Junior Doctors: Industrial Action

Debate between Lord Prior of Brampton and Lord Ribeiro

Monday 5th September 2016 Lords Chamber

[Lord Prior of Brampton]

I am not sure the Government ever made that promise. That was a promise made by the Brexit campaign. The Government have committed to putting an extra £10 billion into the NHS over the course of the Parliament, but they are certainly not in any way committed to fulfilling promises or pledges made by the Brexit campaign.

[Lord Ribeiro (Con)]

My Lords, we can all be gratified that the junior doctors have decided to postpone their strike. I am sure that this is partly as a result of the pressure being put on them by senior doctors. They are the ones who know the consequences for patient safety because they are ultimately responsible when things go wrong. David Watkin, a past president of the Association of Surgeons, has written a letter to the Times today in response to Simon Wessely’s letter. He makes the interesting point that there is a real issue about the way our junior doctors feel supported—or should I say unsupported. There has been the loss of the firm structure whereby junior doctors worked part and parcel in a team, and they and a consultant knew each other, trusted each other and could rely on each other. As mentioned by the noble Lord, Lord Hunt, that has gone partly because of shift working, rota gaps and the need to fill those gaps.

Brexit provides an opportunity, whether we like it or not, to take time and look again at two regulations: the European working time directive, and the new deal. The main thing about the European working time directive is that some junior trainees—particularly in my specialty, surgery—wanted to work longer than 48 hours a week. For all other specialties you have to acquire knowledge, but for surgery, cardiology, nephrology and some other specialist areas, you have to learn the skills. Learning and acquiring skills takes time. Can we look at Brexit as an opportunity to assure some of our junior doctors, who feel unloved and unsupported, that there may well be a way to look at and improve their working practices?

[Lord Prior of Brampton]

My Lords, the origins of this dispute and lack of trust go back many years, to the end of the old firm structure. Many junior doctors feel a lack of support. It is easy to lob bricks at the Government, but the senior doctors and the royal colleges need to look at themselves pretty carefully and pretty hard in the mirror because they have some responsibility for this as well. I hope they will be very much part of working through some of these non-contractual issues, along the lines my noble friend suggested.

Junior Doctors: Contract

Debate between Lord Prior of Brampton and Lord Ribeiro

Thursday 5th May 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, we now have a pause for five days. This is not dogma; we have two parties who have different views about a small part—about 10%—of the existing contract. Over the next five days we have a chance to resolve that.

[Lord Ribeiro (Con)]

My Lords, while the whole House welcomes this pause, I hope that, whatever happens, there will be an opportunity for an independent review to look at the very points that were made earlier about the lack of appreciation of and support for junior doctors. If there is one thing last week’s dispute has shown, it is that when consultants man the front door of a hospital, services are very much better. Will the Government consider having an independent review after this dispute to look at the future workforce?

Health: Treatment Rationing

Debate between Lord Prior of Brampton and Lord Ribeiro

Tuesday 26th April 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the noble Lord will be aware of the Atlas of Variation, which encompasses a new programme, Right Care; it looks at variations in medical and surgical practice across different populations and tries to spot unwarranted variation. That is the best way to identify where different CCGs are not delivering the kind of care that we would expect. In view of what we have just said, I am tempted to say that where an individual does not get the treatment he expects, he should complain to his local Healthwatch. That would be one way to do it but every hospital has a PALS and he could always write to his MP. There are lots of ways in which individuals can raise concerns if they wish to do so.

[Lord Ribeiro (Con)]

As a surgeon, I had cause to cancel or delay operations on patients who were obese or were smokers, but those decisions were based on clinical grounds from the knowledge I had of the individual patient. Clinical commissioning groups can give guidance but they should not provide diktats. What assurance will the Minister give that clinical decisions will be left to those who have the best interests of the patient at heart and who know their patients?

