National Health Service: Pensions Tax

Lord Patel Excerpts

Wednesday 30th October 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank my noble friend for that very direct question. Our estimate is slightly different—that around one-third of GPs and consultants have earnings high enough to potentially be affected by the tapering of the annual allowance for tax-free pension savings. Not all clinicians are affected—it depends on the personal circumstances—but we accept that there is a need for urgent action in this area. That is why NHS employers have published guidance for short-term approaches that could have a mitigating effect on pension tax for the workforce this year and throughout the winter. We have also opened our consultation, which will close this Friday. We have already had 750 responses to it, and stakeholders are broadly supportive of the additional flexibility that has been proposed. We intend that flexibility to be available by April.

[Lord Patel (CB)]

My Lords, I apologise for asking another direct question. The results of a recent survey carried out by the Royal College of Surgeons of nearly 1,900 surgeons were that 68% of consultant surgeons are considering early retirement because of the pension tax situation, 64% have been advised to work fewer hours in the NHS and 69% have reduced the amount of time they spend working in the NHS. What effect does the Minister think that might have on surgical care?

[Baroness Blackwood of North Oxford]

The noble Lord is exactly right to raise this issue and we have taken it very seriously. I have met the president of the Royal College of Surgeons to take on board his concerns. It is exactly why we have brought forward this consultation as a matter of urgency and why the department is making strenuous representations to the Treasury, which is reviewing the operation of the annual tapered allowance, and it is why we will continue to make those representations. However, it is also why we are taking other actions around elective surgery so as to reduce the pressure on surgeons up and down the country.

Health Service Safety Investigations Bill [HL]

Lord Patel Excerpts

2nd reading (Hansard): House of Lords
Tuesday 29th October 2019 Lords Chamber

[Lord Patel (CB)]

My Lords, I am last and probably least. I have a problem: how much do I say? I have been here and I have done this.

It has been mentioned that this will be the first time that a world-class patient safety organisation is developed. That is wrong; it is not the first. We had one. It was called the National Patient Safety Agency, which was established by another Secretary of State. It was internationally respected for the work it did, but another Secretary of State decided that it was a quango and got rid of it. I remember the conversation that I had. He asked, “What has it achieved?” I can tell your Lordships, it achieved a lot and I can give loads of examples. However, it had also failed to achieve a lot, partly because of the volume and the methodology; it was only a drop in the ocean. It was disbanded, and I tried to persuade that Secretary of State that he should give it more statutory powers that it did not have, particularly of investigation.

Of course I welcome this Bill, because it gives the HSSIB statutory powers to investigate incidents that occur within the health service, which is not easy to do. I agree that the experiences of the aircraft industry are not always transferable to healthcare. Healthcare is complex, and many other types of issues can arise.

I should declare an interest. For 37 years I have been a maternity care clinician. I have had other positions in my life connected with patient safety, not only as a chairman of the National Patient Safety Agency but also in Scotland, implementing patient safety across the health service in all its aspects.

The noble Lord, Lord Turnberg, mentioned a case involving medicine being given through the wrong route. There were lots of examples, which have been investigated, of medicine being wrongly given through the spinal route or in long doses intravenously. We also found three cases of wrong-site surgery—but then we found that actually, there were 179 cases over three years. The agency established what is now universally regarded as an excellent idea: the surgical checklist. The Royal College of Surgeons gave it the credit—it does not deserve much credit otherwise—and it took it on board. Usually it is gung-ho, but it has taken on the responsibility of implementing what we developed as a safe surgical checklist. It is now universally accepted. By the way, the learning that we produced was also accepted in Canada, Australia and parts of the United States. Canada and Australia adopted our system in totality. So yes, it is possible to do this, but it is not easy to realise an ambition to stop however many hundreds of thousands of incidents. Neither is it necessary to chase that. It takes a long time to analyse where the system failure is. The safe space is a novel way to deal with it, but whether it is successful will depend totally on the respect that it gains of the profession, the patients and the public. If it does not gain their respect, it will be dead in the water.

There will be lots of challenges. We have already seen reports in the media—in one of the health journals, I think—about the dysfunctionality of the organisation. That will continue. We must also ensure that in its reporting it is fair and proportionate. Where it finds that there is a resource or staffing issue, as the noble Baroness, Lady Hollins, and others, mentioned, then it must say so, even though the Secretary of State and the NHS leadership might not like it. If it gives guidance that is directed to the leadership of the NHS, it must say so. That includes NHS England, the commissioners and anybody else. If it only targets the health professionals, it will fail, because system failures are not necessarily always the fault of the health professional, as we have found in many other areas. For instance, a drug was packaged in a 50-millilitre vial, even though it was always given as 5 millilitre infusion or less. The error occurred because somebody thought that 50 millilitres was the dosage and put that in an infusion, and the patient died. That had happened a couple of times in other hospitals, so we had to persuade the industry to change the packaging. It objected because of the cost, but in the end it was persuaded.

