NHS: Healthcare Data

Lord Bishop of Southwark Excerpts

Thursday 6th September 2018 Lords Chamber

[The Lord Bishop of Southwark]

My Lords, I too express appreciation to the noble Lord, Lord Freyberg, for securing a debate on a subject so full of possibilities for enriching our knowledge and improving the lives of fellow citizens. In England alone the National Health Service deals with more than 1 million patients every 36 hours. The potential use of data is enormous.

The right reverend Prelate the Bishop of Carlisle, who takes a special interest in health matters, is particularly sorry not to be able to participate in this debate. I also congratulate the noble Lord, Lord Bethell, on the quality of his maiden speech. I was, furthermore, particularly grateful for the wisdom of the noble Lord, Lord Kakkar, who spoke from his great expertise in this field. My focus is on mental healthcare data, which was recently highlighted in the Church of England’s toolkit on minority ethnic mental health issues, launched at our General Synod in July.

We know from the Adult Psychiatric Morbidity Survey, conducted every seven years, that one adult in six has a common mental disorder. By gender this breaks down to one woman in five and one man in eight, with the rate for women increasing since 2000 and the rate for men largely static. It is important to know why this is the case. Most mental disorders are more common among those living alone, in poor physical health or unemployed. One should avoid simple remedies, but esteem, living in a community, relational contact, activity and purpose seem to correlate with better mental health.

It is also important to note that there are wider demographic inequalities in who receives treatment for common mental disorders. According to the 2014 survey, after controlling for need, people who were white British, female or in mid-life, which in this instance means 35 to 54—rather younger than the average of fellow Peers—were more likely to receive treatment. Black ethnic groups had particularly low treatment rates. That is a serious matter. Analysing the data by socioeconomic variables demonstrates fewer inequalities in treatment, although people in low-income households were more likely to request a particular treatment but not to receive it.

I appreciate that even a debate as lengthy and as valuable as this is not going to solve systemic issues. It is clear, however, that there are discrepancies in how people are served. In a very different arena from this one—criminal justice—the Lammy report, addressing disproportionality, proposed a standing order of “explain or change”: if the disproportionality cannot be justified, action must be taken to remedy it. In this instance it would be good to know what action will address the failure to treat a category of citizens on the basis of ethnicity.

One of the outworkings of the gospel is the creation of a new society where distinctions do not matter. That is no easy thing, since so much of our security, identity and understanding is based on distinction and difference. Ultimately, however, this is not healthy, and in an area of pathology and treatment where provision is as sadly lacking as in mental health, to make less treatment available where the key variable is ethnicity is not a justifiable way to ration the system.

I have said before, in respect of public service reform, that a failure to include a clear relational element is a great deficit in any programme. I trust that in the wake of the Windrush scandal we may yet be learning that lesson.

Alcohol: Minimum Unit Pricing

Lord Bishop of Southwark Excerpts

Wednesday 28th February 2018 Lords Chamber

[Lord O’Shaughnessy]

As I have said, and reiterate to the noble Baroness, we will look at the impact of minimum unit pricing. We must not just take into account any revenue that we generate and the health benefits that could accrue, but make sure that it provides a fair deal for those who drink sensibly.

[The Lord Bishop of Southwark]

My Lords, the report of the University of Sheffield referred to earlier said that the top 30% of drinkers consume 80% of all alcohol consumed, as measured in pure ethanol; and that, of the beer sold in supermarkets, a disproportionately high amount is sold on promotion—and much of that well below 50p per unit. Does the Minister agree that a floor in the unit price of alcohol would help to yield a more orderly, content and healthy society by bearing down on demand?

[Lord O’Shaughnessy]

The statistic mentioned by the right reverend Prelate is in a way even more alarming because 4.4% of the heaviest drinkers account for a third of all alcohol drunk. A lot of people are drinking sensibly, within the guidelines. We need a system capable of targeting those who are sensitive to both price and health interventions, among those drinking in a way that is very deleterious to their health. We are doing that for a range of interventions—public health and taxation. As I said, we will look at the progress of minimum unit pricing in Scotland as it takes place.

End of Life Care

Lord Bishop of Southwark Excerpts

Tuesday 5th September 2017 Lords Chamber

[Lord O'Shaughnessy]

I agree that there is more to do but progress has been made since the first national framework was published a couple of years ago, building on the work of successive Governments. Staffing is important. There are more early-life nurses than there were seven years ago. More than that, additional training is also going on. This is a really important part of this. Health Education England’s mandate now includes end-of-life care training within various care packages. Indeed, through the Nursing and Midwifery Council, midwives are starting to get systematic end-of-life care training. Given that, unfortunately, 40% of these child deaths happen in the neonatal and newborn setting, that is incredibly important. But I take the noble Lord’s point.

[The Lord Bishop of Southwark]

My Lords, as the Minister has already intimated, the key to delivery of end-of-life care to children and young people is the work of our children’s hospices. Given the 22% figure, will Her Majesty’s Government follow the lead of the Scottish Government and agree to work towards funding 50% of children’s hospices’ charitable costs, to the benefit of the patients concerned, rather than allow the proportion to decrease?

[Lord O'Shaughnessy]

I thank the right reverend Prelate for making that point. In Scotland there are different funding environments. I am aware of the 50% funding commitment from the Scottish Government. We are trying to make sure that CCGs in England not only have the funding they need by increasing NHS funding in real terms but that they understand how to spend it well for end-of-life care, and topping that up where necessary with central funds. So there is a big spending commitment there and with the new accountability framework we have a way of holding those CCGs to account for their performance.