Consumer Rights (Enforcement and Amendments) Order 2016

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 20th December 2016 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I thank the noble Lord for his comprehensive analysis of the order before us this afternoon. I declare my interest as president of the Royal Society for Public Health.

We have made great strides in this country in reducing smoking. I am particularly proud of the last Labour Government’s measure in relation to the ban on smoking in public places—and, indeed, of my own amendment in the last Parliament, which the Lords passed, to ban smoking in cars when children are present.

Although the number of smokers in this country has halved since 1974, currently one in five adults still smoke. Enforcing the regulations and legislation relating to the sale, packaging and marketing of tobacco is, therefore, important. In that regard, I want to ask the Minister about progress on the enforcement of the Tobacco and Related Products Regulations 2016 and the Standardised Packaging of Tobacco Products Regulations 2015. Can the Minister confirm that enforcement officers have already had a number of options available to enforce these regulations? Secondly, how much enforcement activity has there been? Thirdly, how good does he assess compliance to be?

I want to pick up the point made by the noble Viscount, Lord Ridley, on e-cigarettes. The noble Lord, Lord Prior, will recall that e-cigarettes were embraced within the tobacco regulations. I want to ask him about the recent alarmist and, I believe, misleading report of the US Surgeon General, on the use of electronic cigarettes by young people, in which he urges greater restrictions on access to vaping products. Would the Minister go so far as to agree with me that it was a pretty shoddy piece of work, which does not seem to be evidence based? Does he agree that it focused on risk to teenagers without looking at potential benefits to adult smokers; that while the science is detailed in the body of the report, the headlines and marketing material are not appropriately caveated; that the report does not put vaping risks into context with smoking or other risks; and that the Surgeon General proposed restrictive policies on e-cigarettes for the supposed benefits to young people without considering the likely harmful consequences for adult vapers or smokers? He also appears to be treating vaping products as just another form of tobacco, which of course is absolutely wrong.

Will the Minister say that the Government will not go down the route that the US Surgeon General has taken? Will he confirm that vaping has been outstandingly successful in helping adult smokers to stop smoking? Will he also confirm that there is no evidence of vaping in the UK being a gateway to smoking for young people? Has he also noticed that, in reality, in the US the most recent data on youth smoking, published, just after the Surgeon General’s report, actually contradicts the alarmist nature of that report, since it shows that vaping is in decline? That point was made by the noble Viscount.

The relevance of raising this in your Lordships’ House today is that the risk is that the kind of alarmist headlines that we heard in our own media in relation to that report might dissuade smokers from switching from smoking to vaping. There are concerns that a large and increasing number of smokers incorrectly believe that vaping is as harmful as smoking, and there is a real danger that smokers may decide not to switch to safer alternatives, such as e-cigarettes, and are potentially missing out on what I can describe only as a very useful smoking cessation aid. Will the Minister reiterate that evidence to date on e-cigarettes indicates that they present a safer alternative to smoking and, for many—for thousands and thousands of people—are a useful cessation tool?

[Lord Prior of Brampton]

My Lords, two questions have been raised. The first related to the existing powers of trading officers, how much enforcement has been going on and how good our compliance is. I hope that the noble Lord will be happy if I write to him with the details as I do not have the figures at my fingertips. We have already had two quite long debates in this House on vaping. I entirely take on board the point made by my noble friend Lord Ridley—namely, that the road to hell is paved with good intentions, and sometimes good intentions have unintended consequences. I have not read the work carried out at Yale University to which he referred, but I will certainly ask my officials to have a look at it. I am very happy to meet him subsequently to discuss its findings.

On the more general point raised by the noble Lord, Lord Hunt, I absolutely reiterate that all the evidence, whether from Public Health England or the Royal College of Physicians, indicates that vaping is much better for you than smoking cigarettes. Of that there is absolutely no doubt, so we should be unequivocal about it. On the other hand, I think the noble Lord will agree that better than vaping is not to vape or smoke cigarettes or anything else at all. Therefore, we certainly should not encourage young people to vape. I cannot comment on the science behind the US Surgeon General’s report, but I think that his concern was that the number of people taking up vaping has gone up by some 900% from 2011 to 2015, and that people may have been caught up in vaping who would not otherwise have smoked. If these people would otherwise have smoked, it is obviously much better that they should vape. However, if they would have done neither, it is much better to have done neither. I think that is the Surgeon General’s fundamental concern. Therefore, the policy in this country is to encourage vaping compared with smoking but not to publicise vaping to young people in the traditional way through risqué advertising and the like. That is probably not a bad balance to strike.

Consumers and businesses benefit from the Consumer Rights Act in all sectors. The Act was introduced to simplify, strengthen and modernise the law and consolidate enforcement powers. It is right that these powers are applied to the specified legislation without further delay and to provide legal certainty for enforcement authorities.

NHS: Community Pharmacies

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 6th December 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the fact is that across the NHS we are looking to save £22 billion, and sadly, community pharmacy cannot be exempt from those necessary efficiency requirements. But I repeat that, over time, we will see more and more NHS services delivered by community pharmacies, whether it is a sore throat testing service or the treating of minor ailments.

[Lord Hunt of Kings Heath (Lab)]

My Lords, in these rather strange times, can I take it that the noble Lord’s party no longer believes in competition? This policy is intended to reduce the number of community pharmacies in the high street. Why do the Government want to reduce patient choice when the profession clearly can help reduce demands on GPs and A&E services at a very pressurised time?

[Lord Prior of Brampton]

This party does believe in competition. But it also believes that the NHS’s supporting community pharmacies to a very large extent when 40% of them are in clusters of three or more within 10 minutes’ walk from each other, and paying an establishment fee to each of those pharmacies, is probably not a very good allocation of resources.

HIV Diagnosis: Clinical Guidance

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Thursday 1st December 2016 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness is absolutely right. Early diagnosis is absolutely critical. We have made huge progress. The WHO guidelines aim for 90% of people with HIV to be diagnosed. We are at 87%. Sweden is the only country in the world that has hit the 90% target. I point to the It Starts With Me programme, which is based around individual responsibility and is co-ordinated by the Terrence Higgins Trust, which is making great progress.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I very much welcome the initiatives taken by the Government in this area but does the Minister accept that the NHS itself could do more, particularly in accident and emergency departments and in primary care? Would he be prepared to convene a meeting with NHS England to discuss how the NHS could be persuaded to be much more proactive in relation to testing?

[Lord Prior of Brampton]

My Lords, I am very happy to arrange a meeting of that kind. We are expecting an announcement very soon on the PrEP issue and it may be worthwhile having that meeting after that announcement.

HIV: Barriers to Treatment

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Thursday 1st December 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, one of the purposes of the Act promoted by my noble friend Lord Lansley was to remove the Secretary of State, and indeed politicians, from these very difficult clinical decisions. That decision will be made by NHS England, and we expect a positive decision to be made in the very near future.

[Lord Hunt of Kings Heath (Lab)]

My Lords, Ministers cannot evade their responsibility for the NHS in the end. NHS England is not a clinical body; it is a quango wholly owned by and wholly responsible to government. The decisions it has made have been purely about money, and it is continually endorsing crude rationing of services and the restriction of drugs. In the current agreement with the drug companies, the Minister’s Government have received nearly £2.5 billion back in rebates from those companies. Why on earth has his department allowed the Treasury effectively to ambush that money, instead of it being spent, as it should have been, on innovative new drugs for NHS patients?

[Lord Prior of Brampton]

My Lords, I think the noble Lord will agree that there is a clinically driven process, through the specialised commissioning groups and the clinical priorities group within NHS England, that attempts to look at all these drugs in an objective, clinical way. Surely it is better that these decisions on priorities should be made by clinicians acting in that way than by politicians, who are subject to all the pressures of which we are all only too well aware. Of course affordability is an issue in assessing whether a new drug should be commissioned; it always has been and always will be. The £2 billion, which the noble Lord has mentioned before and which I think comes from the PPRS, is taken into account when setting the overall budget for NHS England.

Mental Health: Children and Adolescents

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Wednesday 16th November 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, when I read the noble Baroness’s paper over the last couple of days, I thought the part about schools was the most persuasive. School is clearly critical. The pilot project being done by the Department of Health and the Department for Education, trialling the single point of contact in schools, is very important, as is the PSHE guidance on teaching about mental health at the four key stages of education.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Lord’s sincerity in this area is not in any doubt. However, he knows that, despite the instructions that Ministers have given to the NHS through the NHS mandate, the health service is actually disinvesting in many mental health services. On Monday, the noble Lord will have seen the King’s Fund report on sustainability and transformation plans, on which he has rested much of his hope about the future of the NHS. Mental health services appear to be very marginal to the focus of those STPs. What action do the Government intend to take on this?

Cataract Operations

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Wednesday 16th November 2016 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I declare an interest as a trustee of the Royal College of Ophthalmologists. I understand from the Minister that NICE is preparing guidelines, but in the meantime, will he take this opportunity to condemn CCGs in which there is crude rationing of cataract services? I refer him to the Daily Mail freedom of information survey in July, which showed that under some clinical commissioning groups, a person not only had to have poor eyesight, but had to demonstrate that they had fallen twice in the last year, lived alone and had hearing problems, or that they were caring for a loved one. If that is not crude rationing, I do not know what is.

[Lord Prior of Brampton]

Clearly the case that the noble Lord mentions is totally unacceptable. Where CCGs are rationing access to cataract operations on such a crude basis, we would all deplore that. But as I said, there is variation around the country, and the new NICE evidence-based guidelines will help to address that.

NHS: Cancer Patients

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Wednesday 9th November 2016 Lords Chamber

[Lord Prior of Brampton]

My noble friend is right; the use of IMRT has increased from around 10% to about 40% in the past year—so it is increasing greatly. There is much less collateral damage with IMRT. We have also, as my noble friend will know, commissioned two proton beam centres, at the Christie and UCLH, which will also make a difference. We have just announced a £130 million investment in new linear accelerator machines. Those three developments will, I think, greatly improve our ability to deliver world-class radiotherapy.

[Lord Hunt of Kings Heath (Lab)]

My Lords, is it not time for a bit of honesty on this? The two targets the Government are missing are the crucial ones of the 62-day cancer treatment waiting time and the two-week wait for referral for patients with suspected cancer. The Government have said that early diagnosis and quick treatment are essential, but those two targets relate exactly to those key points. The Minister knows that, in the mandate for this year, the Government said to NHS England that this must be a priority. But, given the huge funding and staffing pressures on the NHS, is it not time for the Government to come clean and admit that they cannot deliver this?

[Lord Prior of Brampton]

I think I was being honest, actually. I have never hidden the fact that these targets are very tough and difficult to meet. But we have increased activity enormously. We accept that early diagnosis is critical and probably as important as the 62-day referral for treatment target, which is why the 28-day target from urgent referral to diagnosis is so critical and will be one of the four key targets that will be in the CCG assurance framework. I accept what the noble Lords says; early diagnosis is critical. We are making progress and Sir Harpal Kumar, who developed the cancer strategy a year ago, is overseeing performance and progress towards meeting those targets.

NHS Funding

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Monday 31st October 2016 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very grateful to the noble Lord for repeating that, but I am afraid that his attempt to gloss over the real story of the Government’s manipulation of NHS funding figures simply will not wash. The Government have been found out by the considerable and Conservative chairman of the Health Select Committee, Dr Sarah Wollaston. She has pointed out that the so-called extra £10 billion can be arrived at only through significant manipulation of the figures, including an extra year in the spending review period, changing the date from which the real terms’ increase is calculated, and disregarding the total health budget.

The Nuffield Trust pointed out in a report this morning that the £8 billion figure—which is the real figure, not the £10 billion figure—

“has been flattered by redefining what counts as ‘the NHS’. In the past, the government used to count NHS spending as the entire Department of Health budget for England. Now it only counts the subset of that spending that comes under the control of the department’s commissioning arm, NHS England. Only ‘NHS England’ is protected with ‘real-terms increases’ while the rest of Department of Health spending will be cut by £3 billion by 2020-21”.

Therefore, not only is the £10 billion or £8 billion a wild exaggeration: but the fact is that the NHS is facing an acute funding crisis, wholesale rationing of services and the denial of life-enhancing medicines to many patients.

I would like to put three points to the Minister. First, I see that he quoted OECD figures, but looking at the latest OECD per-capita spend on health, I note that 18 countries in the OECD group have a higher GDP spend on health than we do in this country. Can he confirm that, compared to any country of equally sizeable wealth, we have fewer doctors, fewer nurses, fewer beds and less access to medicines and new medical equipment?

Secondly, when the Minister says that the £8 billion was what the NHS asked for, can he confirm that the NHS did not ask for £8 billion, but indeed took no part in any discussions? There were discussions with NHS England, which is a government-appointed quango and is not the National Health Service. Can he also confirm that, in negotiations, the Government themselves—including the Treasury—told the chief executive of NHS England that £8 billion was the maximum amount that he could call for?

Finally, on the five-year forward plan—the underpinning of it by sustainability and transformation plans—can the noble Lord confirm that first analysis shows that swingeing reductions are to be made in acute care without any guarantees that community and other services will be put in their place to reduce demand on acute services?

[Lord Prior of Brampton]

My Lords, I will try to respond to those last three points. First, the noble Lord is right: the NHS is—and I would regard it still as—the highest-value healthcare system in the world. It does have fewer doctors and MRI machines—however you want to measure it—compared to many other OECD countries, but its outcomes, on the whole, are very good. I can, therefore, certainly confirm that the NHS is a very high-value healthcare system. As far as the involvement of the NHS in the plan is concerned, it was very much put together by the NHS and signed by all of the arm’s-length bodies at the time. This is a quote from Simon Stevens about the spending round settlement:

“This settlement is a clear and highly welcome acceptance of our argument for frontloaded NHS investment. It will help stabilise current pressures on hospitals, GPs, and mental health services, and kick-start the NHS Five Year Forward View’s fundamental redesign of care”.

This brings me to my last point, the fundamental redesign of care. That was possibly not really recognised at the time of the NHS review, because it is a fundamental redesign of care. As the noble Lord said, it means moving resources away from acute settings into community settings, very much as mental health care was restructured 20 or 25 years ago.

Mental Health: Young People

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 11th October 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the issue of suicide clusters and contagion is serious and real. By 2017, as recommended by the Five-Year Forward View on Mental Health prepared by Paul Farmer, every authority will have a multiagency plan addressing that issue. I agree with the noble Baroness that we need to do a lot more in schools. Interestingly, 255 schools are now part of a pilot scheme where there is a single point of contact within the school, so that when a child is feeling suicidal or has mental health problems, it is at least clear who they should go to to seek advice.

[Lord Hunt of Kings Heath (Lab)]

My Lords, it is clearly not just an issue of funding, but you cannot escape the issue of funding. Yesterday, police chiefs said that they were being forced to act as emergency mental health services because of the inadequacy of provision up and down the country. Recently, an FoI request showed that two-thirds of CCGs which responded are spending less as a proportion of their budget on mental health this year, rather than more, as Ministers required them to do. The Minister mentioned the review to come out later this month, which will reflect on this distressing issue. The question is how one can have confidence in what the Government are saying, because they clearly are having such little impact on what the NHS does locally.

[Lord Prior of Brampton]

My Lords, this is a difficult issue. As the noble Lord will know, a key part of the five-year forward view is to take resources out of acute physical care, out of acute hospitals, so that there is more available for mental health care, community care and primary care. It is very difficult to do that. As the noble Lord will know, we have been trying to do this since 2000 but all that has happened is that more and more of the available resource has been sucked into the big acute hospitals. Getting that resource out and into the community and into mental health is extremely difficult. The STP process is going on at the moment. We are committed to seeing more money going into mental health, but I acknowledge the difficulties.

Junior Doctors: Industrial Action

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Monday 5th September 2016 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to the noble Lord for making the Statement.

Clearly the prospect of a series of five-day strikes is very worrying, coming after the protracted negotiations, agreement between the negotiators and then the subsequent ballot rejection. The promised action, though now delayed, would have a damaging impact on patients, the NHS and the junior doctors themselves. However, the Secretary of State and the Government cannot escape their own responsibility for the threatening catastrophe.

At the heart of this dispute is a complete absence of trust by the junior doctors in the Government and, specifically, the Secretary of State. It is not hard to see why. Towards the end of the Statement the noble Lord mentioned a seven-day service. It is the conflation of the seven-day service issue with the junior doctors’ contract which has exacerbated an already difficult situation, particularly as it is the junior doctors on whom the service is so dependent for out-of-hours working.

The Minister did not mention the advice received from officials but he knows that the documents obtained by the media outlining the risks detailed by officials on the seven-day NHS were clear in their assessment that the NHS was likely to have too few staff and too little money to deliver a truly seven-day NHS. Moreover, it gives the lie to the last sentence of the Statement where the Secretary of State comes out with all that blah about making the NHS the safest, highest-quality service in the world when everyone knows that it is crumbling through a lack of resources, a lack of staff and a lack of leadership. We have a Secretary of State who is in his own world, one that is occupied by no one else. He is charging ahead with implementing the seven-day working week without the resources, staff and support needed to do it.

Let me be clear: no one more than I would like to see a truly seven-day working NHS, but that is dependent on the resources being available to ensure its proper implementation. What I deplore—and this is a core reason for the disenchantment among junior doctors—is the Secretary of State’s distortion of the statistics in relation to weekend mortality figures to justify the imposition of the contract.

I would like to ask the Minister a number of questions. First, he referred to the contingency plans being put in place by the NHS, but clearly with the postponement or cancellation of the first proposed action there is now time for the NHS to give more consideration to those contingency plans. I wonder if he can tell the House a little more about them. Secondly, the chief executive of NHS Providers has warned that with little notice the unprecedented action,

“will cause major disruption and risk patient safety”.

What discussions have taken place between Mr Hopson and Ministers to discuss his concerns? Thirdly, where elective operations and clinics may be cancelled as a result of the promised late action, what assurances can the public be given that new dates will be scheduled as quickly as possible?

Can the noble Lord say what discussions have taken place between the Department of Health and junior doctors? In its statement today announcing the postponement of the action, the BMA has said that it will call off further action if the Secretary of State stops his imposition of the contract, listens to the concerns of junior doctors and works with the BMA to negotiate a contract based on fresh agreed principles that have the confidence of junior doctors. What is the Minister’s response to that statement by the BMA? It has been reported in the media that the Secretary of State has refused to engage with the junior doctors. Can he confirm whether that is the case, and if so, why is that the position?

Finally, what are the Government’s plans to restore junior doctors’ trust in the National Health Service? There is a clear risk that the morale of a whole generation of doctors is being destroyed as we speak. When that is put alongside the implications of Brexit and the potential loss of experienced staff through the decision by many junior doctors to leave the profession or to go abroad, this is a worrying position. I have met a number of junior doctors over the past few months. They are clever, articulate and passionate about the NHS, but they have told me about the pressures that they are under, of the risky gaps that we now have in rotas which have developed over the past few years, of locums not always being available, of existing staff having to cover gaps at short notice, and of being hugely dependent on the good will of many staff, including junior doctors. The Statement of the Secretary of State is full of warm words about junior doctors’ working conditions, but as the Minister knows, the fact is that they do not have confidence in them. Frankly, I also do not think they have confidence in local management to implement the proposed contract in a way that is sensitive to their working conditions.

