general election. I reassure the Minister that, when our positions are reversed, the work that she is leading on this Bill will not go to waste.
I thank all noble Lords for their contributions and the Minister for her comprehensive explanation of the Bill at the beginning of this debate. I agree with the noble Baroness, Lady Jolly, that, in his way, my noble friend Lord Turnberg’s wise speech has given the House a test that we need to pass to make this Bill work. He did that eloquently and movingly and I thank him for that.
The noble Lord, Lord Patel, was quite right about the NPSA. I forgive the Minister for not having our historic memory; we had this in the past. I have in front of me quotations from the speech that the noble Earl, Lord Howe, made when he killed it off. He said that we needed to get rid of the arm’s-length body of the NPSA and integrate patient safety into the NHS and the social care system. Here we are today setting up an independent arm’s-length body to do just that. That is all I am going to say on that matter.
On these Benches, like most noble Lords today, actually we broadly support the aims of the HSSIB—not pretty, that name—and welcome the changes that have been made to the Bill since it was introduced in 2017.
I congratulate the Joint Select Committee on its deliberations and thank the many organisations, including the Library, which have taken the time to send briefings through to assist our consideration of the Bill.
Of course, the test of the Bill’s success will be whether it has a significant impact on patient safety and changes culture, habits and working practices. I hope that we will not find ourselves in five years’ time realising that we simply added another layer of complexity and bureaucracy to the NHS’s existing patient safety regimes and that it had little impact. The reason I say this—again, it was highlighted eloquently by the noble Lord, Lord Patel—is that we know that it is people who need to change their habits, culture and working practices. However clever the structures and however laudable the aims of the HSSIB, if it cannot influence and change those habits, culture and working practices throughout the NHS, it will not succeed. In many ways, that is the most difficult thing we seek to do here.
The concept of safe space is interesting, plucked from the aviation industry, as many noble Lords said, where it has worked well. However, the NHS is not British Airways. In many ways it is a much more complex organisation, and it is full of human beings who do things to other human beings. Whether it is possible to transpose that concept is one of the key questions we will have to address during the passage of the Bill. The safe space provisions need to be balanced with the rights of patients and their families to be involved in the investigative process, and their results being open to public scrutiny—the noble and learned Lord, Lord Judge, said that, drawing the attention of the House to the need for patients to be at the centre of this, which is absolutely vital.
Is there a potential conflict between the proposed safe space powers for the HSSIB and the duty of candour for healthcare professionals? The duty of candour is intended to promote openness and transparency with patients and families within health and care. However, will the proposed powers for the HSSIB undermine that by allowing professionals to share information in private? Perhaps the Minister would like to share her thoughts about whether the duty of candour is helped or hindered by the proposed safe space powers. As the Professional Standards Authority says in its brief:
“The proposed powers for HSSIB must not be a substitute for further work to embed a learning culture within regulatory structures and ensure that professionals feel safe and empowered to raise concerns within their workplace”.
The issue of protected materials was raised with us by several organisations. It is obviously true that newspapers, in print and online, play a vital role in scrutinising the NHS on behalf of the public, so transparency and freedom of information laws not only help to protect the public but are part of the public confidence in the system. That the Bill seeks to impose a statutory ban on the disclosure of information beyond that warranted for its purpose, and backed by criminal sanctions, is very serious indeed. Our job is to scrutinise the breadth of that ban, and to test whether its sanctions could prove counterproductive. The question is whether the Bill could undermine confidence and patient safety rather than improve it. I think we all look forward to probing this issue, particularly when we read the comment of the Campaign for Freedom of Information:
“The FOI Act’s nuanced approach protects the information that the government says this bill is designed to protect, but without the bill’s sweeping secrecy. The purpose of the prohibition, and the threat of prosecution, may be to reassure participants that they can assist the HSSIB without jeopardising their own position. But the terms in which this is done will lead to the withholding of information that could be disclosed without undermining that objective and which could contribute both to public understanding of safety issues and the HSSIB’s own accountability”.
