Health: Zika Virus

Lord Patel Excerpts

Thursday 4th February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, there has been one case where Zika may have been sexually transmitted—I use the words “may have been” advisedly because it is not proven. Indeed, the link between Zika and microcephaly is not yet scientifically proven. There seems to be a strong probability that that is the case, but we should bear in mind that Zika was first identified back in 1947 in Africa and since then there has been no such connection with microcephaly, although in Brazil there appears to be a very strong connection now. There has been one case in Texas, where there may have been sexual transmission and the advice for men who are sleeping with women who may become pregnant is to wear a condom.

[Lord Patel (CB)]

My Lords, while absolutely agreeing that we should carry on supporting the science of genetically modified mosquitoes, it may be that mosquitoes that are already genetically modified for dengue can do the same job for Zika, but we do not know that. Much more important is the recent report and questions about the assessment of the spread of the Zika virus. The Minister has just referred to sexual transmission, but that applies to any bodily fluids, not just sexual transmission. The other worrying thing is that the common mosquitoes have now been found possibly to be infected by Zika. That is a much more worrying prospect, because they are much more widespread.

[Lord Prior of Brampton]

I understand that the common mosquito which we find in southern Europe could potentially carry Zika, which I think was reported in the Times today. There is as yet no evidence that it does carry Zika, but it is something that we need to watch very carefully.

Sugar Tax

Lord Patel Excerpts

Wednesday 3rd February 2016 Lords Chamber

[Lord Patel (CB)]

My Lords, I am sure the Minister is aware of a meta-analysis study carried out of nine studies which compared the pricing of sugar-sweetened beverages against the reduction of consumption of such drinks. It showed considerable price elasticity. Therefore, it is difficult to determine in an economy like ours the level of taxation that is required to achieve the right reduction. What plans do the Government have to find such evidence?

[Lord Prior of Brampton]

My Lords, it is interesting that in the plans put forward for consultation by Simon Stevens of NHS England they are looking at a levy of 20% on sweetened beverages. In Mexico, they brought in a sugar tax of 10%, which according to a study by the Lancet resulted in a reduction in consumption of some 12%. But it is very difficult to isolate the particular impact of tax when many other measures are being used at the same time.

NHS: Trust Finances

Lord Patel Excerpts

Monday 1st February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, it is true indeed that Jim Mackey mentioned those figures. He is hoping that he can get that deficit down to £1.8 billion by the end of the year as a result of some of the capital to revenue and other accounting adjustments to which the noble Lord referred. We are also hoping that the reduction in agency spend will start to have a big impact in the final quarter of the year. We will get the third quarter results in two weeks’ time, when we will have a better idea as to where we will end up at the end of the year.

[Lord Patel (CB)]

Correct me if I am wrong, but the noble Lord mentioned in his Statement imposing a tariff on agency staff, cutting down on consultancy fees and the potential savings that the report of the noble Lord, Lord Carter, might produce—although most people doubt that it will. Where does he think that the finances of the NHS will be on 1 April 2017? What is his prediction?

[Lord Prior of Brampton]

The cap on agency staffing rates and on agency staff has really started to apply only in the past six weeks. So far, it looks as if we are making significant progress there. As I said in answer to the Question, the NHS is receiving £3.8 billion of extra funding in the forthcoming year. We believe that that will enable it to restore its finances to a proper balance by April 2017.

Pregnancy: Neural Tube Defects

Lord Patel Excerpts

Monday 21st December 2015 Lords Chamber

[Lord Prior of Brampton]

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

[Lord Patel (CB)]

My Lords, the Minister has said that he is against mass medication. Do we really think that this is mass medication? We are talking about adding to flour micro amounts of nutrition that is lacking, to give a choice to people: if they intend to get pregnant, they eat bread made from that flour and not unfortified flour.

[Lord Prior of Brampton]

Just to correct the noble Lord. I did not say that I was against mass medication; I said that it was one of the things that should be considered. It is also worth saying that, even if there was mass medication, it probably would affect between 15% and 30% of women who have babies with neural tube defects and not all women.

Southern Health NHS Foundation Trust

Lord Patel Excerpts

Thursday 10th December 2015 Lords Chamber

[Lord Prior of Brampton]

Avoidable deaths are estimated at some 10,000 a year. “Unavoidable deaths” is the phrase that I think I used, which are estimated at some 10,000 a year. That is not out of line with what is found in other countries, such as America and Germany. However, it should not be accepted, which is why the Secretary of State has asked Bruce Keogh to produce these new statistics for every trust, starting from next spring.

[Lord Patel (CB)]

The Minister might want to look at those figures again, and correct them with a letter if necessary, regarding avoidable and unavoidable deaths. Turning to my question, on a daily basis now we get at least two items of bad news relating to the NHS, mental health, public health or other issues in social care. Is it not time to look at the whole organisation of the NHS, including funding and so on, through an independent commission? Why would the Government not do that? The Opposition might not support it but it would take politicians out of it and we might end up with a better service.

[Lord Prior of Brampton]

The noble Lord makes an interesting point. We have a much more transparent system than we used to. Surely it is better that we know about what is going wrong within the NHS rather than that we cover it up as it was in the past.

Alcohol

Lord Patel Excerpts

Wednesday 9th December 2015 Lords Chamber

[Lord Prior of Brampton]

I am happy to be told that by my noble friend and I can only agree with him.

[Lord Patel (CB)]

My Lords, as it is Christmas, does the Minister think that the Parliamentary Estate should be alcohol-free, as it is smoke-free?

