NHS: Cancer Treatments

Lord Turnberg Excerpts

Thursday 25th January 2018 Lords Chamber

[Lord Turnberg (Lab)]

My Lords, it has been a real privilege to hear the noble Baroness, Lady Jowell, give such a brave and inspiring speech. I do not know how anyone cannot be very touched by her words. I have long admired her and now more than ever see her as an inspiration. The spirit that she demonstrated so clearly is absolutely characteristic of her. If I may be permitted a personal note, I love the hat.

The noble Baroness makes an impassioned case for the availability of new experimental forms of treatment, and who is there to gainsay her? Cancer Research UK says we need much more research to understand the nature of glioblastomas—and of course it is right too—but meanwhile what are patients to do? It is true that doctors are able to prescribe novel treatments for individuals on what is known as the named patient basis, and the Bill of the noble Lord, Lord Saatchi, a couple of years ago encourages that approach. However, the problem is that many such new treatments are specific for very small numbers of cancer patients and the costs are enormous.

That immediately brings us to the question of funding—we cannot get away from that. The late lamented cancer drugs fund was soon overwhelmed by the high costs of new diagnostics and drugs. The remarkable advances in so-called liquid biopsies, in scanning, in proton beams and in specifically tailored molecular therapies and immunotherapy are all extremely costly, and no amount of juggling with flexible pricing mechanisms and outcomes-based pricing will find the money needed. So I ask the Minister whether the Government will take note of the recommendation in the Select Committee’s report on the future sustainability of the NHS for a new method of funding involving a hypothecated tax system based on national insurance payments. I am sorry to be so controversial.

The average age of your Lordships’ House is 69. That means that almost half of us have or will have had one cancer or another. I have had two and I suppose, statistically speaking, that saves one other from having one. That makes cancer take on an intensely personal meaning for all of us and we are fortunate to live at times when so much more can be done for us than ever before. Unfortunately, it all comes at a cost and we could be doing so much better. As we lag behind in so many ways, in some cases we are complicit in failures that should just not happen.

I finish on a point about prevention, where we might be able to save someone. We have an extremely effective way of detecting women who are susceptible to ovarian and breast cancer. Here I express my interest as a recently retired trustee of the charity Ovarian Cancer Action. Testing for the BRCA gene, the gene responsible for passing on susceptibility, is now offered to close relatives of ovarian cancer patients, but a relative who is not quite so close, with a smaller chance—say 5%—of being a carrier, cannot have the test. If you have a one in 20 chance of carrying a gene such as that, would you not go for a test costing just £175? It is a bargain for the NHS. I ask the Minister: will the offer of such a test now be made to all such at-risk relatives?

Finally, the briefing I have had from Cancer Research UK suggests that our ability to conduct vital cancer research will be compromised after we Brexit from the EU if we cannot ensure the future of cross-border clinical trials, as has been spoken of. Will the Government ensure that we will be able to continue to collaborate seamlessly with centres in the rest of Europe after Brexit?

Children: Oral Health

Lord Turnberg Excerpts

Monday 4th December 2017 Lords Chamber

[Lord O'Shaughnessy]

Yes, I agree with my noble friend. Preventive care is important. Pilot schemes have been going on in 75 practices to look at incentivising preventive care and population care. I understand that an evaluation report of that first full year of prototyping is due to be published in the new year.

[Lord Turnberg (Lab)]

My Lords, regarding fluoride and dental decay in children, can the Minister provide figures for the incidence of dental decay in areas that fluoridate their water compared with those that do not?

[Lord O'Shaughnessy]

I do not have that exact comparison in front of me. I understand that areas that fluoridate have much better oral health than others, which is why, as I said to my noble friend, we encourage all local areas to look at the evidence and make decisions accordingly.

Nurses and Midwives: Numbers

Lord Turnberg Excerpts

Monday 4th December 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Lord’s mental maths are far better than mine. I agree that it will provide for the possibility of yet more funding for the NHS, which is something that this Government have delivered in the past seven years.

[Lord Turnberg (Lab)]

My Lords, I wonder whether the Minister can help clear up my confusion. He is telling us that the number of training places is increasing while my noble friend Lady Thornton suggested that the number of people coming into those places is decreasing. What is the correct interpretation? Have we got more, fewer, or what?

[Lord O'Shaughnessy]

I will do my best to provide clarity. If you look at nurse training places in universities, in 2016 the number was 3% higher than this year. One reason for that has obviously been the change in the financing arrangements. However, this year still represents the second-highest number since it became a degree profession. If we look to the future, from 2018 onwards there will be 5,000 more funded clinical placements which will enable the number of nurse training places to increase by some 20% to 25%.

Health and Social Care: Falls Prevention

Lord Turnberg Excerpts

Thursday 30th November 2017 Lords Chamber

[Lord O’Shaughnessy]

I accept that there is a challenge that we have to meet in social care: it is the reason that the Government are committed to a social care Green Paper next summer to provide long-lasting reform. In the meantime, I hope that my noble friend will recognise that another £2 billion was announced in the previous Budget to go into social care over the next three years in order to move people out of inappropriate hospital stays and into their homes. That is backed up, as I pointed out, by a doubling of the disabled facilities grant year on year, precisely to provide the kind of interventions that have a huge pay-off for the public sector. Something like £1 spent on the disabled facilities grant saves £4 in the wider public sector, so this is very important work.

