Abortion: Misoprostol

Baroness Thornton Excerpts

Tuesday 20th March 2018 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Baroness for her question. No timeframe has been set for any decision on a policy change. She will understand that any change of policy would need to be done cautiously, in the light of the evidence and of legal developments—for example, relating to Scotland’s decision to name homes as a place. It is on that basis that we will consider any further evidence.

[Baroness Thornton (Lab)]

My Lords, if women in Norway, France and now Scotland can take this drug at home, not in a clinical setting, with careful safeguards and support in place—I have looked at what has happened in Scotland, and there is no doubt about that at all—it is important that the Government should afford the same facility to women in England. I would like the Minister to perhaps go further than he has now and say that there will be a timetable for this to happen.

[Lord O'Shaughnessy]

In terms of the experiences in other countries, of course only the countries of the UK are operating under the auspices and obligations of the 1967 Act, which any Government would have to act under. The Scottish Government have made that decision, but the noble Baroness will know that it is subject to a dispute and that a judicial review has been brought against it by the Society for the Protection of Unborn Children, which is obviously testing the legality of the Scottish Government and their powers to act. We shall look closely at developments in these legal proceedings, as well as any other evidence that arises. Unfortunately, this is why I am not in a position to give her a timetable.

Children and Young People: Mental Health Services

Baroness Thornton Excerpts

Thursday 8th March 2018 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for that response and Statement. What emerges from the Care Quality Commission’s review of children and young people’s mental health is the glaring finding, to which he has not referred, that children are suffering because of high eligibility thresholds. We know that 50% of mental health problems develop before the age of 14, and 75% develop before the age of 18. Does the Minister recognise that imposing high eligibility thresholds means that children and young people are treated only when their condition becomes very serious? Will he look into the referral criteria as a matter of urgency so that children and young people are getting proper treatment at the right time, thereby preventing a crisis that brings greater suffering for those children and their families, and greater expense for the health service?

[Lord O’Shaughnessy]

I thank the noble Baroness for those questions. On the issue of high eligibility thresholds, we are grappling with a need to expand the amount of mental health services that can be provided. Currently, about one in four children with a diagnosable mental health condition accesses NHS services. That is clearly not enough and the intention is to get that figure to one in three by 2021. Again, that is not enough but it would be progress. There is a need to move along the path, dealing first with those in the most acute trouble and then rolling out to those with less acute conditions. I agree with the noble Baroness’s point and recognise the issue. However, this cannot achieved overnight, not least because a huge number of new staff are needed to be trained in order to deliver that. We are looking at the issue of referral criteria. I should also point out to her that we have made big steps forward on waiting times and new standards for early intervention in psychosis and eating disorders. We are piloting a waiting time for access to specialist help and hope that that will start to move things along in terms of more children being seen more quickly, which is what we all want.

General Practitioners: Workforce

Baroness Thornton Excerpts

Monday 5th March 2018 Lords Chamber

[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.

[Baroness Thornton (Lab)]

My Lords, I declare an interest as a lay member of a CCG. GPs are indeed retiring before the age of 60; in fact, last year, twice as many retired as three years ago. More GPs are leaving the profession than are joining it, and soaring numbers of junior doctors are leaving the NHS after their two-year foundation training. How do the Government intend to fill the failing pipeline of junior doctors, and would the Minister care to speculate why there is a flood of departing junior doctors right now? Could it be due to junior doctors’ rock-bottom level of morale after their shabby treatment by the Secretary of State?

[Lord O’Shaughnessy]

The noble Baroness might be interested to note that in 2014, the number of GPs in specialty training was 2,671, and in 2017, it was 3,157—an increase of nearly 400. That is how we are filling the places.

NHS: Waiting Lists

Baroness Thornton Excerpts

Monday 26th February 2018 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government what plans they have to reduce the waiting lists for consultant-led NHS treatment; and to what timetable they intend to carry out such plans.