[Lord Prior of Brampton]

My Lords, I think that we would be setting an excellent example if we did that.

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

Lord Patel Excerpts

Tuesday 1st December 2015 Lords Chamber

[Lord Patel (CB)]

My Lords, perhaps I might start by suggesting to the Minister that this is another example of why the NHS might be unsustainable and that we probably need an independent commission to look at the whole of the NHS. I realise that neither he nor the Opposition Front Bench are likely to agree with me on that, but I make the point that this is yet another nail in the coffin, so to speak, which will get us to that end some day.

I find myself in agreement with some of the things that the noble Lord, Lord Hunt, has just said. We have an example here of where raising the tariff to 66% actually means ruling out the ability of the providers to engage in any kind of discussions relating to the tariff because the target is too high. If that is the case and the providers are therefore not able to engage with NHS England and Monitor, which sets the tariffs, what other mechanisms do they have? They cannot see the proposed tariffs until the consultation occurs, which is rather too late for them even to road test whether the tariffs are likely to be workable—particularly if they involve, for instance, any implications on pensions or proposals that the Government may have brought about pay deals, or any other issues that may impact on the cost. So how is the provider likely to get any input at an early stage and engage with the tariff-setting mechanism? There will be no such input, I suggest, through these proposals, which will make it impossible. They will therefore have to live with the tariff.

I realise that the big providers might be able to do that, because they might save some money from other aspects, but let us take the specialist providers. We can particularly imagine this in paediatrics and with some cancers, where providers work on small margins and the costs may escalate. Because of a few patients having highly complex issues, costs can overrun. That is why the top-up fees of some £300 million were introduced, 70% of which go to paediatric specialist services. Now the proposal is to remove those or reduce them considerably. In paediatrics, the top-up might go down from £217 million to £95 million. So these specialist providers have a choice: either to provide poor-quality service, which impacts on the patients, or to opt out. Who will then suffer? It will be not the commissioners, NHS England or Monitor but the patients—because they will not have a service or will have a poor-quality service.

I agree with the noble Lord, Lord Hunt, that there needs to be some kind of mechanism where there is early involvement of the providers, which can engage in the tariff-setting mechanism. They would not necessarily dictate it; they might disagree with it but suggest some proposals. One of the ways, as he suggests, would be a stakeholder forum involving all the parties at an early stage. The Department of Health can then have some accountability from all the people in the stakeholder forum, including the providers. I am attracted to that suggestion, and I hope the Minister will respond to it.

The Minister responding in the other place sounded sympathetic—or at least suggested that he understood the issues. I hope that we can go further today and that the Minister will say that it sounds attractive and that he might look at it.

Junior Doctors Contract

Lord Patel Excerpts

Monday 30th November 2015 Lords Chamber

[Lord Patel (CB)]

My Lords, I am not allowed by the rules to make any statement but only to ask a question, which is a pity because I wanted to make some comments about what the Minister just said. We will leave for another day the discussion of this mounting academic evidence that mortality rates are higher. They might be, but we need to investigate the cause-and-effect scenario. Leaving that aside, the Statement says:

“So our plans will support the many junior doctors who already work weekends with better consultant cover at weekends, seven-day diagnostics and other support services, and the ability to discharge at weekends into other parts of the NHS and the social care system”.

Is the Minister able to update us on whether we will have another Statement related to this or whether there are plans in process to deliver all that the Statement says?

[Lord Prior of Brampton]

There is a recognition that the weekend effect is caused by many factors. It is certainly not just the ability of trusts to roster junior doctors at weekends but the absence of senior cover and the fact that much diagnostic capacity is not available at weekends. Of course, you also have to be able to discharge patients at weekends, which means that social care has to be working as well. To have a truly seven-day NHS requires a lot more people and resources to be available than just junior doctors.

Accident and Emergency Departments

Lord Patel Excerpts

Monday 30th November 2015 Lords Chamber

[Lord Prior of Brampton]

The report done by Queen Mary’s, which was based in Oxford, indicated that the under-fives attending A&E departments accounted for 7% of all attendances, which gives an idea of the scale of what we might try to achieve. The reduction, in real terms, in local authority spending over the next five years is 3.9% per annum. Our feeling is that local authorities are well equipped to live with that kind of reduction.

[Lord Patel (CB)]

How good are A&E departments nationally at collecting information on the nature of the accident, and at root cause analysis to prevent it, and how is this information fed into a national database?

[Lord Prior of Brampton]

I am afraid that I am not aware of how A&E departments collect and collate this information, but I will write to the noble Lord on that matter.

Health: Global Health

Lord Patel Excerpts

Monday 26th October 2015 Lords Chamber

[Lord Prior of Brampton]

I can assure the noble Baroness that this Government are fully committed to supporting our life sciences industry. I will look into her specific question on the Newton Fund and write to her directly.

[Lord Patel (CB)]

Following on from the Question from the noble Lord, Lord Crisp, does the Minister agree that, given the predicted growth of about 15% in the healthcare needs of countries such as India and China, we have a great opportunity not only to promote education but to develop health expertise? Does he agree that we need to have a stronger relationship with these countries in health?

[Lord Prior of Brampton]

I completely agree with the noble Lord. According to the report, health spending is likely to increase by 8% per annum in Asia for the foreseeable future and by some 5% in the rest of the world. This is a huge opportunity. The NHS is arguably the best-value healthcare system in the world, and the many lessons we have learnt since 1948 will be valuable when we go overseas.