Antimicrobial Resistance

Lord Patel Excerpts

Thursday 25th October 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Baroness is quite right about the risk in London. We actually have a good TB story in this country—a 41% reduction between 2011 and 2016—but London has the highest rates in the UK. I can tell her that Public Health England and the GLA are working closely together to reduce TB. In fact there are innovative new approaches, such as UCLH’s Find & Treat mobile unit, which I myself visited last year, which is going out and finding people at the highest risk, screening them and then taking them for treatment.

[Lord Patel (CB)]

My Lords, accepting that the overprescribing or inappropriate prescribing of any drug is a bad idea, the issue of bacterial infections will remain with us. I hope the new strategy that the Minister mentioned will address the issue of how we might tackle bacterial infections in future. This could be by developing new antibiotics; developing drugs that deal with infections but do not produce resistance; developing therapies such as boosting the immune response to be able to cope with these infections; and even, if I may say so, developing drugs that might deal with so-called zombie cells that cause infections, which would be more appropriate for older people. I therefore hope his new strategy will address the necessary research.

[Lord O’Shaughnessy]

I can reassure the noble Lord on that front. We have made good progress in dealing with hospital-acquired infections such as MRSA and C. difficile, although unfortunately we have had less success with E. coli. Obviously, a big part of this is driving down infections completely. The other part is about drug discovery, and that is a big global action. It is part of the G20 work that we are taking forward with Argentina to ensure that we have new classes of antibiotics to deal with these problems.

Health: Flu Vaccines

Lord Patel Excerpts

Tuesday 23rd October 2018 Lords Chamber

[Lord O'Shaughnessy]

First, take-up was actually at its highest level ever last year. The issue was the effectiveness of the vaccine, which is why the committee’s recommendation was to move to this new vaccine. In terms of confusion about who can get the flu jab, it is clear that we have the most comprehensive flu vaccination programme in Europe. Anybody who has gone to a GP’s surgery or pharmacy and has not been able to access it up to now will—or should—have been told when they can come back and when new supplies will be available. As I said, it is about making sure that can happen before the end of November. We had a fantastic take-up among NHS staff this year; the jab is freely available to NHS staff, social care staff and, for the first time this year, hospice staff.

[Lord Patel (CB)]

My Lords, the reason why the vaccine last year was not as effective was that in the majority of older people, the immune response was poor. The enhanced vaccination, although effective for only three strains of viruses—as opposed to four, before it was enhanced—is better to wait for because it will be more effective in older people. It is the older people that the flu kills so because there is a shortage of supply, Scotland took the view that it will be available only to the over-75s. Does the Minister agree that it is worth waiting for?

[Lord O'Shaughnessy]

I thank the noble Lord for that point but it is important to point out that the over-65s will not have long to wait and that anybody who wants to have it will be able to do so by the end of November, in time for the flu season.

General Practitioners

Lord Patel Excerpts

Wednesday 17th October 2018 Lords Chamber

[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.

[Lord Patel (CB)]

My Lords, one of the key recommendations made in the House of Lords report The Long-term Sustainability of the NHS and Adult Social Care related to training of health professionals. It was based on the evidence that we received of the very thing we are discussing today, which is poor recruitment, not only in general practice but in other areas in healthcare. The key recommendation was that NHS England be asked to review and come forward with a paper that will change the way we train health professionals, so that training is more flexible and integrated and encourages people to go into specialties that are currently in shortage. Does the Minister agree?

[Lord O'Shaughnessy]

I agree with that recommendation. It is certainly being considered as part of the long-term plan, for which workforce is clearly critical. That is one reason why it is significant that there are 3,000 more clinical staff in general practice who are not doctors—nurses, pharmacists and others. Clearly the nature of general practice is changing. Doctors do not have to do everything, and other well-qualified professionals can carry out essential roles.

Health: Contraceptive Services

Lord Patel Excerpts

Thursday 11th October 2018 Lords Chamber

[Lord O’Shaughnessy]

I know the noble Lord is very active on this particular issue. We respect the evidence and are considering what to do about it at the moment.

[Lord Patel (CB)]

My Lords, in response to a request for information, nearly 42% of local authorities reported that they had reduced sexual and reproductive health services because of budget cuts. All the directors of public health in local authorities report that services related to contraception have been reduced because of cuts to the public health budget. There has been a rise in the number of abortions for women around the age of 30 and above and a decrease in the uptake of long-acting reversible contraceptives among women over the age of 30. All this points to the cause being the reduction in the public health budget for local authorities. Evidence-based policy would suggest that that needs to stop or be reversed. I am sure that the Minister will say that he will fix it.