Incidents also occur in intensive care—for example, pneumonia-related incidents. By examining the system, the death rate from pneumonia caused by using a humidifier in intensive care was reduced to less than 30%. I could keep giving lots of examples but the point I am trying to make is that the systems must be examined. The organisation must also make sure that it gets the respect of the profession.

The key thing is learning; where we failed was in implementing the learning. Here, the organisation must address the issue of who will implement the learning. If that is not done, three years later we will be having the same problems and the organisation will be blamed for not doing much, rather than the people who should be blamed for the implementation. In that respect, you need all the other people: not just the leadership of the NHS but professional organisations and others. I will give the example of an airline pilot’s wife who died because of failed intubation during minor surgery, in the presence of an ENT surgeon. They were all concentrating on getting the tube down to intubate while the surgeon, who was completely scrubbed, was standing there and could have done the tracheostomy in 30 seconds. But that patient died, and the Royal College of Anaesthetists took on board how to find a safe system so that that might not happen again. It implemented that through its training procedures; anaesthetists in training practised this on models. I pay great credit to it but there are lots of other examples.

I agree with the noble Lord, Lord O’Shaughnessy, and others who mentioned that a culture change is required whenever a safety incident happens. It is important to work wherever it happened to bring about culture change, so that we grow an attitude and mindset about patient safety. We tried to do that when working with Don Berwick, who was mentioned earlier—I think by the right reverend prelate the Bishop of London. In Scotland, we employed his expertise for three years to bring about the culture change that was required.

Governance was mentioned—I think by the noble Lord, Lord Hunt of Kings Heath—and it is an important issue. When I took over, I faced the problem of poor governance that was making the organisation dysfunctional. I spent nine months trying to get rid of everybody in the leadership of that organisation. I was the bad guy, but it was not respected because of its poor governance issues. In that respect, it would help a great deal to have a chair with experience of patient safety. I am sure that we could find one.

I also agree about the private sector. I know that I commented yesterday to the noble Baroness, Lady Finlay, that maybe the private sector ought not to be involved. However, there should be an all-systems approach. I note that a briefing I got from the private sector says that it would like to be involved.

Maternity care and childbirth injuries are an area crying out for urgent attention. Litigation is to a large degree about money. Any practice that may cause damage to the new-born is horrendous—it should not happen. There should be zero tolerance of a baby that has grown normally having hypoxaemia at birth and brain damage for the rest of its life. It must not happen. We must not talk any more about who should do it and in what way; just have a strategy so that it does not happen. I assure your Lordships that it can be done. I would not like to blow my colleagues’ trumpets, but it is possible to do it. I know that the current medical director of the HSSIB is capable of undertaking this exercise—a preliminary study on how to investigate and bring about the change that is needed in order to have zero tolerance of childbirth injury to the baby. It is possible to do that.

I look forward to Committee—whenever we get it—and I hope I can be fully involved then.

Queen’s Speech

Lord Patel Excerpts

Tuesday 22nd October 2019 Lords Chamber

[Lord Patel (CB)]

My Lords, it is a pleasure to follow the speech of the noble Baroness, Lady Doocey. I have of course been deprived of being able to congratulate the noble Baroness, Lady Emerton, on her valedictory speech, but nevertheless I would like to put on the record some points because I think that she might have been amused by what I have to say about her.

I never referred to the noble Baroness as “Baroness Emerton” or “Audrey”—I always called her matron. I think she enjoyed the idea that I, as a perhaps one-time senior doctor, was petrified of matron, as I always was. She is a formidable lady and was referred to as such by the noble Baroness, Lady Cumberlege, on the day she made her maiden speech. I say to the noble Baroness, Lady Watkins, that three nurses spoke that day: the noble Baronesses, Lady Emerton and Lady Cox, and Lady McFarlane of Llandaff—three formidable ladies, you might say. We all know that the noble Baroness, Lady Emerton, has contributed an enormous amount, quite forcefully, and has championed the causes she felt strongly about—particularly the health service and, within it, the important role that nurses play. I was interested to see that her motto is “Pro fide, pro utilitate hominum”—quite appropriate for a nurse, you might say. A more appropriate motto for her might have been “Cibum non est mecum”. I hope my Latin from a long time ago makes the point. For noble Lords who cannot translate: “Don’t mess with me”.