At the annual meeting of the Royal College of Physicians, its chairman pointed to the need for junior doctors to be valued, supported and motivated. Some months ago the RCP wrote to the Secretary of State outlining recommendations for improving conditions in training, including protected time for training and the promotion and support of flexible working, publishing rotas earlier and prioritising handover sessions. What progress has been made in responding to the sensible suggestions made by the Royal College of Physicians, and above all what are the Government going to do to endeavour to get back the confidence of junior doctors in the NHS and thus seek an end to this action?

[Lord Prior of Brampton]

My Lords, the noble Lord has raised many questions in his response to our Statement. He may well have read the article published earlier this week in the Times by Sir Simon Wessely, the president of the Royal College of Psychiatrists, which goes to the heart of what I would call the non-contractual issues that have bedevilled, coloured and provided the context for this dispute:

“Changes to the way that doctors are trained means that juniors face switching not just jobs but addresses every few months without much say about where they end up and when. Many seem condemned to spending years rootlessly shuffling from one place to another like lost luggage. Without any familiar faces, long hours are endured in relative isolation and managers who change all the time provide little or no recognition, let alone reward”.

This in a sense is what lies behind much of the dispute. The fact is that we had a contract that was wholeheartedly welcomed by Dr Ellen McCourt, now the president of the BMA, and by the association itself. The issues of difference in the contract were pretty small.

We have been discussing this contract for three years now and the Government have made 103 concessions. The Secretary of State’s door has been open throughout that time. The new contract is due to be introduced in October and at some point we really have to get on and introduce it. There is provision within it to review aspects as it goes forward. We have committed to looking at the gender pay issues that have been raised by the BMA and today HEE has published the work that it is doing on non-contractual issues with the BMA when the association is prepared to talk to it. The Government are bending over backwards to meet the BMA, but there comes a point where we just have to bite the bullet and go ahead with the contract that has been agreed, and that is the place we are in now.

The noble Lord referred to a lack of trust in local management and in the Secretary of State, but we now have the guardians of safe working hours built into the contract. They have a contractual commitment to report every quarter to the boards of trusts and to the GMC and the CQC every year. Plenty of independent safeguards have been built into the new contract. So while of course I understand many of the issues raised by the noble Lord, the Government have gone the extra yard every time they have been asked to do so and now we must get on and introduce this contract.

NHS: Junior Doctors’ Contract

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Wednesday 6th July 2016 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I beg leave to ask a Question of which I have given private notice.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, in May after nearly three years of talks, several days of damaging strike action and following conciliation through ACAS, the Government, NHS employers and BMA leaders reached agreement on a new, safer contract for junior doctors. The Government decided that to help deliver their manifesto commitment for a seven-day NHS, they will now proceed with the phased introduction of the new, safer contract, which is supported by the BMA leadership.

[Lord Hunt of Kings Heath]

My Lords, I am grateful to the Minister for that statement. It is clearly a matter of great regret that the issue of the new contract for junior doctors has not been resolved satisfactorily and that the Government are intent on imposing the contract. What legal power do the Government have to impose that contract? Can he tell me whether the Government have any plans to resume discussions with the junior doctors? At the heart of the dispute is a lack of trust in the Government on the part of those junior doctors. What plans do the Government have to restore that trust and the trust of patients in the NHS?

[Lord Prior of Brampton]

My Lords, it is certainly a matter of regret on all sides that this dispute has not been resolved in an amicable, satisfactory way; I agree with the noble Lord on that. The Secretary of State plans to introduce the new contract with NHS employers in a phased way beginning in November. He has said that in terms of how the contract is implemented and any extra-contractual issues that arise, his door is always open; he is willing to talk to the BMA and junior doctors.

Public Health England: Alcohol

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 5th July 2016 Lords Chamber

[Lord Prior of Brampton]

I cannot plead that I did not hear the question again, but I am going to have to say that I do not know the answer, so I shall write to the right reverend Prelate later.

[Lord Hunt of Kings Heath (Lab)]

My Lords, my understanding is that junior doctors have rejected the Government’s final offer by 58% to 42%, which is quite a large majority. Will the noble Lord make a Statement tomorrow in your Lordships’ House on the consequences of this?

On the issue of the limit of 14 units of alcohol per week, I looked at the Department of Health’s website this morning and although it talks about the risks of alcohol, it does not actually specify the additional risks of, for instance, keeping the maximum units for men at 18 per week? The lay summary of the principal expert advice and research given to the Chief Medical Officer again does not quantify the risks. It states simply that there is a raised risk. Does the Minister accept that if we are not prepared to give the public the real facts, it is unlikely that the advice of the Chief Medical Officer will be taken seriously? I wonder if he can have a look at this.

[Lord Prior of Brampton]

On the first issue, I cannot commit to giving a Statement tomorrow—that depends on decisions elsewhere. Certainly, if there is a Statement in the House of Commons I would expect it to be repeated in this House. On the other issue, the Chief Medical Officer’s guidelines are based on real facts. The last time the CMO issued guidelines was, I think, in 1995. Between then and now the scientific link between alcohol and cancer has changed, so she feels that it is right to put the facts into the public domain. As I said, we are consulting on how we word those guidelines to the public.

Health: HIV

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Monday 4th July 2016 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government whether they will instruct NHS England to commission the use of pre-exposure prophylaxis (PrEP) for patients with HIV.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, after taking legal advice, NHS England has concluded that it has no legal power to commission pre-exposure prophylaxis. NHS England’s decision is currently subject to judicial review by the National AIDS Trust and we are therefore unable to comment further on the legal position. We will consider the options available following the outcome of the legal review.

[Lord Hunt of Kings Heath (Lab)]

My Lords, this is a perverse decision on a ground-breaking drug that could save many people’s lives. Essentially, NHS England is hiding behind the responsibilities of local authorities in relation to sexual health services. How long must we wait before the public get the use of this drug, which is widely available in other countries? The Government should instruct NHS England to get on and make it available.

[Lord Prior of Brampton]

My Lords, the judicial review is being held next Wednesday, which is only 10 days from now, at which point we will know the exact legal position. I really cannot comment further on it today. As far as this drug being widely available as a prophylaxis, it is widely available only in some countries for very specific groups of people. If we commission it in the future, it is important that we are clear about where we can get the most benefit from it.

Tobacco and Related Products Regulations 2016

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Monday 4th July 2016 Lords Chamber

[Lord Prior of Brampton]

It is possible. There is always a possibility when there is a regulation that a black market will develop, and for the very high-strength products, which had to be regulated by the MHRA—the ones above 20 milligrams—there is a risk that there will be a black market. I think I recall that the noble Lord said earlier that a black market had already developed in this product. We are trying to bring some minimum quality standards, at least, into this market so that people who are thinking of moving from smoking to using e-cigarettes can have confidence that the product they use is regulated to a minimum standard.

I remind noble Lords that new and important tobacco control measures are also contained in these regulations. I have not talked about them specifically because they are slightly off the main point of this debate. The regulations will be reviewed within five years of entering into force. I also commit, here and now, to commissioning Public Health England to update its evidence report on e-cigarettes annually until the end of this Parliament and to include within its quit-smoking campaigns consistent messaging about the safety of e-cigarettes.

Clearly, there are strong arguments on both sides of the debate. As I said, I am not an instinctive regulator by any means but I feel that these regulations are proportionate. They do not go over the top, are entirely sensible and are backed by the RCP and all the major charities in this area. I hope that my noble friend Lord Callanan will not wish to push this to a vote, but of course that is entirely his decision.

[Lord Hunt of Kings Heath]

My Lords, I thank the Minister for his wind-up, which I think was very fair. I agree with him that this has been an excellent debate and various views have been put forward. I understand why some noble Lords have concerns about e-cigarettes, particularly in relation to young people. I understand that there are still some uncertainties. I accept that there is a need for some regulation in relation to e-cigarettes.

The Royal College of Physicians produced an excellent and dispassionate report but in the end it concluded that, while not absolutely safe,

“the hazard to health arising from long-term vapour inhalation from the e-cigarettes available today is unlikely to exceed 5% of the harm from smoking tobacco”.

That is a pretty powerful statistic. The royal college supports the regulations—I understand that. We have been told by the noble Baroness, Lady O’Cathain, that 2.8 million people currently use e-cigarettes. We know that often it is the poorest people in society whom many of the traditional approaches to giving up smoking have not touched. Equally, we know that there is a problem with smokers who think that e-cigarettes may be much more harmful than they actually are.

The noble Lord, Lord Prior, rightly said that smokers are aware of e-cigarettes: I take that point. However, there is this worrying statistic that many smokers feel that e-cigarettes are very harmful—almost as harmful as smoking cigarettes. That worries me. I worry that the regulations may make that worse. This is where the absence of cohesive, strongly financed public health programmes comes in. That is why I believe that my amendment finds a delicate way through the morass that we have been debating today and why I wish to test the opinion of the House.

NHS: Unsafe Hospital Discharges

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Wednesday 15th June 2016 Lords Chamber

[Lord Prior of Brampton]

The noble and learned Baroness is right, up to a point. I said one or two because the PSHO report focuses on nine individual cases. In so far as they are representative of behaviour across the country, they are important, but I want to put on record that the vast majority of hospitals the vast majority of the time are getting their discharge procedures right and are doing an outstanding job.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister has readily identified the problem of unsafe discharges. Why is there no explicit reference to this issue in the NHS mandate to NHS England for 2016-17?

[Lord Prior of Brampton]

I cannot give the noble Lord a reason off the cuff. It is very much a part of the better care fund. There is a CQUIN for 2016-17 that is focused on delayed discharges. One of the fundamental purposes underlying the STPs and the vanguards, which are a critical part of taking the Five Year Forward View into a serious plan, is to reduce delayed discharges and improve the relationship between acute care and social care.

Learning Disabilities: Transforming Care

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Thursday 9th June 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, progress since the horrendous events at Winterbourne View some five years ago has not been as fast as we would like. Under the Building the Right Support programme, NHS England is putting in an extra £30 million, which will be match-funded by CCGs, and another £20 million for capital investment. That is a very significant commitment of extra resource, but the proof will be in the eating.

[Lord Hunt of Kings Heath (Lab)]

My Lords, as the noble Lord said, it is five years since “Panorama” exposed the scandals in Winterbourne View. Ministers’ responses at the time and since have been admirable in their expressions of concern and the action they require in the NHS. The problem is that very little has happened. Is the Minister satisfied that NHS England, which has been consistently charged with implementing the changes, understands what it is required to do by Ministers? So far there is very little evidence that it does.

[Lord Prior of Brampton]

It is very clear in the NHS mandate that it knows exactly what it has to do. It was NHS England that produced Building the Right Support. There is a lot more governance around the programme now. Every month we will see the numbers of patients in in-patient care settings. The noble Lord will be interested to know that over the last year 185 people who had been in hospital for more than five years have now left hospital and gone into the community. There are signs that things are happening, but I would advise the noble Lord that what is needed is constant scrutiny.

National Clinical Director of Adult Neurology

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Thursday 9th June 2016 Lords Chamber

[Lord Prior of Brampton]

I do not want in any way to diminish the huge clinical importance of this and the suffering of many people with long-term neurological conditions. They are among some of the worst illnesses that anyone can have and I am delighted that my noble friend recovered from his. From everything that I have been told by NHS England and Bruce Keogh, I do not believe that the lack of a national clinical director will in any way detract from the resources that we are making available to neurology.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I have enormous respect for Sir Bruce Keogh but, as my noble friend Lady Gale said, NHS England has essentially set out to decimate the influence of clinical advisers at the level of senior decision-making teams. When we set up national clinical directors, they were based in the Department of Health, had direct access to Ministers and were hugely influential. The current situation in NHS England is that they are often part-time appointments with virtually no support and limited influence. Is it not time that Ministers started to reassert control over services for which they are accountable to Parliament?

[Lord Prior of Brampton]

I do not think I agree with the last part of the question. We have set up NHS England as an arm’s-length body, and a key part of the reforms—the bit that probably everyone supported in the 2012 Act—was to get politicians more out of the day-to-day running of the NHS and to give more power to clinicians. It is better that clinicians rather than politicians should make these decisions. On what the noble Lord said about decimating the influence of clinical advice in NHS England, I just do not think that that is the case. In so far as he has raised it with me, I will have a meeting with Bruce Keogh and put that point to him and get his response.

Dental Health: Children

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 7th June 2016 Lords Chamber

[Lord Prior of Brampton]

My noble friend will be aware that a part—only a part—of the obesity strategy includes a levy on fizzy drinks. That will be a levy on the manufacturer not the consumer. That is a very important part of trying to improve the diet of young children.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I should remind the House of my presidency of the British Fluoridation Society. I come back to the issue of fluoridation. The noble Lord has been rightly positive about its impact. The real problem is that the law gives responsibility to local authorities but local authority boundaries do not always fit with the way that water is produced by the water companies. Given that, does the noble Lord agree that there is a role for the Government, working in partnership with those local authorities, to give impetus to water fluoridation? Will he also pick up the point raised by his noble friend and work with the Greater Manchester Combined Authority to see whether Manchester could be brought up to the level of the health of people in the West Midlands?

NHS England: Pre-exposure Prophylaxis for People at Risk of HIV

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 7th June 2016 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

I am grateful to the Minister but this decision by NHS England not to commission and fund PrEP is a matter of great regret. In the UK there are more people living with HIV than ever before. Without any need for an evidence review, it is absolutely clear, without any uncertainty whatever, that PrEP has the potential to be a game-changer. It is proven to be effective in stopping HIV transmission in almost every single case. There is no need for an evidence review. It is simply a delaying tactic because of this absolutely disgraceful decision not to fund this drug. The Minister mentioned our record in relation to other countries. It is a matter of shame that this drug is being used extensively in other countries but is being denied to NHS patients without any justification whatever.

At some point the Minister will pray in aid the cost of new drugs. On a number of occasions I have asked him this question but he will never answer it—because, I suspect, the answer is too embarrassing. He knows that he is in the middle of a five-year agreement with the branded drug industry through which, if the cost of drugs goes over the base level plus a small allowance for inflation, the department receives a refund every three months. That agreement should enable new drugs to be funded, but that money is not being used to invest in those new drugs. If he says that this cannot be done because of cost, that is simply not true. I very much hope that the Government will reconsider this decision. It is utterly indefensible.

[Lord Prior of Brampton]

My Lords, I am not going to proffer the argument that it is too expensive, because that is not the issue today. The issue today is that NHS England feels that it does not have the power to commission this particular drug. Whether or not it has that power may well be judicially reviewed, so I cannot comment on the outcome of that judicial review.

The PROUD study produced strong evidence of the effectiveness of Truvada as a preventive drug. The work that NICE is going to do, and the pilot scheme to look at the effectiveness of this drug—it will cost £2 million and will be funded by NHS England and PHE—will ensure that when the question whether NHS England has the power to commission this drug is resolved, there will be the evidence on which to make that decision.

NHS: Diabetes

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Thursday 26th May 2016 Lords Chamber

[Lord Prior of Brampton]

As the noble Baroness will know, the Government will produce their childhood obesity strategy later in the summer. I am sure that advertising, particularly before the 9 pm watershed, will be addressed in that strategy.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I hope that “Bake Off” will not be removed from our screens as a result of the strategy. The Minister said that the strategy has now moved from being published in the summer to later in the summer. Will he say a little more about when we can expect to see it? Also, will it answer my noble friend’s original point? Will he crackdown on clinical commissioning groups that are making arbitrary decisions to cut foot care services, which are a short-term saving but a long-term disinvestment?

[Lord Prior of Brampton]

My Lords, on the first point, I think we can say that “later in the summer” means before the parliamentary Recess. I do not mean the Recess starting tomorrow, but the main Recess later in the summer. On foot care services, this goes back to the unconscionable variations we have across the country. These are being addressed in part by the diabetes audit and in part by the improvement and assessment frameworks that have been developed for CCGs, so that we can see the results of different CCGs around the country and take action accordingly.

NHS: Bursaries

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Wednesday 25th May 2016 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government whether they intend to halt plans to withdraw National Health Service bursaries.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, the Government do not intend to halt plans to withdraw National Health Service bursaries for nursing, midwifery and allied health students undertaking pre-registration training at university. The Government are currently running a public consultation on how to most successfully implement those reforms. The changes will affect only new students commencing courses on or after 1 August 2017.

[Lord Hunt of Kings Heath (Lab)]

But, my Lords, has the Minister seen the PAC analysis which says that, because of the loss of the bursary and the introduction of loans, there is a real risk that many people, particularly older people with children, will be dissuaded from applying to train as nurses and in allied health professions? Given that, and given the desperate shortage of nurses and other professionals, should not the Government take a little time to examine whether their original decision was justified rather than simply consulting on the way that it is going to be implemented?

[Lord Prior of Brampton]

My Lords, all the evidence is—not just from nursing but from other university courses—that loans have not reduced the numbers of people wishing to go to university: indeed, quite the contrary. The number of people going to university has gone up since student loans were introduced. The demand from young men and women who wish to go into nursing is very strong. The noble Lord will know that 57,000 people apply every year to become nurses and there are only 20,000 places, so we are confident that this will result in more, not fewer nurses.

Health: Alcohol

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Thursday 12th May 2016 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I commend the Minister on his courtesy in answering Questions in your Lordships’ House. Perhaps one or two of his colleagues might learn from that example. The logic of the Chief Medical Officer’s position is that essentially all alcohol is harmful. Is that the position of the Government?

[Lord Prior of Brampton]

Thinking very quickly, my Lords, our position is that alcohol is not safe but it is low risk depending on how you drink. It is a low-risk activity at a level of about 14 units spread evenly across the week. I am sure that the noble Lord will adhere strictly to that guideline.

National Health Service Trust Development Authority (Directions and Miscellaneous Amendments etc.) Regulations 2016.

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 10th May 2016 Grand Committee

[Lord Hunt of Kings Heath]

I thank the noble Lord, Lord Prior, for his response. I certainly understand the need for speed and the erosion over time of the distinction between foundation trusts and non-foundation trusts. I also agree with the Minister on the issue of competition. The past years have shown that while it can play a role, that role should be limited, and I have no objection to that, nor, indeed, to the extended remit of improvement. That is something which has been missing from the regulatory apparatus and it is to be welcomed.

I would like to make a couple of points. First, the Minister said that we are moving locally to system-level leadership and development. I am sure that that is right, but I hope that local accountability will be borne in mind. I have just had responses to a number of Questions for Written Answer that I tabled about accountability in the sustainability and transformation plans. As the Minister knows, they have to be in by 30 June. We know that they will all say that the acute care footprint will be reduced by so many hundreds of beds—to be honest, this has all been done before—and they will then say that there is going to be heroic demand management and, somehow or other, there will be miraculous developments in the community. But they will not have ownership locally because, essentially, they are being top-down led. At some point, they will have to go through formal consultation procedures and I believe that, unless there are some powerful forms of local accountability, they will run into trouble.

