Health and Social Care Information Centre (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023

Baroness Finlay of Llandaff Excerpts

Wednesday 25th January 2023 Lords Chamber

Finally, I return to the timing and the speed. This feels very much like a rerun of the closure of Public Health England and the creation of the UKHSA when a Covid surge was still going on; officials in the department and NHS staff were working at full tilt and had to change the way in which they worked in order to cope with the UKHSA as a new body. Can the Minister reassure us that that will not be the same when NHS Digital moves into NHS England? My fear is that the pressure on the NHS at the moment means that the situation could be similar to the pressure that the UKHSA has faced over the past year in trying to create a new organisation and new structures at a time of immense pressure.

[Baroness Finlay of Llandaff (CB)]

My Lords, I am grateful to the noble Lord, Lord Hunt of Kings Heath, for having put this amendment before us. I am not going to repeat the important points made by other noble Lords who have spoken but I have a few questions for the Minister. I should declare that I am a member of the BMA’s ethics committee and I am slightly concerned—if I heard the Minister right—that there has not been a comment back from the BMA, because there have been concerns about the potential monetisation of NHS data.

There were a lot of discussions within NHS Digital at the time of the passage of the legislation about pharma companies possibly having early access to some data and negotiating discounted prices as a result, particularly for expensive medication and early access. Can the Minister tell us how much discount has been achieved by some of those arrangements, whether those discounts have applied across the whole United Kingdom or whether they have been only of specific benefit within NHS England? As health is a devolved issue, we now have a problem particularly between Wales and England, where there is effectively a porous health border and many people are going from Wales to England for parts of their treatment cycles. That means that data moves across the border. So my next question is: what has happened in discussions with NHS Wales and what is being done to ensure compatibility for data transfer?

My next question relates to our experience last year when an NHS trust had its systems hacked and the whole system went down. How will the security of the new, larger holding of data be ensured? Obviously, if you have a lot of data held together, there are benefits but also risks. How are those risks being looked for and, as much as possible, mitigated against?

The other issue, again in relation to Wales, is somewhat historical but I have not been able to track down exactly what happened to some data. The Health and Social Care Information Centre merged with Connecting for Health in the 2012 Act. At that time, the data side was a UK-wide database. I wonder what happened to the data that was being held for Wales; whether NHS Digital still holds any data relevant to Wales; what discussions have been had with Wales over the transfer of relevant data; and what arrangements are being made for the future transfer of patient data—again, to allow the transfer of data while, importantly, preserving patient confidentiality. Of course, one of the problems when data is transferred between organisations is that there is a potential risk in terms of confidentiality and a possible leak.

My last question for the Minister is quite simple: why were these regulations not laid earlier? As I understand it, the processes are now well under way—indeed, they are almost complete in terms of the staff, the merger and so on. It would have been helpful for everyone to have been able to have sight of these regulations, as well as all the supporting documentation, earlier.

PPE Expenditure

Baroness Finlay of Llandaff Excerpts

Wednesday 25th January 2023 Lords Chamber

[Lord Markham (Con)]

Right now, less than 1% of stock is held in China—to answer that question directly. In terms of cost, we are currently paying about £700,000 per day, which is why we are writing off the stock and effectively disposing of it. We have tried to donate as much of it as possible to people who want it, but we have to bite the bullet on the rest and say, “You know what? It’s no longer required so we are disposing of it as rapidly as possible.” We are bringing down those costs; we will be saving £200 million a year through that rapid disposal.

[Baroness Finlay of Llandaff (CB)]

How many health and social care staff are now off long-term sick with long Covid? What correlation has there been between long Covid and their perception that they did not have adequate PPE for the job to be done?

[Lord Markham (Con)]

I will write to the noble Baroness with the statistics. I can be clear that the endeavours undertaken to buy the PPE were to make sure that we did not run out. Again, there is quite a bit of hindsight going on in saying, “Ah, we bought too much of it”, when at the time everyone was scrambling to say, “You need to buy more.” That was the result of the situation, and to try to apply hindsight now is quite wrong. They did a pretty good job regarding the amount that they bought; they got 97% of it right, which I think we would agree is a pretty good result.

