NHS Funding

Lord Lansley Excerpts

Monday 31st October 2016 Lords Chamber

[Lord Prior of Brampton]

I entirely agree with the comments made by the noble Lord. We have to integrate health and social care to a much greater extent. We also have to integrate healthcare: healthcare is delivered in silos and is highly fragmented around the country, and that comes out of the same budget, so he is absolutely right. However, we have to recognise that another massive reorganisation between social care and healthcare could be highly disruptive. The great beauty of the STP process is that people in local areas—local authorities, health providers and commissioners—are sitting around tables coming up with plans for their local areas.

[Lord Lansley (Con)]

My Lords, does my noble friend agree that it is only by virtue of the 2012 Act that NHS England is an independent body, able to express, on behalf of the NHS, a plan for the future, and that this would not have been possible otherwise? Will he further confirm that the coalition Government, in the last Parliament, met their promise to increase the NHS budget in real terms, year on year, but that that promise applied to an NHS budget that included public health and NHS education and training? The NHS’s future sustainability requires a more preventive approach and increased numbers of domestically trained NHS staff.

[Lord Prior of Brampton]

I entirely agree with my noble friend that the independence of NHS England has been very important. Had the NHS plan been developed by politicians it would have had a lot less credibility. I entirely agree that prevention and public health are hugely important, but of course it takes a long time for public health initiatives to have an impact, so I do not think that any reductions in them in the last two years will have any major impact over the five-year period. Clearly, it will have an impact over a longer period. As for the changes to Health Education England, those savings have largely been generated by moving from a bursary system for nurses to a loans system, which will actually deliver more nurses and therefore help to deliver the five-year forward view.

Drug-Resistant Infections

Lord Lansley Excerpts

Thursday 15th September 2016 Lords Chamber

Moved by

[Lord Lansley]

That this House takes note of the report Tackling Drug-Resistant Infections Globally: Final Report and Recommendations, published on 16 May.

[Lord Lansley (Con)]

My Lords, it is my privilege to be able to introduce a debate on the subject of tackling drug-resistant infections and in particular to take note of, and certainly to welcome and take forward in our debate, the review on antimicrobial resistance led by my noble friend Lord O’Neill. It is a great pleasure to see him in his place for the debate.

In his 1945 Nobel Prize lecture Alexander Fleming said, some 17 years after his discovery of the antibiotic properties of penicillin:

“Then there is the danger that the ignorant man may easily underdose himself … He buys some penicillin and gives himself, not enough to kill the streptococci but enough to educate them to resist penicillin”.

Those words were prophetic in terms of the emergence of antibiotic resistance, which did indeed occur shortly thereafter. But for the subsequent 40 years or thereabouts, although such resistance did regularly emerge, the discovery and development of new antibiotics gave us all an increasing reassurance that no longer would we fall victim to infections either as readily or as rapidly as did our forebears. The burden of mortality, particularly in developed countries, has shifted from infectious diseases to non-communicable disease. Over time, however, the development of increasing antibiotic resistance across a range of bacterial infections has outstripped the limited further development of novel antibiotics, and the extent of the use of the drugs which are currently available has increasingly prompted the development of organisms capable of near universal resistance.

In this decade, and especially over the past three to four years, we have seen a most welcome high-level political and scientific awareness and response to the risks we face from antimicrobial resistance. In this country, not least following the urgings of the Chief Medical Officer, to whom I pay tribute in this regard, the coalition Government adopted in 2013 a five-year strategy. In 2014 the Prime Minister asked my noble friend Lord O’Neill and his team to look at the global response. Working with the Wellcome Trust, the review has produced a series of reports over time describing the extent of the risks we face, how to seek to contain those risks by extending the life of our existing antibiotics through reducing unnecessary use not only in humans but also in animals and the environment, how to speed up diagnosis so as to deliver the right treatment by limiting the use of antibiotics to what is necessary, and to promote the development of new drugs, vaccines and other approaches to combating infections.

Those several papers were brought together in May this year in the review’s final report. I am most grateful to your Lordships’ House for the opportunity to debate that report soon after its publication, and in particular to do so in the wake of the discussions at the G7 and the G20, and in anticipation of the UN high-level meeting on antimicrobial resistance next Wednesday, to take place in the General Assembly. I see our short debate as needing to enable this House to talk about how we move forward from the analysis, work and achievements thus far to try to generate more action and measurable progress. If we do not, my noble friend Lord O’Neill’s report quantifies the risk we face: in the next 35 years the mortality attributable to AMR could rise from 700,000 across the world to some 10 million. Our children and grandchildren could be vulnerable to infections we thought we had conquered.

