Childhood Obesity

Debate between Lord O'Shaughnessy and Baroness Walmsley

Thursday 13th December 2018 Lords Chamber

[Lord O’Shaughnessy]

I agree with the noble Lord about the importance of the issue and I am grateful to him for the role he has played in bringing that relationship together. He knows very well that the BBC has played a critical role over decades in many very important health campaigns, such as on HIV or the “Just Say No” campaign on drugs. The BBC is absolutely committed. Of course, it would be inappropriate for Ministers to lean on the BBC, which has editorial independence that I am sure we are all anxious to protect. However, it is committed to doing more. It is doing a number of activities through its programming, including the “Blue Peter” cooking club, various CBBC programmes and so on. I do not think anyone doubts the BBC’s commitment to this, and we will see the fruits of that soon, I am sure.

[Baroness Walmsley (LD)]

My Lords, is the Minister aware that food economists have calculated that, calorie for calorie, fruit, vegetables and high-quality proteins are much more expensive than foods high in carbohydrate and fat? Is it surprising that poor parents find that they have to fill up their children with those foods that eventually often lead to obesity? The structural underpinning of this problem is poverty, which goes much wider than the Minister’s department. It should be a whole-government issue. What are the Government doing about that?

[Lord O’Shaughnessy]

I absolutely recognise the problem that the noble Baroness has pointed out. The prevalence of childhood obesity doubles between the least deprived and the most deprived areas. The Government are committed to reducing that deprivation gap and taking a broad range of actions to combat poverty, none more so than making sure that everybody has the chance to work, which is why we have more people in employment than has ever been the case.

Blood Safety and Quality (Amendment) (EU Exit) Regulations 2019

Debate between Lord O'Shaughnessy and Baroness Walmsley

Wednesday 12th December 2018 Grand Committee

[Lord O'Shaughnessy]

I thank both noble Baronesses for their questions. I do not quite agree that this is a waste of time; after all Parliament voted both for a referendum and for a withdrawal Act, so we have to prepare for every eventuality even when we hope that they will not happen. This SI is particularly important for the continuity of this important medical product.

To deal with the questions posed by the noble Baronesses, communication with agencies is absolutely happening. It is being co-coordinated by NHS blood and transport—sorry, I always say “blood and transport” because it transports the blood; I mean NHS Blood and Transplant—as well as the relevant agencies in the devolved Administrations. We know that sometimes relationships between the DAs and Westminster can be strained, but I think it is fair to characterise them as being positive and co-operative on this and other health-related issues. We are making sure that all agencies are involved in that process, with central co-ordination and collaboration and consent from the DAs.

Regarding reassurance for people with rare diseases in respect of imports, the whole point here is that we would be operating to the same standards as the EU. In a no-deal scenario, we would also be accepting, as it were, the regulatory standards and approvals of the EU to ensure that such products were not impeded on their way into our country. As the Committee will know, a range of activities are going on to ensure continuity of supply through the borders.

On the point made by the noble Baroness, Lady Walmsley, there is nothing untoward about my comment that there is no policy change at this moment. The critical point here is that under the Bill we are limited to technical changes to address flaws in the legislation that emerge as a result of technical flaws moving from one situation to another. Of course any future Government can change policy; I cannot bind the hands of any Government of any kind in future years. However, I can tell noble Lords that we have no intention of watering down the standards, so please be reassured on that point.

On the question from the noble Baroness, Lady Thornton, about when this would happen, in a no-deal scenario it would happen from 30 March 2019, so it would be from day one onwards.

I turn to the remaining issues raised by the noble Baroness, Lady Walmsley. In Wales we effectively have a single market in blood products—that is one way of putting it—all working to agreed standards. From that point of view, there is no difference in the products that are used in different domains. I understand her point about hip replacements but I am not sure that it is an exact analogy. Of course the beauty of devolution is that we have choice and experimentation.

Lastly, on the important point about communications with the EU, the reason why that has been removed is that it is a reciprocal obligation. Obviously it is illogical to have a reciprocal obligation that can be fulfilled only by one side.

[Baroness Walmsley]

I accept that, of course, but what I want to know is what is going to be put in its place.

Breast Scans

Debate between Lord O'Shaughnessy and Baroness Walmsley

Monday 19th November 2018 Lords Chamber

[Lord O'Shaughnessy]

I am grateful to the noble Baroness for the Question and the spur to ask the advisory committee to look at this issue. She is quite right about the experience. It can be painful. As she pointed out, it is the experience of pain that puts some women off taking up their appointments. Around half a million each year do not take up the appointments they are invited to. That is obviously a problem if we want a comprehensive screening programme. I will make sure that the advisory committee not just considers the evidence for use of them, but looks at how we can get qualitative evidence from women to inform their use across the country.

[Baroness Walmsley (LD)]

My Lords, can the Minister encourage the NHS to do some proper research with the women who do not turn up for a mammogram when invited to do so and bear in mind that there is more than one reason why? In my case it is the very sharp edge of the plate that sticks under your armpit. It is really extremely painful. Will he agree that such discomfort should not discourage women from attending mammograms, which are so very important for saving thousands of lives, including my own?

[Lord O'Shaughnessy]

Absolutely. I completely agree with the noble Baroness. Indeed, breast cancer screening saves 1,300 women’s lives every year. It is an essential part of our health system. On why women do not turn up, Professor Sir Mike Richards is reviewing all the cancer screening programmes at the moment. I will specifically put that question to him to ask him to investigate it.

Domestic Abuse: General Practitioner Charges

Debate between Lord O'Shaughnessy and Baroness Walmsley

Thursday 15th November 2018 Lords Chamber

[Lord O'Shaughnessy]

I agree with the noble Lord. I feel uncomfortable with the idea of these letters being charged for. They have been identified by the Ministry of Justice and MHCLG as barriers to accessing support for victims of domestic violence. That cannot be right, and we are seeking to end that situation. GPs are independent contractors and therefore have that freedom unless it is specifically prohibited in their contracts, and that is what we are seeking.