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

My Lords, the joint NHS England and NHS Improvement plans for 2018-19, published on 2 February 2018, set out how £1.6 billion of funding announced in the Autumn Budget will be spent on additional elective surgery as well as ensuring that the four-hour A&E waiting times standard is met. The guidance refreshes two-year plans already in place to improve waiting times performance.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer. Waiting lists at the end of November 2017 stood at 3.72 million. The head of NHS England, Simon Stevens, says that at present waiting lists will grow to 5 million by 2021, and the Minister’s Answer is inadequate in solving that problem. Does he agree with the findings of the Royal College of Physicians research that shows among other things that 45% of advertised consultants’ posts remain unfilled, 82% believe that the workforce is demoralised and 74% are worried about their ability to deliver safe patient care in the next 12 months? What are the Government’s plans to deal with this crisis in an NHS that is underfunded, underdoctored and overstretched?

[Lord O'Shaughnessy]

It is absolutely our goal and obligation to return to the referral-to-treatment standard. It is worth pointing out that the NHS has been dealing with an annual growth in demand of around 4%, which is extraordinary when looked at historically. What we have seen in the plan set out a few weeks ago are important steps to get a grip on that, including halving the number of 52-week waits, halting the growth in the waiting list and delivering more every year. Clearly that is an interim step and more needs to be done; the way to achieve that is by continuing to provide real-terms increases, which we have done and will continue to do, and by dramatically increasing the number of staff in the NHS, which again we have done. We have also increased the number of training places.

Disabled People: Social Care

Baroness Thornton Excerpts

Tuesday 20th February 2018 Lords Chamber

[Lord O'Shaughnessy]

I am very aware of this issue. Indeed, we have had the opportunity to speak about it in specific cases. Local authorities of course are obliged to provide respite care. The noble Baroness highlights an important point about care, which seems in a way to slip between the boundaries of the two. I shall write to her about the general policy work that is going on, but I know that we need to solve this because we have children who are now living longer who before might not have lived so long and who require care, as do their families. It is essential that they get the care that they deserve.

[Baroness Thornton (Lab)]

My Lords, I know that the Minister will tell me and the House again about the extra billions that the Government are putting into social care. However, when everyone else says that there is clearly a social care crisis, we have some dissonance here. The evidence of this crisis is the regression of opportunity and care for young disabled people, which is there to see in personal cases where people are not receiving the sort of support that they need. I am not convinced about the Green Paper looking at social care for older people. The noble Baroness, Lady Campbell, is right—that makes me more concerned, and I join her in that concern. Will the Minister explain how the Government will achieve their target of 1 million more disabled people being in work by 2027 if they cannot get out of bed and travel to work without help because of this combination of cuts and the stalling of a coherent support policy to make that possible?

[Lord O'Shaughnessy]

I do not want to disappoint the noble Baroness, but she is aware that more money is going in. To address the specific issue that she talks about—and I obviously can talk about it only from the point of view of the Department of Health—we want and are seeing more disabled people going into work. I would point to one big investment that the Department of Health is making, which is the disabled facilities grant. That is about making sure that disabled people can live at home and have their independence, which of course is critical to maintaining their physical health and confidence to make them, in a way, ready to go into work. I know that there are other programmes being put through job centres and the Department for Work and Pensions to make sure that they are supported, too.

NHS: Winter Crisis

Baroness Thornton Excerpts

Wednesday 7th February 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Baroness is quite right to highlight the issue of bed occupancy; it is very high. The service managed to get it down below 85% before Christmas but inevitably it has risen since then. There is a big improvement in delayed transfers of care; we need that to continue to happen, and it was welcome that the Secretary of State for local government announced more funding for social care so that we can increase those transfers into social care and free up space in hospitals.

