King’s Speech

Baroness Jay of Paddington Excerpts

Thursday 9th November 2023 Lords Chamber

[Baroness Jay of Paddington (Lab)]

My Lords, I follow other noble Lords, in welcoming and supporting the measures to reduce smoking, but like the right reverend Prelate, I am most concerned this afternoon about the lack of any broad-based public health programmes in the gracious Speech. Public health, after all, is central to successful healthcare in this country and, indeed, to the overall health of the nation, yet it has been neglected for many years and is neglected again. I repeat my welcome for the tobacco products Bill, but one Bill does not create a strategy. In every area we look at, the need for a broad-based programme to meet the public health crisis we are facing is urgent. In every problem you look at—from obesity to sexual health, from children’s dentistry to disease caused by damp housing—the situation is getting worse and worse. At the same time, we have seen the capacity of the NHS fall. Sadly, it has become a struggling health sickness service, rather than a positive health service. If we want the NHS to be renewed and restored to its proper role, we must primarily focus on avoiding preventable disease and promoting healthy living through cross-government programmes.

At the Labour conference last month, the shadow Health Secretary, Wes Streeting, promised that a Labour Government would deliver a prevention-led revolution. He insisted that a broad revolution, putting prevention first, could be delivered through social, economic and environmental change. This, he said, must lead to less illness and therefore less pressure on the NHS. Now there is no doubt that achieving this type of change is complex, difficult, expensive and long term. But under the Conservative Government, many prevention initiatives have been greeted with the cliched expression, “a nanny state” calling for intervention in our private lives. I understand that even the new anti-smoking Bill, which has the Prime Minister's personal endorsement, has already been criticised by his own MPs on this basis.

In the last 13 years, many of the specialised institutions that focused on promoting good health have disappeared or been marginalised. The Government abolished Public Health England, which had a global reputation for its expertise and research. The grandly titled Office for Health Improvement and Disparities has been recently set up, but so far no grand practical statement of environmental activity has been announced. Today, many of the responsibilities for public health have been devolved to local authorities; at first sight that seems a good idea as so many services that can affect people’s general health are provided at a local level. However, the Treasury’s public health grant to local authorities has been reduced by a staggering 26% in the last years; not surprisingly, basic services have suffered badly or completely collapsed. Apart from the financial cutbacks, the connections between organisations commissioned by individual councils and the health service can be weak and can reduce vital capacity. Services have sometimes been outsourced to independent bodies, which do not have the necessary expertise to deliver them. This has been recently drawn to my attention in relation to HIV and other sexually transmitted infections. There has recently been an alarming increase in many of these infections, some of which are growing by as much as 50%. These must require medical care, which is often lacking in an outsourced clinic. For example, only half the clinics can now offer face-to-face appointments for individual advice and treatment—they simply cannot deliver good practice.

However, even if the Government have somewhat neglected the needs of good public health, it is encouraging to see the current level of parliamentary interest and engagement with these issues. The well-established All-Party Group on Health in all Policies has been able to broaden the discussion about reducing health inequalities and promoting healthy lives in ways that go way beyond traditional concerns about, for example, working conditions and safety. The Levelling-up and Regeneration Act 2023 could have been an opportunity to put some of these policies into legislation, specifically in the area of poor housing. There were several attempts to amend the Act in this way but all failed, although it must be remembered that the health effects of inadequate housing already cost the NHS about £1.4 billion a year. In this House, the noble Lord, Lord Crisp, with his vast experience in public health, pursued his amendment on healthy new homes to the point of ping-pong proceedings and still he did not succeed. In final exasperation he said:

“I have taken the key message that the Government do not want to … ensure that new homes and neighbourhoods promote health, safety and well-being. I think this is extraordinary.”—[Official Report, 23/10/23; col. 437.]


I must say that I agree with him.