We need to avoid seeing this as simply a future threat. It is a clear and present danger. If I may, I will delve into the review’s report for one example, which I thought conveyed that very persuasively. It is about dealing with drug-resistant E. coli. Its prediction of what it might look like in 35 years’ time was that some 40% of the economic impact of drug-resistant infections would be attributable to drug-resistant E. coli. But that drug-resistant E. coli is already with us. Incidence of carbapenem-resistant E. coli has doubled between 2008 and 2013 in the United Kingdom alone. There are countries in Europe where it is endemic. The last-line antibiotic to combat it is not always now effective. There are isolated incidents of it failing.

In its methodology, the review conducted research to look at what would happen if, over the next decade, there was an increase in drug resistant E. coli similar to the increase in the last decade of a parallel pneumococcal bacterium. Using that assumption, it would mean that in Europe by 2026, which is only 10 years from now, 40,000 more people would die from E. coli infections as a result, but if we were to develop the additional new and rapid diagnostic systems we need, that in itself could save 6,000 of those lives. If a new antibiotic to combat it were available, a further 7,300 lives could be saved. That is a measureable, specific example of the threat we face and combat, not at some distant time, but now.

We should thoroughly welcome the report and focus on how we now turn this into action. If the House will forgive me, I will not dwell on the importance of the reduction of infection itself through the adoption of the most rigorous means of dealing with hygiene and clinical practice. We have done that a lot over the years. We can demonstrate in this country that after 2006 and all the way through to now, and, I am happy to say, under the coalition Government in the last Parliament, we continued to see a dramatic reduction in the incidence of MRSA and Clostridium difficile in our hospitals. We can take some pride in what we have achieved, but it needs to be true for combating all bacterial infections.

In addition, we need now to have measurable progress. Key to that is surveillance. This is a global threat and we need surveillance globally to be at a high level. I am sure my noble friend the Minister will refer to the Government’s Fleming fund, which gives us a place and resources that can make a dramatic impact on that surveillance. However, my first of a number of suggestions is that through the Department for International Development and the deployment of our international aid budget we can say to the people of this country that that budget can be of direct, significant benefit to them, not only if we deploy it in reinforcing basic health systems in many of the most vulnerable countries—the importance of developing that basic health infrastructure was demonstrated during the Ebola outbreak—but also if we go on to make sure we have lab capacity and surveillance systems, diagnostics and treatment protocols enabling us to combat the rise of drug-resistant infections.

We need quantification of this here and in developed countries. As with everywhere in my experience of healthcare systems, understanding variation and the reasons for it, and combating the worst to bring everybody to the level of the best, are critical. The quantification in this respect shows at least a threefold variation in the use of antibiotics in developed countries. Some use far more antibiotics than other countries. We are not the least: countries such as the Netherlands have extremely good records on antibiotic use. We need to bring everybody not through their national action plans but in the global system to the best possible level of activity.

I focus for a moment on animal health. The One Health model, in working together with the veterinary world, characterises the approach of the World Health Organization to this. It is really important that we reduce the unnecessary use of antibiotics in animal health. Of course, we cannot say that there should not be proper use of antibiotics for animal health but we must reduce the level of prophylactic use in animals. We should look—as I know the Americans are, and we are in Europe—for the elimination of antibiotic use simply for the promotion of growth in animals rather than for treatment. We should make sure that the use of antibiotics in animals is properly subject to veterinary supervision. We should also consider reserving the necessary but small number of last-line antibiotics for human health purposes rather than have them deployed in animal health, with the finite risk of infections forming drug resistance in animal populations and spreading to humans.

The improvement of rapid diagnostics is terrifically important. The Longitude Prize demonstrated public awareness and support for developing cheap, accurate and rapid point-of-care test kits for bacterial infection. That is vital and I hope we will hear more about it. The technology platforms and many of the assays are there. In the NHS, often there is a tendency for innovation, for promoting innovation and seeking to bring it forward, but then it all stops at the moment it should be rolled out through a procurement process within the NHS. In this context, now is the moment to think about putting into the NHS mandate, to be published later this year, specific proposals relating to the NHS England approach to the rollout of rapid diagnostics and the resistance of antibiotic use in the NHS. For example, in America, two-thirds of antibiotics are frankly not needed by those to whom they are prescribed.