[Baroness Thornton (Lab)]

My Lords, following the noble Baroness’s question about bed occupancy, it is absolutely true that in 30 of the last 70 days in the winter period occupancy has been above 95%, which is dangerous. Some hospitals are at 100%. Was that part of the winter plan that the Minister assures us was timely and thorough? Will he accept that the winter plans have now been compromised in the light of pressure on beds, lack of staff and the fact that at least 23 trusts are now on black alert, which means that they are under very severe pressure?

[Lord O’Shaughnessy]

I agree with the noble Baroness that bed occupancy is higher than we want it to be and in some hospitals it is far too high. The question, of course, is what we do about that. It necessitated the difficult decision, for which the Prime Minister apologised, to cancel non-urgent elective surgery. Happily, that has not been repeated and rolled forward into February. We think and hope that the situation with flu, in particular, has stabilised and that that will start to relieve the pressure. I absolutely understand the hard work that staff are having to put in under tremendous pressure and I know that we all appreciate that.

NHS Winter Crisis

Baroness Thornton Excerpts

Monday 5th February 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for that Statement. Before I ask my questions, I also thank the Secretary of State and the Prime Minister for their responses to the United States President’s bizarre attack on our NHS.

Over 95% of hospital beds were full last week, leaving just one bed in 20 available. We saw the highest number of accident and emergency diverts for any week this winter, with 43 incidents across England. I pay tribute to our NHS staff, who have gone the extra mile in very challenging circumstances. We know that 50,000 elective operations were planned to be cancelled, but it would seem that some urgent operations have been cancelled, too. Will the Minister explain to the House why those operations have been cancelled, despite NHS England’s advice to the contrary?

It would also now seem that the accident and emergency targets that are enshrined in legislation and the constitution have been abandoned until March—that is, March 2019. Will the Government bring forward legislation to amend the constitution? Finally, will the Minister accept that the winter plans that have been outlined are now being compromised in the light of the fact that at least 23 trusts are now on black alert, which means that they are under severe pressure?

[Lord O'Shaughnessy]

My Lords, I thank the noble Baroness for her questions. I agree with her that we are all proud of our NHS, on all sides of this House, and I am sure that we all have great pleasure in stating that through whatever means we are required to. I also join with her in paying tribute to the staff, who do such a fantastic job, often in challenging circumstances.

She asked first about urgent operations. It is clear in the guidance that they should not be cancelled when it would negatively affect patients’ outcomes. If that has happened, NHS England is investigating and reinstating those operations. The guidance is quite clear and NHS England has followed that up.

As for A&E targets, we know that they have not been achieved recently. It is important and instructive to look at the extraordinary increase, not just in winter but overall, in the number of episodes that are happening. They really are increasing at a very high rate. Demand is very high—higher than I think could have been anticipated—and it is a credit to the NHS that it has produced the performance that it has. The aim now, with funding given at the Budget, is to get us back to the four-hour target that we all agree ought to happen. That is what will be happening over the coming year.

NHS: Clinical Negligence

Baroness Thornton Excerpts

Wednesday 31st January 2018 Lords Chamber

[Lord O'Shaughnessy]

I point the noble Baroness in the direction of a five-year strategy that was published by NHS Resolution, the body that acts on behalf of what used to be the NHS Litigation Authority. The strategy looked at many issues, not only how we can prevent escalation. One of the drivers of cost is unsuccessful claims; more of those are going on. It also looked at how we can reduce incidents in the first place and learn from deaths and injury throughout the system, so that we can start to reduce the burden overall.

[Baroness Thornton (Lab)]

My Lords, it is telling that if you google “clinical negligence”, the first four or five pages that come up are companies offering their services to support people making claims. According to the Medical Protection Society report last year, the annual costs to the NHS in England of settling clinical negligence claims was equivalent to training 6,500 doctors. That is expected to double by 2023, so the noble Lord is quite right that this is a terrible drain. I am very pleased to hear that the Government have plans to reduce the number of claims. Have they included taking into account the recommendations in the PAC report published at the end of last year?