Meanwhile, our very active Peers for the Planet organisation is urging an even broader approach to public health, which I support. It argues that the crises of climate change and threats to nature have a profound impact, and there are calls for the WHO to declare this a global health emergency. As far as the UK is concerned, the effects of higher temperatures have already been observed. In 2022, heat-related mortality in this country was up by as much as 42%, which is well over the five-year average. The very respected journal the Lancet has suggested that we should act immediately in this country on cleaner energy, improved air quality and access to green space. It is a vast agenda, but it should not be overwhelming. It needs a new clear strategic approach by the Government and resources to match. Given their record, I do not expect the present Government to give priority to this in the last months before a general election. On the other hand, the Labour Party has already published ambitious plans for its prevention and revolution in health. I am confident that there will be manifesto commitments on public health in all social policy. We can then have a programme that both improves health and renews the NHS. I look forward to discussing a new approach in the debate on the next gracious Speech.

Covid-19 Regulations: Assisted Deaths Abroad

Baroness Jay of Paddington Excerpts

Tuesday 10th November 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Baroness is entirely right; Covid has, in a very sad way, thrown a spotlight on the circumstances of those dying alone. That is one of the harshest and most heart-breaking dimensions of this awful pandemic. It throws a spotlight in particular on the way in which the law is applied in this country. The collection of data is a very important component of our review of this important area and I will definitely ensure that the indication given by my right honourable friend in the other place is picked up back at the department.

[Baroness Jay of Paddington (Lab) [V]]

My Lords, I am generally encouraged and relieved by the Government’s responses on this Statement, particularly the point made in the Commons by the Secretary of State that assisted dying must be considered in the general discussion of good end of life care. I hear the Minister say that a formal review is not planned, but when the Government come to look at the concerns about death and dying that have been thrown up by the pandemic, will they ensure that the questions of proper personal choice at the end of life will be both included and emphasised?

[Lord Bethell (Con)]

Well, this is an extremely complex issue. As the noble Baroness alluded to, there is a wide variety of issues at stake, including values issues, questions of faith and, as she rightly said, questions of personal choice. There are the components here for an important national debate. I acknowledge the comments of several noble Lords already that we are approaching the moment when that debate seems more relevant than it has ever done. When that debate takes place, certainly personal choice will be an important part of it.

Hospitals and Nursing Homes: Do Not Resuscitate Notices

Baroness Jay of Paddington Excerpts

Thursday 1st October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, it is completely unacceptable for any group of people to have blanket DNACPR provisions apply to them. The adult social care winter plan published on 18 September reiterates that and makes the position crystal clear. The General Medical Council is providing additional support and guidance to clinicians on how to meet the needs of patients and relatives, and the Resuscitation Council UK is creating a large amount of resources to provide training. The CQC is monitoring the situation extremely carefully.

[Baroness Jay of Paddington (Lab) [V]]

My Lords, the distressing circumstances of the pandemic have once again highlighted the difficult and sometimes controversial issues about end-of-life treatment in general and individual choices. Will the Government set up a long-proposed review to examine all these issues, particularly to improve real patient choice?

[Lord Bethell (Con)]

The noble Baroness is entirely right. The Covid epidemic has shone a spotlight on the awful arrangements around end of life at a time when contagious disease presents a threat to all those present in a nursing home or hospital. Our thoughts and prayers go out to all those who have lived through such an experience or will face one in the near future. I note the noble Baroness’s call for a review. There is no current plan for one but I will carry the idea back to the department.

Covid-19: Rise of Positive Tests

Baroness Jay of Paddington Excerpts

Wednesday 9th September 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, we are deeply concerned about the BAME incidence of this horrible disease. We have put in place extensive new marketing arrangements targeted at BAME audiences. We have targeted our testing arrangements through mobile testing and door-to-door availability at that communities that have been hardest hit, and there are guidelines to NHS trusts to put in place the necessary safety arrangements for those with a BAME background.