[Lord O’Shaughnessy]

I thank the noble Lord for his question and reiterate the point I made; of course public health budgets have been under pressure and we know why that is. Nevertheless, there are some positive outcomes in the changing of services, such as services moving online, as they have done in London with good effect. It is also worth saying that, in the same survey that the noble Lord referred to, more than 50% of local authorities had either kept the same levels of service or increased them. That is also worth focusing on. Nevertheless, I recognise that there are pressures and that there are behaviours that we do not want to see, such as increasing abortions among the over-30s. We are making the case, and will be doing so in the spending review, for the benefits of public health spending on issues such as this.

General Practitioners: Indemnity Scheme

Lord Patel Excerpts

Monday 16th July 2018 Lords Chamber

[Lord O’Shaughnessy]

I can tell my noble friend that the scheme we are designing is for England, the jurisdiction that the department looks after. However, the Welsh Government have announced their intention to have a state-backed scheme and we are speaking to the devolved Administrations in Scotland and Northern Ireland to make sure that we act together in this regard.

[Lord Patel (CB)]

My Lords, when the scheme is introduced, what plans are there to reduce the level of litigation in primary care, considering that the majority of primary care practitioners are independent contractors, and those who are not are employed by GP principals and not by the National Health Service?

Hepatitis C

Lord Patel Excerpts

Monday 9th July 2018 Lords Chamber

[Lord O'Shaughnessy]

The first thing I would say to the noble Baroness is that, in terms of sexual health clinics, local authorities are mandated to commission comprehensive testing services. Clearly, however, testing needs to happen in many more areas. We have introduced testing in pharmacies, for example, for hepatitis C. That has proved very effective in identifying it in people who take drugs, as well as offering other opportunities to test particularly high-risk communities. Another example is that there has been an increased screening of the south Asian population, where there is a much higher prevalence. It is about using the opportunities of community health services and taking testing into those communities, so that we can deliver on our target.

[Lord Patel (CB)]

My Lords, direct-acting antivirals are the greatest advance that has occurred in trying to eliminate hepatitis C infection—it is effective in 95% of those who carry the infection. So a policy that does not treat everybody who is known to have the hepatitis C virus is wrong. Secondly, if we are to eliminate it, we need to identify those who carry the virus but are not diagnosed. Strategies focusing only on the prison population will not do that. Thirdly, we need to reduce the risk in the at-risk population by educating them. Unless we have a strategy across these three areas, we will not eliminate hepatitis C by 2025.

[Lord O'Shaughnessy]

I agree with the noble Lord that we need a whole-system approach, but I do not think that we necessarily need to condense that into a document. There are lots and lots of things going on, some of which I have talked about. Of course, the WHO target is about the elimination of hepatitis C as a public health risk; it is not about elimination completely. As he said, it is very difficult to find everybody who has not yet been diagnosed. The main thing is that it is reduced as a health risk: it does not kill people anymore and cannot be transmitted. That is what we are on track to do by 2025.

Health: Endoscopy and Bowel Cancer

Lord Patel Excerpts

Monday 2nd July 2018 Lords Chamber

[Lord O'Shaughnessy]

I will have to write to the noble Lord with an answer to his question about the type of endoscopy he mentions, as I do not have the details of it. The risk of false positives is one reason that we have to be extremely careful with screening programmes of all kinds, whether it is the faecal immunochemical test or an endoscopy. As he knows, whatever screening programmes are implemented, the National Screening Committee tries to reduce the number of false positives wherever possible.

[Lord Patel (CB)]

My Lords, given that we have one of the poorest outcomes compared with other health services in the developed world and that the demographic changes that will occur in the population may well mean that one in two people will develop cancer, are the Government aware of what determinants there are for poor outcomes? What plans do they have to improve them for cancer patients?

[Lord O'Shaughnessy]

The noble Lord is quite right to point that out. While outcomes have improved, they lag behind those of other countries, which we need to correct. The independent cancer taskforce set the goal of saving 30,000 extra lives a year by a number of different routes. The one that I pick out in particular is early diagnosis. We know that too many cancers are diagnosed at a late stage, so this year the NHS has committed to increasing the proportion of cancers diagnosed at stage 1 or stage 2, and we are spending £200 million in cancer alliances to support early diagnosis in the community.

Chronic Lymphocytic Leukaemia: Ibrutinib

Lord Patel Excerpts

Thursday 7th June 2018 Lords Chamber

[Lord O'Shaughnessy]

First, I thank my noble friend for the question and for the opportunity to meet sufferers of this illness two weeks ago. As he and the House know, the point of NICE is to provide that expert, objective evaluation of the benefits of drugs both clinically and in terms of value for money. It has clearly made a recommendation in this case. I also know that there is concern about the discrepancy between NICE’s guidance—or, I should say, the summary in section 1 of that guidance—and NHS England’s commissioning guidance, which is narrower. It is precisely that concern about a discrepancy that we are investigating at the moment, and which will be the subject of the meeting that we are having. Once I have more information on that, I shall of course write to him and place a copy of that letter in the Library.