There are serious questions which we will have to address in the later stages of the Bill. How will the public and other stakeholders be able to assess the rigour of the investigation, the propriety of the recommendations or whether improvements are being made, if they do not have access to the information on which the recommendations are based? Is the Bill compatible with Article 10 of the European Convention on Human Rights on the freedom of expression?
I turn to the issue of privately funded care. The HSSIB’s investigations are limited to NHS services and do not extend to privately funded care under Clause 2. However, only today, noble Lords will have received a report from the CQC that addresses the safety issues in cosmetic surgery. Of course, most cosmetic surgery procedures are privately funded. The report is very critical and underlines the point about independent hospitals, 41% of which the CQC recently rated as requiring improvement. We must include the independent sector under the scope of the Bill.
The Joint Committee highlighted the restriction to NHS-funded care and asked that it be reconsidered. In 2015, the Public Administration Select Committee said that the exclusion of the independent sector is not consistent with the whole-system approach, which is kind of obvious. The EHRC, in its briefing, asked the Government to look further at extending the HSSIB’s remit to privately funded care. I have a great deal of sympathy with the RCN, which said that,
“patients who use both NHS-commissioned health care services, and those who opt to have healthcare provided by private services, should receive the same rights to protections and safety from harm”.
Like many other noble Lords, we will be raising this issue at the next stage of the Bill, and we have time to draft the necessary amendments for consideration.
It does not need the setting up of the new structure, or the time and expense that that involves, to know that we have a crisis in our NHS workforce. That of course has an impact on patient safety. Will an HSSIB review consider planned and actual nursing staff levels in healthcare settings during any incident that takes place? Will it do that in every investigation that it undertakes? That will be crucial.
Turning to the exceptions from prohibition, on the High Court order, Clause 17 states that a person may apply to the High Court to disclose protected materials to the HSSIB. It states that:
“The High Court may make an order on application … only if it determines that the interests of justice served by disclosing by the protected material outweigh … any adverse impact on current and future investigations by deterring a person from participating in them, and … any adverse impact on the ability of the Secretary of State to secure the improvement of the safety of NHS services”.
Some of the briefings we are receiving express concern that the test for disclosure by the High Court is too vague. They are unclear how the considerations set out in Clause 17(3)(a) and (b) can be evidenced, other than by a statement to the effect that they apply in a case. The reasons that healthcare regulators will seek disclosure from the High Court are likely to be linked to the proper exercise of their public protection duties. Is not the Minister concerned that we might find a high volume of speculative applications to the court in cases where insufficient information is held by the regulators to satisfy themselves that they are aware of all pertinent information regarding their statutory duties to maintain public protection? That is one area where we will need to determine the interests of the different regulators.
As the Minister knows, I serve on the quality and safety committee of my local CCG. Our objective as part of the commissioning landscape in our area is to improve the quality and safety of commissioned services by identifying gaps in and concerns about service provision and to seek assurance related to those issues. If that sounds familiar, that is because it is exactly what is being said in the Explanatory Notes to the Bill.
My point is that many parts of the NHS are looking at patient safety. We look at all the never events in the hospital trusts in our area. We look for patterns; we look to fill gaps. That is exactly what we are there to do. Last night, I put to the Minister the question of how that fits into this new regime because, as the noble Lord, Lord Faulks, said, the question here is one of duplication and confusion.
Finally, what about people? How will we stop people taking a scattergun approach when they are outraged about the treatment of a member of their family and going to everybody—which happens, as we can see—including to this new body? It seems that we will have to be much more concise.
I will not cover the maternity issue. I am confused about that; we will need clarity on it. As I say, we welcome the Bill. We have heard some excellent contributions. The noble Baroness, Lady Hollins, asked what is, in many ways, the most pertinent question: how do we ensure the proper implementation of the excellent reports that the Bill will produce?