I will not dwell on regulated co-operation but frankly we must do a lot of that in clinical trials. Some 80% of the cost of developing a new drug is in clinical trials. If we can make clinical trial practice across the world more consistent and easier to achieve, we will do an enormous amount to bring through new medicines. We must do that; we must bring through new antibiotics. Vaccines have a lot to offer in this respect. Perhaps at the moment we underestimate what we can do. It would make an enormous difference in reducing the overall use of antibiotics if some common infections, such as Clostridium difficile, were capable of being immunised against. We would see the prospective benefit of that. We should use vaccines as a cost-effective approach wherever we can.

On generating new treatments, the US has gone down the road of generating antibiotic incentives though the GAIN system, which gives priority review and market exclusivity. Frankly, if we want a global response we should look at how successful that system is. The US has approved five new antibiotics so far under that proposal. It could be allied to market entry reward, as the review recommends, and that reward could be made much more affordable across the world if market exclusivity—even a transferable market exclusivity—could be allied to it.

Let me conclude. Those are some of the key areas; I have not attempted to talk about all 10 key recommendations. Getting that One Health approach by working on animal as well as human health, as I have described, and really focusing on rapid diagnostics, where we could make an enormous impact quickly with technology that is already available, can take us a long way. However, we need the global system to respond. The G7 recommendations that I read seemed compelling and supportive but did not actually involve much pledging—for example, to support the global innovation fund which Her Majesty’s Government have put in place. That fund needs to be matched and added to by other countries around the world to bring forward new treatments. In the G20 conclusions, I saw that one paragraph at the end—almost an afterthought—simply called for a report back over the course of the coming year to the Berlin meeting. That seemed disappointing.

I look very much for the UN high-level meeting to take measurable and decisive actions in this respect. It is always difficult. I was a chair of a High-Level Meeting on Non-communicable Diseases, back in 2011, where we thought that we might be able to generate a response similar to that of the high-level meeting on HIV many years before. I do not think that it happened. However, what we need for antimicrobial resistance is for the UN high-level meeting next Wednesday to generate the sort of global response in tackling this threat that we saw years back by the UN high-level meeting in relation to HIV. That is what I would like us to achieve. I hope that more of the contributions in today’s debate will prompt that to happen. I am grateful to your Lordships.

--- Later in debate ---

[Lord Lansley]

My Lords, I have been in your Lordships’ House for less than a year and once again I am reminded of how much relevant expertise can be brought to an important subject—in this case an extremely important subject—even in the course of a short debate. I am most grateful to all noble Lords who contributed to the debate. It not only gave force to the report we are taking note of and reinforced our thanks to my noble friend Lord O’Neill of Gatley and his colleagues for an excellent review that is a basis for taking action, but illustrated in a number of specifics how that action should be taken forward, highlighting some of the opportunities that lie ahead in tackling the extremely dangerous situation in which we might otherwise find ourselves.

I was grateful to my noble friend Lord Rees—if I may call him that on a Cambridge basis. The Longitude Prize and the work that went into it demonstrated magnificently that there is public recognition and awareness of the importance of tackling antibiotic resistance and doing so rapidly. I had not realised that there is a 30 minute/90 minute distinction between us and the United States, but I am with the Longitude Prize panel here in saying that we are looking for 30 minutes. These kinds of rapid, desktop, easy-to-use diagnostics can make a fabulous difference: first, in identifying viral rather than bacterial infections—innumerable prescriptions are issued for antibiotics for what turns out to be a viral infection—and in identifying what character of infection we are dealing with and to what antibiotics it may be susceptible. That will make a dramatic difference, and what the noble Lord said about that work was encouraging. That is of the moment; in the current few months that work is being reviewed and it will be reviewed regularly over the period ahead.

I am grateful to my noble friend Lord Selborne for sharing the expertise of the Science and Technology Committee. We were reminded of the previous work of the committee, to which he brought his expertise. He reminded us that the survival of the most adaptable organisms is a demonstration of the underlying biological power of bacterial infection which we have to deal with—we have to be eternally vigilant about that. I will pick out one other thing. He talked quite rightly about the Davos declaration and the relationship with the pharmaceutical industry. The declaration in January was important but we have to take this forward.