The Queen’s Speech said:

“Measures will be brought forward to support and strengthen the National Health Service”,


and its workforce. Furthermore, it said that legislation will be brought forward to establish,

“an independent body to investigate serious healthcare incidents”.

It also said:

“My Government will bring forward proposals to reform adult social care”.


It has been said enough already that there is, as yet, no Green Paper on reforming adult social care; we all await that.

Furthermore, the Speech said that:

“My Government is committed to establishing the United Kingdom as a world leader in scientific capability”,


and that there will be,

“a more open visa system”,

to encourage and recruit talented individuals from overseas to support our science. We have no workforce strategy as such. We have repeated comments that we are recruiting more nurses or doctors, or that we have more places for medical students or nurses. But the challenge of the NHS and social care workforce is far too great to be dealt with by those policies. I do not criticise the Government; I just say that more needs to be done.

The report following the House of Lords inquiry, The Long-term Sustainability of the NHS and Adult Social Care, made the point that the greatest challenge the NHS faces for its sustainability is its workforce. We need to do more about it. Let me give a small example. I thought the Government would bring in legislation to regulate health professionals following their July report, Promoting Professionalism, Reforming Regulation, but that did not happen. The legislation that governs the UK’s medical regulation is not fit for purpose. Noble Lords might be shocked to hear me to say that, but it is true. It is the regulation that followed the Medical Act 1983. It does not allow the flexibility to easily put on the registers GPs and specialists, particularly fully trained senior people. It has no flexibility and legislation is needed to change that. The General Medical Council is very open to this and wishes it would be done, but it is not in the Queen’s Speech.

Making specialist and GP registration more flexible could make it more accessible to doctors to join both registers and would go some way to dealing with the workforce required. We are trying to recruit more doctors because we are short of psychiatrists—as we heard yesterday—geriatricians, radiologists and many others. There is an enormous shortage of nurses, too. Change here would be helpful, and I hope the Government will bring in legislation through another Bill; otherwise, I will be minded to put forward an amendment at some stage to do this.

I now come to the science side. Two-fifths of the UK’s academic workforce in science and technology are from overseas, and 50% of postgraduate researchers are overseas staff, so we need to make sure our visa system is more flexible.

Finally, I will have a lot to say about the Health Service Safety Investigations Bill when it comes to Second Reading. All I will say at this stage is that I wish we had not started it in this place.

National Health Service: Healthcare Advice

Lord Patel Excerpts

Tuesday 16th July 2019 Lords Chamber

Asked by

[Lord Patel]

To ask Her Majesty's Government what analysis they have conducted of the impact of the National Health Service introducing the use of devices such as Amazon’s Alexa for health care advice.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, digital technology will play a key role in making the NHS sustainable. The Secretary of State’s technology vision sets the foundation for a new generation of digital services focused on user need, privacy and security, interoperability and inclusion. The collaboration with Amazon simply connects people to medical information and is already freely available through the NHS website. This service does not provide advice or any form of diagnosis. More modes to access medically verified NHS information can only give UK citizens a better understanding of different medical conditions. The agreement with Amazon is convenient for those who rely on voice-activated technology, in particular blind and visually impaired people.

[Lord Patel (CB)]

My Lords, I thank the Minister for her response and might I say it was a good defence? While I have absolute confidence that Matthew Gould—our previous ambassador to Israel who leads on the project—will get it right, voice-recognition technology has its problems. It must recognise the correct phrase, word and accent. It might be interesting to hear the answers that the Opposition Chief Whip were to get if he asked a question with his accent. I asked five questions at the weekend; all health-related. One I repeated twice and got two different pieces of advice: one was to call 999 and the other was to go to bed and rest.

I know that it is not a diagnostic technology, but it runs the risk of a diagnosis being made, so the key questions are what trials are being carried out, what data protection do we have against Amazon collecting vast amounts of data, and what is the risk of misdiagnosis?

[Baroness Blackwood of North Oxford]

The noble Lord makes very important points. It is important to understand that this is not a technology to offer advice or diagnosis. NHS Digital and NHSX have built an interface to connect the NHS website so that other organisations can make NHS information available on their own sites. That is so that a greater number of people can access NHS information. It has already been made available through a number of other examples such as NHS Go, which is designed to inform young people, accuRx and eConsult. No health data is collected by Amazon. No money is exchanged via this route and all data protection laws, such as GDPR and the NHS data protection rules, still apply. Data protection is still required to protect data through this system.