Drugs: Methadone
Baroness Thornton Excerpts(4 years, 6 months ago)
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Baroness Blackwood of North Oxford
My noble friend is quite right that we have to ensure that we prevent individuals getting addicted to drugs in the first place. That is why there is a wider drugs strategy, which ensures that we take action to reduce the number of people who become addicted in the first place, why the Home Office is holding a summit in Glasgow focused on tackling the problem of drug use, and why Dame Carol Black is working on the association between drug use and violence. However, we recognise that the use of methadone is an evidence-based and effective way to reduce the harm as cost-effectively as possible, which has been proven through extensive clinical and evidence-based trials.
Baroness Thornton (Lab)
My Lords, the lack of local government funding for drug treatment, combined with a policy-driven emphasis on abstinence rather than harm reduction, has frequently been cited as a likely reason for the increased number of drug-related deaths. In 2016, the Advisory Council on the Misuse of Drugs advised the Government on how to reduce opioid-related deaths in the UK. Despite Ministers claiming to accept the recommendations made by the ACMD, funding for drug treatment services, including OST—opioid substitution therapy—has been cut across the UK. Can the Minister confirm that this is the case and explain why the Government are not following the advice of the ACMD?
Specific Food Hygiene (Regulation (EC) No. 853/2004) (Amendment) (EU Exit) Regulations 2019
Baroness Thornton Excerpts(4 years, 6 months ago)
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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 consideration of the regulations. I am confident that we have the shared intention to ensure that the high standards of food and feed safety and consumer protection we enjoy in this country are maintained when the UK leaves the European Union. This instrument, and the original instrument that it amends, seek only to protect and maintain these standards. Changes are limited to minor drafting amendments to ensure that the legislation is operable on exit day. No policy changes are made through these instruments and we have no intention of making any at this point. This amends a previous EU exit SI, the Specific Food Hygiene (Amendment etc.) (EU Exit) Regulations 2019. Further clarity was required in setting out the authorisation process for products that can be used to remove surface contamination from products of animal origin. The clarification will ensure that the process is robust and can be applied clearly in assessing the risk of new products.
This instrument was made on 9 September under the urgent, made-affirmative procedure, which was considered appropriate to meet the deadline for the European Commission’s third country listing vote on 11 October. It needed to be in place to support the UK’s application for third country listed status with the EU. Third country listed status guarantees that the UK can continue to export animals and animal products to the EU after exit. The application was voted on by the European Commission on 11 October, and I am pleased to report that the vote was indeed in favour of accepting the UK’s application for third country listed status for products of animal origin.
I shall now talk a little about the specific detail of the minor and technical changes made by the instrument. The new instrument makes clear that the responsibility to approve substances that may be used to remove surface contamination from products of animal origin rests with the Secretary of State for Health and Social Care and the appropriate Minister in each of the devolved Administrations. Lack of clarity may affect implementation and has the potential to undermine the responsibilities for authorisation; the instrument therefore rectifies this. The measure introduces no substantive policy changes to what was successfully passed and made in Parliament in March 2019.
Food business operators are not permitted to use any substance other than potable water or, where permitted, clean water, to remove surface contamination from products of animal origin unless this has been approved. This relates to business establishments that handle products such as meat, eggs, fish, cheese and milk and do not supply to final consumers. Currently, approval for such substances is given by the European Commission, but after EU exit this responsibility will be carried out by Ministers. The amendment to Regulation (EC) 853/2004, made by the specific food hygiene SI, is being further amended to make it absolutely clear that Ministers will be responsible for prescribing the use of any other substances and the process of consulting the Food Safety Authority is retained. That decision will be made based on rigorous, evidence-based and independent food safety advice from the FSA and the FSS.