Junior Doctors: Industrial Action

Debate between Lord Prior of Brampton and Lord Ribeiro

Monday 25th April 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, we have discussed this issue outside the Chamber. Although one must never give up hope, I find it hard at the moment to see how a negotiated, agreed solution might be found. We have had three years of negotiations; we have had 75 meetings. We came within a hair’s breadth of a solution, with the Government making concessions around how much of Saturday should attract premium pay, but we were unable to do the deal. Sir David Dalton, a very distinguished, well-respected chief executive of Salford Royal, led those negotiations and his advice to us afterwards was that he could not find a way through it. His advice then was that we had no choice but to impose the contract. None of us wanted to impose the contract; we all wanted to find a solution. But with the current BMA executive we found that impossible. Much as I regret it, as things stand this evening, I do not see a solution.

[Lord Ribeiro (Con)]

My Lords, as a junior doctor in 1975, I went on strike, so I can understand why junior doctors might feel the way they do. The difference between 1975 and now is that we did not withdraw emergency cover. That is the point we should concentrate on, because I fear that, on Tuesday and Wednesday, people will be denied care irrespective of the cover provided by consultants and we will see some deaths occurring. When they do, the blame will fall squarely on both parties, which is most unfortunate. Something needs to be done. It is late and, as the noble Lord, Lord Patel, said, we are talking about a sticking point over Saturday. Surely we could agree that emergency care starts at 1 pm with premium pay. Perhaps that would be both sides meeting in the middle.

When this is all over—I regret that I think that tomorrow’s strike will go ahead—may I please ask that we have an independent inquiry and review? This is about the sustainability of a workforce that does not use junior doctors at the front door to deal with all the work. We need a workforce that will put senior decision-making at the front door of a hospital so that the juniors can have more time to be supervised and trained.

[Lord Prior of Brampton]

My Lords, I completely agree with that. When the dust has settled, we have to take a wholly new and independent look at how junior doctors are trained. As the noble Lord will know, Sue Bailey, chair of the Academy of Medical Royal Colleges, has been asked to look at this, but I do not think it is possible to do that sensibly while the dispute is ongoing. We need the full co-operation of junior doctors in that review. I would personally welcome an independent assessment of the way we train junior doctors once this dispute has been settled. I share my noble friend’s views entirely: it would be wonderful if the junior doctors would agree to provide emergency cover on Tuesday and Wednesday this week. But it is now 8.15 pm on Monday and time is rapidly running out.

Sugar Tax

Debate between Lord Prior of Brampton and Lord Ribeiro

Wednesday 13th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the Government have taken into account a range of evidence from Public Health England, the McKinsey institute, the SACN and others in coming to their strategy. The noble Baroness is absolutely right that the response will need to take into account issues such as reformulation, portion size, availability and a whole range of other issues that affect sugar intake.

[Lord Ribeiro]

My Lords, while the sugar tax for fizzy drinks is a regressive tax, the very people it would target stand to benefit from such a tax because, leaving aside obesity, which is a long-term problem, dental caries are a short-term problem. There is no doubt that sugary drinks are causing a massive amount of dental caries, the cost of which falls on the NHS, as these unfortunate children have to have dental extractions which will affect their well-being and quality of life for years to come.

[Lord Prior of Brampton]

My Lords, reduction of sugar is a critical part of the Government’s obesity strategy. It has been made clear by the reports of Public Health England, the McKinsey institute and others that there is no silver bullet. It is not just a question of passing a tax and getting the results that you wish to have. If a tax were to come in, it would be part of a whole range of other measures.

Health: Liver Disease

Debate between Lord Prior of Brampton and Lord Ribeiro

Wednesday 9th December 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, as part of the responsibility deal, a financial contribution was made by some of the alcohol companies. I accept that it was a small contribution. I shall have to take this under advisement as I am not sure how much the industry does contribute to the victims of alcohol disease. I agree with the noble Lord’s premise that the damage done to many people through excessive alcohol consumption is a cause of great concern.

[Lord Ribeiro (Con)]

My Lords, does my noble friend agree with recommendation 3 in the report, which requires the establishment of liver units in district general hospitals, acting in a hub-and-spoke network with specialist hospitals? This is important to provide access to people, particularly in the north-west, where, sadly, there is very little access to specialist hepatology units.