[Lord Prior of Brampton]

I think that the noble Lord has put his finger on it. If the STP process is just another top-down-led system redesign, it will not have any teeth to it. But what has happened in Manchester, for example, is that there is clear local leadership and accountability, which mean that some of the really difficult decisions that have not been taken for generations are now being addressed. There must be effective local accountability and governance around the STPs.

[Lord Hunt of Kings Heath]

The other area, which I have raised with the Minister before, is in relation to clinical commissioning groups. First, the creation of federations of GPs makes the model unsustainable in the long term, because in some parts of the country the electoral body for the GP members of CCGs will be almost coterminous with the federations. Clearly, there is a conflict of interest in that. Secondly, there is still an issue about the accountability of CCGs. If ever one needed a governance structure that made them somehow locally accountable, the foundation trust model would provide some answers which I hope that the Government will look at.

My final point is on what legislation will be in the Queen’s Speech. Clearly, from all that the Minister has said, much of the 2012 Act is defunct in practice. We are moving to a planning model, and the Act is very different from that. The longer that this goes on, the more need there will be at some point for some legislative change, because at the moment people in the health service are at risk. They are essentially being asked to develop a system-led planning model, but that is challengeable because the Act is very different from that. I believe that at some point it will be challenged. The Government may not want to have core health legislation debated, but at some point that will have to be done. I also remind him that we still have a draft Law Commission Bill and I am hoping that, at the very least, we will see a short form of that announced in the Queen’s Speech.

This has been an excellent debate and I am very grateful to the noble Baroness, Lady Walmsley, and the noble Lord, Lord Prior.

Care Quality Commission (Fees) (Reviews and Performance Assessments) Regulations 2016

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 10th May 2016 Grand Committee

[Lord Prior of Brampton]

I believe that it has gone into the baseline funding of the GP contract, but if I am wrong about that I shall write to the noble Baroness.

More generally, the CQC’s scope and the way that it does its inspections is just much broader than it used to be. They are done in more depth and detail. This statutory instrument was introduced to Parliament so that it would reflect what the CQC is now doing and recognise its enlarged scope. The regulations do not extend the remit of the CQC’s activity or the scope of reviews or performance assessments to additional providers or services; neither does it change the fees actually charged.

The CQC, like every other aspect of the NHS, is going to have to save a considerable amount of money over the next five years, which the noble Lord, Lord Hunt, referred to in his speech. This means that the kind of inspections which we have seen in some NHS trusts, where a large number of very expensive people descend upon a trust, will have to be scaled back to some extent. As the noble Baroness intimated, I think that we will see a more risk-based inspection model—a bit more like the Ofsted model. I suspect that we will see more unannounced inspections as well, because a large part of the cost of the CQC is not just its direct cost but the indirect costs on the trusts preparing for the inspections. Sometimes the degree of preparation undermines the validity and insightfulness of the actual inspection.

I take on board entirely the strictures of the noble Lord, Lord Hunt. This is another expense when times are extremely hard, but it reflects the fact that the scope of the CQC is now broader than it was three years ago, and the need to have full cost recovery over a fairly limited time.

[Lord Hunt of Kings Heath]

My Lords, again, I am grateful to all noble Lords who have spoken in this debate and to the Minister. I have no problems whatever with the wider scope of the CQC’s responsibility, which inevitably has an impact on its cost base. Nor do I object to full cost recovery as a principle, because that has obviously been accepted by Governments over many years.

My complaint is that it is hugely insensitive for the Government to insist, which is essentially what has happened, that the NHS and parts of the care sector had to move to two-year full cost recovery. I note the alleviation given to GPs and domiciliary care, but I am puzzled that residential care was not given the same amelioration, given that, as we know, the care sector is in such a parlous state at the moment. We obviously look forward to the CQC strategy; I am sure it is right that it should be more risk based.

I very much welcomed the intervention of the noble Earl, Lord Lindsay. The United Kingdom Accreditation Service does its role very well. I also recently met RDB Star Rating, which is based in Sussex although it covers a number of institutions nationwide. It also made the point to me that, if you have a strong accreditation system, not only is there greater ownership by the bodies being accredited—because they have volunteered for it—but it ought to tie into the CQC process. The Minister has encouraged the noble Earl to meet the CQC; I hope that he might encourage the CQC to meet the noble Earl to see whether further progress can be made, because we clearly ought to take up the offer in relation to accreditation, if at all possible.

This has been a good debate. It is not at all a criticism of the CQC but of the Government and their approach, and it has been useful to raise those issues.

Tobacco and Related Products Regulations 2016

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 10th May 2016 Grand Committee

[Lord Hunt of Kings Heath (Lab)]

My Lords, this has been a great debate and I am grateful to the noble Viscount, Lord Ridley, for once again bringing our attention to this matter. It is a pity that we are in Grand Committee and not in the Chamber, but I can understand the reason for that. I should declare my presidency of the Royal Society for Public Health, which has of course produced documentary evidence on electronic cigarettes.

It is tempting to debate Europe—and I look forward to the view of the noble Lord, Lord Prior, on that, as it clearly seems to be part of our debate—and it looks as if we have quite a long time to wait this evening. I am in favour of remaining in the EU, but I would remark that this directive does not seem to show much evidence of the Prime Minister’s claim to have negotiated a new concordat and relationship with the EU.

I am very doubtful about the argument that, if we were outside the EU, we would not be doing this. The fact is—I speak as president of the RSPH—that some elements in the public health world were prejudiced from the start against e-cigarettes. That clearly influenced the Department of Health and is the reason why it has taken such a mealy-mouthed approach to e-cigarettes, which is simply not based on evidence at all. It is interesting that, if you look at some of the papers produced by public health bodies, there are some weaselly words around this issue: “We still don’t know and we need to be very careful”. They are really trying to find a legitimisation for the initial very negative reaction, which I am afraid has laid the foundations for where we are today, because this is bonkers. It is simply madness. Here we have a product which is clearly of benefit to smokers and there is no evidence whatever that it will be used by non-smokers, which is where all this nonsense has come from. Why would a non-smoker take up these e-cigarettes?

The noble Lord, Lord Stoddart, and I have debated tobacco issues for many years, and he will know that I have been strongly in favour of very strong legislation. I moved the amendment to ban the smoking of tobacco in cars with children only a year or two ago, so I am not at all worried about being very tough on smoking, but e-cigarettes are completely different. I do not understand why they are part of the directive at all or classified in the same way.

The evidence is abundantly clear that e-cigarettes are almost wholly beneficial. My concern is that it is also clear that the public are, at the moment, confused. RSPH research revealed that 90% of the public still regard nicotine itself as harmful. Going back to September 2015, Public Health England issued a joint statement with other UK health organisations, saying:

“And yet, millions of smokers have the impression that e-cigarettes are at least as harmful as tobacco”.

It seems to me that one of the real adverse consequences of this is that, as it becomes known that there are going to be major restrictions on the promotion of e-cigarettes, all that will do is emphasise the belief that they are harmful. I have seen the RIA, but I could not see there any analysis of the impact that that could have on reducing the uptake of e-cigarettes among smokers. However, it is a very important point.

I want to put three points to the Minister. First, the noble Viscount, Lord Ridley, asked him what would happen to the investment in smoking cessation services. My understanding is that, as a result of the Government’s cut to the grant to local authorities for public health, smoking cessation services investment is going down. Will the Minister confirm that and say what he is doing to reverse the pattern?

The second point is that, clearly, this directive will go through, because there is no Motion to stop it. What monitoring will take place, and how soon will the Government undertake an assessment of the impact? Assuming that we are still in the EU, is the Minister prepared to go back to the EU if evidence becomes clear that this is having an adverse impact on smokers giving up smoking? I hope he can give some reassurance on that.

The third issue relates to enforcement. In the statutory instrument, regulation 53 makes it clear that:

“It is the duty of each weights and measures authority in Great Britain and each district council in Northern Ireland to enforce these Regulations within their area”.

What guidance is going to be given to the weights and measures authorities about taking a light-handed approach to enforcement?

It is quite clear that these provisions are not supported. It is pretty obvious that the Government themselves do not support them because of the amelioration that they have attempted in transposing the directive. At the very least, one could expect a message to be given to weights and measures authorities that the Government expect enforcement to be proportionate, minimalist and certainly light touch.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, I do not know whether to thank my noble friend Lord Ridley for bringing this debate here today or not. The arguments that have been put have been very powerful and it would be obtuse of me to say otherwise.

Perhaps I can start by going back to the opening words of my noble friend Lord Ridley, who said that there are three ways of trying to influence the behaviour of people doing things that do harm: you can punish them; you can hector them; or you can try to offer safer alternatives. In the article he wrote in the Times some time ago, he used the example of methadone as something that is not desirable in itself but is used as a means of treating people with heroin addiction.

In the case of tobacco we have tried all three things. We have penalised people through taxation, we have hectored them incessantly for years, and having tried nicotine replacement therapies, in a sense vaping is a way of encouraging people to use something that is considerably less harmful than smoking. Actually, most people would agree that we have been hugely successful in reducing the consumption of tobacco in England. I was asked for a statement of the Government’s view on vaping; I think I can say unequivocally that we are in favour of it as a means for people to come off smoking cigarettes. There is absolutely no question about that. The reports produced by Public Health England and most recently and very powerfully by the Royal College of Physicians entirely endorse that view. The president of the Royal College of Physicians, Professor Jane Dacre, said in response to the report:

“With careful management and proportionate regulation, harm reduction provides an opportunity to improve the lives of millions of people”.

I pick that out because she used the words “proportionate regulation”, and that is really what we are discussing today. It is not about whether we are in favour of vaping or not, it is about what kind of regulation should be around it.

On the European element, given that the noble Lord, Lord Hunt, could not resist throwing that in as one of his questions, I am not sure whether if we had been left to our own devices we might not have come out with something far worse several years ago. The noble Lord was kind enough to mention the original views of PHE and the MHRA, so we may well have brought in a licensing system or even have banned them altogether. I am not sure that one can lay this at the door of Brussels or indeed our own Government. We have been far too quick to resort to regulation in many areas and as a rule I am wholly in sympathy with less regulation. That is the best place to start. What we are discussing today is whether this regulation is proportionate, what damage it could do or what the directive’s unintended consequences might be.

I should just mention while I have it to hand, to put the concerns of my noble friend Lord Brabazon of Tara to rest, that the concentration which he is taking it at will not be affected. It will not have to be licensed by the MHRA, but sadly I cannot say the same to my noble friend Lord Cathcart, who at 2.4% is higher than 2%, which is the cut-off point for licensing. But I shall come to that in more detail in a minute, if I can.

Perhaps I may pick up on a few of the fears that noble Lords have expressed about the directive and see whether I can allay their minds today. It has been said that the directive will ban flavourings in e-liquids. I should make it clear that it will not do so. What it does say is that flavourings which pose a risk to human health should not be used; we could probably all agree that that is a sensible rule. There is an additive called diacetyl, which I think is also used in the making of popcorn, and there are other flavourings where there is some evidence that airways can be inflamed. The noble Lord appears to be questioning that, but I think the RCP report cites evidence that some flavourings can cause damage.

It has also been said that the directive will ban all advertising and prevent shop owners communicating with their customers. It does not do that. The new rules do not prevent information being provided to customers either online or in physical retail outlets, nor does it ban online forums, independently compiled reviews or blogs. Some advertising will also be allowed, such as point-of-sale, billboards and leaflets, subject to the rules set out in existing advertising codes to ensure that these do not appeal to people aged under 18 or non-users. There will therefore remain a wide range of information on the products available to smokers who wish to buy these products.

--- Later in debate ---

[Lord Prior of Brampton]

The intention of the regulations is to make vaping safer and less variable than it currently is. The intention of the directive is to make it a better product and to cause more people to use it. If it does indeed result in smokers not giving up smoking, then it will have achieved the reverse of what the Government wish to do. The Government’s view is clear: we wish people to quit altogether but if, as a way of quitting, they can give up smoking and take up vaping, that is something that we wish to encourage. Of course, I understand that nothing I can say today will satisfy my noble friends and other noble Lords, but I have done my best to put our case forward.

[Lord Hunt of Kings Heath]

The Minister is very gracious to keep giving way. It is interesting that he used those terms. There is a reluctance to promote vaping. Even in the words that he used there was a qualification. The Government would prefer everyone to give up smoking but it sounds as though they are half-hearted about this. I understand why they are in that position but the issue that I raised with the Minister is that the evidence is that the public are confused. My concern is that if weights and measures authorities enforce this in a heavy-handed way, it will confirm the public’s view that there is something wrong with vaping. For goodness’ sake, if we could persuade all smokers to vape, it would be a fantastic public health movement. Why is there this hesitation? I do not understand it.

[Lord Prior of Brampton]

I think that the hesitation comes because for a number of years the evidence around vaping was not clear. Many distinguished scientists felt that it was potentially harmful; it was not just the tobacco lobby. It is now absolutely clear, as I said earlier—I am unequivocal about this—that vaping is far more preferable to smoking. That does not alter the fact that quitting altogether, either smoking or vaping, is probably the best outcome.

National Living Wage: Social Care

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Thursday 5th May 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the increase in the minimum wage from £6.70 to a living wage of £7.20 has been universally welcomed, I think, including by most Members of this House. Care workers and people who work in care homes do an incredibly difficult job and £7.20 does not seem a small fortune to pay them. It will increase the costs for people in the care sector and there is some evidence that some care homes are closing. The figures I have are that in the past two years 2,000 beds have closed in the care sector, but during that time 600 domiciliary care agencies have opened—so I think that there is going to be a switch in the way that care is delivered from residential care to domiciliary care.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I must say, it is very difficult to know sometimes what planet Ministers live on. That was an extraordinarily complacent answer. The survey yesterday showed that a quarter of all care homes are facing closure because of the financial squeeze. The Minister’s Government decided unilaterally to postpone—probably for ever but certainly for four years—the introduction of the Dilnot care cap. This proved massively disappointing to many people. The Government have put £6 billion into forward programme spending plans. Why not use some of that money to help the viability of the care home sector?

[Lord Prior of Brampton]

My Lords, if I sounded complacent, I did not mean to. I recognise that there is tremendous pressure on many providers of adult social care, particularly those funded by local authorities. It is for that reason that—disappointingly, frankly—Dilnot has been postponed. We wanted to bring in Dilnot but we decided that the cost of bringing it in was too great for local authorities to finance in the short term, although we are committed to doing it in the long term. The Government have allowed local authorities to raise a 2% precept and will be increasing the better care fund by £1.5 billion at the end of the period, bringing the total to £3.5 billion. It is a tough settlement—no one is making any bones about that—but tough choices have to be made.

Junior Doctors: Contract

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Thursday 5th May 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I am not sure where that question ended up, to be honest. All I will say for today is that we have an opportunity over the next five days for the BMA and the Government to find a resolution to this issue. If we can, it will make the implementation of seven-day working across the NHS much easier.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Government’s approach has been cack-handed throughout the process. It would have been much better if, instead of initially rejecting this proposal and now setting out some new conditions, the Government had accepted it. Obviously, we hope the outcome will be successful and the situation will be resolved. At the end of this process, we are left with thousands of junior doctors disengaged from the service because of the circumstances of the dispute and the alarmist statements issued by the Secretary of State. Will part of the discussions look at how the junior doctors are to be brought back into the fold and given the support they so richly deserve?

[Lord Prior of Brampton]

My Lords, I think there is general recognition that many of the issues that lie behind the dispute over the contract are not actually involved in the contract itself. It is about how junior doctors are trained, valued and integrated into hospitals and the workforce. These are much broader issues than just the contract, and I assure the noble Lord that the Government are fully aware of that. Once this dispute has been settled, we can start to resolve those bigger, deeper and more fundamental issues.

Mental Health Services

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Thursday 28th April 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, this year NHS England has chosen primary care, cancer and antibiotic prescribing to be the three key parts of the national quality scheme but, as the noble Baroness has said, 30% is determined locally, of which 17 indicators are related to mental health. NHS England proposes to include a mental health indicator in its national scheme in 2017-18. The point about the national schemes is to provide incentives and they will change from one year to another. If they are the same every year, they will cease to be incentives.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister will know that the general record on mental health has been very poor over the past few years. We are far away from parity of esteem; indeed the National Audit Office has commented on this. There is widespread concern within the circles involved in mental health services that, despite what Ministers say, the NHS itself and NHS England are not committed to parity of esteem. Leaving mental health out of the national priorities sends a signal to the NHS that, despite what Ministers say, in the end it is not important. I wonder whether the Government would reconsider this issue and give new instructions to NHS England on it.

[Lord Prior of Brampton]

My Lords, I find it hard to believe that anyone can think that mental health is not a key priority for this Government, given that we have promised to spend another £1.4 billion on children and young people’s mental health and a further £1 billion a year on adult mental health, along with accepting the findings of the Farmer report in full. I assure the House that mental health remains an absolute priority for the Government.

Health: Hepatitis C

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Thursday 28th April 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, there is clearly a budgetary constraint. The noble Lord mentioned 220,000 people—I thought it was slightly less than that—and this drug costs many tens of thousands of pounds per treatment. Clearly, however much we would like to treat 220,000 people, it is just not feasible to do so. That is why we have NICE, which has produced its appraisals and said that, using its modelling, the number of people who need to be treated in the coming year is likely to be between 7,000 and 10,000, rising to 15,000 by 2021. However, I agree with the noble Lord that this interferon-free treatment is a massive improvement on previous treatments, with a very high cure rate.

[Lord Hunt of Kings Heath (Lab)]

My Lords, this is a wonderful treatment, but what has happened is blatant rationing. The Minister says that it is down to money, but something has long puzzled me. The Government reached a five-year agreement with the pharmaceutical industry that any additional costs over a baseline plus inflation would be refunded by the industry and, every quarter, his department gets back millions of pounds from the drugs industry. So can he tell me why arbitrary limits are being placed at local level on the provision of new drugs? What is happening to that rebate money? Is it in fact going back to the Treasury and not the NHS? It is quite unnecessary for there to be this rationing.

[Lord Prior of Brampton]

I feel almost as if we are living on a different planet—of course there are going to be budgetary constraints. Some of these new drugs are hugely expensive. We have a good scheme—the PPRS scheme that the noble Lord referred to—which enables us to get rebates from big pharma, but some of these new drugs are extremely expensive. I cannot say what the exact cost is of this interferon-free treatment for hepatitis C, but I can tell the House that it is many tens of thousands of pounds for a treatment. There are 220,000 people who could benefit from this treatment, according to the noble Lord, Lord Patel—that means many billions of pounds. If we spend many billions on this particular drug, there are many billions that we will not be able to spend on mental health or in other parts of the NHS.