I am not sure that I have yet heard from my noble friend Lord Prior in his response to the debate how we can mobilise on a global basis a system of incentives for market entry that we know will be effective in mobilising the pharmaceutical industry’s capacity—to the extent that it has such capacity—to find new treatments. Clearly there is a desire on the part of the industry for this to happen and a desire on the part of Governments to make it happen, but different and distinctive approaches are being taken, whether it is the American one, the market-entry process or the European support for innovation. We need to bring these together, and if we are to deal with this globally, we need to look for a global solution among some of the leading countries. My personal view is that a combination of extended market exclusivity plus a market-entry incentive could be affordable and achievable. I hope that that will be taken forward by some of the leading Governments working together.

The noble Lord, Lord Trees, reminded us compellingly of what has been done in this country and needs to be done elsewhere. That is the essence of it: it is about taking the example of this country and making it global in tackling inappropriate and extensive antibiotic use in animal health, agriculture and the environment. That can be done, as we have demonstrated here.

As the noble Baroness, Lady Walmsley, among others, said, there may be a role for us in trade control and in trying to make sure that it is not productive or profitable for people in other countries to produce food through the inappropriate use of antibiotics. We should certainly look at that.

I am grateful to my noble friend Lord Colwyn for talking about how we can find new treatments. I was always aware of the disinfectant properties of hydrogen peroxide but I was not aware that reactive oxygens specifically could achieve the control of infections in individuals.

The noble Baroness, Lady Hayman, rightly illustrated why vaccines could constitute the most cost-effective and important approach. The noble Baroness, Lady Walmsley, also mentioned vaccine development, and these questions need to be taken up.

Finally, with the high-level meeting coming up, I will say this to my noble friend the Minister: I hope that the Government will take every opportunity next Wednesday to encourage those at the meeting to look for quantified progress in the way that our national action plan does and some other national action plans do. There is no reason now why we should not look for a global action plan that has quantifiable targets. Allied to that, we need more pledges to support the funding that the British Government are putting forward. I hope that, through the high-level meeting, there will be structural follow-up.

The Minister referred to the G20 and said that it was looking to return to this next year, but that is not sufficient. We want structural action to take place straight after that meeting. I am very grateful to your Lordships for their contributions.

Motion agreed.

NHS: Health and Social Care Act 2012

Lord Lansley Excerpts

Thursday 8th September 2016 Lords Chamber

[Lord Lansley (Con)]

My Lords, I am sure that we are grateful to the noble Viscount for initiating the debate. I hope that the debate will be more directed towards the future of the National Health Service, its sustainability and how it can achieve improving quality. I do not, therefore, propose to examine in detail the many assertions made in the noble Viscount’s speech, but I put on record that I think there were many errors in what he had to say about the past.

On one particular point, from my personal point of view, I will just say this. As the Conservative Party’s lead spokesman on health for more than nine years, I am proud that, with David Cameron’s active support, we made it very clear that we would not at any point countenance a shift away from the NHS as a comprehensive, universal service, available free at the point of use and funded out of general taxation. I am also proud that, in the midst of the financial imperatives that we faced in 2010, he and I, together with our Liberal Democrat colleagues in coalition, gave the NHS the priority that it needed and increased its budget in real terms through the last Parliament.

What did the Health and Social Care Act set out to do? It was and has been a structural change. It was founded on a set of principles that were not new to the National Health Service at all. Over the preceding 20 years, pretty much every Secretary of State agreed, with the exception of Frank Dobson—the noble Viscount in his speech was at least even-handed in condemning past Labour Governments and coalitions as well as the Conservative Party—that we needed to devolve responsibility within the National Health Service, to give greater freedoms to providers to promote patient choice and indeed to be very clear about the distinction between the commissioning function and the provider function. I make no bones about the fact that it is designed to create a stronger commissioning structure. Where I agree with the noble Viscount is that that is as yet an unfinished task.

There is a constant pressure within the National Health Service for the providers to control the structure of activity and for commissioners, not independently, to use their budgetary and statutory powers to determine what is in the best interests of patients. That actually is what is in the Bill. It does not say that there has to be compulsory competitive tendering. It does not tell the commissioners how they should go about it in terms of the use or otherwise of competition. What it says is that they have to use their powers in order to deliver what is in the best interests of patients, and if there is something that does not involve competition, they are entirely at liberty under the statute to do exactly that.

