The NHS

Lord Astor of Hever Excerpts

Thursday 5th July 2018 Lords Chamber

[Lord Astor of Hever (Con)]

My Lords, I, too, congratulate the noble Lord, Lord Darzi. I was in the Chamber when he leapt across that Bench to save the life of a noble Lord who had had a heart attack, and a very impressive sight it was. I, too, have suffered a cardiac arrest and I received life-saving care from two wonderful paramedics from the South East Coast Ambulance Service.

My personal experience, not in a way that I would have chosen, was of the NHS at its very best. Everything at every stage, from the moment the cool-headed handler took the 999 call, the paramedics who got my heart going, the surgery, to the kindnesses and the professional aftercare that I received in East Surrey Hospital, could not be faulted. I was honoured when the hospital asked me to open its wonderful new cardio wing and meet the staff. It was an emotional event for me to stand in front of the very people who had saved my life, giving me an opportunity to join this debate today.

I declare an interest, in that my sister was a state registered nurse, my brother-in-law is a retired senior surgeon with the NHS and my niece is a junior doctor training in infectious diseases. She is extremely proud to be part of the NHS and very optimistic for the future.

While we bask in the reflected glory of all that the NHS has achieved in the past 70 years, I agree with the noble Lord, Lord Winston, that we must be realistic. We need to remember the winter pressures and looming targets that put the NHS under immeasurable pressure and result in less than optimal patient care.

At this late stage of the debate, I will touch on just one challenge facing the NHS, which has been mentioned by many noble Lords: creating a sustainable workforce moving forward, particularly as we rely so heavily on European and overseas staff. Since we voted to leave the EU, there has been a dramatic reduction in the number of staff coming from Europe. Although immigration restrictions have been lifted, it is going to take time to recruit staff. The NHS must be able to offer a long-term future, or why would they come? The focus should be on making medicine and nursing attractive again and developing a long-term plan that meets workforce challenges. There is much bridge-building to do after last year’s junior doctors’ strikes if the NHS is to keep them once they have completed their training. Junior doctors welcome Jeremy Hunt’s pledge for more medical school places, but there are ongoing concerns about low morale and rota gaps in the workforce causing significant issues with retention of staff. Worryingly, junior doctors are leaving not only the NHS but the profession altogether.

With regard to nurses, this is the last year that those in training are entitled to receive a bursary and will not have to pay university fees. They will then have to pay £29,000, plus living costs, for a three-year period. This means that most nursing graduates will leave university with debts of around £54,000. I would be interested to hear whether the Minister is concerned that this issue will have a negative impact on nurses’ recruitment.

Health Inequality: Autism and Learning Disabilities

Lord Astor of Hever Excerpts

Thursday 10th May 2018 Grand Committee

[Lord Astor of Hever (Con)]

My Lords, I declare an interest as the father of an autistic daughter. I agree 100% with the noble Baroness, Lady Scott, that those on the autistic spectrum are among the most vulnerable in our society. The Government’s mandate to NHS England requires them to tackle health inequality for autistic people, and ensuring access to good quality mental health support is one important way in which this can be achieved. I have to stress that, as the noble Lord, Lord Touhig, said, autism is not a mental health condition, but more than 70% of autistic people will develop mental health problems at some stage in their lives. This is why it is one of the key drivers of the stark health inequalities faced by people on the spectrum.

The noble Lord pointed out that, in 2016, NHS England published its mental health five-year forward view, which outlines how it plans to improve mental health services in England. It includes a number of proposals, as the noble Lord said, for care pathways to help people to access the right support and, importantly, it proposes a care pathway for autism. The Government have indicated that work on designing that pathway is due to start this year, but it is now May and we do not yet have any detail on what the pathway will include. Like other noble Lords, I would welcome some clarity today from the Minister on how the pathway is progressing and, in particular, the plans they have for developing the pathway in conjunction with autistic people and their families.

The new care pathway is a welcome building block that will, in time, help to reduce the stark health inequalities that autistic people face, but it is vital that the new pathway covers timely access to autism diagnosis; autism training for all mental health staff; and making reasonable adjustments to mental health treatments so that they work for autistic people. Finally, it should also contain the capacity to research what works and then use that research to share best practice with other agencies.