Health: Treatment Rationing

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 26th April 2016 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what is their response to the Royal College of Surgeons report showing that Clinical Commissioning Groups are rationing treatments by the use of restrictions on routine surgery for patients who smoke or who are overweight or clinically obese.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, we would not support CCGs imposing arbitrary restrictions on patients. However, there are often sound clinical reasons for encouraging patients to lose weight or stop smoking—for example, to get the best clinical benefit from joint replacement surgery. CCGs should support patients to reduce their tobacco usage or reduce their weight and signpost them to the appropriate services. It is for CCGs to ensure that their local commissioning priorities use resources in the best interests of their patients.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very grateful to the noble Lord for that Answer because it is clear that these blanket bans are nothing more than crude rationing and cause great distress to patients. Will he issue instructions to CCGs that they are not to embark on these kinds of blanket bans? Does he agree that the programmes to support weight management and smoking cessation should be part of the treatment programme rather than be used as a barrier to treatment?

[Lord Prior of Brampton]

Yes, my Lords. The noble Lord has quoted almost verbatim from the recommendations of the Royal College of Surgeons report, which I have in front of me. I agree with him completely.

--- Later in debate ---

[Lord Prior of Brampton]

My Lords, I am not able to answer that question, as I do not have the facts at my fingertips. However, I will investigate it and write to the noble Viscount.

[Lord Hunt of Kings Heath]

My Lords, the Minister said that the obesity strategy would be coming out soon. What is his interpretation of “soon”?

[Lord Prior of Brampton]

Before long, my Lords.

Wheelchair Users

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Thursday 21st April 2016 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government whether they will introduce uniform standards and a national tariff payment in order to achieve high-quality outcomes for wheelchair users.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, NHS England is developing a national dataset to ensure transparency about the quality of services in order to drive improvement. NHS England and NHS Improvement are actively working with the sector to define the currencies and reference costs that will enable national tariffs to be set.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Lord will know that the wheelchair alliance, chaired by the noble Baroness, Lady Grey-Thompson, has shown that we have, essentially, a set of dysfunctional local wheelchair services with variations in access, standards and waiting times. The noble Lord has referred to a national specification but the reality is that, unless he can ensure that it is mandated at local level we will not get high-quality, consistent services. Will Ministers be prepared to meet the wheelchair alliance to discuss how we can get uniform, high-quality standards at local level?

[Lord Prior of Brampton]

The noble Lord is right: the variation in wheelchair standards around the country is wholly unacceptable. The truth is that we do not know the level of this variation because we have never collected the data before. The data are now collected and, of course, I can answer yes to his question. In fact, my honourable friend in the other place is making an announcement on 18 May, I think, about the support we are going to provide to local CCGs over wheelchair provision. I am sure that I can speak for him and say that he will be delighted to meet the wheelchair alliance.

NHS: New Junior Doctor Contract

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Monday 18th April 2016 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very grateful to the Minister for repeating the Answer given in the other place, which I have listened very carefully to. It now seems abundantly clear that the Secretary of State does not have the power in law to impose a new contract on junior doctors. The problem is that the Secretary of State’s various Statements over the last few months could not be interpreted in any way other than that he thought he had the power and he was going to impose a contract. The significance of this is that the junior doctors took him at his word. The importance of that is that the Junior Doctors Committee of the BMA took the unprecedented decision to escalate industrial action on the back of his apparent decision to impose the new contract when talks collapsed.

The noble Lord, Lord Prior, knows that I have absolutely no argument with the development of fully comprehensive seven-day services in the NHS. However, the tragedy is that the very group of staff on whom so much is now dependent for clinical out-of-hours care—the junior doctors—has become utterly disenchanted with the way this has been handled. We have reached a very serious situation, and I very much fear for the future of the NHS and what is happening. I just say to the noble Lord that surely, even now, the Government need to find a way through. Interestingly, in the response, which has come from Ministers in the other place, there is a recognition of the benefit of collective bargaining. Is it not time to give collective bargaining another go?

[Lord Prior of Brampton]

My Lords, the noble Lord has raised two substantial points. The first is the difference between introduction and imposition. The fact is that, in the context of the NHS, where there is really only one offer, the difference between introduction and imposition is very small. Technically, it is true that individual employers are responsible for its imposition, but in reality, as the noble Lord will know from all his years in the Department of Health, the Secretary of State has considerable powers in this matter. I do not think the noble Lord would want all trusts to cut their own deals locally—there has to be an actual contract. It is true that when the legislation for foundation trusts was brought forward by the noble Lord’s Government a few years ago, they were given the power to negotiate their terms and conditions locally but, with the exceptions of, I think, Southend and possibly Guy’s and St Thomas’, they have chosen to stick with the national contract.

On the noble Lord’s last point about a way through, there are no winners from this dispute. The patients are very clear losers, and it is tragic that we have got to the situation that we have. The threshold for withdrawing emergency cover from hospitals needs to be a lot higher than the one the junior doctors are adopting on this occasion.

Health: Neural Tube Defects

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Monday 21st March 2016 Lords Chamber

[Lord Prior of Brampton]

I will certainly draw that point to the attention of the SACN. It would be surprising if it was not already aware of that fact, but as I said I am addressing not really the science but whether it is right or proportionate to fortify bread for everybody to reach such a small number of people.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Lord made it clear that this is a political decision, for which we should be grateful. He also made it clear that the Government have decided that it is not going to happen. But does he accept that a 30% improvement is actually a large, positive outcome? The fact is that the voluntary approach that this Government have been wedded to is simply not working. If the answer is no, and if the voluntary approach is not working, what, then, will the Government do?

[Lord Prior of Brampton]

My Lords, the evidence given by the SACN is that it affects between 15% and 30%. My honourable friend in the other House, Jane Ellison, is bringing together a round table of all stakeholders interested in preconception health to discuss this matter.

NHS: 111 Service

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Monday 21st March 2016 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what assessment they have made of the safety and reliability of the National Health Service 111 service.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, NHS 111 is a vital service helping people to get medical advice quickly and easily. It has received more calls this year than in the same period in 2014-15 but continues to perform well overall. The Care Quality Commission has announced that it will inspect all NHS 111 providers by September 2016. The CQC will assess whether the services are safe, caring, effective, responsive to people’s needs and well led.

[Lord Hunt of Kings Heath (Lab)]

My Lords, is not the problem that when the excellent NHS Direct service was replaced, very many experienced nurses ceased to work for the new 111 service and were replaced by call handlers with a few weeks’ training who have to follow instructions on a computer rigidly? The evidence is that there have consequently been misdiagnoses. One ambulance trust fiddled the response time for 999 calls routed through 111 to meet the targets. There have been a number of personal tragedies as a result. Therefore, in addition to the CQC’s inspection, will the noble Lord institute a review of the safety of 111 and return to having qualified nurses handling the calls?

[Lord Prior of Brampton]

My Lords, the decision to stop NHS Direct was, of course, taken in 2008, when I think the noble Lord was in post. He shakes his head, so perhaps he was not, but the decision was taken in 2008, before this Government were in charge, if you like. The new system uses the NHS Pathways algorithms developed by the Royal College of GPs, on which the BMA and the Royal College of Paediatrics and Child Health sit, so we have considerable confidence in the algorithms used. We will also increase the number of clinicians. I accept the noble Lord’s point that we need to have more clinicians answering these calls rather than call handlers, as he puts it. It is our intention progressively to increase the number of clinicians in these 111 hubs.

NHS: Hospital Overcrowding

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 15th March 2016 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what assessment they have made of the latest NHS performance figures and the concerns expressed by the Society for Acute Medicine that overcrowding in hospitals may result in avoidable deaths.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, a significant increase in emergency demand in January put the NHS under great pressure. Compared to January last year, the NHS had almost 175,000 more attendances in A&E in January 2016. We recognise this rise in demand is not sustainable, which is why we have invested £10 billion in the NHS’s five-year forward view.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to the Minister, but he will know that the January performance was the worst A&E performance of the NHS on record. The Society for Acute Medicine has warned that this is bound to have an impact on the number of avoidable deaths that take place. Ministers cannot just blame the public for coming to A&E departments. The fact is: they have cut nurse training places; they have cut social care; they have squeezed the NHS budget; and today the Public Accounts Committee says that the NHS has no chance whatever of clearing the financial deficit. I would simply ask the Minister when he thinks the NHS will next meet the four-hour target.

[Lord Prior of Brampton]

My Lords, there was a 10% increase in demand in January, which put the NHS under huge pressure. It is much to the credit of A&E services that we saw 111,000 more people within four hours than we did the previous January. It is also worth mentioning that, over the last five years, the number of consultants working in A&E has increased by 49%. The number of people working in emergency care as a whole has increased by 3.7%. It does not alter the fact, which I recognise, that A&E departments are under tremendous pressure—they often are in winter. We hope that that pressure reduces as spring approaches.

E-cigarettes: Regulation

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Monday 7th March 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the benefits of e-cigarettes are well understood. The figure of 1 million people who have given up smoking by taking up e-cigarettes is a valid and true one. The tobacco regulation that the noble Viscount refers to does not have any proposals for an excise tax—it purely relates to ensuring that these products are used safely and are of a given quality.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister will know that the impact of this directive is to make it much more difficult for e-cigarettes to be promoted. Why is that, given the clear benefit to public health? The answer is that public health programmes can substitute for it—but this Government have slashed those programmes. Given the Prime Minister’s success in EU negotiations about a change in direction, can the Minister confirm that we will not now have to implement Article 20 if we do not want to?

[Lord Prior of Brampton]

My Lords, this directive originated partly because a number of European countries wanted to ban these products. The fact that there is a directive, which will lead to a regulated market, means that British manufacturers will have access to those large European markets. As I understand it, the main issue that the noble Lord may be concerned about is that where the nicotine content goes above 20 micrograms per millilitre, there will have to be MHRA approval, which may mean that the higher strength nicotine substitutes are less readily available. But that is done on safety grounds.

Pharmacies: Funding

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Wednesday 2nd March 2016 Lords Chamber

[Lord Prior of Brampton]

The noble Lord raises an important point which I regret I cannot answer. I will have to write to him on that matter. However, for community pharmacy to play the important role in primary care that we expect it to do, it will have to have access to integrated patient records. The confidentiality that surrounds those records is very important.

[Lord Hunt of Kings Heath (Lab)]

My Lords, this is all very well but will the noble Lord confirm that one of the ideas of his department is for doctors to prescribe medicines for a longer period so that fewer trips are made to the pharmacy, thereby compensating for the closure of up to 3,000 pharmacies? However, is he aware that it is estimated that £300 million-worth of medicines are wasted every year? I understand that a third of that is in medicines that are never opened by patients. Surely it is not cost-effective to extend the length of the prescription time because all you will do is add to wastage of medicines.

[Lord Prior of Brampton]

My Lords, there is no intention to extend the prescription time just for the sake of it. But there are many people who have stable long-term conditions, for whom a 90-day prescription period might be appropriate. We are not saying that all prescriptions should be for that length of time but some of them might be.

Health: Black and Minority Ethnic Psychiatric Patients

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Monday 29th February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the Government are committed to putting more resources into mental health. There is a recognition, across all parties in this House, that mental health has been a Cinderella service for ever. We are all committed to parity of esteem between mental and physical health and more resources are now going into mental health.

[Lord Hunt of Kings Heath (Lab)]

My Lords, in his Answer, the Minister mentioned the Mental Health Taskforce report. It points out that, while there is a workforce race equality standard, there is no equivalent standard for access to services. He said that the Government will appoint a champion, but why not agree to set a standard and appoint a national director to make sure that it is implemented?

[Lord Prior of Brampton]

My Lords, there are two separate things there. We are committed to the recommendation of appointing an equalities champion. Extending the workforce race equality standard to carers and patients was recommended by the noble Lord, Lord Crisp, and welcomed by Paul Farmer in his report. I hope that we will adopt that recommendation, but I cannot promise it.

National Health Service: Workforce Race Equality Standard

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Wednesday 24th February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the ability to undertake the duties of a post is absolutely fundamental. The tragedy is that so few people from BME backgrounds are encouraged to put their names forward. It is more important that we get the actual recruitment process right.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister should be commended on his approach to this issue. Has he seen the survey undertaken in 2015 which shows that when looking at the national bodies of the NHS such as NHS Executive Search, Monitor and the NHS Trust Development Authority, none of their boards had any BME representation at all? Given that those appointments are made by Ministers, can the Minister tell us what they are doing to rectify that?

[Lord Prior of Brampton]

My Lords, I am not sure that the noble Lord is quite right. I can certainly think of two people from BME backgrounds on the board of NHS England. We can influence this, but it is important that the appointment process is independent of political bias. We have to rely on the chairs and the boards of these arm’s-length bodies to make those appointments.

Accident and Emergency Services: Staffing

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 23rd February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I can perhaps be excused for not following all that carefully Private Members’ Bills in the Welsh Assembly promoted by the Liberal Democrats. Safe staffing is obviously very important. I quote Mike Richards on this, who says that it is,

“important to look at staffing in a flexible way which is focused on the quality of care, patient safety and efficiency rather than just numbers and ratios of staff”.

That is extremely important.

[Lord Hunt of Kings Heath (Lab)]

My Lords, will the Minister tell me why the Government told NICE that they could not publish safe staffing levels for accident and emergency departments, when they accepted fully the recommendations in Sir Robert Francis’s Mid Staffordshire inquiry report, which said that safe staffing levels should be published? Will he also tell me how NHS trusts are enabled to achieve safe staffing levels when they have been told by the regulator, NHS Improvement, that they have to cut their workforce to cut their financial deficits?

[Lord Prior of Brampton]

My Lords, NHS Improvement never said that trusts should cut staffing levels to below safe levels. It has said that there is a right balance between efficient and safe use of staff. Getting that balance right is so important. That is what Mike Durkin, the national patient safety champion at NHS Improvement, is doing. His work will be reviewed by NICE and by Sir Robert Francis.

Mental Health Taskforce

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 23rd February 2016 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to the Minister for repeating this Statement. The final report, which came out recently, gave a very frank assessment of the state of current mental health services and describes a system which is said to be ruining some people’s lives. It is entirely consistent with the report by the noble Lord, Lord Crisp, on acute in-patient psychiatric care. It makes a number of recommendations which, if implemented in full, could make a significant difference to services that have had to contend with funding cuts and staffing shortages as demand has continued to rise, leaving too many vulnerable people without the right care and support.

We return to a question which was debated yesterday: the £1 billion by 2021. A number of questions remain unanswered. Can the Minister confirm that there is no actual, additional money other than the existing £8 billion that has been set aside for the NHS up to 2020, as previously announced by Her Majesty’s Treasury? Given that mental health services receive just under 10% of the total NHS budget, surely these services would actually expect to receive much of this additional money anyway, as part of the NHS settlement. Will the Minister explain how this can be expected to deliver the transformation that he and the task force say is urgently required?

In a recent Oral Question, there was the usual discussion of whether there should be a national debate about NHS funding. The Government need to get on, not just to debate it but to ensure that the NHS has enough money. Has the Minister studied the advice given by Professor Don Berwick, the Government’s safety adviser? He said, “I know of no nation that is seeking to provide healthcare at the level that western democracies can at 8% of GDP, let alone 7% or 6.7%. That may be impossible”. His advice to the Secretary of State was that it is crucial that the Government reflect on whether they have overshot on austerity. What is the Minister’s response to his own safety adviser?

[Lord Prior of Brampton]

My Lords, we have strayed somewhat from the subject. On the money, the Prime Minister announced an extra £1 billion in January. It is the same £1 billion and is within the £8 billion—or £10 billion—that was in the settlement in November. The Government asked Paul Farmer to set out in his report where the priorities are and where the money should be spent, and that is exactly what has happened. Interestingly, I saw Don Berwick last week. He is a very distinguished American with a lot of experience in patient safety and health improvement. There is no question: it is going to be tough. It will be very difficult to do on around 7% of GNP, but there is absolutely no doubt, from the work of the noble Lord, Lord Carter, and others, that there is a lot to go at. If it was not tough, we would not be going at it. We must take advantage of the fact that it is going to be tough by addressing some of the difficult issues which we should perhaps have addressed in the past but did not.

Health: Adult Psychiatric Care

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Monday 22nd February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, that is a complicated question, or number of questions.

[Lord Hunt of Kings Heath (Lab)]

It is very simple.

Pharmacy (Premises Standards, Information Obligations, etc.) Order 2016

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Monday 22nd February 2016 Grand Committee

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very grateful to the noble Lord for his careful explanation of the order. On the whole, the changes seem sensible, and I note that some of them follow the Law Commission’s recommendations. As the noble Lord will know, there has been disappointment that the Government did not bring forward a Bill or a draft Bill in relation to the whole package, and I know from our previous discussions that the Government are considering what further to do in relation to the regulation of individual health professionals. Is he able to update me on where the Government are on that?

On the detail of the order, I noted that overall the consultation outcome showed a great deal of support for the proposals, although perhaps less so in respect of the change in relation to standards for registered practices, which are no longer to be placed in legislative rules. I noted that some concerns were expressed, according to the Explanatory Memorandum,

“that removing the ‘black and white’ rules could lead to unhelpful variation for employee pharmacists in the way pharmacy owners choose to meet the standards”.

I assume that the proposal for an outcomes-based approach would ensure that there will be consistency about the standards themselves but leave more discretion for individual community pharmacies to decide how to meet them. Could the noble Lord confirm that for me?

The noble Lord made a very interesting comment at the end of his speech about the rapid change in the way community pharmacy services are provided. I certainly agree with that. I am sure he is aware that an estimated 1.6 million people visit a pharmacy every day. There is no question but that they have huge potential, not just in dispensing medicines but in many of the other services that are now available in community pharmacies, for example home delivery, compliance aids and other support to help old and frail people in particular live independently. There is also no question about the strong professional advice community pharmacies can give, particularly in relation to medicine management. We know, again, that older and frailer people in particular can be prescribed individual medicines without perhaps the GP or other doctors looking at the whole impact, whereas community pharmacies, through medicine management approaches, can have a very beneficial impact. For instance, this winter, NHS flu vaccines were available for the first time through community pharmacies. Again, that shows the benefit of recognising the professional expertise they have and of trying to ensure that they can relieve some of the load on other pressurised parts of the National Health Service.

The Government have made clear in a number of publications how they value community pharmacies, so I have been puzzled by the reductions that are going to be made in the community pharmacy budget, which is the subject of an Oral Question next week. I am puzzled by the thinking behind that reduction, which I think will start in October 2016, according to a letter that the Department for Health and NHS England sent out to community pharmacies. I just wanted to ask two or three questions about this.

First, in the letter that was sent out to community pharmacists, or to their representative organisations, there was a clear implication that the Government think there are too many community pharmacies at the moment. The letter points out:

“In some parts of the country there are more pharmacies than are necessary to maintain good access. 40% of pharmacies are in a cluster where there are three or more pharmacies within ten minutes’ walk. The development of large-scale automated dispensing, such as ‘hub and spoke’ arrangements, also provides opportunities for efficiencies”.

The department is also looking at ways of online ordering, which will make it easier for the public. The letter also says it is looking at,

“steps to encourage the optimisation of prescription duration”,

which I assume means prescriptions for a lengthier period than currently.