If, after EU exit, any additional substances are proposed to be approved for this purpose, they will be subject to risk analysis by the FSA, which has established a rigorous and transparent risk analysis process for assessment and approval of any such new substances. Any requests for substance approval would be subject to thorough scientific risk assessment and risk management before being put to Ministers for the final decision. The advice provided to Ministers, and the analysis and evidence on which that advice is based, will be publicly available. All decisions to approve the use of substances to remove surface contamination from products of animal origin will be implemented by means of legislation, thus also providing opportunity for parliamentary scrutiny.
Let me be clear that neither this instrument nor the instrument it amends introduce any changes for food businesses in how they are regulated or run, and nor does it introduce an extra burden. The overall changes to the food hygiene regulations will ensure robust systems of control that will underpin UK businesses’ ability to trade both domestically and internationally.
It is also important to note that we have engaged positively with the devolved Administrations throughout the development of this instrument, and this ongoing engagement has been warmly welcomed. The Welsh Government have provided their consent and the Northern Ireland Civil Service has given its acknowledgement of this instrument. FSA officials have also been in close contact with the Scottish Government regarding these regulations. They have not yet had the opportunity to give their agreement, due to the necessity of having these regulations in place by 11 October, but we expect that to continue in a positive direction. I stress that we are still committed to the intergovernmental agreement accompanying this Act not to normally make EU exit regulations without the agreement of the devolved Administrations where the policy area is devolved in competence. However, as I explained, this is a very minor drafting change to a regulation the Scottish Government have previously agreed.
Finally, I draw noble Lords’ attention to the fact that, in line with informal communications that the FSA has had with the Joint Committee on Statutory Instruments, the agency will, in accordance with the terms of the free issue procedure, be making this instrument available free of charge to those who purchased the earlier exit SI. The Government accept that this instrument should have been made available under the free issue procedure when it was first made, but that did not happen due to an oversight. I apologise to noble Lords for that oversight and confirm that it will be corrected. The Food Standards Agency will be taking action, together with colleagues in the National Archives, to ensure that anyone entitled to a free copy of the instrument under that procedure will, where appropriate, be able to apply for a refund, or otherwise obtain a free copy of this instrument on request, in accordance with the usual terms of that procedure.
This instrument constitutes a necessary measure to ensure that our food legislation relating to food safety continues to work effectively after exit day. I urge noble Lords to support the amendment proposed to ensure that we continue to have effective food safety and public health controls. I beg to move.
Baroness Thornton (Lab)
I thank the Minister for introducing these regulations. I also thank my noble friends Lord Rooker, Lady Jones and Lady Wheeler for carrying the bulk of the food standards instruments that we dealt with before the summer, when we seemed to do a great many of them. As the Minister said, these are important regulations because they address the process for approval of substances that may be used to remove surface contamination from products of animal origin.
As the noble Baroness confirmed, this SI was discussed earlier this year, but a great deal has changed since then, as we all know. We have a completely new Government, though I am pleased to see that the noble Baroness has remained in her job. What has not changed is the uncertainty over whether the UK will leave the EU in the next 15 days or so, with or without a deal, and the impact that could have. For the record, once again, we find ourselves back debating necessary statutory instruments and having to spend time and money putting through legislation in case of a no-deal Brexit.
We all agree that the safety of our food is of the utmost importance to our health and well-being. We have been fortunate to lead the world in food safety, in some areas. We have also had to learn some very hard lessons from our own food scares. We know that food safety must be protected at all costs. Therefore, I share the Government’s commitment to ensuring that there is no change in the high-level principles underpinning the day-to-day functioning of the food safety legal framework. Ensuring continuity for business and public health bodies is of the utmost importance and in the interest of the public. This has been the protection that the EU regulatory framework has afforded us in the UK.
While the Minister assures us that there is no substantive policy change, I need further reassurance. Paragraph 2.7 of the Explanatory Memorandum states:
“Following further policy deliberations, a revised approach to describing the process for approval of substances which may be used to remove surface contamination from products of animal origin is felt to be desirable”.
What does that revised approach consist of if it is not a policy change?