[Baroness Walmsley (LD)]

My Lords, while supporting the concerns of the noble Lord, Lord Kennedy, perhaps I may point out that next week sees the International Day for the Elimination of Violence against Women. Will the Government celebrate the day and the end of austerity by funding more refuges and services for victims of domestic violence? This is necessary because during the recent years of austerity many refuges, which offered hundreds of safe places for women and their families, have been closed.

[Lord O'Shaughnessy]

I can reassure the noble Baroness that we will celebrate that day. I think this Prime Minister has done more than any to clamp down on domestic violence and to support victims. That was shown in the £100 million that was set aside to support victims of domestic violence in a number of innovative ways. I can further reassure her that, as I understand it, the number of beds in refuges has increased over the past few years.

Government Vision on Prevention

Debate between Lord O'Shaughnessy and Baroness Walmsley

Tuesday 6th November 2018 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, at last we have a Secretary of State who has been listening to my speeches over the years, or perhaps, more realistically, he has come to the same conclusion all by himself that the NHS is unsustainable with the changing demographics and higher demand unless we do something to prevent the 40% of illnesses that are preventable. I am therefore delighted to welcome the Secretary of State’s new focus on prevention.

However, he said in his speech yesterday that it is difficult to divert money into prevention unless funding is rising, because otherwise you will be taking money from treatment. Well, funding is rising. The Minister spoke about diverting part of the extra £20 billion for the NHS into prevention, but that is only part of the answer. This a whole-government problem. People do not live in hospitals or GP surgeries. They live in cities with polluted air, often in overcrowded and damp homes, in areas with too many fast-food outlets and too few fruit and vegetable shops where the local sports centre or swimming pool has closed. They are stressed about paying the bills on low wages or benefits.

Then there are lifestyle decisions. Often when people are in their own homes or the local pub, they smoke or send out for a high-fat and high-salt takeaway or drink too much alcohol. Many do not take enough exercise. They are subjected to large amounts of TV advertising for the wrong kind of food and drink, and far too many ads encourage them to gamble. None of this is good for their physical or mental health.

My point is that the organisations that can help them with this are often not the NHS or wider national government, although both can do a lot. I am speaking about local authorities, whose overall funding, particularly for public health services, has been cut since July 2015 and is projected to carry on being cut. Does the Minister think that this is in line with the Secretary of State’s vision? There is evidence that sexual health services, sports centres and weight management services have closed. Smoking, alcohol and drugs prevention and treatment services have been discontinued. Does the Minister not agree that some of the new funding should be diverted from the NHS into local authorities and ring-fenced to allow them to reinstate and widen these services? Of course, NHS professionals must be involved, but this should come under the public health responsibility of local authorities, where it correctly lies.

Councils run as many of these good services as they can but they cannot afford as many as are needed to stall the national epidemic of obesity and other preventable health problems. According to a systematic review of the available evidence, published online in the Journal of Epidemiology and Community Health, every £1 spent on public health saves £14 on average, as referred to by the noble Baroness, Lady Thornton. In some cases, significantly more than that is saved. We should listen to such a meaty piece of research. Local directors of public health claim that they can spend money more efficiently than the NHS to prevent ill health. Why not fund them to do so?

Turning to two other matters, I applaud the Secretary of State’s initiatives for people with learning difficulties; I strongly wish them well. However, the Minister will understand from my background in cannabis-based medicines that I am still very concerned about the too-restrictive guidance that has been published on prescribing pharmaceutical-grade cannabis-based medicines. It seems that there is still a bureaucratic nightmare for patients who thought that the Government’s recent relaxation of regulations meant that their troubles were over. I fear we do not have time now to go into this in detail, but I welcome the intention expressed in the Statement to get it right. What further reassurance can the Minister give me that clinicians will be given the information from patients and other countries to enable them to make sensible prescribing decisions—not just for Sativex and Epidiolex? Can he assure me that it will not have to be done as a last resort when a lot of licensed drugs with nasty side-effects have already been tried unsuccessfully?

[Lord O’Shaughnessy]

I am very grateful to the noble Baronesses, Lady Walmsley and Lady Thornton, for their questions. I concur completely with their point that the NHS is not sustainable if it is a national hospital service, which the Secretary of State was trying to get across yesterday. He used the stark figures of £97 billion being spent each year on treating illness and only £8 billion on preventing it. Clearly, we need a shift there. Investing more money makes that shift easier; I am glad that the House recognises that we are doing that.

Before I get on to the specifics of responsibility for health, I concur with the idea that this is a whole-government challenge. It is also a societal challenge; it is not just for government to make this happen. It is about people as well, as the Secretary of State said in his point about personal and family responsibilities. We all have a role to play in making it easier for people to do the right thing. That is quite different from a finger-wagging approach; it is about making sure that it is easy to make healthy rather than difficult choices. When you talk to people about that, they feel it is a sensible approach.

On the funding question that both noble Baronesses asked about, it is worth pointing out that local authorities received £16 billion over this SR period. That obviously involves a reduction, as they pointed out. The recent Budget did not change the funding. It has been suggested that it reduced it, which it did not. Clearly, any new budget for public health specifically and for the role of local authorities will be decided at the spending review next year. I hope the noble Baronesses will forgive me if I cannot say more about that, other than that I absolutely concur that local authorities have a critical role working with the third sector, industry and others. So does technology. Noble Lords will know that we have a real technophile in the Secretary of State. He is absolutely right that, while technology will not necessarily change everything, it gives us the possibility to change behaviours much more cheaply and more cost-effectively than in the past, which I hope means that we can do more with our money. That is the promise of new technology if we get it right.

On the specific questions on the prevention strategy, the noble Baroness, Lady Thornton, asked about junk food advertising. The consultation on that is due to be published before Christmas. We are trying to train more staff on children’s health. We are working with Health Education England on a health and care workforce plan as part of the long-term plan. She also mentioned health inequalities. The Prime Minister had been very clear that she wants people to enjoy five more years of healthy life. At the moment, on average, children being born today will live to the age of 81 but might have 18 years of unhealthy life and there is a great discrepancy in that depending on one’s demographic. The greatest gains from that will therefore be for the least advantaged. That is something we are focused on. It is part of the NHS mandate today and it will be part of the plan.