The Pharmaceutical Services Negotiating Committee has told me that it feels that the cut in budget is incompatible with the Government’s ambitions in relation to the contribution of community pharmacy. It wants to know whether it is government policy to see a reduction in community pharmacy premises. It would be a brave Government who said that they wanted to see that, but clearly it would be helpful to know if that is a stated intention. The development of an online pharmacy service is clearly to be encouraged. The record of community pharmacy has been very good in relation to being able to adopt a digital approach. Will that be done in a way that does not bypass the actual value of the advice that pharmacists can give to individual patients, particularly about medicine management?

Finally, on the question of increasing the length of time of a prescription, we know that a lot of medicine is wasted. Often, patients give up the course before they reach the end, even though they are recommended to take the full course. I can see that making the length of a prescription longer will mean that they will need fewer visits to the community pharmacist, thereby reducing the money going to the community pharmacist. However, if it leads to a greater waste of medicine, it might be a false economy. Has the department undertaken any work on that?

Overall, the SI itself is eminently sensible, but it cannot be considered without looking at the context of where community pharmacy is going. When we debated the Health and Social Care Bill in 2012, we discussed whether community pharmacists should be represented, as of right, on the board of a CCG. The Government resisted that, but there is evidence that because community pharmacists are not around the table at CCG level, the contribution they can make is often missed when it comes to issues such as how you make a health economy work effectively together or how you can, say, reduce pressure on A&E. We may be missing a trick here in not embracing community pharmacy rather more than we have been for the past year or two.

[Lord Prior of Brampton]

My Lords, I had a feeling that we might stray beyond the order, and we duly have. The noble Lord raised three broad points. The first was to request an update on the Law Commission’s report into the regulators. I do not have much to say that we have not already said. We think that a lot of what was in the Law Commission’s report was absolutely right, but it was a long and fairly prescriptive approach to the matter. We are considering it and may return to it in this Parliament, but it is not a priority in the short term.

The noble Lord referred to the outcomes-based approach and raised concern about whether the standards will be consistent. The intention is that they will, but there will be more discretion in how the outcomes are achieved. We are at one on the intent that lies behind his question.

I turn to the much more difficult matter that the noble Lord raised, which does not relate directly to the order, although he is right to say that it provides some context. The first thing to say is that I agree wholeheartedly with what he said about the vital role of pharmacists not just in dispensing but in how we manage medicines, perform vaccinations and look after the old and frail. I was interested by his comment at the end about why pharmacists are not represented on the board of CCGs. When we come to debate our whole approach to community pharmacy in more detail, we will set out our views on how pharmacy should be more integrated with the delivery of health and social care. It may well be that we should revisit whether pharmacists should be on the board of CCGs. Perhaps I can take that away to think about it further.

I do not want to be taken down the route of the number of pharmacists, because we are out to consultation at the moment. It is a fact that 46% of pharmacists are located in very close geographic proximity to each other. That is one reason why we have been looking at the structure of delivery of community pharmacy. On the one hand, we absolutely recognise that in rural areas we must have community pharmacies close by, and we want them to be much more integrated with healthcare delivery; on the other, there must be a question mark about the structure of community pharmacy. The number of outlets has grown from 9,000 to 11,500 in the past seven or eight years, which is a huge increase. Much of that increase has come from people setting up shop in very close proximity to existing pharmacies. It is right that we look at the whole delivery of healthcare by pharmacies, and it will be interesting to see what emerges from the current consultation.

Allied Health Professionals: Training

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Monday 8th February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, Health Education England is proposing a net increase of 334 places in 2016-17 and we expect a growth in overall numbers of nurses and AHPs from 2017 onwards as a result of moving on to the standard student loan system.

[Lord Hunt of Kings Heath (Lab)]

My Lords, will the Minister clarify that? He says that there is to be a net increase, but he will know that in relation to some specialties there is actually to be a reduction next year. This is a shambles. The Government have announced an increase in figures by 2020, but next year we are going to see an actual reduction in some of those places. What is going on?

[Lord Prior of Brampton]

My Lords, as I said, overall there is a small net increase of 334. That is largely for paramedics, where HEE believes that there is a more serious shortage than for other allied health professions. As I said, we have seen a significant increase in AHPs of more than 16% over the last five years and we expect that growth to continue after 2017.

Junior Doctors

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Monday 8th February 2016 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to the Minister for repeating the Answer given in the other place. Clearly, the current situation is very worrying and we all want a speedy resolution of it, but I have three quick points to put to the Minister. First, he will know that imposing a contract which the overwhelming majority of junior doctors oppose risks industrial action further than that to which he has referred tonight, and more anger among NHS staff at a time when morale is low. If a new contract cannot be agreed, will he now rule out imposing one?

Secondly, the Minister knows that much of the angst among junior doctors has been caused by the Health Secretary’s repeated attempts to conflate reform of the junior doctor contract with the issue of a seven-day NHS. Will the Minister tell the House, for the record, which hospital chief executives have told the Government that the junior doctor contract is a barrier to seven-day service working? Will he tell me why this Health Secretary has gone out of his way to pick a fight with the very people who are already working across seven days?

The Minister is very well acquainted with the NHS and, indeed, with the views of junior doctors, with whom I know he keeps in very close touch. Does he not consider it absolutely appalling that these hugely important people, on whom the health service is going to depend for the next 20 or 30 years, have been so upset by the Health Secretary’s approach that they feel such estrangement from the NHS? Does he not think that the Government need to completely reset this process and what they have been saying about junior doctors and seven-day working, to get a proper resolution of this dispute?

[Lord Prior of Brampton]

My Lords, the noble Lord said he had three questions; I think there were only two questions there, which is unusual, if I may say so. We do not want to impose a contract. We want the BMA to come back and continue the talks and we still hope that that will happen. Clearly, imposing a contract is not what we ever wanted to do when this whole process started. As was said in the Statement, the Secretary of State’s door is open and we hope that we can resolve these difficult issues in a negotiated, consensual way.

On the noble Lord’s second question, he rightly said that this is an appalling situation, but actually I describe it more as a tragedy. Let me quote from a trainee doctor:

“I feel undermined and not valued at work and I have seen how this flagging morale among colleagues has caused more than ever to leave the profession. It is a hard job that takes dedication and stamina to continue. But as we are criticised and treated as ‘cogs in a wheel’ rather than as individual professionals, I think we will see ever increasing numbers of people leaving this profession”.

That was in 2005, after the contract came in. The issues facing the junior doctors go back a long way. It is not just about plain time on Saturdays or this particular contract but about how we value, reward, train and trust junior doctors. That is the issue we must come to when the current dispute is resolved.

Opticians Act 1989

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Monday 8th February 2016 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, I thank the noble Lord, Lord Newby, for bringing this subject, which is a new one for me, to our attention. I tried on a pair of adjustable-focus glasses a few days ago, and they are easy to use. The noble Lord is wearing some this evening, and although they may not be as fashionable as some pairs of glasses, I can see that they are perfectly serviceable.

It is odd for us on this side of the House—it is certainly odd for me—to find ourselves painted into the position of being against choice, competition and deregulation, which are now being advocated from the Liberal Democrat Benches. I do not normally associate them with that particular role. Instinctively I am a deregulator, and to be honest, many of the arguments that noble Lords have made resonate strongly with me. Clearly there is a huge vested interest at stake. Whether that is being improperly used in this case I do not know—but one can see that there will always be a strong voice for the status quo.

I should also pay tribute to the company for its work in Rwanda, which is clearly very important. Equally impressive, in many ways, is its breaking into the Japanese and American markets—no easy feat for a small private company. I take on board the words of the noble Lord, Lord Hunt, about how often we hear about companies finding it easier to break into overseas markets than into our own market. It is deeply frustrating, when we produce so many highly innovative products such as this one.

As for an independent review, perhaps we can come back to that question later. I rather like the thought, but although the role of the PSA was brought up in the context of the GDC, I am not sure what powers it has in such areas. That may be worth exploring. Unfortunately, however, I am going to disappoint the noble Lord, Lord Newby—but perhaps not wholly. We shall see when we get to the end. I shall put the other side of the argument, if I can—but in doing that I do not want to imply that the arguments we have heard are not powerful: they are. I know that my right honourable friend in the other House, Oliver Letwin, back when the Deregulation Bill was going through, would have instinctively been very positive towards the arguments that noble Lords are making.

As noble Lords are aware, in order to do what the noble Lord asks it would be necessary to amend the Opticians Act to remove requirements relating to the sale and supply of optical appliances. Clearly this is something we would do only after very careful consideration, and if we were confident that the proposal could stand parliamentary scrutiny. So if we were to take this forward at all, an independent review of some kind would be a requirement.

In the UK the sale of optical appliances is governed by the Opticians Act, which requires spectacles and contact lenses to be dispensed to a prescription issued by a registered optometrist or medical practitioner following a sight test. We are probably all aware of the exception that has been made. In response to the noble Lord, Lord Stoneham, I should say at this point that I will reread—or rather, read for the first time—the 1989 review, where similar arguments were put forward against the exception for reading glasses.

The Opticians Act does allow reading spectacles to be sold over the counter to adults with age-related sight loss. However, this exception has very limited criteria. The reading glasses must have the same power in both lenses, the power of the lenses must be in the range between 0 and 4 dioptres, and the glasses must be for reading purposes only. The General Optical Council is responsible for regulating the sale of glasses in the UK.

I am aware that Adlens has been in discussion with the GOC about its proposal that over the counter sale of its adjustable-focus glasses be allowed. As noble Lords know, in considering this issue the GOC sought the views of its standards committee, asking for its views on any benefits that adjustable-focus spectacles might bring, and any adverse effects that these products might have on the public’s health and safety. I am not aware of the extent to which it took into account the Charman report, which the noble Lord, Lord Hunt, mentioned. That is something that we should look into.

The standards committee raised a number of concerns, including concern about the safety of the product and the possibility that the product might not meet legal standards for driving.

[Lord Hunt of Kings Heath]

The point is that although the note we have says that the standards committee was provided with the independent report, it is not clear what it actually did with the report. It does not look as if the committee went through it in detail and considered the arguments—but that might just reflect the way in which the note was taken.

[Lord Prior of Brampton]

We have often been provided with reports, but that does not necessarily mean that we have read them and given them our full attention. I will ask that question.

I was going through the standards committee’s concerns. Another was that individuals may incorrectly self-adjust, causing a danger to the public when driving. Another was that the sale of these products may distract the public from having regular eye examinations. That is an issue that needs consideration. I appreciate that the noble Lord may not be convinced by the arguments put forward by the GOC’s standards committee, but we would be foolish not to take into consideration its professional view—the precautionary view that the noble Lord, Lord Hunt, mentioned. We have to give that due weight.

I understand that one of the original intentions behind the development of these glasses was to bring accessible vision correction to the developing world, particularly to areas where there was little or no affordable eye care. In the UK we are lucky enough to have no barriers to accessing sight tests and optical appliances which correct refractive errors. The NHS provides free sight tests to children, older people, those with or at risk of eye disease, and people on low incomes. In addition, help with the cost of glasses is available to children and people on low incomes.

It is already the case that self-adjustable glasses can be supplied by a registered medical practitioner or optometrist if they would benefit patients in particular circumstances. I do not think that we should downplay the important role of optometrists in carrying out sight tests. Optometrists are healthcare specialists trained to examine the eyes to detect defects of vision, signs of injury and ocular diseases, as well as problems with general health. Anyone who has had a sight test in recent years will know how much more is done these days than would have been done four or five years ago. Optometrists also offer valuable clinical advice, in addition to prescribing glasses and contact lenses.

One of the concerns raised by the standards committee was that members of the public might be discouraged from attending for regular sight tests. I appreciate that noble Lords do not agree with this argument, given that the availability of ready readers has not had such an impact. However, ready readers have a minimal prescription power and are for reading only.

National Health Service: Nurses

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 26th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, we are still consulting on the details of this scheme, but I assure the noble Baroness that the loan scheme will be available for mature students doing their second degree as it is for those doing their first degree.

[Lord Hunt of Kings Heath (Lab)]

My Lords, last night in the education regulations debate, the noble Baroness, Lady Evans, said from the Dispatch Box that last year the cap on applications for nursing students meant that 37,000 applications were rejected, yet today the Minister quoted the figure of 10,000 extra places by 2020, which I take to mean 2,000 places a year. What about the other 35,000 a year who are presumably rejected for a nursing place? If there are ways of getting rid of the cap, why on earth are the Government not allowing many more nurses to be trained? Is it actually because they have cut the budget of Health Education England which would have to finance the placements of those student nurses in NHS trusts?

[Lord Prior of Brampton]

My Lords, I think the noble Lord is wrong in what he says, but I will double check. I believe that there will be an additional 10,000 placements per year, but I will check that afterwards. That is not until 2021 because the new scheme will not come into place until August 2017, which means that the first students will come out of the new scheme in 2020. We are estimating that there will be 10,000 in that year.

Failures of the 111 Helpline

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 26th January 2016 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very grateful to the noble Lord for repeating that. I start by paying tribute to Melissa Mead and her husband Paul, who have fought to know the truth about their son’s death and who are now campaigning to raise awareness about the care of sepsis and how we can improve it.

Clearly, the key is to learn lessons and take action in the immediate future. Ministers were warned about poor sepsis care back in September 2013 when an ombudsman report highlighted shortcomings in initial assessment and delay in emergency treatment that led to missed opportunities to save lives. Can the Minister say what action has been taken by the Government? Will he urgently meet the UK Sepsis Trust to discuss what needs to happen to raise awareness among GPs, the NHS and the public?

The Minister outlined the failures in the 111 response. He will know that the replacement of NHS Direct, which was predominantly a nurse-led service, with NHS 111 means that the service now relies mainly on call handlers who receive as little as six weeks’ training and where turnover among staff can be very rapid. Is he going to review the training that call handlers receive and will he consider increasing the number of clinically trained staff available to respond to calls?

The Minister will be aware that there are two other inquiries into NHS 111 failures at the moment: in the east Midlands and on the south-east coast. Can the public have confidence that the 111 service is fit to diagnose patients with life-threatening conditions?

[Lord Prior of Brampton]

My Lords, I echo the tribute that the noble Lord paid to the Mead family and their recognition that we can only learn from these terrible tragedies. The fact that they are prepared to make available the report to other parts of the NHS will help in that learning process. I, or one of the other Ministers concerned, will certainly undertake to meet the UK Sepsis Trust.

The noble Lord raised the issue of the 111 service. It is worth making the point that, in this case, the call handler took the call and referred it to a GP who was part of the out-of-hours service. The GP then spoke directly to William’s mother and decided on what the right course of action was. However, I take on board exactly what the noble Lord said about training and the mix between clinicians and non-clinicians in 111 call centres. It will become a better service when the out-of-hours service and the 111 service are integrated.

One point that came out of the report was that had there been an electronic patient record indicating the evidence of the time that William had spent with GPs in the preceding six weeks, the GP who took the call might possibly have come to a different decision. This was a tragic case of all the holes in the Swiss cheese lining up to cause this awful tragedy. Therefore, I take on board what the noble Lord said about 111 and will pursue that with NHS England.

Health: Hormone Pregnancy Tests

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Thursday 21st January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I understand that to be the case but I will double-check and, if it is not, I will of course write to the noble Baroness.

[Lord Hunt of Kings Heath (Lab)]

My Lords, is it absolutely clear that there will be full disclosure of all public documents and the regulators’ documents for this review?

Health and Social Care: State Pension

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Thursday 21st January 2016 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what is their response to the suggestion by the Chief Executive of NHS England that they should look at all the options for adequately funding health and social care, including revisiting the guaranteed annual increases in the state pension until 2020.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, the Government are committed to both a state pension system that ensures financial security in retirement, and a sustainable health and social care system. We are increasing funding for the NHS by £10 billion a year in real terms to fully fund the NHS’s plan. Alongside this, local authorities have been given access to up to £3.5 billion extra a year by the end of the Parliament with the social care precept and additional investment.

[Lord Hunt of Kings Heath (Lab)]

I am grateful to the noble Lord. He mentioned billions of pounds, but he will know that the analysis by the King’s Fund shows that over the five years of this Parliament the real-terms growth rate for the NHS is actually less than in the last Parliament, and social care will see a continuation of the cuts. Research published today shows that 25 other countries spend more of their share of GDP than we do on health; we have fewer doctors and nurses and less equipment and access to new drugs than many comparable countries. The NHS is facing a huge crisis. When are Ministers going to tackle this and get a grip?

[Lord Prior of Brampton]

My Lords, the NHS produced its five-year forward view 18 months ago, which called for additional spending in real terms from the Government over the five-year period of £8 billion. The Government have met that in full and are front-loading that investment, as the noble Lord knows, spending £3.8 billion in the forthcoming year. So the Government are fully supporting the NHS’s plan.

Health: Red Cell Folate

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 19th January 2016 Lords Chamber

[Lord Prior of Brampton]

The proposal is that bread should be fortified with folic acid. The point of doing it through bread is that most people eat bread and that it would reach the widest number of people. It would be fortifying a product that most people eat; that is the purpose of it.

[Lord Hunt of Kings Heath (Lab)]

My Lords, is the Minister really saying that adding a very small amount to flour is mass medication; is that not overdoing it? I say to him, as I said on 21 December: can Ministers not come to a decision, yes or no? I get the sense that it is no, because he is putting much more stress on the issue of mass medication now than he has ever done on previous questions. I also go back to the answers that his noble friend Earl Howe gave over the last two or three years. Can the Minister not make that decision? The last thing we need would be to refer it yet again to another expert committee for yet more research, when it is quite clear that it would be effective and safe.

[Lord Prior of Brampton]

My Lords, I can only repeat what I said: we are in the process of making a decision and that decision will be made shortly.

National Health Service: In-Patients with Learning Disabilities

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Monday 18th January 2016 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what is their estimate of the number of avoidable deaths of National Health Service inpatients with learning disabilities since 2011.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, this Government are committed to reducing the level of avoidable deaths. The learning disabilities mortality review, commencing this year, is piloting local reviews of premature deaths of people with learning disabilities. The Care Quality Commission will also be undertaking a wider review into the investigation of deaths in a sample of acute, mental health and community trusts.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to the Minister for his Answer. He is clearly aware of the recent reports which have shown that there have been many avoidable deaths of people with learning disabilities within the care of the National Health Service. Indeed, some estimates have put it at more than 1,000 deaths per year. He is aware that Sir Bruce Keogh, medical director of NHS England, has very recently written to NHS and foundation trusts asking them to carry out a self-assessment of avoidable deaths. Given that the NHS seems to have a real problem with providing decent care generally to people with learning disabilities, how confident can we be that this self-assessment will actually identify people with learning disabilities who have suffered avoidable deaths within its care?

[Lord Prior of Brampton]

My Lords, this is a very important question. The fact that so many people with learning difficulties die much younger than people without them is of concern to everybody in this House. The review being conducted by Sir Bruce Keogh, to which the noble Lord referred, is a self-assessment tool. It is due to report quickly—by April—so is a short-term attempt to get the bottom of this. It is not a long-term effort, which would be much more comprehensive. We have two forms of looking at avoidable or excess deaths. One is the standardised system, which is a statistical basis for looking at the number of excess deaths. The other looks at avoidable deaths and is done by looking comprehensively at a wide sample of case reviews to give us a much more accurate picture of what is really happening.