[Lord Turnberg (Lab)]

My Lords, one of the main causes of fracture of the hip in someone who falls is osteoporosis, which is both preventable and treatable. Will the Minister consider starting a screening programme for at-risk groups?

[Lord O'Shaughnessy]

That is a very interesting idea. I will write to the noble Lord. Of course, since this summer general practices are now obliged to carry out screening of over-65s specifically to look at frailty, looking at those with mild, moderate and severe frailty, and that may already include osteoporosis. But I will write to him with the specific details.

Greater Manchester Combined Authority (Public Health Functions) Order 2017

Lord Turnberg Excerpts

Tuesday 7th November 2017 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, perhaps I may take this opportunity to question my noble friend on the fluoridation programme. I must declare an interest. I cut my legal teeth as a devil and an apprentice with Simpson & Marwick, and my devil master was the junior advocate in the fluoridation case brought by a pensioner who had dentures—she had none of her own teeth. She objected to the fluoridation programme to be carried out by Strathclyde regional council in the early 1980s. She won her case and Strathclyde regional council did not fluoridate the water supply at the time on the grounds that compelling evidence was led by the petitioner, Mrs McColl, to prove, among other things, that fluoride could be a carcinogen.

Has the Minister taken the time to consider such evidence, and can he assure the House that the level of fluoridation in the public water supply will not be such that any such fears will be raised in the fluoridation programme to be carried out by Greater Manchester council?

[Lord Turnberg (Lab)]

My Lords, perhaps I may ask the Minister about infectious diseases and express my interest as a past chairman of what was the Public Health Laboratory Service and as a Mancunian. Infectious diseases know no boundaries, and it is important with any infectious disease outbreak, which may occur anywhere in the UK, that information is spread very easily to epidemiological centres and central laboratories, so that such outbreaks can be traced and checked. Is there anything in this agreement that will ensure that there is association, collaboration and co-operation with the central laboratory services?

[Lord O’Shaughnessy]

I thank noble Lords for their contributions and for their broad support for the order before the House today. As I outlined, it represents another significant milestone in the Government’s devolution agenda and I am glad that that has been welcomed across the House. I will try to respond to the various points that noble Lords have made.

Like the noble Lord, Lord Hunt, we support the idea of the population plan, which will clearly differ from place to place where there is this kind of devolution. I stress that an important and distinctive part of this plan is that it confers on the combined authority the same powers and responsibilities as a local authority. It is therefore about them acting concurrently, rather than in an overbearing way, or seeking to override.

I have been in your Lordships’ House long enough to know that fluoridation is an area of particular interest. I wonder only why it has taken so long for me to have to answer a question on it. This is a devolution deal, and it is therefore about those powers being taken locally and acting in concert. I do not think it is consistent with the idea of devolution for me to urge any combined authority to point in one direction or another, and it sounds like my noble friend Lady Gardner has been doing plenty of urging already. Any such move would have to be made in concert by all 10 of the local authorities and the combined authorities and be done through the usual processes of consultation and so on, with regard to all the responsibilities that attend on those public health powers. I hope that provides some reassurance to my noble friend Lady McIntosh.

Health: Sepsis

Lord Turnberg Excerpts

Thursday 14th September 2017 Lords Chamber

[Lord O’Shaughnessy]

I am sorry to hear that sepsis has affected the noble Baroness’s husband in that way and I am glad to learn that he is not one of the more than 40,000 people who die from the condition every year. Public awareness is critical and, as I say, we are looking at new ideas for how to get the message across using a range of routes. The point about clinical awareness is also very important. Until a couple of years ago, there was no widespread clinical awareness of the symptoms of sepsis and how to assess and then treat people, but we have seen quite a big improvement. I can give one example. For those presenting with symptoms in emergency departments, previously only around half were assessed for sepsis; the figure is now up to nearly 90%. I see that as good progress, but clearly there is much more to do.

[Lord Turnberg (Lab)]

My Lords, one of the major difficulties with sepsis is the fact that it is so speedy. It can kill within a few hours. Awareness of this speed is vital—for the public and for practitioners.

[Lord O'Shaughnessy]

That is absolutely right but I draw the attention of the noble Lord to a couple of things. First, in the NICE quality standard published yesterday there are some very clear statements about the speed with which people suspected of these symptoms should be treated. Those are quite robust in terms of getting intravenous antibiotics to people within an hour, being reassessed by a senior clinician if they then fail to improve within an hour and so on. That is very clear and there is implementation guidance going through. Another thing announced yesterday is quite important. It is a slightly odd phrase but “safety netting” is where someone has been assessed on whether they have sepsis, does not have it but is sent away with materials that show what the symptoms might be and how to report back if their condition deteriorates.