We have debated GP numbers in this House. There are record numbers of GPs in training and that flow will continue over the coming years. We are also determined to make sure that there is much better treatment for mental health, not only because people with mental illness die earlier—sometimes dramatically earlier—but because, as we have discussed and as is being discussed now in the other place, there is too much unacceptable use of in-patient facilities for people with mental illness, learning disabilities and autism. I am glad that the Secretary of State’s strong words on this have been well received. He is absolutely determined, as we all are, to ensure that we deal with this. We have made some progress but we have not got as far as we needed.

As to whether such facilities will be needed in the future, I think that they will. I visited Springfield University Hospital in south London recently. It is being redeveloped from a classic Victorian institution to something being designed with patients to be much more suitable for their needs, with better access to light and to communal areas where appropriate. These facilities have a role to play when properly modernised, but they ought to be used for only a short time. They ought to be close to home and there ought to be a discharge plan in place before they are used. Clearly, in some cases none of those things is happening and unacceptable care takes place, which we need to stop.

On the various Green Papers and so on, the Secretary of State has set out vision documents in areas he has identified as early priorities. A lot of this stuff will be wrapped up in the long-term plan that we will publish before Christmas. As we move ahead there will be Green Papers on key areas. Social care will be one, for not just older adults but working-age adults; there will be a prevention Green Paper on that in the new year. There will be many more for us to discuss, to the great delight of the House, I am sure.

The noble Baroness, Lady Walmsley, asked about cannabis medicine. We are treading a fine line in difficult territory. We know the great benefits that these medicines can bring and are bringing, particularly to children with some horrendous epilepsies and other illnesses. At the same time, we know that there are risks associated with the active ingredient THC. It is about trying to move forward in a way that is compassionate to patients but does not put them at undue risk while evidence is still being gathered.

I will say three things. First, we are trying to fund more research so we understand the real world impact of these kinds of medicines. Secondly, by rescheduling them to Schedule 2, THC-based medicines can be procured through an unlicensed medicines route, which was not something that was there before. That goes beyond the Sativex and Epidiolex question, in terms of licensed drugs at the moment, although again that will be done with care and caution by specialist doctors. NICE is working on a clinical guideline to supersede those currently in place, which are temporary guidelines. It will be gathering evidence as broadly as possible internationally from patient groups, clinicians, families, industry and elsewhere. I am confident that, while we have clearly not perfected the system yet, there is a genuine attempt to get a much better, more compassionate system that ensures that drugs such as this can get to people who will benefit from them when they need them. I am confident that we will get to the right position eventually.

Cannabis: Medicinal Uses

Debate between Lord O'Shaughnessy and Baroness Walmsley

Thursday 1st November 2018 Lords Chamber

[Lord O’Shaughnessy]

I can absolutely reassure my noble friend by reiterating the position outlined by my right honourable friend the Home Secretary. He has been crystal clear that the Government have no plans whatever to legalise cannabis for recreational use. Indeed, the penalties for unauthorised supply, possession and production remain unchanged.

[Baroness Walmsley (LD)]

My Lords, while it is true that the faculty warns against the use of dried cannabis plant of unknown composition, it accepts that there may be benefits to pain management from pharmaceutical products. Fortunately, that is exactly what patients are demanding and what the Government have just legalised. However, the faculty is also demanding that, while we wait for clinical trials, a database—which is essential to better understand these medicines—should be set up. Will the Minister support the setting up of this database and ensure that it contains the massive amount of lived evidence and experience available from patients?

[Lord O’Shaughnessy]

I am grateful to the noble Baroness for her question. I believe that the position we have reached now is the right one, not least driven by the heart-rending stories of children who had been benefiting from these kinds of medicines but were then not able to access them. It is a very good thing that we have got to this position. However, we also have to acknowledge—as the Chief Medical Officer did—that there is a lack of evidence, particularly beyond specific conditions such as paediatric epilepsy. It is precisely to provide that evidence that we are going to do two things: first, we will fund clinical trials through the NIHR, and, secondly, we will start collecting evidence and data on usage so that we can gain the evidence base to understand whether there are other applications where these medicines could be helpful.

General Practitioners

Debate between Lord O'Shaughnessy and Baroness Walmsley

Wednesday 17th October 2018 Lords Chamber

[Lord O'Shaughnessy]

My noble friend will know that pension policy is not one of my areas. There are early retirements from general practice but, as he pointed out, a number of those GPs come back either as locums or as part-time doctors. It is important to entice more of them back. That is why we aim to have 500 people going through our refresher scheme to bring GPs back into the service.

[Baroness Walmsley (LD)]

My Lords, I was rather surprised to learn that the Government were trying to recruit more doctors from Australia, the very country to which a great many of our newly qualified doctors go for better pay and conditions. What are the Government doing to try to recoup the taxpayers’ money spent on their training? It is surprising that they go to developed countries such as Australia, and that we get no benefit from the cost of their training.

[Lord O'Shaughnessy]

Some people will inevitably travel abroad after their training, but the vast majority of doctors who train in this country stay here. We have more GPs than ever in training. That is obviously the way to solve the long-term challenges of having the right workforce. However, the noble Baroness is absolutely right that we need to recruit from abroad in the short-to-medium term. The NHS has a recruitment target of 2,000 doctors via that route.

NHS: Equitable Access

Debate between Lord O'Shaughnessy and Baroness Walmsley

Thursday 5th July 2018 Lords Chamber

[Lord O'Shaughnessy]

I thank the noble Baroness for her Question and join the whole House in wishing many happy returns to the NHS on its 70th birthday. She asked an extremely good question: how do we make sure that the NHS is equipped for the future and that everybody can benefit from the technological advances we are seeing take place? I point her in the direction of three issues. First, the National Institute for Health Research has more than £1 billion of funding and supports the translation of research into new technology every day. It is based in the NHS and uses NHS staff. I have also recently commissioned the department to look at the money spent on innovation, which we think is around £750 million in total, to make sure that it supports the uptake of effective medicines and treatments better than it does today, and to make sure that staff have time. Finally, in response to her last question, as we set out during the passage of the withdrawal Act, we will align ourselves to the clinical trials regulation as much as possible, whatever the outcome of Brexit.