[Lord Prior of Brampton]

My Lords, the recommendations in the report about a hub-and-spoke approach, to which my noble friend refers, with district general hospitals having some hepatology services but being linked into a specialist centre are absolutely right. It is the right model; I have no doubt about that. We have established 22 operational networks for hepatitis C treatment, which are all linked into specialist treatment centres. We believe that that may be a model for the future.

Junior Doctors Contract

Debate between Lord Prior of Brampton and Lord Ribeiro

Friday 20th November 2015 Lords Chamber

[Lord Prior of Brampton]

I completely agree with the noble Baroness. I am not going to stand here and be sycophantic about the Secretary of State for Health, but the one thing he has prioritised above all else since he has been there is patient safety and patient quality.

[Lord Ribeiro (Con)]

My Lords, Sir Terrence English in his excellent article in the Telegraph made the point that medicine is a vocation and doctors who enter the profession should recognise that patients always come first. The Armed Forces do not go on strike and neither, I believe, should doctors. On the issue of preconditions, in response to a question from Sarah Wollaston in the other place, the Secretary of State made it clear that there are no preconditions. I have looked at Hansard, and that is what he said. There are no preconditions and the BMA should recognise that and go back to the table.

[Lord Prior of Brampton]

My Lords, the threshold for strike should be very high because of the vocational and professional dedication of doctors. Certainly, the threshold should be higher than it usually is for pay and conditions issues such as the one before us today.

NHS: Costs of Operations

Debate between Lord Prior of Brampton and Lord Ribeiro

Monday 9th November 2015 Lords Chamber

[Lord Prior of Brampton]

The reference costs try to pick up all the costs attributable to certain procedures. As I was saying earlier, a patient-level costing system would probably be more accurate. I did not catch the first part of the noble Baroness’s question, so perhaps we could deal with this outside the Chamber. Hospitals are incredibly complex and picking up all the costs, particularly allocating overhead costs to individual procedures, is difficult. Compared to any other hospital costing system I have seen in the world, though, the NHS reference-cost system is pretty comprehensive.

[Lord Ribeiro (Con)]

My Lords, one category not included in the list is the independent sector treatment centres. Are these proving as cost-effective as we would like? If so, is it not time that NHS consultants have greater access to them to deal with their elective cases, many of which are often cancelled because of the need to bring in emergencies?

[Lord Prior of Brampton]

My noble friend raises an interesting question about independent treatment centres, which are for elective cases, not emergencies. They are able to plan their case mix more accurately, and are much choosier about the case mix they take. They can be extremely efficient, and if they have the volumes coming through, they are. Because of the case mix they take, they ought to be able to deliver significant cost advantages over providing such surgical care in a normal NHS hospital. The argument for ring-fencing orthopaedic procedures, for example, is overwhelming in terms both of cost and the quality of care delivered.

Health: Detection Dogs

Debate between Lord Prior of Brampton and Lord Ribeiro

Thursday 17th September 2015 Lords Chamber

[Lord Prior of Brampton]

I agree with the noble Lord. Dogs—indeed, all pets—can provide companionship to many people who are lonely, particularly elderly people who have lost many of their relations. I congratulate Pets as Therapy.

[Lord Ribeiro (Con)]

My Lords, the Minister is absolutely right in referring to the research in Milton Keynes. As far as prostate cancer is concerned, a man’s best friend probably is his dog. However, there is no doubt that the molecular markers can be detected in urine, and this may be the way to go in future research. It needs to be directed in that way because just a simple dipstick might well be able to detect the markers. If it is possible to detect prostate cancers using dogs, will the Government be prepared to fund such research and carry out a proper controlled clinical trial?

[Lord Prior of Brampton]

Clearly, molecular diagnostics is a growing field and will have a hugely important role to play in diagnosing many cancers. This was certainly a recommendation of the cancer task force led by Harpal Kumar. We are not by any means saying that we should pursue dogs at the expense of molecular diagnostics, just that we should try every opportunity. There seems to be some evidence regarding the number of false positives—for example, the use of dogs to sniff urine is considerably more accurate than more conventional forms of detecting cancer. We would not therefore want to rule out the use of dogs by pursuing solely molecular diagnostics.