NHS Pensions: Taxation

Lord Patel Excerpts

Tuesday 9th July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is right that this is an important aspect of the recruitment and retention of GPs in particular, which is why we are bringing forward the consultation. As I said, we have been working closely with representative bodies, including the BMA and others. When we brought forward the five-year contract for general practice, announced in January, part of that was to provide greater certainty for GPs to plan ahead. Part of the work we have done is looking at other aspects that will ensure recruitment and retention. This includes, as we have discussed before, funding towards 20,000 extra staff working in practices, remaining committed to recruiting an extra 5,000 GPs and looking at targeted enhanced recruitment schemes, which include a £20,000 salary supplement to attract doctors into GP specialty training. The noble Baroness will understand that it takes a little time for these policy changes to be reflected in the data, but she can have no doubt that this is a policy area in respect of which the Government are absolutely determined.

[Lord Patel (CB)]

My Lords, there is currently a disparity in pension arrangements between clinical academics and NHS consultants. Can the Minister confirm that any discussions the Department of Health and the Treasury have will include the university sector? Otherwise, a disparity between pension arrangements will be created, which might affect the recruitment of clinical academics.

Academic Health Science Centres

Lord Patel Excerpts

Tuesday 2nd July 2019 Grand Committee

[Lord Patel (CB)]

My Lords, I, too, thank the noble Lord, Lord Butler, for this debate. I am thankful to follow the presentation of the noble Lord, Lord Darzi; after all, he was the one who started the whole concept of the AAC. I am glad that the noble Lord, Lord Prior of Brampton, will follow me because he might be interested in what I have to say.

Hitherto we have all been supportive of the idea and the successes of the academic health science centres, so let me take a slightly radical view. If we are serious about how good our academic health centres are, we should look at models that really deliver the change. The noble Lord, Lord Darzi, mentioned teaching, research, innovation and clinical application, the key themes of the successful, leading research-based academic health centres in the United States. Are we saying that we have been serious in adopting this in our clinical practice, taking scientific inquiry into clinical application? Yes, of course we have started and have been successful.

In the United States, however, policy-making in healthcare involves a pluralistic approach. In our case it is the department of health that decides on the policy. If academic health science centres are to be successful, they need to be part of that policy-making. That has implications for us to be more pluralistic and for the academic health centres to be involved. For instance, if we agree that this is a good idea, the recognition of the distinctive nature and contribution of academic health science centres might greatly facilitate the development and implementation of policy in a number of areas. These include addressing the current crisis in clinical academic careers in the United Kingdom, growing and modernising the NHS workforce and meeting concerns over clinical governance.

There are, however, additional questions of interest to society that cannot be adequately framed in the absence of an academic health science centre concept. For example, what is the role of AHSCs in supporting government objectives for UK success in a knowledge-based economy—the so-called strategy for life sciences that we are now developing—in improving the impact of research, and in technology transfer? How can AHSCs leverage their academic resources to contribute to improved quality in the NHS? What is the social and economic contribution of AHSCs to local communities? Can AHSCs provide leadership in the development of new models of partnership working and the development of clinical networks? Even to pose these questions it may be necessary to develop a model that is unique to Britain.

Academic health science centres have hitherto been extremely successful. They need to be supported even more and included more in developing our policies.

Hospitals: Listeria

Lord Patel Excerpts

Monday 17th June 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I am sure that the noble Baroness would like to hear exactly how effectively Public Health England and others responded in this case. Obviously, these cases should not have occurred in the first place, but the first case occurred on 26 April. There were two cases in one hospital. The second case in a different hospital did not occur until 16 May. It took one week for Public Health England to ascertain that this was a national issue and that the cases were indeed linked. Thereafter, products were withdrawn. Very swift action was taken by Public Health England and the Food Standards Authority and a clear and concerted investigation is now under way. It will be made clear that this sort of thing cannot happen again and that there will be severe consequences for any companies that do not take careful consideration of the consequences if they do.

[Lord Patel (CB)]

My Lords, several important points come out of this tragic incident of five people dying from listeria infections. The first is how quickly we can get a diagnosis of listeria in the food products that are contaminated. Older tests take several days but there are other tests, so I ask the Minister whether rapid diagnosis tests are available. Secondly, if people are infected with listeria monocytogenes it is quite dangerous, so the death of the people concerned may be related to that infection. It is important that the food in the supply chain is tested. Some countries adopt a regulation that requires regular testing of food in the environment where food such as sandwiches is packaged. In the review that will be conducted, will we look at the possibility of such regulation?

[Baroness Blackwood of North Oxford]

I thank the noble Lord, Lord Patel. He is absolutely right that one reason why such fast action was able to be taken was that it was possible to confirm by whole genome sequencing that cases at Manchester and Liverpool were linked by an identical strain in a week. Previously, that would have taken an awful lot longer, so we can be pleased that action was taken much quicker.