[Baroness Walmsley (LD)]

My Lords, as a member of the Parliament choir I am a bit tempted to start singing, but I will resist. Given the remarkable success of the various vaccination programmes during the 70-year history of the NHS, will the Minister say when preventive measures for two modern-day diseases will be made equitably and nationally available? I refer to pre-exposure prophylaxis for HIV, which has already been shown by the trials to be remarkably effective, and vaccination against human papillomavirus, which should be made available for teenage boys as well as teenage girls to ensure full protection.

[Lord O'Shaughnessy]

I am sorry that the noble Baroness has not started singing; I am sure that we would have all joined in. As she rightly said, the NHS carried out the first major public vaccination programme in the world. We have always led the world in vaccination programmes. As she said, prophylaxis has been deemed to be successful; I will need to write to her on the specifics of the rollout. On the HPV vaccine and its availability for boys, we are still waiting for the final recommendations of the joint committee on vaccinations. We will act on those as soon as we get them.

Cannabis-based Medicines

Debate between Lord O'Shaughnessy and Baroness Walmsley

Thursday 21st June 2018 Lords Chamber

[Lord O’Shaughnessy]

I will pass on my noble friend’s thanks to my right honourable colleagues. We agree with him that there is a very clear distinction: we know cannabis-based products can create harm but the question is whether they can also have therapeutic benefits. If they can, they need to be weighed in the balance and rescheduled appropriately. That does not diminish the negative impact that he has described that the recreational use of cannabis, particularly very strong strains, can have on young people.

[Baroness Walmsley (LD)]

My Lords, I thank the Minister for showing that he quite clearly understands the distinction between recreational and medicinal use. Is he also aware that Epidiolex, which is medicine produced by GW Pharmaceuticals for epilepsy sufferers and which will soon be approved, will not help children like Alfie Dingley who have uncontrolled epilepsy seizures? I understand that the cannabinoid CBDV is very important to such sufferers, and there is none of it in Epidiolex. Will the Minister ensure that the review takes account of the special needs of the 200,000 patients with uncontrollable seizures? Will the panel be able to hear from patients as well as studying research?

[Lord O’Shaughnessy]

The noble Baroness makes excellent points. I know she has been deeply involved in the Alfie Dingley case and I thank her for her work on that. What we are discovering is that it is not the case that just one drug is going to fix this for the 200,000 people who are suffering. There is a need for variety. So it cannot be the case that just because one thing is licensed it is used for everyone; it needs to be specific to the needs of the patient, which is the noble Baroness’s main point. The interim panel is there precisely to make decisions on an individual basis. It is a patch to the system, if you like, not a long-term change, which is why the review is in place so that we can ensure that many other products derived from cannabis, if they are proven to have therapeutic benefits, can be developed into drugs for the range of needs that are out there.

Long-term Plan for the NHS

Debate between Lord O'Shaughnessy and Baroness Walmsley

Tuesday 19th June 2018 Lords Chamber

[Baroness Walmsley]

My Lords, first, the Statement mentions £1.25 billion cash to cope with specific pension pressures. Is that because so many doctors are retiring early, and therefore drawing their pensions early, because of the pressures of the job? I know three GPs who are retiring far too early because of those pressures, so will the NHS be able to spend some of that money to relieve those pressures? Secondly, the Statement mentions that the Government want to prioritise prevention and that the NHS should get better at managing demand effectively. There are two factors that limit its ability to do that: social care has been mentioned by many noble Lords but I would also mention prevention. Can the Minister assure us that, when we get the spending review, the amount of money that goes to local authorities co-operating with the NHS on the prevention of ill health will not just be enough to make up for the cuts they have suffered over recent years but enough to really go forward and transform prevention measures?

[Lord O'Shaughnessy]

To answer the noble Baroness’s first question, I believe that changes in actuarial calculations were the driver of that change. However, it is a technical issue and I will write to her and place a copy of the letter in the Library so that other noble Lords can see the rationale for it. Regarding her question about public health funding, obviously it is not for me to make predictions about exactly what will be in the spending review, save to say again that there was a clear commitment in the Statement that we would not create further pressures for the NHS through the settlements delivered for social care and public health.

Education (Student Support) (Amendment) (No. 2) Regulations 2018

Debate between Lord O'Shaughnessy and Baroness Walmsley

Monday 21st May 2018 Lords Chamber

[Lord O'Shaughnessy]

I do not want to get into an argument about funny money and magic money trees, but it is worth pointing out that the proposal to treble student fees came from the Browne review, which was instigated by a Labour Government, and indeed the 2010 Labour manifesto committed a future Labour Government to implementing the findings of that review.

[Baroness Walmsley]

I would add that the Browne recommendations had no cap at all.

Children: Obesity

Debate between Lord O'Shaughnessy and Baroness Walmsley

Thursday 10th May 2018 Lords Chamber

[Lord O’Shaughnessy]

I am grateful to the noble Baroness for her acknowledgement of that important step forward in recruiting nurses to hard-to-recruit areas. That is important because we want more mental health, learning disability and district nurses in the future. They have an important role to play in schools. If I may say so, the noble Baroness is slightly underplaying the work that schools are already doing in this area. We have talked about the Daily Mile programme, which is going very well, with 900 schools in England adopting it. Learning about food, healthy eating and nutrition is a compulsory part of the curriculum in key stages 1, 2 and 3. However, I agree that there is always a need to do more.