Queen’s Speech

Lord Astor of Hever Excerpts

Thursday 29th June 2017 Lords Chamber

[Lord Astor of Hever (Con)]

My Lords, I want to speak briefly on the specific health issue of Lyme disease, which is a rapidly increasing health risk in the United Kingdom. If Lyme disease is not treated early, it can cause significant illness and devastate affected patients’ lives. This is what life has been like for my daughter, and I declare this personal interest.

Many noble Lords will be aware that ticks harbour Lyme disease, as well as many other equally serious infections. These infections are passed to humans and animals via the bite of an infected tick, due to and during their method of feeding. The danger is no longer confined to rural areas, with ticks now being found in every county of the United Kingdom, and increasingly so in urban parks and people’s gardens. If Lyme is diagnosed and treated early, the chances of a full recovery are good. However, failure to diagnose early and treat adequately can result in serious consequences to the patient. Tick-borne diseases that are misdiagnosed or neglected result in complicated infections, which have devastating and multisystemic consequences. Patients can be left with extremely debilitating and chronic symptoms, needing a wheelchair or completely bedridden, and enduring intense and relentless suffering.

Despite the increasing threat that Lyme disease poses to public health, there remain no suitable UK official guidelines for diagnosis or treatment. What we do have is outdated National Health Service guidance, relying on guidelines written by the Infectious Diseases Society of America and supported by the CDC. According to the National Guideline Clearinghouse of America, the IDSA-CDC guidelines are not fit for purpose. They are outdated and do not take into account recent developments in the understanding of these complex infections.

The absence of adequate guidelines is closely linked to the fact that insufficient levels of training are available to our doctors. Even if a positive test is obtained, expertise is seriously lacking, both in value of interpretation and in dealing appropriately with the illness. That stark statement is in accordance with multiple testimonies from patients. Expert patient input is crucial in turning the situation into a positive solution, not only for patients themselves but for the National Health Service as a whole.

Failure to meet the challenges of Lyme disease has led to unknown numbers of people becoming infected, but not diagnosed or treated. It could amount to tens or even hundreds of thousands of people. The UK now finds itself in a situation where patients with diverse illnesses and symptoms might actually have unrecognised Lyme disease. In these patients, the infection could have reached a stage where treatment will be difficult and lengthy and will require the supervision of expert physicians, trained and experienced in this complex disease and the frequently occurring co-infections.

The cost to the Exchequer in terms of numbers of patients unable to work and using the NHS for serious health problems must be a truly staggering amount. Neither this country, nor affected patients, can afford this. Early recognition of symptoms and early treatment would save our National Health Service a great deal of money.

Given the huge cost, both in terms of the impact on the patient’s quality of life and, in practical terms, on our health service, it is clear how important it is to prevent as many cases as possible reaching this stage. Improvements in the training available to our doctors should be made a top priority. However, awareness among the general public of the risk posed by ticks should also be prioritised. There are some very simple measures that can be taken to reduce one’s chance of becoming infected with Lyme disease. However, few people have any knowledge of this. How can we safely, and with a clear conscience, encourage children to play outside and make the most of the outdoors if we are carelessly allowing them to risk their health by contracting one of these insidious, infectious diseases?

Outdated guidelines, unreliable blood tests, insufficient training for doctors, a lack of tick-borne specialists of calibre and a widespread lack of awareness among the general public of preventive measures are all factors that are leaving us alarmingly ill-equipped to tackle a problem that poses a rapidly increasing risk to every UK citizen. In the light of this, I ask my noble friend what his department is doing to ensure that GPs receive training in Lyme disease that is mandatory and thorough enough to allow them to make clinical diagnoses. Proper awareness will prevent the number of Lyme disease sufferers growing.

Lyme patients want to regain their health. They want to get back to work. They wish for nothing more than to regain control over their lives and take part in all the activities they enjoyed before they became ill. Most Lyme patients have the will and determination to achieve this. But none of these aims can happen if they are sidelined and hobbled by misguided opinion—which includes the current health system situation, with its constraints and limitations.