Why was this SI not among those we took through in March? What would have happened if we had left in March and this SI had not been on the statute book? What would have happened to this regulatory framework?
I am not convinced that the SI does not give some leeway for Ministers to approve substances that can be added to our food. I shall be interested to hear how confident the Minister is that the high standard of food safety will be maintained. What additional substances could be approved by Ministers if needed? How will that impact food safety? The safety of our food is hugely important and we cannot get this wrong, so I have made these very brief comments. I do not want to delay the Committee, but I welcome interventions from other noble Lords. We will, of course, not oppose this statutory instrument and I look forward to the Minister’s response.
Baroness Kingsmill (Lab)
My Lords, I shall add a few comments to my noble friend’s remarks on subjects that concern me considerably. I lived through the BSE food crisis. It was the result of what was described at the time as a minor change in the regulations. That minor change cost UK farmers something like £3.75 billion and led to the slaughter of very many cattle. Minor changes to regulations can make an enormous difference. Therefore, we should give this statutory instrument very careful scrutiny. It seems a little rushed, so I should like more explanation of why we have to rush it. It ought to be considered very carefully.
I notice in Hansard the words that the Minister repeated today: “for the moment”. That worries me slightly. What does it mean? Is there some intention to change things in the near future and is this SI just a means of getting something through fast, as it is necessary for the moment?
My concerns about this minor change in regulation are not simply about the food safety implications, although they are enormous, but about changes to the substance used to remove contamination from animals for human consumption. That can mean many different things and can have a huge impact not only on consumers’ health and safety but on animal welfare. I think particularly of what has become a bit of a euphemism for health and safety in food: chlorinated chicken. I am also concerned about the substances used to prepare farmed salmon for human consumption. I should like specific clarification of the Government’s intentions about future regulation in this area, to the extent that the Minister is able to give it.
One of the things that has always concerned me about these regulations—I have dealt with quite a few—is that there seems to be no sunset clause in the event that we do not leave without a deal. Is there a proposal for a sunset clause for these regulations? Can the Minister give us an assurance about the extent to which animal welfare has been taken into account? We all know that chlorinated chicken means treating at the last minute and that it does not matter what contamination the animal received beforehand; once you have washed it in the swimming pool, if you like, it will be okay for human consumption, which is not necessarily the case. It is important that such issues should be taken into account and considered in these regulations.
Brexit: Medicine Supply and NHS Staffing
Baroness Thornton Excerpts(4 years, 8 months ago)
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Baroness Thornton
To ask Her Majesty’s Government what assessment they have made of the impact of a no-deal Brexit on (1) the supply of medicines, and (2) the staffing of the National Health Service.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)
My Lords, we recognise that leaving the EU could affect a wide range of areas across the health and care system. We are doing everything possible to prepare, and our plans should help to ensure that the supply of medicines remains uninterrupted. We continue to monitor staffing levels, and we are working to ensure that there will continue to be sufficient staff to deliver the high-quality services on which the public rely.
Baroness Thornton (Lab)
I thank the Minister for that Answer. I suspect that this Question is an appropriate one, given the debate we are going to have later. Given that the majority of the House is trying to save the Government from their foolishness of crashing out of the EU, these are very important questions because they affect people’s lives and their futures.
I have two questions. What is the department doing to sort out the fact that the Home Office is still completely failing to deliver how settled status can be offered? We are losing European staff from the NHS, including senior and experienced doctors, at a huge rate, which will mean enormous problems. Secondly, on medicines, what measures have the Government put in place to ensure that the shortage protocol does not negatively impact patient safety, and how are the Government going to prevent the UK from becoming a third-tier market for medicines and ensure that we can access medicines and new drugs in a timely fashion if we crash out of the EU?