[Baroness Walmsley (LD)]

My Lords, does the Minister agree that when you cook your meals from scratch, you know what is in them and are more likely to stay healthy? Can he assure me that children learn to cook in schools, not just the theory of nutrition? Will he also join me in encouraging the BBC to produce a cookery programme aimed at children?

[Lord O'Shaughnessy]

I am turning into the commissioner of children’s programming. I am trying to remember—I think that there is actually a CBBC programme that encourages children to cook. Its name has gone completely out of my mind but it was popular with my children. The noble Baroness raises an important point. Children learn to cook in primary schools, most of which have some sort of kit that allows them to do that. It is critical for them to understand that food does not just come from packets or shops but can be created by hand—and enjoyably, too.

Nurses: Training

Debate between Lord O'Shaughnessy and Baroness Walmsley

Wednesday 7th March 2018 Lords Chamber

[Lord O'Shaughnessy]

I thank my noble friend for highlighting that important issue. A very stringent language test is imposed by the Nursing and Midwifery Council—indeed, it is perhaps so stringent that it has excluded some nurses who are perfectly capable of practising in this country. A review of that is going on at the moment to make sure that a proper line is drawn—ensuring professional competence, including in technical language, while not excluding people who would be perfectly capable of practising well in this country.

[Baroness Walmsley (LD)]

My Lords, is the Minister aware that the vacancy rate for nurses in social care settings has doubled over the last four years? Given the other pressures on nursing homes, will the Government take specific action—perhaps grants for placements—to relieve this problem, which the NAO has described as dangerous?

[Lord O'Shaughnessy]

The noble Baroness has highlighted an important issue, which is the number of nurses in social care. I recognise that to be a problem, as does the department. A specific social care workforce consultation will get under way and is linked to the overall draft workforce plan that Health Education England has published. This is something that we are looking at. We can solve it to some extent by increasing the overall number of nurses, but we need to find ways of attracting them into the social care profession.

NHS: EEA Doctors

Debate between Lord O'Shaughnessy and Baroness Walmsley

Tuesday 12th December 2017 Lords Chamber

[Baroness Walmsley]

To ask Her Majesty’s Government what assessment they have made of the number of doctors from European Economic Area states working in the United Kingdom who may be planning to leave the NHS after the United Kingdom’s withdrawal from the European Union.

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

My Lords, the Government value the contribution of all European Union staff working across the NHS and social care systems immensely. We have set out a clear pathway to permanent residency for these EU citizens. According to the latest NHS digital data, there are now more non-UK EU doctors working in the NHS than ever before, with almost 500 more since 30 June 2016.

[Baroness Walmsley (LD)]

My Lords, according to the BMA, almost half of EEA doctors are considering leaving the UK and one in five has already made plans to do so. Given that it takes 13 years to train a consultant, what is the Minister doing to fill these gaps in the short term? Is he aware that there are numerous doctors from around the world already resident in the UK but whose qualifications fall short of what is required by the NHS? They would dearly love to be able to upgrade their qualifications and help us to fill the gap that is going to be left by the Tory Brexit, but there is no organisation that will advise and support them to improve their qualifications. What will the Minister do about that?

[Lord O'Shaughnessy]

I recognise that, as the noble Baroness pointed out, there has been uncertainty. That is why I am sure that the entire House will welcome the agreement reached last Friday to provide that certainty, and I encourage all noble Lords to look at and circulate the letter written by the Prime Minister to EU citizens explaining how much we value them, how much we want them to stay and how we have now agreed with the EU a process for doing that. The noble Baroness will be interested to know, as I am sure will other noble Lords, that there were 470 more EU doctors working in the NHS in June 2017 compared to June the year before—so, happily, we have not seen the exodus that so many people have warned about. We need to grow more of our own in the future, of course, and there are 1,500 training places for doctors coming on stream in September 2019, but I shall certainly look at the issue that she raises about providing opportunities for doctors—not least refugees; that issue has been raised with me—to upgrade their qualifications so that they can serve in the NHS.

Young Women: Self-Harm

Debate between Lord O'Shaughnessy and Baroness Walmsley

Thursday 16th November 2017 Lords Chamber

[Baroness Walmsley (LD)]

My Lords, on behalf of my noble friend Lord Storey, and at his request, I beg leave to ask the Question standing in his name on the Order Paper.

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

My Lords, in recent years there has been an increase in self-harming among young women. This is a worrying trend that the Government are committed to addressing. That is why we updated the cross-government suicide prevention strategy and expanded its key areas for action to include self-harm. We are also committed to implementing a community-based care pathway for self-harm by 2019 and to making sure that every acute hospital has mental health liaison services in place by 2020-21.

[Baroness Walmsley]

My Lords, I thank the Minister for acknowledging the shocking 68% increase in the number of young girls being admitted to hospital for self-harm over the last decade. Does he agree that school counsellors can be a very valuable resource in helping to tackle this terrible epidemic of emotional distress among young people, because they are non-stigmatising and easily accessible? However, I visited an area yesterday where I was told that all the school counsellors have had to be sacked because the schools cannot afford to pay them. Will the Minister work with the Department for Education to ensure that by the end of this Parliament every secondary state school in this country has a school counsellor, so that we can tackle the welfare requirements of young people as well as their academic requirements?

[Lord O'Shaughnessy]

The noble Baroness is absolutely right to highlight the importance of schools in dealing with this. It is not just a health issue. Indeed it is not just about education either, but involves a cross-government approach. I would be very keen for her to write to me with the specific details of what she is describing—it does not sound like a positive development. Much more positively, more than 1,000 secondary schools have now had mental health first aid training for at least one teacher in the school, and the ambition is to extend that to all secondary schools. She will also know that there will very shortly be a children and young people mental health Green Paper, which I think will have quite ambitious actions for both schools and the health service to support young people with mental health problems.

Child and Adolescent Mental Health Services

Debate between Lord O'Shaughnessy and Baroness Walmsley

Monday 30th October 2017 Lords Chamber

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

My Lords, the Government are committed to making sure that 70,000 more children and young people each year will receive evidence-based mental health treatment by 2020-21. Since publishing Future in Mind, the Government have made an additional £1.4 billion available to improve children’s mental health. Key mechanisms for delivery are local transformation plans, which cover the full spectrum of mental health, and the upcoming children and young people’s mental health Green Paper, which will contain proposals for further improving access to services.