In terms of lessons learned, the noble Lord is right that we need to look at how to ensure that local authorities undertake inspections and audits of sites that are approved and that we also collect samples every six months and take action on any results of concern. We must make sure that the NHS follows food safety advice from Public Health England and the Food Standards Authority. Public Health England has confirmed that serving sandwiches in hospitals—I apologise. I am going to faint.

Unpaid Carers: Support

Lord Patel Excerpts

Thursday 13th June 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank my noble friend for this important question. The Carers Action Plan was a real step in the right direction. It has 64 action points and good progress has been made. There will be a progress report in July. Some key steps in it are promoting best practice for local authorities, clinical commissioning groups and other providers in order to give carers much-needed breaks and respite care, which can be the difference between coping and not coping; and providing carer-confident benchmarks for employers who can identify carers within their systems and give them the support they need. Of course, there is also the work I have already mentioned: the £5 million carers innovation fund to find more creative and innovative ways to support carers, who are so crucial to our health and care system.

[Lord Patel (CB)]

My Lords, does the Minister agree that any future proposals for the funding of social care need to be sustainable? Any proposal that requires the burden to fall on those who need social care or their families will not be sustainable and will therefore require contributions from wider society.

[Baroness Blackwood of North Oxford]

I completely agree with the noble Lord, Lord Patel, who is absolutely right that we must ensure that we sustainably fund social care. The Government have provided £3.9 billion more in dedicated social care funding, but we recognise that there is a need for a sustainable financial footing for social care as a whole, which is what we are working towards with the spending review. Nevertheless, carers will continue to play an important part in our healthcare system, as they do within our society. Many people consider that they are making a rewarding and important contribution within their family and community, and we must be grateful to them for that.

Tobacco Harm Reduction

Lord Patel Excerpts

Tuesday 2nd April 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

Smoking remains the biggest cause of death in this country. Strict rules are in place to prevent tobacco companies promoting their products, including through sponsorship. We take the unlawful promotion of tobacco products extremely seriously and expect any organisation found to be flouting the rules to be investigated.

[Lord Patel (CB)]

My Lords, although snus contains both nicotine and tobacco—that is why the Swedes use it—the lung cancer rate in Sweden has reduced, whether that is to do with the use of snus or other reasons. That is the main thing that we should be talking about. What strategies do we have to reduce our lung cancer deaths, which run at about 35,000 a year? Tobacco is a key cause—80% of them are related to tobacco. Does the Minister agree that we should think about a strategy for harm reduction, whether it is snus, e-cigarettes or any other product?

[Baroness Blackwood of North Oxford]

I thank the noble Lord, who has expertise in this area, for his intervention. He is absolutely right that we need to target a reduction in lung cancer rates. Cancer Research UK states that smoking tobacco is the biggest cause of lung cancer in the UK, with seven out of 10 lung cancers caused by smoking. The NHS Long Term Plan has a very heavy emphasis on prevention, including smoking cessation services. One of the first interventions from that plan to be rolled out is the innovative targeted lung health check, which will provide an easy-access gateway to lung health and smoking cessation services. I hope that he is reassured by that answer.

Healthcare (International Arrangements) Bill

Lord Patel Excerpts

Report stage (Hansard): House of Lords
Tuesday 12th March 2019 Lords Chamber

[Lord Clement-Jones]

My Lords, the noble Lord used the expression, “giving force”. If those principles are given force, it means that the Government treat themselves and put on the record that they are bound by those principles. That is what giving force would mean in those circumstances, because these are novel circumstances set out in the Bill. That kind of reassurance is needed with the data ethics framework.

[Lord Patel (CB)]

My Lords, I had amendments that the Minister responded to at the Dispatch Box and I accepted her explanation at the time. Now I take the point that the noble Lord, Lord Clement-Jones, is trying to raise, that those principles that she enunciated about data protection included the Caldicott principles. As that reassurance was given at the Dispatch Box, I think it will cover the issue.

[Baroness Thornton]

My Lords, I added my name to the amendment in the name of the noble Lord, Lord Clement-Jones, and I am grateful that he has made the argument so I do not need to repeat it. Of course, I spoke about this in Committee and, like other noble Lords, I was reassured at the time by the explanation given by the noble Baroness, Lady Manzoor. Since then, however, the Bill team has actually made available the Bill data processing factsheet, which is very useful. It explains things in great detail, so I wondered whether it might be a good idea if this was given to everybody involved with this Bill. I do not know whether the noble Lord has seen this, but it is a very useful piece of information. Otherwise, I was satisfied in Committee, and if the Minister answers the questions, I am sure that I will remain satisfied.