Baroness Blackwood of North Oxford
I thank the noble Baroness for her comprehensive questions. Regarding the EU settlement scheme, we are very pleased that there are now record levels of EU nationals working in the NHS and the social care system. We hugely value their contribution. We need them, and we want them to stay. EU nationals working in the NHS can obtain their long-term status in the UK through the EU settlement scheme, and we are supporting NHS Employers in promoting the EU settlement scheme. On 15 August, the Home Office said that 1 million people had been granted settlement status. Where there have been challenges to working through that, there is support to address it. The EU settlement scheme statistics confirm that not a single person has been refused the status that they applied for. About three-quarters of people receive that status without the Home Office needing to ask for additional evidence on the length of residence; we are checking that is working as it should.
When it comes to medicines, we continue to implement a multi-layered approach to minimise any disruptions of medicines and medical products in a no-deal scenario to ensure that patients will have access to the medicines they need. There are about 7,000 prescription-only and pharmacy-only medicines, and we have been working very closely with suppliers, asking them to hold at least six weeks of stock. The shortage protocol will be led by clinicians, to ensure that patients can access the medicines that they need and are not put at risk. Any decision about this will be made between the patient and their clinician, to ensure that it is appropriate for the care of the individual patient in question.
National Health Service: Healthcare Advice
Baroness Thornton Excerpts(4 years, 9 months ago)
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Baroness Thornton (Lab)
My Lords, it is exciting to contemplate the new world of communication technology and how it might help in all kinds of ways, but the noble Lord, Lord Patel, has raised some important points. The NHS-Alexa partnership has to be seen in the context of Amazon’s ambitions for our wider healthcare industry. I seek assurance. I am sure that at the moment the data is being protected, but I want to know what will happen in the future. If Amazon collects yet more data on patients raising medical concerns, what use might be made of that in the future?
I do not know how other noble Lords are getting on with their Alexa in the corner of the sitting room, but ours regularly joins in with conversations and tells us very bad jokes. My granddaughter thinks it is wonderful because she knows what noise a unicorn makes, so I am not sure, as the noble Lord said, how that plays if one is trying to have a serious discussion about a medical condition.
Baroness Blackwood of North Oxford
I thank the noble Baroness for that. I would be interested to know what jokes she has heard from Alexa in her family conversations. However, patients look on well-known search engines for medical advice and at the moment they may receive advice from all sorts of untested sources. NHS.uk is clinically based advice which has been approved by NHS England. The purpose of making that advice more available through the Open API, which is available through the developer system, is to ensure that that clinically based advice is more widely available and more readily searchable for patients. A reasonable point has been raised which is to ensure that the right advice reaches patients and that patients go through the right triage system, whether it is 111 or another system, but that is the intention of the programme. It will be carefully monitored and managed by NHSX, NHS England and the department.
Childhood Obesity
Baroness Thornton Excerpts(4 years, 9 months ago)
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Baroness Blackwood of North Oxford
I absolutely agree with my noble friend. Obesity is a crisis that will not only create misery for those who will then experience increased risk of tooth decay and of diseases such as cancers, diabetes and other severe illnesses, but it will also create significant unsustainability within our health service, which we are able to prevent. Since we know the tools that we have to prevent it, we should all be working together to make sure we do.
Baroness Thornton (Lab)
My Lords, we know—and the noble Lord, Lord Bird, made this point—that it is the poorest children who are obese. This is largely because their parents buy food which is high in fat, sugar and salt, because it is cheaper than fresh food. It may or may not be from Waitrose, but the noble Lord makes an important point there. I have two questions for the Minister. First, is it true that two-thirds of the deadlines of the plans that have been put forward for the obesity strategy have been missed? Secondly, what is the Government’s strategy for dealing with summer hunger—those children who will not get proper meals during the summer break?
Baroness Blackwood of North Oxford
The noble Baroness is quite right to raise inequalities. This is exactly why chapter 2 of our plan is focused on childhood obesity trailblazer programmes, where we have identified areas of highest deprivation to provide specific support to local authorities in those areas. We have also recognised this issue around school holidays: around 50,000 disadvantaged children will be offered free meals and activities over the upcoming summer holidays, funded by £9.1 million from the Department for Education. That follows a successful programme last summer, which saw improvement, with football play sessions and cooking classes for more than 18,000 children across the country. However, the noble Baroness is right to recognise that this is a real challenge that we need to address.