[Lord Patel (CB)]

My Lords, I agree with all the things that the noble Lord, Lord Forsyth of Drumlean, has said. Ibrutinib as a drug was developed after an extensive study to understand the biology of the disease, chronic lymphocytic leukaemia, which increasingly affects older people. Because it was developed following an extensive biological study, it is a targeted drug. In technological terms, it is a tyrosine kinase inhibitor. Therefore, it is more effective in the treatment of this disease and has a better outcome, and some countries have adopted this drug as the first line of treatment. We have used the guidelines that say that the first line of treatment—apart from patients who meet certain criteria, such as those with 17p deletion, who will be given the drug—will be chemotherapy. That then subjects people who have relapsed to a second toxic treatment with chemotherapy, which is wrong. For NHS England to use criteria that are completely arbitrary, except for cost, is also wrong. It should be required to produce the scientific evidence for that, and I hope that the Minister will agree.

[Lord O'Shaughnessy]

I thank the noble Lord for his question. There are two important issues here. First, on this treatment as a first-line treatment, the evidence that was put into NICE by the company itself did not propose its use as a first-line treatment, which is why it has been proposed as a second-line treatment. It is important to distinguish there. However, clearly there is this apparent discrepancy between the NICE guidelines and NHS England. I have, obviously, investigated this, subsequent to the meeting with my noble friend and sufferers. NHS England’s view is that its commissioning guidelines are consistent with the commissioning when the drug was in the cancer drugs fund, and the full NICE guidance, but I also know that that is not satisfactory to some of the patients suffering from this illness who have been in remission for three years. That is precisely what I want to get to the bottom of next week.

NHS: Cybersecurity

Lord Patel Excerpts

Wednesday 2nd May 2018 Lords Chamber

[Lord O'Shaughnessy]

My noble friend makes an excellent point. Not only is it critical that data is joined up for direct care—quite rightly, patients are amazed when that does not happen—it is an absolutely essential resource for research into new treatments. One thing we are doing to try to provide that reassurance to the public, which has not always been there, is introducing a new data opt-out at the end of this month to provide that reassurance for patients who do not want to be part of it. We are focused on providing that resilience and security so that they can be confident that, when the NHS holds their data, it uses it securely, safely and legally.

[Lord Patel (CB)]

My Lords, one of the lessons learned following the WannaCry attack was that the weakest links in the NHS had to be identified. The Minister has already referred to the upgrading of software that was found to be weak. What work is being done to identify other areas in the NHS that would be open to cyberattacks?

[Lord O'Shaughnessy]

The noble Lord makes an excellent point. One thing we are now doing is more intelligence-led penetration testing based on work that the Bank of England does, which is to probe in a safe way any weaknesses and to make sure that they are dealt with. The CQC has also added data security to its well-led criteria for inspections. We have now demanded that a board member of each trust takes responsibility for cybersecurity. Indeed, for a trust to be rated as well led, it has to demonstrate that competence.

The Long-term Sustainability of the NHS and Adult Social Care

Lord Patel Excerpts

Thursday 26th April 2018 Lords Chamber

[Lord Patel (CB)]

I truly say “Hear, hear” to the Minister, and thank him for his response. He has covered everybody’s concerns and the points raised in the debate in great detail, for which I thank him.

I recognise that good progress is being made, but among that good progress is a need to do more to integrate the care and make the NHS a truly outcome-based service. I was always for a commission. We had a debate here three years ago, in which there were 22 speakers, three previous Secretaries of State, and only two dissenters. Both dissenters were on the Front Benches, so there is nothing new; nothing changes. As I said in my introduction, the reason is that election time comes, and the NHS is a good topic for trying to win votes.

However, I now see a chink of support towards a political consensus, and I hope that today’s debate has contributed to that, and that there will be other times to help to do that. I also thank most sincerely each and every one of you who spoke today. It has been a tremendous effort. I recognise the great support that noble Lords have given to this report and to this debate today. There were many more: over 10 people had to drop out because the dates were changed, and I had more than 24 emails or notes from people saying that they would have liked to have taken part but could not. There is a great deal of interest in this House on the subject of the NHS and all the issues related to it, such as science, development, et cetera.

I see that there is no acceptance for an office for health and care sustainability, but its time will come. There will be a time when the public will demand it and some independent scrutiny of health and social care. I await the developments of the 70th-year celebration that the Minister mentioned. I await the Green Paper, and no doubt we will have an opportunity to discuss that. We await the report from the Institute for Government that is looking at bodies, like the OBR, that we suggested. It has been a great debate on which we have spent nearly seven hours, with fantastic contributions.

Motion agreed.