[Lord O'Shaughnessy]

We absolutely have. Indeed, the PAC investigation and the National Audit Office report on this issue are very thorough and looked at the causes and drivers behind it. One is increased NHS activity—not worse safety but the fact that the NHS is doing more. The investigation also looked at the legal environment and some of the changes that have occurred. The noble Baroness is right: a number of firms offer these services. That is important for access to justice but we also need to fix the costs that they can claim so that we get this budget under control.

NHS: Cancer Treatments

Baroness Thornton Excerpts

Thursday 25th January 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, at the beginning of this debate it became clear that we are dealing with one of those extraordinary parliamentary moments. In a way, I have a much easier job than the Minister today, so my sympathy is with him in answering this debate.

Are any of us surprised that when Tessa, my noble friend Lady Jowell, was diagnosed with what she called this “bloody tumour”, she tried with her usual courage, energy and vigour to try to improve the outcomes for all people with cancer? No, we are not, because this is the woman who, as the first ever Public Health Minister, promoted the tobacco control that we all now take for granted, facing outrage from the tobacco industry, its friends at the Sun and the Mail and, though probably less well-known to the public, many Back-Bench Labour MPs who thought pubs and clubs would go out of business if people were not allowed to drink in the smog created by cigarettes. “Nanny” was the label that the papers gave her at the time, but how many lives have been saved already as a result of my noble friend’s determination to do the right thing? The label of nanny was continued because of Sure Start—of course it was. But this is a woman whose determination led her to take on the Prime Minister and all comers to convince us that the Olympics should come to London, could come to London and, when they did so, to ensure, with others, that we all had an absolutely great time in 2012.

The reason I am reminding the House of these matters is not only because of my admiration for my friend Tessa. I am reminding the House, particularly the Minister, that in the face of opposition and scepticism, my noble friend will win through. She has proved to be correct time and again. I say to the Minister and the Government that they had better believe this noble Baroness and take what she is telling us very seriously. From the relatively modest suggestion that fluorescent dye to identify the tumour should be available in all brain surgery centres in England, which seems to me perfectly correct, to the more innovative—adaptive clinical trials, testing multiple treatments against a standard, which could speed up the introduction of new drugs as well as enabling existing ones to be repurposed, linked to a platform to share data across the world—my noble friend is saying: this is a demanding new paradigm, but the prize is surely worth the struggle.

The Government and all of us should follow her example and not be afraid to commit to making this happen.

Public Health: Strength and Balance Programme

Baroness Thornton Excerpts

Thursday 18th January 2018 Lords Chamber

[Lord O'Shaughnessy]

I am grateful to the noble Baroness for pointing out the benefits of physiotherapy. She might be aware of a scheme in Middlesbrough that is providing for people who have fallen a precise pathway from physio into community activities involving strength and balance work. As ever, one of the challenges is to make sure that all local authorities know about such programmes and put them in place. They are not necessarily expensive, but they take a bit of time. I will make sure that Public Health England is taking that attitude of spreading good practice across the country.

[Baroness Thornton (Lab)]

My Lords, NICE’s most recent and excellent quality statements in January 2017 offer guidance on falls and the importance of multifactorial risk assessments and interventions. These interventions require resources, particularly from social care specialists and public health workers, who we know are at the sharp end because of the financial pressure the Government have put on local authority funding and the successive reductions of public health budgets. Now that the Secretary of State has responsibility for social care, will he therefore ensure that strength and balance programmes are properly resourced? When will NICE next update its statistics on the uptake of guidance on this matter?

[Lord O'Shaughnessy]

I will write to the noble Baroness with specifics on the NICE guidelines, which are incredibly important because they establish best practice. Of course, it is then incumbent on professionals to follow that best practice. We know that public health budgets have been under pressure, but local authorities are still getting £16 billion over five years. That is a lot of money and they can use some of it to focus on such activities. Moreover, in the spring Budget last year, there were big increases in the social care budget, which I know we all welcomed. That money is particularly focused on older people and preventing falls, which is what we want to see as part of that programme too.