Social Care: Integrated Care Systems

Baroness Finlay of Llandaff Excerpts

Wednesday 11th January 2023 Lords Chamber

[Lord Markham (Con)]

Clearly, it is early days. These were set up last summer and we must ensure that they bed in properly and learn. I am confident that that is the right approach, but, as the noble Lord mentioned, we must make sure that regulators in this space ensure that that is the case. It is probably a question for a few months’ time, when we can be sure.

[Baroness Finlay of Llandaff (CB)]

My Lords, according to Hospice UK, of which I am a vice-president, up to half a million people last year had a palliative care phase before they died. In many of those cases, a failure of social care resulted in a breakdown of care in the community and hospital admission. Following on from the question asked by the noble Lord, Lord Touhig, when these patients are seriously ill or disabled children, they need access to respite care during their illness, as well as at the end, with rapidly responsive care. How are the Government monitoring whether the needs of these people are being met and that the timeframe to put in place the social care that they need does not just slip to the point of becoming a meaningless exercise?

[Lord Markham (Con)]

Those monitoring processes are in place, but to give sufficient detail, it is best that I write.

Streptococcus A: Antibiotics

Baroness Finlay of Llandaff Excerpts

Thursday 15th December 2022 Lords Chamber

[Lord Markham (Con)]

My general thinking—this is a personal view—is that the market is normally very well placed to supply these things. There was the excellent example of the vaccines, whereby it acted incredibly quickly and got Covid vaccines out as necessary. I think we are always better placed using the strength of the whole market and looking to international suppliers as well. They are always going to be able to provide the necessary medicine to a quicker timescale than our own company would.

[Baroness Finlay of Llandaff (CB)]

My Lords, since the risk of invasive group A streptococcal infection is increased in the presence of other viral infections—any of them; it could even be chickenpox in children—what guidance are the Government giving to all schools on public health measures to decrease cross-infection between children and ensure parents are encouraged to keep those who might be unwell away from school, rather than sending them to school, as is the tendency, because of attendance registers?

[Lord Markham (Con)]

The noble Baroness is correct; it is the coincidence of more than one condition, particularly respiratory conditions, which causes the more extreme cases. The advice is definitely to keep children away from school if there is any question on that at all, especially as we are about to enter a period of school holidays. It is very much the view of the experts that the school holidays should flatten the curve of infections. I should also say at this point that while we are all quite correctly concerned about this, and doing everything we can regarding supply, the current levels are still lower than those we saw in 2017-18, when March and April had the normal peaks of around 2,000 a week. We are currently at around 1,200 cases a week and, as I say, we expect that to flatten out a bit with the firebreak, so to speak, of the Christmas holidays.

Bereavement Support

Baroness Finlay of Llandaff Excerpts

Wednesday 9th November 2022 Lords Chamber

[Lord Markham (Con)]

I am afraid that I do not have any knowledge of the case in point. As I said before, I welcome the role of the right reverend Prelate the Bishop of London in producing this report, which I know all the bishops and all the Church, of whatever faith, will take directly to heart. Again, I can only repeat the title of the report: Bereavement is Everyone’s Business. The Church has a key role to play in that, as it fully understands.

[Baroness Finlay of Llandaff (CB)]

My Lords, will the Government ensure that groups who are undertaking good bereavement support of children, particularly in schools, are actively engaged in cross-departmental working, given that a large number of children who are acutely bereaved do not get any support at all and often do not have the language with which to express their feelings? Will the Government also ensure that, through the Ministry of Justice, the Prison Service is actively involved? It has been estimated that about four out of five remand prisoners have had a seriously traumatic bereavement experience with no support at all, which has culminated in progressive anger resulting in criminal activity.

[Lord Markham (Con)]

I was very struck when I read the report by the breadth: for every death, five to nine people are bereaved, and often they are young people or people in prison. The truth, as we know, is that it is people across the board. That is why I particularly welcome the new policy team, which has members from the DfE and, I think, the Ministry of Justice; however, I will check, because the point the noble Baroness has made is a good one. The whole point of the policy team is that it is cross-functional, to try to ensure that we really can touch every single point where there are institutions which can help the bereaved.