[Baroness Walmsley (LD)]

My Lords, does the Minister agree that early intervention is essential to prevent escalation into crisis and lifelong problems? Is he aware that the number of CAMHS psychiatrists fell by 6.6% between 2013 and this year, while demand for their services rose? The number of qualified doctors who go into psychiatry is 2.6%, the lowest of any specialism, and some universities do not send any. Will he consult Health Education England to find out what it is doing about this, because the pipeline is drying up?

[Lord O'Shaughnessy]

The noble Baroness is quite right to highlight the fact that we need more staff to meet the mental illness burden in society, which is sadly growing. I hope that she will have seen that Health Education England has announced that there will be 21,000 more mental health staff by 2021, of which 13,000 will be qualified clinical staff, including 700 more doctors. The warning she has made has been heard loud and clear and those changes have been made.

If I may, I would like to use this opportunity to say that I made a mistake in my previous answer, when I talked about there being 21,000 people eligible for flu jabs. If that really was true, that would be a poor place to be. It is actually 21 million, which is slightly more reassuring.

Adult Social Care in England

Debate between Lord O'Shaughnessy and Baroness Walmsley

Tuesday 10th October 2017 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord is quite right that the CQC report highlights that. It also highlights a broadly stable residential care home situation. What is changing the nature of care provision is the increase in the amount of domiciliary and community-based care that is being provided; we are seeing a shift there. The CQC report also shows big discrepancies across the country in terms of the proportion of beds per head of population. That is one thing we are trying to address, to make sure there is much more evenness of care.

[Baroness Walmsley (LD)]

My Lords, the CQC report emphasised the need to co-ordinate care by stating that in future it will report not only on the quality of care in individual providers but on the quality of co-ordination between services. It quotes examples of services working together using technology and innovation to share data and improve care. How do the Government plan to encourage this approach? Will they look at funding models to make sure that they encourage co-ordination rather than deter people from co-ordinating?

[Lord O’Shaughnessy]

The noble Baroness makes an excellent point. We will certainly look at those funding models. Co-ordination, as we have been saying, is the way forward, because if you are a user of care in your eighties, you may be visiting a GP, you may be based in a nursing home, and to you, it ought to be one system and you ought to be travelling through it smoothly. Of course, we know that that is not the case at the moment, and the noble Baroness is quite right to highlight that there are great gains to be made, whether from having pharmacists in nursing homes or from having GPs coming to visit. Her point about technology and data is a good one. We still have an argument to win in reassuring people that their data are safe within the NHS so that they can be confident that they are used wisely for their direct care. That is the policy area I am now responsible for, since the election, so I am focused on providing that reassurance so that we can unlock the kind of innovation she is talking about.

National Health Service

Debate between Lord O'Shaughnessy and Baroness Walmsley

Tuesday 10th October 2017 Lords Chamber

[Baroness Walmsley]

To ask Her Majesty's Government what assessment they have made of remarks by the Chief Inspector of Hospitals that the NHS is not fit for the 21st century.

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

My Lords, the Government agree with Professor Baker’s statement that,

“we need a model of care that is fit for the 21st century and the population as it is now”.

That is why we are backing the NHS’s own plans for transformation with an extra £8 billion a year in real terms by 2020-21 and an extra £2 billion over the next three years for social care.

[Baroness Walmsley (LD)]

I thank the Minister for his reply. Does he also agree with Professor Ted Baker’s statement:

“The model of care we have got is still the model we had in the 1960s”,


and that this “needs to change”? Can the Minister say how many of the new models of care are up and running and how many of the sustainability and transformation plans are in special measures? On World Mental Health Day, will he look into how many clinical commissioning groups are failing to commission good and timely mental health care, especially for young people?

[Lord O'Shaughnessy]

The noble Baroness asked a few questions that I will try to deal with. First, on new models of care and STPs: STPs are now being ranked in order to see their fitness for moving forward. The Chancellor announced in the Budget that we will invest £325 million initially, with more funding in the future to support the transformation that we all want to see. The noble Baroness is right to point out that our care model is still based around hospitals and curing infectious diseases, rather than dealing with chronic illnesses and comorbidities. That needs to change.

I echo, as the noble Baroness would, the Care Quality Commission’s report, which talked about staff dedication—nowhere is that more true than in mental health, where staff often deal with very difficult circumstances. It is important to talk about that on World Mental Health Day. She may be interested to know that the Cabinet was briefed today by mental health experts about training programmes going into schools, and so on. There is a lot of work going on, but these are the NHS’s own plans for change, which this Government are backing.

End of Life Care

Debate between Lord O'Shaughnessy and Baroness Walmsley

Tuesday 5th September 2017 Lords Chamber

[Baroness Walmsley]

To ask Her Majesty’s Government how they intend to implement the NICE guideline End of life care for infants, children and young people with life-limiting conditions: planning and management.

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

My Lords, responsibility for implementing the NICE guidelines lies with local NHS commissioners and providers. NHS England has commissioned the charity Together for Short Lives to assess whether local provision follows these guidelines. The results will be shared to help spread best practice and address common challenges. These actions form part of the Government’s commitment to ensure that everyone at or approaching the end of life has good-quality, compassionate and joined-up care in a setting of their choice.

[Baroness Walmsley (LD)]

I thank the Minister for his reply. The resource impact tool published with this guidance shows that by investing £12.7 million in implementing the guidance, savings of £34.7 million could be made by the NHS in England. What plans do the Government have to emphasise to local commissioners the cost effectiveness of implementing the guidance? Secondly, does the Minister think it is right that adult hospices in England receive 33% of their funding from statutory sources while children’s hospices receive only 22%?