Secondly, what did the Health and Social Care Act not do? It did not introduce competition. There is a reason why the noble Viscount referred to 2006 as the starting point for his analysis of private sector activity on outsourcing in the National Health Service. It was in 2006 that the previous Labour Government introduced it. PFI is the largest element of privatisation, and there is nothing in the 2012 Act that requires any extension of privatisation. On the contrary, it did away with the past Labour Government’s ability under the law to discriminate in favour of the private sector. There is no potential to do that. The only reason why any commissioner should use the private sector is because it would provide a better service and at a lower cost. Actually, we shifted the structure of “any qualified provider”—which is not in the Act—from a cost basis to a quality basis; it has to provide a better quality and they are on the same tariffs.

What the Act also did not do is create deficits in the National Health Service. I am proud of the fact that, in the three years during which I was responsible for the financial situation in the National Health Service, it was in surplus all that time and, indeed, not on a declining trend. The number of trusts in deficit in 2013-14 was proportionately the same as in 2009-10. There are subsequent reasons why the NHS has shifted into financial deficit. It is partly to do with the Francis report, which came after I ceased to be Secretary of State. It is not that it was not a good report, but the response to it focused on the extension of staffing and measuring staffing, with the consequent impact on agency costs not least, rather than a focus on outcomes. I am proud of the fact that the outcomes framework for the National Health Service and a focus on quality and outcomes were at the heart of the reform process—and should be, and often still is not. Too often, the debate about the National Health Service is completely obsessed with inputs and activity levels, and far too little focused on outcomes. We have an outcomes framework and we should focus on it.

What do we need to do in the future? We should not, in my view, revert to monopoly. Sustainability and transformation plans, while they are rightly the product of collective and collaborative working, should not attempt to create monopolistic structures in the NHS because a monopoly in the NHS would do exactly the same thing as it does anywhere, which is to pretend, through offering short-term benefits, to provide long-term benefits but actually to entrench provider interests as opposed to the patient interests. We should not restrict choice and we should not end clinical commissioning. We should not allow the commissioning function and the provider function to be submerged into one organisation; they are distinct and separate, and the conflict of role between those two should not be confused. As to sustainability and transformation plans, we should not allow them to become what they were back in 2006, when there were substantial deficits, albeit at a time of rising resources. We should not allow them to be an effort to try to constrain demand by restricting supply, which is what tended to happen back in those days.

What we need is more integration, and the Act led, through health and well-being boards and the role of local government and its ancillary additional functions on public health, to a real opportunity for greater integration. The commissioning function should involve local government and the NHS very much working together. One of the principal reasons for the deficits is the lack of reform in social care, and we should implement Dilnot. As I have said in this House, there were reasons why it was not done, which I do not accept. It should have been done, it still must be done and it should form part of an input to social care.

Finally, we must acknowledge the necessity for the NHS to have the resources it needs for the future. Time does not permit me to explain all that, but we never would have anticipated in 2010 that we would go for a full decade with a less than 1% real-terms increase year by year. We have to accept that the sustainability of the NHS requires resources for the NHS and for social care on a scale that is not presently anticipated in the current spending review.

Tobacco and Related Products Regulations 2016

Lord Lansley Excerpts

Monday 4th July 2016 Lords Chamber

[Lord Faulkner of Worcester]

It is very interesting, because in countries which take tobacco cessation seriously, the tobacco industry is switching to vaping, as it knows its traditional market is largely lost. Only last month, in this country, it attempted to undermine public health by trying to overturn the standardised packaging regulations. It cannot be trusted.

Finally, I share my noble friend Lord Hunt’s call for continued funding for stop smoking services, making them accessible and available to all smokers, and for such services to work with electronic cigarettes. It is wrong that these services are being cut back while the regulations are being introduced.

Our aim must be to be as ambitious as the most committed nations are in achieving a tobacco-free society over the next few decades. Over the last 10 years, we have already come a huge distance in changing public attitudes towards smoking, which is now largely seen as a socially unacceptable behaviour. My concern over vaping is that it must not in any way renormalise the smoking habit.

[Lord Lansley (Con)]

My Lords, from my point of view, my noble friend Lord Callanan chose to talk very selectively about the record of the Conservative Party and the coalition Government in relation to tobacco control. I think he should bear in mind that Conservatives—myself, my noble friend Lord Young of Cookham—worked hard from the Opposition Benches in another place, and succeeded in securing the ban on smoking in public places. When we came into the coalition Government together, we implemented the ban on sales through vending machines and a progressive ban on displays in shops. I also initiated the consultation on standardised packaging, following discussions with Nicola Roxon, who was then Health Minister in Australia, which my successors have taken forward. The product of all that is that we have not only secured continuing reductions in the overall prevalence of smoking—albeit I could wish this rate was faster—but we secured, I think three years ago, recognition that we had among the toughest tobacco-control regimes anywhere in the world. That is right and we should strive to make that the case.