NHS: Automation
Baroness Thornton Excerpts(4 years, 9 months ago)
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Baroness Blackwood of North Oxford
Tremendous innovations are being introduced, including in robotics and AI-based automation, particularly in diagnostics, which have the potential to transform how healthcare is delivered in the NHS, but the role of automation to carry out basic administrative and repetitive functions, and of robotics in surgical operations in particular, is due to increase over the next decade. The main purpose of this automation in health is not to replace staff with machines or to reduce the role played by humans in providing care but, rather, to enable staff to spend more time delivering personalised care. But it is also to improve the productivity of health services and systems so that we can ensure that the NHS becomes more sustainable in future.
Baroness Thornton (Lab)
My Lords, the noble Baroness, Lady Seccombe, made a valid point about the need for human beings to be involved in the delivery of healthcare, but the use of AI and other technology is also very exciting, as is the fact that it features so largely in the long-term plan. Are the experiments in automation taking place across the country, where are they taking place, when will we see the results and who is delivering automated healthcare and AI? Is it the NHS or are private contractors being commissioned to do this work? I accept that the Minister may not be able to answer all those questions in detail, but if she cannot, I would appreciate a letter being placed in the Library.
Baroness Blackwood of North Oxford
The noble Baroness is absolutely right: this is a very exciting area of ongoing work and a key part of the grand challenges which we put in place as part of the life sciences strategy, part of which is the AI and early diagnosis initiative, which aims to transform the prevention, early diagnosis and treatment of chronic diseases. NHSX’s work across government is to deliver that mission, creating an ecosystem of safe and effective development of AI and the regulatory infrastructure so patients and clinicians can be reassured that where it is introduced, it will be safe. There will be lots of research and development of those innovations. We are at an early stage of implementing them, but there are five centres of excellence across the country. I will be very happy to place a letter in the Library updating the House on progress with the AI mission and these exciting developments.
NHS Dentistry Services
Baroness Thornton Excerpts(4 years, 9 months ago)
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Baroness Blackwood of North Oxford
I am very sorry to hear of my noble friend’s experience with the Mayor of Manchester. Children’s oral health is now better than it has ever been, with more than 75% of five year-olds in England being decay-free, which we welcome. However, the number of children requiring tooth extraction remains a concern. It fell slightly between 2016 and 2017-18, which we welcome; however, we recognise that there is much more to do. That is why the NHS outcomes framework is working to ensure that we perform better, with much work being done to target improved oral health of young people, with the Starting Well core framework and Starting Well pilots in the 13 areas of greatest deprivation.
Baroness Thornton (Lab)
My Lords, in Portsmouth there are 20,000 patients without a dentist, due to the closure of three practices. In Cornwall, 22,000 people are on the waiting list, having to wait an average of 529 days before they get an NHS dentist. The noble Baroness is quite right that there are some serious problems to address here about access to NHS dentists. I should like to know exactly how those areas in desperate need, such as Portsmouth, will be tackled. Secondly, how many of the babies, children and young people included in those numbers currently have no dental care whatever?
Baroness Blackwood of North Oxford
As I said in my previous answer, children’s oral health is better than it has ever been. This is not to say that there is any complacency or acceptance of where we are. We recognise that while access has significantly improved, there are still areas where NHS England needs to do more to meet local need. NHS England is responsible for helping patients who cannot find a local dentist. Those in that situation should contact NHS England’s customer contact centre for assistance. Things that are being done to improve this include the introduction of new nationally flexible commissioning, which can help national commissioners commission a wider range of services from dental practices, and the testing of a new, reformed dental contract, which we think will make the profession more attractive for new dentists.