Maternity and Neonatal Services

Baroness Finlay of Llandaff Excerpts

Tuesday 25th October 2022 Lords Chamber

[Lord Markham (Con)]

We all acknowledge a duty of candour. That should be fundamental to the leadership and to everyone in every trust. In this case, I was pleased to see the trust completely accept the findings and its failings and apologise unreservedly. That is something we need to make sure that all trusts do. We have the framework in place to do that but, if we do not, we will not hesitate to act further to ensure that it is.

[Baroness Finlay of Llandaff (CB)]

My Lords, this alarmingly clear report flags up flawed teamworking as a major failing throughout. That also reflects previous reports. It also points out the unintended adverse consequences of using the phrase “normal births”, which should perhaps be replaced by “safe births”. Will the Government consider the problem of teamworking? Although there already is a joint group between the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists, there also needs to be commissioning guidance to make sure that services are commissioned only when there is joint education and training, audit, and co-production of guidance with parents who have experience of the unit.

[Lord Markham (Con)]

Again, we agree with Dr Kirkup’s third recommendation that teamwork is vital in all this. Some £26 million has been invested in maternity teamwork training, and a core curriculum has been set up for professionals in this area. Strong leadership has been established, with two national maternity safety champions and a number of regional and local maternity safety champions. We believe that we have the framework in place for these independent working groups but, as we review these recommendations, if we find they are inadequate we will not hesitate to act further. We will bring this back to you in the four-to-six-month timeframe when we report on the recommendations.

Health and Social Care Update

Baroness Finlay of Llandaff Excerpts

Monday 10th October 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Viscount for his good luck wishes. I do not understand completely the economics of the doctor’s surgery yet. I want to get my head around that, because I understand that a surgery needs to be set up so that it can be a successful business for them and can have the proper infrastructure. I am very interested in the dentistry field as well; as I said, I have an interest in terms of my wife. But I realise that in a lot of these situations, you are asking doctors and dentists, who are trained to be excellent medics, to effectively set up their own business. That is a quite different thing and demands quite different skill sets. I believe that we need to have a package of support to help them in this respect. As part of that, we need to understand exactly what funding can be used and whether it gives them the headroom—for want of a better word—to allow them to do those elements and have the support staff in the numbers they need. Understanding further this area is on my to-do list, and I would like to get back to the noble Viscount as soon as I can.

[Baroness Finlay of Llandaff (CB)]

I also welcome the Minister to his post, which I think is probably one of the trickiest ministerial posts in government. I declare that I am a registered medical practitioner and remain on the clinical register. I would like to briefly return to the question of workforce. We have spoken about doctors, dentists and nurses; in addition, there are allied health professionals. I should state here that I am president of the Chartered Society of Physiotherapy.

I have come across a lot of professionals who have had time working abroad, for one reason or another, and who have remained clinically up to date but find it extremely difficult to get back on to the register. I have also had conversations with retired professionals who have been allowed to be reregistered under the Covid regulations but find that, because they do not have a responsible officer, it is extremely expensive for them to undertake the processes to come back on the register.

In addition, I have also had conversations with refugees. We have a lot of refugee doctors, dentists, nurses and allied health professionals who currently are completely unable to work because they have not gone through the different exam processes—yet all the time they are not working, they are losing some of their clinical skills. Will the Minister meet with me, because I think there are some ways, in conjunction with the registration bodies, that we could possibly create a provisional registration category to allow these people’s skills to be used rapidly for the good of the NHS, rather than waiting the several years it would take them to get through the different hurdles laid before them?

As part of that, these clinicians—particularly doctors and nurses—could then have input into 111, where we know that currently only 40% of calls have a clinical input. The Royal College of Emergency Medicine has calculated that this figure needs to be 65% of all calls in order to decrease the demand on A&E departments from calls to 111. Will the Minister meet with me fairly urgently? It seems a waste to have people who want to get back on the register but, for many reasons, cannot.

[Lord Markham (Con)]

I thank the noble Baroness, Lady Finlay, for those excellent points. I have to declare a further interest: my wife is not only a dentist, she is a dentist originally from the Dominican Republic who practised in Spain for 20 years before coming here. So many of the excellent points the noble Baroness made are well recognised here. I am in the market for good ideas, so I will meet with the noble Baroness with pleasure to understand and discuss some of the ideas she spoke about.