I know it would not be the effect of the Motion in the name of my noble friend Lord Callanan, but were it passed it would indicate your Lordships’ desire to withdraw the regulations if they could. That would be an entirely retrograde step. I will not go through all the ways in which the tobacco products directive helps to strengthen the tobacco control regime other than in relation to e-cigarettes, but it certainly does.

I will isolate one important point which has not yet been mentioned. Much of what we have done in recent years, from my point of view and that of my colleagues—Anne Milton when she was Public Health Minister, and I believe it was among Anna Soubry’s and Jane Ellison’s objectives subsequently—was to focus on reducing the initiation of smoking among young people. We have some 200,000 young people a year initiating smoking. That is what we have to bring down. We want to arrive at the point where the initiation of smoking is minimised. As part of that, we have to look frankly and critically at how electronic cigarettes and vaping can contribute to the reduction of smoking, through access to smoking cessation services. It is absolutely right and I do not have any brief against e-cigarettes in that respect. But, to pick up the final point made by the noble Lord, Lord Faulkner of Worcester, we have to understand what the social and behavioural impacts of large numbers of people continuing to smoke e-cigarettes in the long term look like. I am not sure that promoting it through advertising is necessarily the right way to go.

We should enable smokers to access e-cigarettes and vaping, and do everything we can through the public health budget. Noble Lords will know—I will go into it on another day when more time allows—that my objective in creating a separate public health budget with local authorities was to maximise and protect our preventive activity, not to see it subsequently reduced. I deplore that fact because we were making considerable progress with smoking cessation services, as we should. But we also have to ensure, in addition to the use of e-cigarettes in a way that reduces smoking, that we do not create a new mechanism which might entrench in young people an expectation that they should initiate any kind of smoking, be it through vaping and using e-cigarettes or, even worse, through smoking tobacco. For that reason I agree entirely with many other speakers that it would be undesirable to support my noble friend’s Motion, and I hope that the Minister will agree that we should reject it.

[Lord Rennard (LD)]

My Lords, the noble Lord, Lord Lansley, is to be greatly congratulated on his tremendous record of achievement in this area, and his advice this evening should be followed very carefully. I must declare my interest as a former director of Action on Smoking and Health. There is a consensus in the debate that using e-cigarettes is much safer than smoking. Together with other clean nicotine products, they have an important role to play in cutting tobacco consumption and improving public health, but I do not agree with the e-cigarette trade body brief which has been circulated. It claims that nicotine is not itself dangerous. As the noble Baroness, Lady Hollins, pointed out so effectively, we have to recognise that nicotine is a known toxin that is poisonous when swallowed and is also addictive.

I do not want to see e-cigarettes subject to more regulation than is necessary, but I do want to see them subject to all the appropriate regulation necessary to support public health objectives. We know that the best chance of success for people seeking to quit smoking is to use smoking cessation services as well as alternative nicotine products in order to help reduce withdrawal symptoms. The regulatory regime required for e-cigarettes and related products must be one that supports their use by smokers trying to quit. It is also right to discourage their use by children and young people who have never smoked. Both these objectives are supported by the regulations being introduced.

I agree with the many noble Lords who have said that we need a public information campaign to reassure smokers that electronic cigarettes are less harmful than normal smoking but, as the Motion in the name of the noble Lord, Lord Hunt, points out, there have been major cuts to the media campaigns to persuade smokers to quit. That is very regrettable because such campaigns can be highly cost effective in supporting quitting. We know that alternative nicotine products for smokers have most public benefit when they are used together with expert behavioural support. That is one reason why we need to make sure that such products can be available on prescription for people seeking help to quit tobacco products. Our approach to e-cigarettes, therefore, must be to treat them not as an exciting new social drug or as a cash cow for e-cigarette companies, many of which are owned by the tobacco industry, but as a potentially important means of improving public health and reducing the toll of death and disease caused by smoking.

The regulations under discussion are not perfect, but they include important steps in tobacco control that must not be lost and must be part of a tobacco control strategy that must be properly resourced to produce real public health dividends.

Health: Alcohol

Lord Lansley Excerpts

Thursday 12th May 2016 Lords Chamber

[Lord Prior of Brampton]

I am sure we will all be following in the noble Baroness’s wake when we do that. It is worth making the point that one of the benefits that came out of the responsibility deal, which I know not everyone in this House thinks was successful, is that the labelling on alcoholic products has got much better.