General Dental Council (Fitness to Practise etc.) Order 2015

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Monday 18th January 2016 Grand Committee

[Lord Hunt of Kings Heath (Lab)]

My Lords, I, too, thank the Minister for his careful explanation of the order. I welcome the opportunity to debate it as well as the performance of the General Dental Council.

This is one of a number of Section 60 orders that the Minister has brought before your Lordships’ House in the absence of a Bill following up the Law Commission’s work. Will the Minister be able to update the Committee on exactly where we stand with the Government’s intention with regard to whether they see that any part of the Law Commission’s work will lead to legislation in the future? On the order itself, its terms seem unexceptional, although I would like to raise a few points with the noble Lord. The real question before us is whether the General Dental Council is a fit and proper organisation, capable of implementing the changes.

I shall start, however, with the order and will come on to the issues with the GDC and the various reports that have been published about its poor performance over the past four years. On the order, first, I refer to paragraph 8.4 of the Explanatory Memorandum, which refers to a number of organisations which have commented. The British Dental Association is not listed there. I have received a briefing from the British Dental Association, and I wondered whether it had submitted a response to the department. If it has, I am surprised that it is not listed in paragraph 8.4.

The other point I want to make about the order concerns the question raised by the noble Lord, Lord Colwyn, which is about the performance of the GDC. The BDA briefing that I have received states that while the GDC is,

“Britain’s most expensive healthcare regulator”,

it,

“is also the least efficient, most troubled and enjoys little confidence among”,

either dentists or the Professional Standards Authority. It states that the GDC failed to meet eight out of 24 of the PSA standards of good regulation in its 2014-15 performance review and, crucially, fully met only one of the 10 standards relating to fitness-to-practise processes, representing what the PSA describes as,

“a significant decline in its performance compared to the assessment of the year before”.

The BDA points out that, in comparison, last year, the GMC met every one of the 24 standards while charging its members less than half of the annual retention fee that the GDC charges.

I also pick up the point raised by the noble Lord, Lord Colwyn, about the importance of the independence of case examiners. This is a point that we have raised before on some of these Section 60 orders. It is crucial because of the problems that have arisen from the way the GDC has conducted cases in the past, as identified by the various inquiries. I very much support the noble Lord in emphasising that case examiners must be, and be seen to be, independent.

We then come to the real issue for me, which is GDC governance. The Minister will be aware that in February 2013, the Professional Standards Authority published a report following the resignation of the GDC’s chair, Alison Lockyer, in May 2011. The Department of Health had asked the PSA to investigate several concerns which the then chairman had raised in a letter she had written to the Secretary of State on her resignation.

The PSA’s findings were complex. It did not find that the GDC was failing, but it identified some general learning which could be gained from the experiences of the GDC. Following the PSA’s report into the allegations made by Lockyer, it wrote that new evidence had come to light about poor practice in the support and operation of the GDC’s investigation committee. In July 2013, a member of the investigation committee raised concerns under the GDC’s whistleblower policy that certain processes were compromising the independence of the investigating committee’s decision-making. The GDC also commissioned an independent review into the concerns of the whistleblower, which was published in 2014, but in April 2014 the PSA started its own investigation. This was published on 21 December 2015.

The PSA came to a number of conclusions and found several areas of improvement for the GDC. I will come to the main recommendation but I read this report with considerable disquiet. I do not think I have ever seen a report relating to a statutory regulator quite like it. It was published only a few weeks ago, before Christmas. Paragraph 2.1 of the summary states:

“The approach taken by the GDC to recruiting, training and supervising the Investigating Committee Secretaries is likely to have contributed to the development/continuance of objectionable practices”.

These are objectionable practices by the statutory professional body concerned with dentistry. It is a very long report of more than 300 pages but, to get the flavour of it, here are some of the objectionable practices listed that the PSA looked into. First, there are:

“Discussions about cases between Investigating Committee Secretaries and Investigating Committee Chairs prior to Investigating Committee meetings”.

Then, quite remarkably, there is,

“advance drafting of Investigating Committee decision documents/reasons by Investigating Committee Secretaries”.

There are irregularities around the,

“provision of legal advice by Investigating Committee Secretaries to the Investigating Committee during Investigating Committee meetings … Inappropriate interventions/undue influence by Investigating Committee Secretaries during Investigating Committee meetings”,

and,

“amendment of Investigating Committee decision documents after Investigating Committee meetings by Investigating Committee Secretaries without appropriate authorisation”.

There are other identified irregularities but I do not need to go into them; I have made the point. The PSA report goes through this in great detail and its overall recommendation is:

“The GDC’s Council, executive management team and the relevant committees should consider this report in full, both individually and collectively, in order to identify all the lessons that should be learnt in particular in relation to governance, accountability and management oversight, as well as the actions the GDC should take to address our recommendations”.

The point I want to make about this is that these matters now go back some years. It was 2011 when the then chairman first raised those issues. This report was started in 2014 and finished only a few weeks ago. It clearly found continuing improper practices—or at least those that would not accord with good practice. Reading between the lines, I see here a culture of utter complacency within the GDC. It looks as though the GDC has simply not accepted the core conclusions of the various reports written about its conduct and carried on with that complacent culture. It is also clear from reading between the lines of the report and the careful way it has been put together that the PSA lacks confidence in the performance of the GDC. Frankly, I would have expected the entire board of the GDC to resign in the light of that report just before Christmas. I understand that the chief executive has resigned but no one else on the board seems prepared to take responsibility for a culture that has clearly lasted over a good many years. That is not acceptable. Can there be any confidence that this organisation is fit for purpose?

I now understand the concerns that the profession has about the GDC. I had not realised until I went through this information just why there was so much angst within the profession. It is absolutely justified. I would be doubtful of putting any order through in relation to the GDC unless we were absolutely certain that it is able to carry out its job properly.

[Lord Prior of Brampton]

My Lords, a number of points have been raised. I will start with those raised by my noble friend Lord Colwyn. He said that independence is critical for the case examiners; I will address that issue first. It is important to remember that case examiners will not be making findings of fact in respect of whether a registrant’s fitness to practise is impaired. They will make the decision about whether a case needs to proceed to the adjudication stage and be considered by a practice committee.

Additionally, in its rules and guidance, the GDC will provide that the case examiners must make decisions based on documentary evidence, which will be supplied to them in the same manner as is currently the case for the investigating committee. The case examiners will not be involved in evidence-gathering. There will be one lay and one registrant case examiner considering an allegation. I accept, however, that they will be employees of the GDC. Nevertheless, our feeling is that sufficient safeguards are built into the way that case examiners will work.

The issue raised by my noble friend and expanded on by the noble Lord, Lord Hunt, is fundamental. If the GDC is not a fit organisation—if its governance and performance are not right—that is a much more profound worry than the details of the order before us today. Before I address this, I will deal with one other point that the noble Lord raised. He asked whether the BDA had submitted anything. It has; it was omitted in error and is now being attached.

Clearly, we are concerned about the performance of the GDC. The report from the PSA is indeed extremely worrying. As the noble Lord said, this has not happened just recently; it goes back many years. It is very important that the council takes responsibility for the proper running of its organisation. My colleague Ben Gummer is the Minister with direct responsibility for the GDC and he has a meeting coming up in the very near future to discuss the GDC’s performance in the light of the PSA report. It is not all bad news in that report. There are some signs that the GDC is working hard to improve. Nevertheless, as my noble friend and the noble Lord have both said, there is a lack of confidence in the GDC among the profession and that confidence must be rebuilt.

Perhaps I might bring to Ben Gummer’s attention the comments that have been made by my noble friend and the noble Lord and ask him to draw them to the attention of the GDC when he meets it in the near future. Clearly, he will wish to keep a very close eye on the performance of the GDC as we go forward. I do not think I can say much more today about that. I do not have the information with which to comprehensively address the issues that the noble Lord has raised. Is he content on that basis? If he would like to meet my honourable friend Ben Gummer, I can arrange for him to do that.

[Lord Hunt of Kings Heath]

My Lords, I am very grateful. One of the problems is that this was scheduled very late and therefore I was able to look at the information only over the weekend. I suspect that I would have put a Motion down for a debate in the Chamber if I had had time to do that.

Secondly, I realise that this is quite a difficult situation. Clearly, the independence of the regulators of the health profession is very important and I have always been keen to protect it. The PSA has a crucial role and I think it does a great job. I pay tribute to the chairmanship of my noble friend Lady Pitkeathley, and Mr Harry Cayton, the chief executive. I think they have done a fantastic job, but it seems to me that there is a gap.

It is patently obvious when you look at it from the outside that the board should have read those reports, accepted its ultimate responsibility and stood down. I accept the invitation; I would be very glad to meet Mr Gummer. Of course, this will be debated tomorrow in the other place, and other Members may come back on that. This message clearly needs to go to the GDC council: that it is not good enough and the members should consider their position. I wonder whether it is right that the board carries on willy-nilly simply because the chief executive has stood down.

I am not someone who rushes to say that this, that or the other board should resign because something has gone wrong, but this has been a continuing problem. I accept that improvements have been made, but only a few weeks ago the PSA had to publish a report that continues to draw attention to what is, essentially, the culture of the organisation. Therefore, I very much hope that Ministers will take the appropriate action; that is all that they can do. Ultimately, I am surprised that the board of the GDC feels that it is able to carry on and I think there needs to be a change.

I am grateful to the Minister for the way that he has responded; clearly, he understands the issues that are being faced.

[Lord Prior of Brampton]

My Lords, perhaps we can leave it on the basis that I will organise for the noble Lord to meet Ben Gummer and perhaps ask Harry Cayton to come along, too, as he fundamentally authored the report, so that the noble Lord can express his concerns directly to them. On that basis, I beg to move.

Children: Obesity

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 12th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, we all recognise, as does the Prime Minister, that obesity is a scourge in this country that affects many thousands of young people. Some 2.1 billion people worldwide are overweight or obese, so it is a huge global problem that requires a comprehensive strategic response. I hope that our obesity strategy will be announced in the very near future.

[Lord Hunt of Kings Heath (Lab)]

My Lords, in developing this strategy, is his department talking to the Department for Education? He will understand that this is a particular issue at primary school level. There is evidence that the incessant determination of the Government to test primary school children at every age at every moment is squeezing the curriculum of playtime and physical activity. I hope that his department will talk to the Department for Education to turn this around.

[Lord Prior of Brampton]

My Lords, we have got to have a collective response to the obesity problem across many government departments, as the all-party parliamentary group made clear in its paper. Education is a critical part of that. The noble Lord will know that in the spending review the Government committed to continue the PE and sports premium in primary schools because we recognise that physical exercise and playtime at all levels in schools, but particularly in the early years, are vitally important.

Pregnancy: Neural Tube Defects

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Monday 21st December 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I think they were helpful and wise words from the noble Lord, Lord Blunkett. This is a difficult issue, and it is not as black and white as is sometimes portrayed. As I said, my honourable friend in the other House is taking all these matters into consideration.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I must inform the House that I am president of the Fluoridation Society. Therefore, although I always welcome my noble friend Lord Blunkett’s interventions, perhaps I welcome this one not quite as much as usual. I have great respect for the Minister’s colleague, the Minister for Public Health, and know that she is committed to public health. But she has had the evidence from the research, which caused the Government to delay a decision, for nine months. Is it not a fact that she cannot get agreement inside government, and that the Government have decided not to go ahead? Is not it time for them to be straight on this?

[Lord Prior of Brampton]

My Lords, I do not think that what the noble Lord has said is entirely correct. My honourable friend Jane Ellison received a letter from the SACN, the committee on nutrition, on 20 October that indicated that many more women were below the foliate level than had previously been thought. That evidence is quite new and came in at the end of October. That is what she is now considering.

Health: Liver Disease

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Wednesday 9th December 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, the recommendations in the report about a hub-and-spoke approach, to which my noble friend refers, with district general hospitals having some hepatology services but being linked into a specialist centre are absolutely right. It is the right model; I have no doubt about that. We have established 22 operational networks for hepatitis C treatment, which are all linked into specialist treatment centres. We believe that that may be a model for the future.

[Lord Hunt of Kings Heath (Lab)]

My Lords, on the issue of specialist centres, has the Minister actually read the Lancet report, which points out that the north-west has the highest incidence of liver disease, yet does not have a transplant centre? In view of the very good outcomes from the transplant centres, are the Government making sure that the north-west gets such a centre?

[Lord Prior of Brampton]

I have read the Lancet report and I noted this rather unusual omission in the north-west. I do not understand why the north-west does not have a specialist liver facility. It is something that I will follow up and find out. I will write to the noble Lord if I can.

Health: Adult Pneumococcal Vaccination

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 8th December 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, the report by the JCVI was very clear in its recommendation that the existing vaccination, PPV, was the most appropriate for those aged over 65 and that PCV 13, which is the vaccination used for young children, because it provides herd protection—that is, young people who are treated with it can no longer carry the disease—offered the best long-term protection for the elderly as well.

[Lord Hunt of Kings Heath (Lab)]

My Lords, this year community pharmacists have been given the opportunity to provide NHS vaccinations. Can the Minister say something about how successful that has been? Does he think that there is much greater potential for community pharmacists to do more work for the NHS in this and other areas?

National Health Service (Licensing and Pricing) (Amendment) Regulations 2015

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 1st December 2015 Lords Chamber

[Lord Hunt of Kings Heath]

My Lords, I am very grateful to all noble Lords who have taken part in this interesting debate. We perhaps went rather wider than the terms of the regulations. I agree with the Minister that payment by results was brought in essentially to drive through reductions in waiting times by providing the right incentives. By and large that has been very successful, but we are moving, and this is a very good thing, into thinking about systems and how they work. There is a clear need to develop a funding mechanism to ensure that there are proper incentives for system-wide working, and I absolutely agree with that.

However, I also agree with the noble Lord, Lord Warner, my fellow former Minister. Looking at the Five Year Forward View, it seems to me that essentially we are moving again to a planning model but we are still stuck with the 2012 Act, and the two do not seem to mesh together. The Minister is struggling with these regulations because they are trying to operate a system that is still based on payment by results, when in essence we are trying to incentivise people to work together to produce a much more effective system and that is very difficult. If he were to tell me that the NHS amendment Act was to be brought forward, I think he would find a warm welcome in your Lordships’ House, but perhaps I dream too far.

I say to the noble Lord, Lord Patel, that I do not disagree at all with his idea of an independent commission; the funding challenges facing health and social care warrant that kind of independent consideration. I say to him, though, that all the work done by the King’s Fund and the Nuffield Trust suggests that if you could maintain real-terms growth at 4% a year, which is the historic annual real-terms growth of the NHS, we would get a pretty good system without some of the pressures that we are facing at the moment. It is not a question of having to increase money to the NHS and social care hugely, but it needs some increase or we will be faced with the kind of problems that we have at the moment. The Barker commission, which was sponsored by the King’s Fund, shows some of the thinking that one might ask a royal commission to go into.

My noble friend Lord Turnberg mentioned the particular challenges of highly specialist providers, which of course are very much tied into the area that he knows so well: our whole R&D effort in this country and the link with the life sciences. While I understand the language of domination by specialist providers, we need to recognise that the link that these very same providers have with R&D and the life sciences is crucial to this country and to the lead that we often have in these areas. We have to be very careful not to undermine their financial viability because of the general financial challenge.

I am delighted that the noble Lord, Lord Warner, is working on, chairing or leading this work on specialised services, and I am sure he is right that we need to have much more effective commissioning. I certainly accept that that is likely to lead to a rationalisation of specialised services, which will not be universally popular. However, if we can show that by doing so we get more bang for our buck, getting better specialist services, and that they are a better investment, clearly, that has to be followed through. I hope that we will see the outcome of that work within the next few months.

I have no problem at all with putting more resources into mental health and community services—I entirely understand that. However, the regulations are a pretty poor show, and in effect disfranchising the providers, who get 96% of the tariff income, is not the way to go forward. However, I am very grateful to the noble Lord, Lord Prior, for what he said. I take his commitment to rebuilding the confidence, as he described it, of providers in the system, as a very strong one. He did not quite go as far as I would have wished with regard to endorsing the open book approach. Does that mean that that is still being considered, or has it been rejected? Can I take anything from that?

[Lord Prior of Brampton]

I will have to defer to Jim Mackey, the chief executive of NHS Improvement. It would not be fair for me to answer that question.

[Lord Hunt of Kings Heath]

I am sure of that, my Lords. I will just say to the Minister that I hope the spirit of this debate will be conveyed to him and NHS Improvement. I certainly have been very impressed by the chief executive’s words since his appointment, and of course the chairman, Ed Smith, commands great respect and authority, not least for the work he has done on behalf of Birmingham University, for which those of us in the city are very grateful.

With that, I thank all noble Lords who have spoken. The point has been made, we look forward to a better approach in the future, and I hope that the spirit of the proposal regarding early consultation and an open book process will be acceded to. I beg leave to withdraw my amendment to the Motion.

Accident and Emergency Departments

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Monday 30th November 2015 Lords Chamber

[Lord Prior of Brampton]

My noble friend makes a very important point. Many people go to A&E departments who need not go there. The review of Sir Bruce Keogh, the medical director of NHS England, concerning how we structure emergency care in this country will be very important. Clearly, we can make much more of NHS 111.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the point that Minister’s noble friend made was that the Government’s decision to phase out NHS Direct, which used qualified nurses, and replace it with call handlers who simply use algorithms on their screens means that those call handlers are risk-averse, which therefore leads to many more people being sent to A&E. Is it not time to get qualified nurses back behind those screens and talking to patients?

[Lord Prior of Brampton]

The noble Lord makes a good point. If qualified people take the call, the level of risk they are prepared to absorb will be greater, and that applies throughout the whole system.

Health

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Thursday 26th November 2015 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, I shall try to do this without hesitation, repetition or deviation, but I fear I shall fail on all three counts.

First, I echo what all noble Lords have said and thank the noble Lord, Lord Crisp, for introducing this debate, which has been fascinating. He brings to it a lifetime of experience in healthcare, both in the NHS in the UK and, of course, globally. He mentioned two quotes in his speech. The first was:

“Modern societies actively market unhealthy life styles”.

In a sense, that lies at the heart of much of what he said.

He also referred to the African saying: health is made at home, hospitals are for repairs. That is something we should take to heart. He has always said that we have much to learn from other countries, and perhaps we can learn a great deal from that particular saying.

I want to pick up some of the important issues raised by noble Lords in this debate. The noble Baroness, Lady Jay, talked about localism, about which she has some reservations. I suspect that that is an issue we will come to many times over the next few years. While I do not regard her as “a centralised dinosaur”, as she put it, the thrust of much of government policy over the course of this Parliament will be very much towards accountable localism.