NHS: Winter Challenges

Baroness Finlay of Llandaff Excerpts

Monday 10th October 2022 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, will the Government now ask NHSE to publish the 12-hour length of stay times for emergency departments in order to be able to evaluate the efficacy of the proposed 7,000 beds and financial investment? Data shows that, at the moment, 52% of all emergency medicine trainees are already burned out. On top of that, there is the flight of nurses from emergency departments because of stress. The emergency departments are already in crisis, yet the key data on 12-hour waits there is not being collected.

[Lord Markham (Con)]

I do not have the detail on the 12-hour wait-list at this moment, but I will come back to the noble Baroness with a detailed written response.

Primary and Community Care: Improving Patient Outcomes

Baroness Finlay of Llandaff Excerpts

Thursday 8th September 2022 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, like others I congratulate the noble Lord, Lord Patel, on raising this crucial debate. I declare that I am a fellow of the Royal College of General Practitioners as a GP—indeed, a medically qualified Dr Finlay—and got my fellowship before moving to hospice work. I am also a patron of the Louise Tebboth Foundation to prevent GP suicides and am president of the Chartered Society of Physiotherapy. I will focus on family medicine specialists—GPs—but we must not forget the major impact that physios and others have on conditions through direct access.

I chaired the Independent Commission on Medical Generalism for the Royal College of General Practitioners and the Health Foundation. Our 2011 report concluded that the generalist approach is essential across healthcare and that if it did not already exist it would have to be invented, while work by Barbara Starfield showed that the health of a nation depended on the quality of its primary care services. I do not believe that that has been dented by Covid.

Patients are the raison d’être of healthcare delivery. People become ill at all times of the day and night, presenting with undifferentiated conditions. Some conditions progress rapidly, in others the course is fluctuating or resolves. In our communities, many people live, work and contribute to society with a broad range of chronic long-term multiple co-morbidities. Some have rare conditions. Differentiating abnormal from the normal requires diagnostic skills and risk-assessment experience. Good primary care training is essential, providing adequate experience in paediatrics, women’s health, acute and early presentations of serious illnesses and the complexities of medicine in the elderly—and now the workload of GPs has become increasingly linked to social problems in society and mental health.

However, the problem we have is that GPs are leaving practice faster than they can be recruited. The 27,500 whole-time equivalents GPs are made up of a workforce with a headcount of around 40,000. As the noble Lord, Lord Hunt of Kings Health, pointed out, there are now 2.5% fewer GPs than in 2019 and 5% fewer than in 2015, but the average GP is responsible for 16% more patients than 10 years ago. More patients need to be seen than there are 10-minute appointments in a day, let alone time for home visits.

Seeing 40 to 60 patients a day, many of whom have complex medical and social problems, for five days a week is unsustainable. GPs become burnt out and leave. They seek work in other areas in medicine, but often in much more administrative or peripheral roles. Many GPs develop an extended role, developing expertise in some branch of medicine, such as women’s health, diabetes or hospice work, or in emergency medicine departments as part of a portfolio of clinical work. They need to carry on working but feel burnt out with the workload of routine general practice.

The GP is the first point of contact for undifferentiated complex problems. They can provide a holistic and comprehensive service for the long-term and acute care of the population they serve in their communities. An integrated approach must address the whole person: the physical, psychological, spiritual and emotional aspects which have led to the condition that has presented. Importantly, there is good evidence that, where continuity of care is in place, there are better clinical outcomes at lower cost, with greater patient satisfaction. We desperately need more GPs—incoming newly qualified GPs—but also to find ways to retain our experienced, highly skilled doctors who are leaving the profession in large numbers.

These doctors are trained family medicine specialists, and they need parity of esteem with consultant specialists in secondary or tertiary care. From that position, some will need to be able to pursue particular special interests, which will support other services such as mental health—thereby combining the family medicine specialist’s interest with some days in community practice—where integration with social care provision is essential.

There have been efforts to increase the numbers of allied health professionals in primary care to help with the shortage of GPs. But there is increasing evidence that, unless these professionals are carefully integrated into the primary care team, they cannot replace the experience and value of a GP. They need support and nurturing. The incoming chair of the council of the Royal College of General Practitioners, Professor Kamila Hawthorne, wants to create associate membership of the college for those allied health professionals who contribute to the primary care team to ensure better integration and understanding between the different disciplines in proper team working. In GP clusters that work well, all disciplines coming together has been shown to improve clinical outcomes and decrease the burden on secondary care. Change will be embraced if those delivering care can lead it and funding issues cannot be ignored in terms of the way that people are paid and reimbursed for their services.