[Lord Lansley (Con)]

My Lords, my noble friend will be aware that the risk of dementia in later life is now one of the public’s principal concerns, and of course it is established that there is a relationship between harmful alcohol use and the risk of alcohol-related dementia and Korsakoff’s disease. The One You website does not readily click through to give that information so that people’s concern about dementia is something that they understand can be related to the harmful use of alcohol.

[Lord Prior of Brampton]

My Lords, that is an interesting point, which I will draw to the attention of Public Health England. If that click-through is not clear, it should be. Since the Blackfriars Bridge agreement, PHE has been working with Alzheimer’s UK to do more research into analysing the impact of alcohol on dementia.

Healthwatch England

Lord Lansley Excerpts

Tuesday 26th April 2016 Lords Chamber

[Lord Prior of Brampton]

I disagree. I had a private sector background when I became chairman of the CQC, I might add, so perhaps I am slightly biased in this regard. Having a mix of people from all different backgrounds, whether private, public or voluntary sector, is a very good thing.

[Lord Lansley (Con)]

My Lords, would my noble friend the Minister agree with me, as one who was responsible for the creation of Healthwatch, that there is a powerful rationale for its close working relationship with the CQC? The CQC needs to listen to the patient voice in the exercise of its responsibilities, and Healthwatch benefits significantly from being able to trigger action by the CQC where it finds that things are going wrong.

[Lord Prior of Brampton]

I agree with my noble friend. Healthwatch has two principal roles: first, to gather intelligence locally, which it can then feed into the CQC and its inspections; and secondly to be the strong voice of patients at a national level.

Royal National Orthopaedic Hospital: Redevelopment

Lord Lansley Excerpts

Thursday 17th March 2016 Grand Committee

[Lord Lansley (Con)]

My Lords, I am pleased to have the opportunity to contribute to the debate and to join colleagues in congratulating the noble Baroness, Lady Dean, on securing the debate and on the way she introduced it. She absolutely captured a sense of what the RNOH is and has been, and what it means for the patients whom it has looked after.

In that respect, I share with my noble friend Lord Tebbit a sense of gratitude for how the RNOH has looked after Margaret Tebbit. Indeed, it was at exactly the same time 30 years ago that I first got to know Stanmore because I was the Civil Service Private Secretary to my noble friend, who was then Secretary of State. When I was not carrying his box to and fro at Stanmore, I was learning about the hospital. About 25 years later, it was somewhat ironic that my noble friend was lobbying me as Secretary of State to secure the rebuilding of Stanmore. I believe he was right when he said that it would have been wholly wrong to have pursued the PFI route to secure the rebuilding of Stanmore. It was my responsibility in 2011 to say that that was not the way I thought Stanmore should go. I am pleased that that is not the way that the RNOH chose to go.

I will quickly say three things. First, I believe in specialist institutes in the NHS. That was not always the case. I remember that probably 25 or so years ago, Stanmore was being pushed to merge with Northwick Park. Subsequently, there were other proposals for the hospital to be absorbed into a large trust. All the evidence tells us that this is the wrong way to go. Amazingly, specialist institutes in the orthopaedic field, not just the RNOH but the Robert Jones and Agnes Hunt Orthopaedic Hospital in Gobowen near Oswestry, obtain excellent results. That is true for clinical outcomes and for innovation and research. When we introduced the friends and family test, I was especially struck by what fantastic numbers the specialist institutes, such as Stanmore and Gobowen, got on recommendations through the friends and family test from staff and patients. That is incontrovertible. That being the case, we have to find ways to support them where they are.

Secondly, the partnerships that they create are tremendously important. Papworth Hospital in my former constituency is going alongside Addenbrooke’s. It will remain a specialist institute but it needs to be alongside for clinical partnerships and research partnerships. Given its location, Stanmore does not need to move anywhere else for these partnerships to function. Indeed, as the noble Baroness said in introducing the debate, it has drawn UCL into an excellent bioengineering centre based at Stanmore. That is evidence of the partnerships that are integral to specialist institutes’ future success, not least because they need to be part of the academic health science networks to make that success work. Creating those partnerships is tremendously important and can secure its position.