[Lord O'Shaughnessy]

I thank the noble Baroness for raising this very important issue. On the tool and the cost effectiveness, we know how important it is to invest in these services. What we have now is not by any means a perfect service, but we do have the first national framework, NICE guidance and the CQC inspecting the quality of end-of-life care and showing up where there are still issues in provision. That is why we are working with Together for Short Lives and I think that the tool the noble Baroness has highlighted will help make the case to providers in order to do that.

There is significant funding going in from clinical commissioning groups and also what is called a care currency—a way of looking at that spending and making sure that it is being distributed to provide the care that is needed in a way that is predictable for the providers. In addition, another £11 million goes in from NHS England to support it. So there is always more to do but I think we are making good progress.

Health: Obstetrics and Gynaecology

Debate between Lord O'Shaughnessy and Baroness Walmsley

Monday 17th July 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is quite right to highlight the appalling tragedies involved. As she said, over 500 families could have had different outcomes if the care they had received had been different. That is worth dwelling on because every one of these incidents is a human tragedy. She highlights midwives. There are over 2,000 more midwives in the National Health Service and 6,500 in training. There has been a big increase in the number of births in recent years, so the number has had to rise. Of course, I would be delighted to meet her to discuss the training and to make sure that it is the very best available so as to avoid and, as the Secretary of State has said, to reduce the number of maternity incidences in future years.

[Baroness Walmsley (LD)]

My Lords, does the Minister agree that it is good practice to involve parents in the reviews of what went wrong during their baby’s birth? Why were only 28% of parents involved in the reviews of what went wrong? Surely it is totally unacceptable that 25% of parents were not even told that a review was taking place.

[Lord O'Shaughnessy]

I agree that parents should be involved in such reviews—as those who are ultimately most affected by these tragedies, they absolutely should be involved. It is fair to reflect that issues around maternity deaths, brain injuries and so on have been going on for a very long time, and in certain trusts there have been acute instances of tragedy. That is why, as I said, the Secretary of State is determined to halve the number of deaths and incidents. We have had a number of reports, not only the one we are discussing today but also that of my noble friend Lady Cumberlege, Better Births, in an attempt to improve the way that services are delivered.

Adult Social Care Services

Debate between Lord O'Shaughnessy and Baroness Walmsley

Thursday 6th July 2017 Lords Chamber

[Lord O'Shaughnessy]

I shall respond to the several questions that the noble Baroness asked. She is right that the CQC made that warning last year, and that is precisely why the Government have chosen to put in additional money—£2 billion extra was announced in the spring Budget—to support the social care system and provide real-term increases in funding.

It is worth pointing out that today’s report shows that 79% of care settings received a good or outstanding rating, compared with 72% last year. There are obviously differences in the kinds of settings that were inspected; nevertheless, it shows an increase in the number of good or outstanding settings.

I completely agree with the noble Baroness’s point about patient safety. I think that the phrase “the Mum test” is both accurate and evocative. Clearly, nobody wants to choose care settings that do not pass that, and any care that is inadequate is unacceptable. However, the reason we have that information about unacceptable care settings is that this Government, in coalition with the Liberal Democrats, introduced a very tough inspection regime in 2014. I believe that today’s report shows that four out of five settings that were judged inadequate on the first inspection had improved on reinspection, so the inspection regime is itself a critical part of dealing with the issue that she rightly points to.

The noble Baroness highlighted the number of beds and staffing. Around 165,000 more staff are working in the care sector, but of course care is moving more from residential homes to domiciliary settings, so the nature of care is changing there. However, more staff are going into the service and they are now being paid the national living wage.

Finally, it is fair to say that no Government have a completely unblemished record in getting to grips with the problem of funding care. The Labour Government had Green Papers, royal commissions, the Wanless review and so on; we have had other investigations. However, to go back to the beginning, the point is that we cannot wait any longer—we need to get on with this—and that is why I set out in the Queen’s Speech debate last week that the consultation that we will publish at the end of this year will look not just at an open question but at very specific proposals around floors and caps, and I hope that we will be able to build a consensus on the need to move forward.

[Baroness Walmsley (LD)]

My Lords, quality improvement is really urgent given that, as the noble Baroness, Lady Wheeler, said, one in four settings was found by the CQC either to be unsafe or to require improvements in safety. Safety is fundamental when you are looking for a setting for one of your loved ones. Given that, according to the CQC, the rate of improvement is slowing down in some settings and in others has deteriorated, does the Minister agree that a shortage of well-trained staff is at the root of this problem?

While we wait for the Green Paper, will the Government respond to the CQC’s second warning that social care is at a tipping point and inject some urgent cash into it? Many authorities, which really understand these issues, told us last autumn, when the extra money was announced, that it was really only half of what social care required to keep it at the same level, let alone improve, so some extra cash is urgently needed.

[Lord O'Shaughnessy]

I reiterate the point I made to the noble Baroness, Lady Wheeler. I completely agree that safety is paramount: it is the beginning of any good care setting. As I said, the new regime highlights issues of safety where they exist so that operators and commissioners, whether that is local authorities or whoever, can demand turnaround in those services. As I said, the response to that has been demonstrated.

I mentioned that more staff are, of course, getting the national living wage, which will continue to attract people to the sector. The noble Baroness is quite right about skills, which is why we have the skills for care programme.

It is also worth pointing out that one thing the CQC report did show, as indeed you would hope it would, is that 79% of settings provided either good or outstanding care. There is no doubting the motivations of the people who work in this sector, and we all pay tribute to them. It is about making sure that there are enough of them and that they are properly skilled. That is precisely why we have put additional money into social funding, to enable real-term increases over the next three years to address the fact that we have an ageing and growing population.

NHS: Working Conditions

Debate between Lord O'Shaughnessy and Baroness Walmsley

Wednesday 5th July 2017 Lords Chamber

[Lord O'Shaughnessy]

I join the noble Lord in paying tribute to the commitment and selflessness of NHS staff. I am of course aware of the report that he talked about. That is why we need to increase the numbers of both nurses and doctors in training, which has happened. On pay, I think we all know that everybody has had to make sacrifices as we get the public finances in order. That is well understood. My right honourable friend the Secretary of State is shortly meeting the leaders of the Royal College of Nursing, for example, but of course any decisions on pay will be made as a consequence of the reports from the independent pay review bodies.