There are other disciplines and services in the community. Hospice home care teams and Marie Curie nurses can be an essential supplement to primary care provision, but they need to be involved early. As many GPs have an interest in palliative care, I hope that the specialty will reopen to those with MRCGP, rather than allowing entry to consultant level training only to those with RCP membership, because their mature clinical experience in the community is invaluable, especially for hospice at home.

We must recognise that the diagnostic, management and risk-assessment skills of the trained GP are essential for our communities and the NHS. Community work is not easy, but it can be very fulfilling if allowed to work properly. The employment of family medicine specialists, with parity of esteem with the hospital consultant body, would allow those who wish for a much more flexible career approach to develop their special interest roles while retaining a firm foothold in family medicine in the community, with all its complexities. Working with their communities, with their own patient population and with all aspects of social care, they can be community leaders.

In the pandemic, around 30,000 doctors were granted temporary emergency registration and over 9,500 have remained licensed to practice until now. At the end of the month, they must apply to restore their registration and for their licence to practise to remain. To date, around 8,000 have not acted despite a streamlined process being in place. Will the Government request NHS trust responsible officers to be available to doctors in their area who wish to relicense?

I have not focused on pensions, but it has aggravated the problem of the loss of GPs from practising. As judges have been given an exemption from the pension cap, will the Government review the pension cap for clinicians? It would be far more cost effective than gaps being filled by expensive locums or leaving services with gaps unfilled and a population without the healthcare it needs.

More medical school places, greater flexibility around revalidation and an ability to have flexible career paths could help supply and retention. However, the problems leading to attrition must be addressed, and the scenario from dentistry is the flashing warning light in front of our eyes.

[Lord Baker of Dorking (Con)]

Before the noble Baroness sits down, I thank her for a very interesting, well-informed speech. She identified the pressures placed upon GPs, which are not going to be relieved easily. Would she welcome what happens in a country such as France, where many—

NHS: End-of-life Care

Baroness Finlay of Llandaff Excerpts

Thursday 8th September 2022 Lords Chamber

[Lord Kamall (Con)]

I return the favour by thanking my noble friend for the meeting, but also for the frequent conversations we have had about mediation, for example. I know my noble friend is a qualified and experienced mediator. We are quite clear that the review has to attach no blame. We want to hear from as many people as possible. It will investigate the causes of disagreements in the cases of critically ill children between providers of care and persons with parental responsibility. It will look at whether and how these disagreements can be avoided, how we can sensitively handle their resolution, provide strong evidence and inform future recommendations to support end-of-life healthcare environments in the NHS. As much as possible, it will promote collaborative relationships between families, carers and healthcare. We can see it from both sides: as a parent, just put yourself in the shoes of someone who has to make these difficult decisions. Sometimes they feel that the medical profession acts like God; on the other side, there are medical professionals who believe that the parents do not really understand all the details. Let us make sure that we get this right.

[Baroness Finlay of Llandaff (CB)]

My Lords, I too thank the Minister for having met me earlier in the week to discuss this issue. When parents receive devastating news, they are in such a state of shock that communication with them, however sensitively undertaken, risks being misunderstood. Parents are unaware of the limitations on their ability to request interventions or transfer for their child, unlike when the child is at home. So will the Minister confirm that the review will take direct, in-person evidence from parents who have been in this terrible situation and who wish to contribute from their experience—not to apportion blame, but to improve care for others?

[Lord Kamall (Con)]

I thank the noble Baroness, Lady Finlay, for the conversations we have had since the passage of the Health and Care Bill. My officials have been incredibly appreciative of her bringing her expertise to this field and, in fact, for educating them—and me—on some of the sensitive issues that people have to deal with in these environments. We want the review to be as wide as possible; we do not want to cut it off; probably the only thing we want to avoid is blame. We want to do this in a sensitive way; we want to hear from the families; we want to make sure it is a balanced review, and we hope to take evidence for the review from as many people as have a view on this. That is why we are taking our time; we have to publish it by 1 October 2023.