Thirdly, and finally, however, we need to understand where the difficulties lie. RNOH is an extremely well-run hospital and has been for a very long time. The calibre of staffing and clinical leadership is excellent. For example, when we looked at MRSA bloodstream infections, notwithstanding the circumstances in which RNOH works, I do not think it has had such an infection for about seven years. That is a wonderful record. When you look at clinical leadership, Tim Briggs, a clinician at Stanmore, has been integral to the work that the noble Lord, Lord Carter, and his team are doing on delivering improvement and efficiency by demonstrating how it was done at the RNOH.

However, since the NHS is the overwhelming customer for this work, it is very hard if the tariff does not support it. We must recognise that the heart of the issue lies in the prudential work done by the TDA—and before it by the strategic health authorities and others—to ensure that the project and the hospital are financially sustainable for the long run. Frankly, it is not just about asking, “Is this a good project?” or, as my noble friend asked, “Do the numbers all stack up?”. I am sure that it can be afforded in the sense of borrowing being available, but what also needs to be affordable in the long run is the revenue to support it. That is where NHS England and Monitor, working together, need to bring in tariffs—not least through the latest iteration of ICD tariff structures when they get to them—that recognise the additional costs involved in the complex and specialised work done by hospitals such as the RNOH. Many big hospitals used to be able to carry such specialist work in the midst of very large amounts of routine work, but a specialist institute cannot do that. Indeed, many large hospitals cannot afford to do it now either. We need the NHS and Monitor together to design a tariff that recognises not only the quality but the cost involved in continuing to deliver this world-leading work.

Mental Health Taskforce

Lord Lansley Excerpts

Tuesday 23rd February 2016 Lords Chamber

[Lord Lansley (Con)]

My Lords, does my noble friend the Minister agree that in order to secure parity between physical and mental health services, it is important to ensure that mental health service providers are properly and fairly reimbursed for the activity they undertake rather than subject to a block grant system where physical health service providers are paid for the work they do? In that respect, will the Government commit to working with NHS England and NHS Improvement to make progress now in the development of tariff-based systems for mental health services which fairly reimburse for delivering quality in outcomes?

[Lord Prior of Brampton]

My noble friend is absolutely right. I am glad he finished by referring to quality in outcomes rather than just activity. That is the critical thing about getting the tariff right, that it is based not just on activity but on quality in outcomes.

Junior Doctors

Lord Lansley Excerpts

Monday 8th February 2016 Lords Chamber

[Lord Prior of Brampton]

It was always agreed that the package offered to junior doctors would be cost-neutral.

[Lord Lansley (Con)]

My Lords, does my noble friend the Minister recall, as I do, that it was a Conservative Administration who introduced the new deal for junior doctors and established a process by which unsafe, excessive hours for doctors were not to be pursued? That started happening in the early 1990s and no one is thinking that we would go back to that. I was delighted that my noble friend was able to make it clear how the negotiations can introduce additional guarantees about not having unsafe hours for junior doctors. However, I put it to him that at this stage in the negotiations there may be an alternative approach—an objective of enabling seven-day rostering for junior doctors, in this instance but also more widely, and an overall financial envelope. It might be put to the BMA that rather than it standing aside from the negotiations, it should take responsibility and say how it proposed that junior doctors should be remunerated within that financial envelope to meet those objectives.

[Lord Prior of Brampton]

My Lords, we certainly do not want to go back to the days when junior doctors were working very long and unsafe hours but nor should we ignore the fact that they do not, by and large, like being treated as shift workers. The continuity of care is very important to most professional doctors. As for the actual negotiations, I have not been directly involved with them so I do not know to what extent the junior doctors have been asked to consider what my noble friend Lord Lansley has suggested. However, what he says has much merit.

Health and Social Care: State Pension

Lord Lansley Excerpts

Thursday 21st January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I am afraid that I cannot today give my noble friend that chink or that hope, because we are supporting the NHS’s plan, which was developed and produced by the NHS. We believe that it would be wrong to set up an alternative at this stage.

[Lord Lansley (Con)]

My Lords, would my noble friend agree that, while the Government are fully funding the NHS five-year forward view, which is very welcome, the sustainability of NHS funding depends on the sustainability of social care services as well? Before establishing any other commissions, would not it be advisable for the Government to make progress on implementing the Dilnot commission’s recommendations? In that respect, will the Government specifically consider enabling that to proceed by removing the exemption on one’s principal personal residence when calculating the means test for domiciliary social care?

[Lord Prior of Brampton]

My Lords, as my noble friend knows, the Government accepted the findings of the Dilnot review but felt that now was not the right time to introduce them, given the financial pressures on local government. We are committed to introducing the Dilnot reforms by the end of this Parliament.