[Baroness Walmsley (LD)]

My Lords, in the 2016 NHS staff survey, 47% of staff who responded said that staffing levels were insufficient for them to be able to do their job properly. One in five GP training places were unfilled, mental health and community nurse numbers fell by 13%, and district nurse numbers fell by 42%. Given that workload is the major reason given for staff leaving the service, how do the Government plan to increase the number of patients treated in primary care and in the community as opposed to in acute settings in hospital, as recommended by a number of authoritative reports, including that of the Select Committee of your Lordships’ House?

[Lord O'Shaughnessy]

I can only reiterate that I recognise the pressures on the workforce. That is why we are recruiting more GPs and nurses. There are more than 50,000 in training, and we are aiming to get 5,000 more GPs into the NHS over the next few years. On the noble Baroness’s point about moving treatment out of hospitals and into the community, that is one of the core drivers of the STP process, which is about reorganising care so that it happens sooner and, ideally, in a preventive way rather than after the fact.

Brexit: Nursing Staff

Debate between Lord O'Shaughnessy and Baroness Walmsley

Tuesday 27th June 2017 Lords Chamber

[Lord O’Shaughnessy]

I am afraid the noble Lord is mistaking cause for correlation in this instance, and let me explain why we think that is the case. The General Pharmaceutical Council introduced language testing in November 2016; it had experienced no significant drop-off in applications from EEA member countries after Brexit but before that point and a big downturn in applications after that point. So it is language testing; it also happened with the GMC as well when it introduced language testing. I know this is something that the noble Lord supports—he said as much in a debate on this very issue in 2015—because it is an issue of safety. That is why language testing has been introduced. I would like to say, however, that of course we value the work of EU staff who come here, and, indeed, all nursing staff. As the Prime Minister set out yesterday, we want them to stay and have offered a generous package to allow them to do so, and there are more EU nurses here than there ever have been.

[Baroness Walmsley (LD)]

My Lords, the Department of Health’s own modelling predicts that there will be a shortage of 40,000 nurses by 2026. My own local hospital has 60 nurse vacancies, and I am sure other noble Lords have similar examples. What do the Government propose to do to avoid the NHS becoming unsafe because of these nursing shortages, given that some nurses are already being asked to stay on at the end of 12-hour shifts in order to fill gaps in the roster?

[Lord O’Shaughnessy]

I thank the noble Baroness for giving us the opportunity to talk about the fact that we have increased the number of nurses and health visitors by nearly 5,000 since 2010. She is quite right to say that we need more of them; we have a growing and ageing population and higher expectations of what the NHS should be delivering. It is for that reason that we have a number of things in action: we have 52,000 nurses in training; we have a return to practice programme, which has already prepared 2,000 nurses to come back into the profession; and we are introducing nursing apprenticeships and nursing associates. We are not complacent about this issue—we know it is important—but there are a number of programmes in train to fill the gap that she has identified.

NHS: Shared Business Services

Debate between Lord O'Shaughnessy and Baroness Walmsley

Tuesday 27th June 2017 Lords Chamber

[Lord O'Shaughnessy]

I will answer the noble Lord’s four questions. The first was on taking advice from officials. I think the noble Lord would probably be alarmed if the Secretary of State was not taking advice from officials. That should be welcomed. It is clearly the case that he was thinking on his own, because he took the decision to follow that advice in the first instance in March, but was of the view by July that enough was known and that it was important to update Parliament before recess.

The second question was about the timing of the Statement. The noble Lord will remember that summer 2016 was a reasonably busy period after the EU referendum. The main point here is that the Statement was made before recess and was not held back until the autumn. As regards NHS Shared Business Services and the consequences for it, those consequences have been severe: it no longer has this contract and will, as my right honourable friend confirmed in another place just now, pay its share of the costs.

Finally, as my right honourable friend said, it could appear that there was a potential for conflict of interest, but in his view there was not one, because at all times—as confirmed in the NAO report—patient safety was the driving force behind the actions of the department and NHS England. It will always be the case, whatever arrangements the department has with an ALB—whether a standard agency, a joint company or whatever it is—that patient safety must come first. That was confirmed in the NAO report today.

[Baroness Walmsley (LD)]

My Lords, as I understand it, that Statement on the last day of term before the Summer Recess last year was one of 30—which implies to me that the Government consider the last day of term to be a very good day to hide bad news.

The Minister suggests that the company, or its shareholders, will have to pay its share of the costs of investigating this scandal. Can he assure us that the NHS will not be out of pocket, particularly in the light of the fact that the loss is not just financial? A lot of doctors and various officials, in both the department and trusts, have had to spend a great deal of their time looking into this—and, of course, time is money. Will this scandal actually cause the Government to be a little more cautious in future when they claim that putting health services out to private companies always gives better value to the taxpayer and the NHS?

[Lord O'Shaughnessy]

The noble Baroness will know that I was not in post at the end of last summer, so I cannot explain why there were the number of Statements that there were. I know that Governments of perhaps different hues have also tended to put out Written Statements, so I do not think any political party is entirely innocent in this regard. The point is that the information was made available to Parliament.

On the point about cost settlement, there are interested parties here and the costs need to be settled once we have got to the bottom of exactly what has happened and once those inquiries and indeed the investigations into the potential for patient harm have been settled. I underline that as yet no instances of patient harm have been discovered.

Finally, the point about privatisation is quite an important one. The noble Baroness will know that the private sector is involved in the delivery of all parts of the NHS. Breach of contract, which is what this is, and the covering up of mistakes happen in all parts of the health service—public, private, shared and all the rest of it. It is not a case of “private sector bad, public sector good”: we know that from instances like Mid Staffs and so on. The core point is that we need very strong data security standards, and that is why the Government will be responding in due course to the Caldicott review and the review of these issues by the CQC.