The noble Baroness, Lady Williams, started her speech by almost praying for a whole-party approach to healthcare. It is probably unlikely, but it would be nice. She talked about prevention and education. I think that the curriculum for those aged up to 14 now has more time for nutrition and healthy eating, but she and other noble Lords mentioned the lack of time for PE. She also talked about mental health, domestic violence and equality of treatment for those suffering from mental health issues, something we all support in this House.

The noble Baroness, Lady Campbell, spoke movingly about what she called the empowerment model of putting patients—service users, or clients—much more in charge. We should not be so hamstrung by the medical model that has dominated healthcare for so long.

I congratulate my noble friend Lady Redfern on her wonderful maiden speech. She talked about nutrition—perhaps not surprisingly, as she said that she comes from a place where beetroot and celery are much talked about. She also talked about rehabilitation and reablement. Acute hospitals need to do a lot in the field of rehabilitation and reablement so that we can get much earlier discharge of care.

The noble Lord, Lord Best, reminded us that housing and health used to be part of the same department. I do not know how many years ago that was, but it is an interesting observation. He reminded us that home can become a trap, a prison—indeed, a fridge if the temperature is not right. Those were very important observations.

The noble Baroness, Lady Masham, talked very powerfully about the Paralympics and the power of sport. However, she also reminded us that there is no room for complacency about infectious disease and the treatment of people with drug and alcohol problems, and, of course, about the importance of hospital food.

I congratulate the noble Lord, Lord Foster, on his maiden speech. Like many of us, he was once a young rising star, but sadly those days are behind most of us. What he had to say about personal responsibility is very important. We can look to the state and to government institutions, but we need to take responsibility for ourselves as well, wherever possible.

The noble Lord, Lord Alton, made some very interesting comments about variation across the system. It is patchy. We talk about a National Health Service, but it is very different depending on where you live. It was interesting to hear him say that 660 million antidepressants have been prescribed where the underlying problem is loneliness, and that medicine is not a remedy for that. The right reverend Prelate the Bishop of Bristol quoted John Donne:

“No man is an island”.

We are all “part of the main”. I fear that the bell might be tolling for myself this evening, but he again made a very strong point. Social isolation and loneliness were common themes from many of your Lordships.

The noble Baroness, Lady Lane-Fox, knows a great deal about the internet. When she said that the organising principle of our age is the internet, she made a profound point. I have absolutely no doubt that the power of the mobile phone and of the various apps being developed will reshape healthcare. It will shift power away from medical professionals towards individual users. I believe that there is now an app that can monitor your life signs from a drop of blood taken once a month. That is hugely powerful. She warned us of the risk that so much of this technology is concentrated in a small number of highly successful technology firms based in California. We need to be well aware of that.

My noble friend Lord Smith talked about the importance of clubs, participation and social interaction. He reminded me of Burke’s “little platoons”, which are such an important part of society. He also reminded us that in 1666, the average life expectancy was 35, so we have come a long way since then.

The noble Baroness, Lady Neuberger, talked about loneliness and how hugging a young baby or child actually helps develop their brain. It is not just about the very young, but the old as well. Lonely people suffer both physically and mentally. We all love human interaction and know that it is not just the elderly who suffer from isolation; many parts of society suffer from loneliness. I fear that computers have not done us proud when it comes to interacting as individuals with others.

The noble Lord, Lord Rea, talked about the importance of primary prevention. He quoted from Sir Michael Marmot’s book on health inequalities, which of, course, is very powerful. I will write to him, if I may, on Sure Start centres after this debate. The noble Earl, Lord Listowel, talked before to me about loneliness and isolation, in particular the importance of relationships for looked-after children, adolescents and those in their early years. I am not familiar with the Bromley-by-Bow model raised by the noble Lord, Lord Mawson, but I would like to learn about it. I was fascinated by his strictures about replication: you cannot just pick up a model in Bromley and dump it in Birmingham, or probably in any other part of London. There are aspects, however, that can be translated. He said it is always better to start small, rather than trying to start big. In the NHS, we perhaps get ahead of ourselves sometimes.

I turn to the comments made by the noble Baroness, Lady Walmsley, and the noble Lord, Lord Hunt. This has been an important debate that reaches across a wide part of government. It raises issues that are not just pertinent to this country, but global. At their base, they reflect the fact that our population is increasingly elderly and people are suffering from many chronic long-term conditions. Lifestyles are causing a growing disease burden, particularly from obesity but also from alcohol and smoking. People’s expectations are changing all the time, and, of course, the cost of new surgical and pharmaceutical developments is huge. I suspect that genomic development and genomics will only add to those costs.

At the moment, however you measure how we fund these things—whether it is 16% of national wealth in America or more like 8.5% in this country or 11% in Germany—healthcare is consuming a vast amount of our GNP. Whatever health system you are in, there is an issue of sustainability. I believe that a strong economy is fundamental to any strategy that any of our parties would wish to have. We must have a strong economy, but that is not just so that we can afford better healthcare: it is actually more profound than that. It is because we have a strong economy that we will have high levels of employment. Work is a critical part of addressing some of the concerns of my noble friend Lord Crisp. If people have decent employment, they will tend to have higher levels of physical and mental health.

Education is also fundamental. It was Sir Michael Marmot, I think—or somebody else—who said that you could pretty much predict people’s future lifestyles from the age of 11. If their educational attainment is well below average at the age of 11, the outlook for the rest of their lives is not good. We also need to consider that the transition from adolescence into adulthood is also a critically important time. So I welcome the last Government’s and this Government’s increased commitment to apprenticeships.

The life expectancy of people living in Kensington and Chelsea was referred to earlier in the debate. I think I am right in saying that the life expectancy of people living in Salford is something like 25 years less than that of people living in Kensington. That cannot be explained just by reference to healthcare. Healthcare is demonstrably a very small explanatory component of such a difference in life expectancy. The differences are much more profound than just those associated with the NHS. When we talk about the health of the nation, it is tempting to focus just on the NHS, but it is only a very small part of it.

I wish to expand on devolution a little more because the driving force for devolution, particularly in Manchester but increasingly in the Black Country and other parts of the country, is to try to get greater economic regeneration. I believe that that, together with devolving more power to local authorities, will help to build a healthier society. I do not want to make a party-political point on this at all but I congratulate the principles underlying the work that Iain Duncan Smith has done in developing the universal benefit to try to make it easier for people to move from welfare into work. It is my fundamental belief that work is a crucial part of building a healthier society.

I wish to give noble Lords two quotes. Having said that the NHS is not a big part of this, I want to dwell briefly on it. The first quote is from the NHS Plan 2000. Perhaps the noble Lord, Lord Hunt, was a member of the Government in 2000. The NHS Plan states:

“The NHS is a 1940s system operating in a 21st century world”.

I believe that that comment, made in 2000, was profound. Now here we are in 2015 and the NHS Five Year Forward View states that,

“there is broad consensus on what that future needs to be. … It is a future that dissolves the classic divide, set almost in stone since 1948, between family doctors and hospitals, between physical and mental health, between health and social care, between prevention and treatment. One that no longer sees expertise locked into often out-dated buildings, with services fragmented, patients having to visit multiple professionals for multiple appointments, endlessly repeating their details because they use separate paper records. One organised to support people with multiple health conditions, not just single diseases”.

So we all know what the issue is and yet getting change in the NHS has proved extremely difficult. I take issue with the noble Lord, Lord Hunt: I think that we have to push these new models of care and treat more people outside hospital settings, not because it is lower cost but because it is better care.

[Lord Hunt of Kings Heath]

I am not arguing against the models; all I am saying is that I think there is a simplistic view that, if you develop the models, you can reduce the pressure on your acute care capacity. I, and I think many commentators, are doubtful about that, given that our acute care capacity is so much less than that of most comparable countries. That is the point I was making.

[Lord Prior of Brampton]

I understand that fully. To be clear, at the heart of the Five Year Forward View are both the new care models—the vanguards referred to by the noble Baroness, Lady Walmsley—and a change in productivity. I wish to dwell on productivity for a minute because the NHS is a lean system. I do not argue against that at all. It is a very high-value system. I was at a meeting with people from the Mayo clinic very recently and they said that they felt the NHS was the highest value healthcare system in the world. That does not mean that it is perfect. However, although we are always highly critical of it, by world standards it is a very good system.

We are going to address productivity through using much greater transparency—using the work of the noble Lord, Lord Carter—as well as trying to get a much higher degree of clinical engagement so that we get real traction. In the past we have had a top-down approach to try to drive through productivity improvements. This time we hope to have a much more bottom-up approach, with a much higher degree of clinical engagement.

The noble Lord, Lord Crisp, divided this issue into three, and the third aspect was the most important. The message is that it can be done. For example, the number of teenage pregnancies has been reduced by half. The number of people who die in fires has been reduced by half. Smoking prevalence has come down from 40% to 18%. Health-acquired infections such as MRSA and C. diff have come down very significantly. We can do it, if people work together.

Some of your Lordships may have read the McKinsey Global Institute report into obesity. It is a very good report. Obesity is a global problem: 2.1 billion people in the world are overweight—30% of the global population. It is going to rise to 50% by 2030. It costs billions of pounds and wrecks millions of lives. The McKinsey analysis makes three good points. First, there is no single intervention—no silver bullet. It is not just passing a sugar tax or a new regulation. In its view, when it comes to tackling obesity there are 74 separate interventions that must be done: housing, education, personal responsibility—it is a combination of all these things. Secondly, no part of society can do it on its own. It cannot just be top-down from government. It cannot just be bottom-up from individuals or the community. It has to be top-down, bottom-up and in between. Thirdly, you can never have all the evidence. If we wait until we have all the evidence about every single intervention, we will end up doing nothing. That is quite a good illustration of what the noble Lord, Lord Crisp, is aiming at. If we are going to have an effective strategy for obesity, which we will be revealing early in the new year, it has to be multifaceted. There is no silver bullet.

Treating illness is the tip of the iceberg that we all focus on but the much greater part of the iceberg is below the water. Improving and reducing health inequalities will require an effort that goes way beyond the NHS. Of course, the NHS has a big part to play but there is a much bigger and wider role for society as a whole. I thank the noble Lord, Lord Crisp, for raising this issue. It has been a fascinating debate and I look forward to pursuing discussions with him and others outside the Chamber.

Health and Care Professions Council (Registration and Fees) (Amendment) (No. 2) Rules Order of Council 2015

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 24th November 2015 Grand Committee

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, I thank the noble Lord for introducing this short debate on the HCPC. It raises other issues beyond the HCPC that are of great interest to us.

The HCPC is a statutory regulator established to protect the public. To do this, it keeps a register of professionals who meet its standards for professional skills and behaviour. The noble Lord knows all that, but this is a preamble. There are 330,000 professionals across 16 health, psychological and social work professions. It is a very large regulator. It is self-financing, with funding coming entirely from registrant fees. It does not receive any regular funding from the Government.

The HCPC’s registration fees are the lowest, and have consistently been so, of all the UK statutory regulators of health and care professionals overseen by the Professional Standards Authority. Its fees are £90 a year. The next lowest regulator, the NMC, charges £120 per year. By way of comparison, the GMC is £420 a year. However, as a self-funding regulator, like all the professional regulators, its needs to keep its fees under regular review so that it can respond to demands on finances and resources, and to continue its role of delivering effective public protection.

As noble Lords will know, from 27 March 2015 to 6 May 2015 the HCPC consulted on raising its fees by an average of 12%, or £10 a year. That is 26 days. I appreciate that it was over an election period but that decision on consultation had to be with the council of the HCPC and the decision to formally review and consult on an increase to its fees was the result of three factors: first, as the noble Lord mentioned, because the PSA fee regulations came into effect, as a result of the Government deciding that the PSA should be funded by the regulators that it oversees, rather than the public purse; secondly, to improve how fitness-to -practise hearings are run; and thirdly, to invest in essential IT systems.

In relation to the first point, the Professional Standards Authority for Health and Social Care (Fees) Regulations 2015 came into force on 1 April 2015. This marked the realisation of the previous Administration’s commitment, set out in the Department of Health’s report Liberating the NHS: Report of the arm’s-length bodies review, to move the PSA away from government funding, to becoming funded by a fee on the nine regulatory bodies that it oversees. As required by those regulations, the PSA’s fee is calculated on each regulatory body’s registrant numbers. The HCPC is the second largest regulator by registrant numbers and will contribute to around 22% of the PSA’s funding. The PSA fee will be determined each year.

This methodology was considered fair because available evidence suggests that the level of PSA resource given to each regulatory body is very much influenced by the number of registrants as this critically informs the level of Section 29 work that the PSA undertakes for each regulator. Section 29 work is where a fitness-to-practise case is heard in court.

While around one-third of the 2015 fee increase was to meet the PSA’s fees, as I have said, the HCPC is also making improvements in the way it works. The HCPC is also looking to improve its fitness-to-practise processes. In doing so, the HCPC plans to introduce dedicated facilities for fitness-to-practise hearings. The HCPC’s existing office space was not purpose built for holding public fitness-to-practise hearings, which affects its ability to run a high-quality and modern adjudication service. It believes that introducing dedicated space will be consistent with the modern adjudication facilities provided by other regulators.

The HCPC also says that that the number and length of hearings are key cost drivers of the fitness-to-practise process. It has said that it aims to keep the cost of hearings low—for example, by proactively looking to conclude cases with the consent of the registrant involved, where appropriate. This avoids the need to have a contested hearing, with all the costs this involves. However, the HCPC says that it has seen an increase in the complexity of the cases since 2012. This has meant that the average length of a hearing has increased over time. The average number of witnesses required for each hearing has also increased to between three and four for each hearing. The HCPC’s primary objective is public protection, and it says that every allegation it receives must therefore be considered on its merits.

On the third point, the HCPC says that the new IT system it is looking to introduce will make its work more efficient by replacing a number of other legacy systems, by driving and delivering time and resource savings. Additionally, a project looking at redesigning the HCPC’s registration processes and systems should improve the level of service that it is able to provide to applicants and registrants by allowing them to carry out many more tasks online.

Finally, in determining budget forecasts for future years and the level of fees, the HCPC says that it had to make assumptions about costs and activity level—in particular, the volume of fitness-to-practise cases. It says that these forecasts indicated that despite generating a surplus in previous years, without the 2015 fee increase it would make operating deficits in 2015-16 and 2016-17. This would not be sustainable and would threaten its ability to fulfil its role of protecting the public. Additionally, the HCPC registers each profession on a two-year cycle, so it will take two full financial years before any increase in the renewal fee has full effect.

The HCPC says that it has not changed its ongoing commitment to the principle of small, regular increases in the fees where possible and necessary. Its latest five-year plan does not forecast any further increase in fees until 2019-2020. That said, in the past the Government have expressed a view on registration fees and the expectation that they should not increase beyond their current levels unless there is a clear and robust business case that any increase is essential to ensure the exercise of statutory duties.

The noble Lord raised a number of issues. First, he asked that in a consultation exercise there should be a detailed breakdown of the reason for a fee increase, which strikes me as a reasonable request, which I will draw to the attention of the PSA. He said that the fees should not increase by greater than the amount of the increase paid to NHS staff. All I can say is that the fee increase must be kept to an absolute minimum. I entirely appreciate that we live in a very difficult world, and fees must be kept to an absolute minimum. I do not think that we can make any commitment that they should be kept to the absolute level of increases of salaries paid to NHS staff.

The noble Lord asked that the PSA should take a more proactive role. Of course, the PSA undertakes an annual assessment of all the organisations that it is responsible for, which is tabled before Parliament. It is of course up to the Health Select Committee, if it wishes to do so, to have any individual regulator before it.

The noble Lord also asked about part-time workers; I hope that it will be all right if I write to him about part-time workers, as I am not sure of my answer on that. As regards the work the Law Commission has done, I think we all accept that it has done an outstanding job and made some extremely important and what could be very useful recommendations. The Government are currently reviewing how to take forward the work of the Law Commission.

[Lord Hunt of Kings Heath]

My Lords, I am very grateful to the noble Lord, Lord Prior. He is right to acknowledge the issue of pay restraint. However, I have three points. On consultation, I hope that the HCPC and the PSA will take note that it is reasonable to have a proper consultation in relation to fee increases in the future. Secondly, I noted what the Minister had to say about the introduction of IT and new systems and that it would lead to resource savings in the future. I have some experience of IT systems in the health service, and I certainly hope that that comes true. I noted the expectation of no further increase until 2019-20. Given the expected resource savings from new IT systems, it would be very disappointing if the HCPC came forward with any other proposal in the next Parliament.

Thirdly, I understand the Government’s reluctance to bring health legislation through Parliament, but one has received so many representations from the regulatory bodies. Given the extensive work of the Law Commission, I hope that the Government will give further consideration to bringing a Bill before Parliament before too long. The debate has been very helpful and I am most grateful.

National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) (No. 2) Regulations 2015

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 24th November 2015 Grand Committee

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, once again I thank the noble Lord, Lord Hunt of Kings Heath, for bringing this to the Committee. My noble friend Lord Lansley has pretty much done my job for me, but I think I had better go through with this to put it on the record. I thank my noble friend for that articulate and eloquent exposition of why we now have one incomplete standard and not the three that we had before.

We all accept that waiting times are critical. I should pay tribute to the Government of which the noble Lord was once a member. Bringing down waiting times was a huge success and there is no doubt that targets were one of the instruments used to do so. However, the noble Lord accepts that they are a blunt instrument and can lead to distorting clinical priorities. They can lead to gaming and extra cost, so they are not the whole answer. In particular, they can lead to perverse consequences. That is why the Secretary of State for Health and Simon Stevens accepted the recommendations made by Bruce Keogh earlier in the year. I will place a copy of his letter to the Secretary of State and Simon Stevens in the Library. The noble Lord may already have seen the letter but I will place it there.

Sir Bruce’s clinical advice on the standards used to measure the 18 weeks NHS constitution right was to remove the two standards that looked at how long people who have started treatment waited and to focus on the incomplete pathway standard—that is, the people who are still waiting. Perhaps I can explain that by using the analogy of a bus. The two earlier standards measured the people on the bus and the incomplete standard is designed to measure those who are left behind at the bus stop. As all three standards were written into the standing rules regulations, this statutory instrument, which took effect from 1 October, was required to make that change.

The change affects the metrics by which we measure the NHS’s performance on waiting times. It does not change the patient’s right. It is important that that is on the record. Patients can still expect to start treatment within a maximum of 18 weeks if they want to and it is clinically appropriate. If this is not possible, patients have the right to ask to be referred to an alternative provider that can see them more quickly, and the NHS must take all reasonable steps to meet patients’ requests. Sir Bruce Keogh recommended this change because having a set of three standards could be confusing and give rise to perverse incentives.

My noble friend described those perverse incentives. The perverse incentive was such that you could treat only one patient who had waited for more than 18 weeks as opposed to nine who had waited for less. There is no doubt that hospitals were managing their waiting lists on that basis. As a consequence, there were people waiting beyond 18 weeks for far too long. That was the wrong that the incomplete standard tried to address. As Sir Bruce said in June, while hospitals may be the ones penalised directly when they breached waiting time standards, the true penalty was laid on the patient who was waiting for much longer than he should have done. I wholly agree that that was not right.

In 2012—I think my noble friend was Secretary of State at the time—the Government introduced the incomplete pathway standard that a minimum of 92% of patients yet to start their treatment should have been waiting less than 18 weeks, to give NHS organisations a reason to prioritise patients who had been waiting a long time. The removal of the two completed pathway standards further minimises the potential for management of the waiting list to cut across clinical decision-making. Clinical priority should always be the main determinant of when patients should be treated. This clinical priority should not have been distorted because it should have been possible to meet all the clinical priorities and meet the waiting time standard, but in practice that was not always the case. Clinicians should make decisions about patients’ treatment and patients should not experience undue delay at any stage of their referral, diagnosis or treatment.

These changes will mean that there is a simplified, clearer focus on only one standard, covering all patients on the waiting list, and ensuring that those who have been waiting a long time are not left languishing. The noble Lord raised the issue, which was addressed by my noble friend, of whether having just the one standard will result in new and different perverse incentives. My noble friend made the important point that it could lead to priorities being skewed in favour of non-admitted, simpler, cases rather than admitted, more complex, cases. That is something we need to keep a very close eye on. NHS England will continue to measure trusts’ performance against all the standards except that there will be only the one measure in the contract.

I stress that changing the standards is not moving the goalposts in response to poor performance. This change has been made on the basis of clinical advice and in the best interests of patients, and has received widespread support, for example from the Nuffield Trust and the Patients Association. More than a million NHS patients start treatment with a consultant each month and the overwhelming majority are seen and treated within 18 weeks. However, the NHS is busier than ever, which is why we are investing the extra £8 billion that NHS leaders have asked for to support the five-year forward view. I hope that the noble Lord will accept that this was done in good faith and in the interests of patients and that it was a decision informed by clinicians, not by politicians. I have not addressed the concerns he raised about the eligibility criteria for nursing, because they are not strictly relevant to these regulations, but perhaps I could write to him on that matter.

[Lord Hunt of Kings Heath]

My Lords, I am very grateful for that. I must say that the intervention from the noble Lord, Lord Lansley, was very helpful. It reminded me that in 2001 I was resplendent in the title of Minister for targets in the Department of Health. I remember asking officials to count up how many targets we had set. When we reached 450, we decided we ought to start again, first by trying to refine the targets and then by setting up foundation trusts, in order to take them out of a directly managed form of control from the centre. Whether that has been entirely successful, in light of today’s circumstances, is up for some debate, though I still maintain that the concept of foundation trusts, with separate governance and local accountability, is the right way forward. I hope that NHS Improvement will see the benefit of trying to protect foundation trusts, and the good bits of their governance—the role of governors, the accountability of the board to local people—from overmanagement from the centre. I know that the noble Lord also chaired a foundation trust; he will know what I mean.

There is no doubt whatever about the targets. The waiting time in 1997 was more than 18 months. It was brought down to 18 weeks, which was driven by a target that people had to meet. That is always justifiable. However, we know that in both the public and private sectors, people who have to meet targets are very clever and sometimes the temptation for perverse behaviour is all too apparent. I hope that we can continue to rely on NHS England to monitor behaviour closely and that if it needs to adjust targets to meet any perversity, it is important that that is done quickly and responds to problems that arise.

I do not oppose these regulations at all; I think it is a sensible approach. However, it would be helpful if we saw that NHS England was fleet of foot in responding very quickly when new problems arise with targets, as inevitably they will. This is a good example of that.

Junior Doctors Contract

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Friday 20th November 2015 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to the noble Lord. The fact that we are here today, with 98% of junior doctors having voted to take significant industrial action for the first time in 40 years, is a matter of very serious concern to the NHS and its patients. Does the Minister agree that, over the course of the next week, everything that can be done should be done to stop the three days of planned industrial action? The Guardian this morning says that the noble Lord, Lord Prior, has urged on the Secretary of State the need for a settlement. Will the noble Lord confirm that? Will he also say why the Secretary of State appeared to dismiss the idea of independent mediation yesterday, has said today that they have not ruled out conciliation, but has again set preconditions, including the imposition of a contract? I have been bemused by the Secretary of State’s approach. Does he understand that the junior doctors are particularly angry about the way the Health Secretary has repeatedly conflated the reform of the junior doctors contract with seven-day services, including the highly selective and misleading use of statistics which has been disowned by the very authors of the research he quotes from?

Junior doctors already work weekends; they already work nights. Why on earth are the Government picking a fight with the very people who are so crucial to keeping the NHS running? There are nine days left before the first day of planned industrial action. I have one message for the Minister: it is time to talk.

[Lord Prior of Brampton]

My Lords, the noble Lord said that this was a serious concern. It is a tragedy that we are in this situation. Of course I want a settlement, as does the Secretary of State. The last thing we want is a strike. We want the junior doctors to come back to the negotiating table and not to go on strike. The only people who will suffer from a strike are patients. I cannot believe that there are many junior doctors who want to go on strike, so it is in all our interests to find a settlement, and the Secretary of State, myself and others are very keen that we do so. The Secretary of State has made it absolutely clear that there are no preconditions, save that we settle this issue within the existing pay envelope. The door is open to the BMA to come back for talks at any time.

Health: Global Health

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Monday 26th October 2015 Lords Chamber

[Lord Prior of Brampton]

I agree with the noble Baroness that there is always plenty that we can learn from other countries. She cited one example, and I am sure there are many others. There is never any room for complacency. Other parts of the world are also making huge advances. One of the findings of the all-party parliamentary group’s report is that we face increasing competition not just from countries such as America, but from South Korea and Singapore, for example. The noble Baroness is right: we must always learn from others.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the report is abundantly clear that the UK gains enormously from its work in other countries but it is also clear that, taking the point of the noble Lord, Lord Crisp, many of our universities are very inhibited in recruiting the overseas talent that reinforces the UK as a global leader because of Home Office policies restricting entry to work in our universities and other institutions. One of the report’s recommendations is that the Home Office review immigration policy in this area. Can the Minister confirm that his department is urging the Home Office to get on with it?

[Lord Prior of Brampton]

I understand that the Home Office is in the middle of this review and is due to report back later this year or early in 2016. It is also worth noting that this important report said we are No. 2 in attracting overseas students to come to England to train as doctors. I think America is No. 1.

Health: Post-polio Syndrome

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 20th October 2015 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government whether they will develop a strategy for post-polio syndrome.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, the NHS Five Year Forward View sets out a number of high-level objectives that will support better care for people living with long-term conditions, including post-polio syndrome. Our overall approach is to enable person-centred care so that health services can work in partnership with people to manage their symptoms and improve their quality of life. The Government wish the British Polio Fellowship every success with its post-polio syndrome awareness day this Thursday.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am sure that the Minister’s response on that latter point will be very welcome. He will be aware that an estimated 120,000 people are affected by post-polio syndrome. This will often occur years after they contracted polio and it brings pain and tiredness. The problem is that the NHS is largely unaware of the condition. There are very few specialist consultants, GPs do not usually recognise it, and the orthotic services are not geared up to provide some of the appliances that are necessary to ease the pain. Is the Minister prepared to look at this again to see whether some kind of national strategy or care pathway could be produced which would lead to a much greater consistency of provision in the health service?

[Lord Prior of Brampton]

The noble Lord is right that there is no specific pathway for people suffering from post-polio syndrome. NHS England will approach this on the basis of all long-term conditions rather than segmenting them by individual disease categories. I will be very happy to meet with him outside the House to discuss this.

Primary Care: Targets

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 13th October 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Lord makes an interesting point. I do not have an answer to give him today, but perhaps I may reflect on that and come back to him.

[Lord Hunt of Kings Heath (Lab)]

My Lords, clearly the role of community pharmacists could be enormous in the future, but in the end we still need more GPs. I have yet to be convinced that the Government really do have a programme that will effectively make sure that current GPs stay in the profession and that new GPs enter it. Can the Minister confirm that a number of the seven-day working pilots involving primary care have had to be cut back because of a shortage of GPs?

[Lord Prior of Brampton]

I cannot confirm that a number of the pilots have been cut back because of a shortage of GPs. I assure the noble Lord that we are committed to having an additional 5,000 doctors and a further 5,000 professionals working in general practice by 2020. That is a key priority for the Government.

NHS: Mental Health Patient Assessment Needs

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Monday 12th October 2015 Lords Chamber

[Lord Prior of Brampton]

In picking up the general point that the noble Baroness made, the Government have committed a great deal of extra resource to the mental health needs of young people. For example, I cite the NHS mandate and the Health and Social Care Act 2012, in which there is a duty to establish parity of esteem between mental health and physical health. It is also true that one can never do enough, and when one hears about a tragic case such as that described by my noble friend earlier, one has to look very carefully in the mirror and ask whether one could do more. That is why I have offered to meet my noble friend outside this House to discuss the matter in more detail.

[Lord Hunt of Kings Heath (Lab)]

My Lords, on parity of esteem, is it not a fact that, in their allocations, clinical commissioning groups have reduced the proportion of resource going into mental health services? Will the Minister tell the House what he is going to do about that? He mentioned the mandate. He will know that, in 2012, the mandate said:

“By March 2015, we expect measurable progress towards achieving true parity of esteem”.

Can the Minister tell me that that progress has now been achieved?

[Lord Prior of Brampton]

I cannot tell the House that we have achieved parity of esteem. Demonstrably, across the country, we have not yet achieved parity of esteem, but we are on a journey to doing so. On the figures that the noble Lord raised, we spent £300 million more last year than the year before on mental health, and every CCG is spending more on mental health this year than the overall increase in their allocation. At the end of October, we will have the figures for the first six months, and perhaps then I can come back to the House and give him those figures in more detail.

Child Health: Play

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Monday 12th October 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, when I am asked a question like that in such an engaging way, the answer has to be yes—and I look forward to it. I congratulate the noble Baroness and her team on the work that they have done with the all-party group on the fit and healthy child—I believe that the report is due to be published later this week. It almost goes without argument, and you do not need a lot of academic literature or UN conventions to know, that play is hugely important in the development of a child. On that, we are absolutely agreed, and I look forward to discussing with her ways in which we can help more in that regard later in the week or next week.

[Lord Hunt of Kings Heath (Lab)]

My Lords, perhaps I could come, too; it sounds a jolly interesting meeting. Does the Minister agree that while fitness is very important for young people, so, too, is diet? Would he like to comment on the story on the front page of the Daily Telegraph this morning which suggests that his boss has prevented Public Health England publishing a report which shows the direct link between too much sugar and obesity? Will he confirm that the Secretary of State has prevented PHE publishing the report and can he tell me what action the Government propose to take to reduce the amount of sugar in foods that children take?

[Lord Prior of Brampton]

I regret that I have not seen the report in the Daily Telegraph, so I cannot confirm or deny what was written in it. What I can say is that the Secretary of State regards the fact that one in five primary school-age children is now obese as being, in his words, a “great scandal”. The report on childhood obesity is due to be produced, I think, before the end of the year, and certainly within the next few months. I imagine that it will say that the problems are a combination of lack of exercise, lack of play and nutrition—but we will have to wait and see.

Health: Detection Dogs

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Thursday 17th September 2015 Lords Chamber

[Lord Prior of Brampton]

It is interesting that the cost of training a dog is some £11,200—considerably less than the cost of training a doctor, I might add. Unquestionably there is considerable evidence to suggest that dogs can make a real contribution as regards people suffering from diabetes and low-sugar problems, whom the noble Baroness mentioned. Decisions in this area are for local CCGs to make, but it is something that we will certainly encourage.

[Lord Hunt of Kings Heath (Lab)]

My Lords, that is a clear hint of the Government’s new approach to the workforce shortage in doctors. We will see the outcome of the Milton Keynes trial, but does he agree that the organisation Pets as Therapy needs to be praised? I do not know about dogs detecting illnesses but they have certainly been shown to provide great companionship to patients, particularly long-stay patients in hospitals and care homes. This organisation does a fantastic job.

[Lord Prior of Brampton]

I agree with the noble Lord. Dogs—indeed, all pets—can provide companionship to many people who are lonely, particularly elderly people who have lost many of their relations. I congratulate Pets as Therapy.

NHS: Clinical Commissioning Groups

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Wednesday 16th September 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness is right that there is considerable variation in the performance of CCGs and, indeed, commissioning support groups. In an effort to address that variation, we are in discussions with the King’s Fund to publish in a very transparent and open way the performance of individual CCGs.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister will be aware that the Global Burden of Diseases, Injuries, and Risk Factors Study was published in the Lancet yesterday. It showed that if the south-east of England were a country, it would come top of the 22 most industrialised countries in terms of health outcomes, whereas the north-west would be in the bottom range of countries. Does he accept that in the end this is a ministerial responsibility, and can he explain why allocations to CCGs, last year and this year, put much more money into the south-east of England than into the north-west?

[Lord Prior of Brampton]

The method of allocation is based around population, demographics and deprivation. The formula has developed over many years. The current formula was developed by the Nuffield Trust. There is no intention in the formula to skew the allocation from one part of the country to another. It is based in an independent and transparent way around population and deprivation.

Health: Children

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Thursday 10th September 2015 Lords Chamber

[Lord Prior of Brampton]

I have indeed read the report by the NCB, although it came out only on Monday so I have not fully digested its conclusions. I think that it very much echoes the work done by Michael Marmot four or five years ago. He said that the first two years, and certainly the first five years, of a child’s life are crucial in determining their subsequent standard of living and health. The variation that the NCB’s report has identified is extremely important. It is a variation not just between rich areas and poor areas but within deprived areas. That level of variation is best tackled at local level by local authorities. The decision to push the commissioning process down to local authorities is probably the right one, but they will be heavily supported by Public Health England.

[Lord Hunt of Kings Heath (Lab)]

My Lords, all the evidence suggests that there is a direct link between poverty and poor health outcomes. In view of that—and I accept that the Minister’s department has noble aims—what is his response to the work of the Child Poverty Action Group, which estimated very recently that by 2020, 4.7 million children will live in poverty? What representations has his department made to the DWP about its disastrous welfare policies?

[Lord Prior of Brampton]

My Lords, the causes of childhood poverty are profound. They are to do with employment, family relationships and education. The work that the DWP is doing with its troubled families programme and the work that the Department for Education is doing in improving educational standards will have a much greater impact on childhood poverty than, for example, focusing solely on things such as tax credits.

Police: Ambulance Support

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Thursday 16th July 2015 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, on the question of the London Ambulance Service’s performance, when does the Minister expect the LAS to perform according to the targets that it has been set?

[Lord Prior of Brampton]

The performance of the London Ambulance Service is improving, albeit too slowly. A new chief executive has just been appointed and the TDA is following the performance extremely carefully. We hope that improvements will continue to be made.

National Institute for Health and Care Excellence

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Monday 13th July 2015 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government why the National Institute for Health and Care Excellence was asked to suspend its work on safe staffing guidelines regarding nurses.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

The Government are committed to supporting NHS trusts to put in place sustained safe staffing by using their resources as effectively as possible for patients. The existing National Institute for Health and Care Excellence guidance on maternity settings and acute in-patient wards will continue to be used by NHS trusts. NHS England, working with NICE and other national organisations, will continue with this work in other areas of care and other healthcare professional groups.

[Lord Hunt of Kings Heath (Lab)]

I am grateful to the noble Lord, but that does not explain why NHS England put pressure on NICE to stop working on guidelines on safe staffing levels, despite the recommendation of Sir Robert Francis following the Mid Staffordshire inquiry. Was it because NHS England was no longer prepared to fund the implications of such work? Given that NICE has now decided to continue with work on A&E guidelines, will the Minister assure me that the Government will insist that the NHS implements those guidelines?

--- Later in debate ---

[Lord Prior of Brampton]

The noble Lord raises a good point. We need to train as many of our own nurses as possible. There will be times when we get those calculations wrong and it will be necessary to bring in nurses from overseas. That is not a desirable outcome for many reasons, which there is not time to go into today. We need to train more ourselves.

[Lord Hunt of Kings Heath (Lab)]

My Lords, will the Minister have another go at the Question? I still fail to understand why an independent body, NICE, was instructed by NHS England to discontinue work on safe staffing guidelines. What on earth caused NHS England to do that?

[Lord Prior of Brampton]

NICE has not been instructed to cease its work on safe staffing standards; on the contrary, it has been asked by NHS England to provide it with appropriate guidance.

Health Funding

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Thursday 9th July 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness will know that decisions on these matters are left to local authorities, and we wish to give them as much discretion as we can.

[Lord Hunt of Kings Heath (Lab)]

My Lords, there is not much discretion if the Treasury decides to take away £200 million in-year on public health programmes from local authorities. If the intention is to squeeze the public health budget, will the Government therefore take action at national level to compensate for this by legislating to reduce the amount of fat, salt and sugar in food and drinks that are aimed mainly at children and young people?

[Lord Prior of Brampton]

My Lords, prevention is very important to the Government and a very important part of the NHS Five Year Forward View. The reduction of £200 million in the grant to local authorities should be seen in the context of a total grant of £3.2 billion; it is a 6% reduction. Public Health England has a campaign to raise awareness of the damage that sugar and salt, as well as smoking and alcohol, can do to people’s lives.

NHS: Whistleblowing

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Tuesday 30th June 2015 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Lord rightly expects a fundamental change of culture among NHS bodies, but does he agree that one way in which that could be helped would be if Ministers welcomed criticism from chief executives and leaders of those bodies of unrealistic expectation on the part of Ministers and of there being too few resources? Does he agree that such leaders are stamped on for making their views known, which is simply not conducive to encouraging openness in their own organisations?

[Lord Prior of Brampton]

The noble Lord makes a good point. If one looks back at the history of Mid-Staffordshire, one sees clear evidence that the priorities of that organisation were too skewed towards hitting financial targets and meeting other extraneous objectives such as becoming a foundation trust. The message to all NHS organisations should be that patient safety and quality of care come first.

NHS: Immigration Rules

Debate between Lord Hunt of Kings Heath and Lord Prior of Brampton

Wednesday 24th June 2015 Lords Chamber

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what their response is to the Royal College of Nursing report concerning the impact of immigration rules on the employment of foreign nurses within the National Health Service.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, ensuring we have the right number of nurses is vital. That is why we are taking the issue of nursing recruitment seriously and have prioritised and invested in front-line staff, so there are over 8,600 more nurses on our wards. Health Education England’s workforce plan for England for 2015-16 forecasts that, following further increases in the number of training commissions, the proposed levels for nurse training will deliver over 23,000 more nurses by 2019.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Lord will know that the RCN report estimates that as a result of the migration rules around 7,000 nurses will be forced to leave the NHS because they do not reach the £35,000 per annum employment threshold. Despite the modest increase in the number of training places, is he confident that that gap can be filled, alongside dealing with the current recruitment crisis, the extra nurses needed for seven-day working, the extra nurses needed for improved patient-staff ratios and the Government’s indication that they want to rule out the use of agency nurses in future? When will all those policies be adopted alongside the 7,000 reduction in overseas nurses?