[Baroness Jay of Paddington (Lab) [V]]

My Lords, following the Government’s statement that the rise in infection rates is due largely to increased spread of the virus among young people, what strategies do the Government propose to adopt to ensure that returning students, for example, and others, comply more stringently with public health regulations?

Tessa Jowell Brain Cancer Mission

Baroness Jay of Paddington Excerpts

Monday 13th May 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank my noble friend for his question. He is absolutely right that we want to focus on outcomes. That begins with earlier diagnosis, shorter waiting times and access to treatment. However, when it comes down to it, we want to know that we have better survival rates. Cancer is a priority for the Government so that we can improve that, and the quality of care for patients. I am pleased to report to the House that survival rates are at a record high: since 2010, rates of survival from cancers have increased year on year. However, we know that there is more to do, and we will never have any measure of complacency about this. That is why in 2018 the Prime Minister rolled out a package of measures to see three-quarters of cancers detected at an early stage by 2028—the current figure is just over half. The plan is to radically overhaul screening programmes to provide new investments in state-of-the-art technologies to transform the process of diagnosis and boost R&D. My noble friend is absolutely right that one of the areas that we must focus on is ensuring that treatment has the lowest burden of side-effects possible. The proportion of cancer survivors living with long-term disabilities as a result of treatment is high, so having more targeted treatment is absolutely a priority within our cancer strategy. I will be delighted to write to my noble friend with a specific update on where we have got to with PET scanners.

[Baroness Jay of Paddington (Lab)]

My Lords, I echo noble Lords who have said what a fitting and appropriate tribute it is to Tessa that, on this anniversary of her death, we have heard this encouraging update from the Minister. It was a great sadness to me that I missed her final speech in your Lordships’ House because I was abroad, but having worked with Tessa for more than 20 years in many different roles, I found it unsurprising that she showed her characteristic determination, courage and campaigning skills, which she carried on with absolutely to her final days. It is extraordinarily good to know that her daughter, Jess Mills, carries on this work today, as my noble friend Lady Thornton said.

I make two points that I know that Tessa would have emphasised. The first is the importance of what one might call translational research, as the Minister said. I know that one problem that Tessa had as an individual was that she could not find out, except by exercising her characteristic energy and skill with the computer, what was going on. It is very important that in developing both treatment and research in these difficult areas of cancer—the glioblastoma from which she suffered being one of the most intractable—individual patients have the opportunity to know more broadly what is available.

That is why it is particularly important that the announcement today reveals not only new treatment but emphasises that it will be available in all cancer centres across the NHS, because not all of us are blessed with Tessa’s energy and ability to find things out. Particularly when people are feeling very vulnerable when they are diagnosed, their need for clear available information is paramount. It is very good to hear that that will be more available in future.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her comments and think that she has hit the nail on the head. I think I can say that Tessa’s characteristic verve is being carried on and honoured by those involved in the mission: I have been in post for a relatively short time, but I have already met the mission and Jess twice, and they have nailed me down on commitments and ensured that I follow through on commitments that my predecessor, my noble friend Lord O’Shaughnessy, had made. It helps that he is still involved in pushing them forward.

One of the key principles of the mission is that it provides a convening function, bringing together government, the NHS, charities, industry and patients in working together to identify and drive through progress on areas that need improvement. One key area that has been identified is patient care, support and communication. As the noble Baroness said, Tessa was passionate about ensuring that patients can get rapid access to new treatments and know where they may be. That is one of the principles behind the brain cancer matrix. Separately, we have introduced the accelerated access collaborative programme to try to bring in other treatments that might be complementary to patients as quickly as possible through the NHS system, recognising that the NHS, while incredibly innovative, can be low and slow at times in adopting those innovations across the system in a consistent way. We want to make that better.

Health: HIV

Baroness Jay of Paddington Excerpts

Monday 4th July 2016 Lords Chamber

[Lord Prior of Brampton]

I can confirm that all the people who are receiving PrEP as part of the PROUD trial will continue to receive it going forward, which I think answers the main point made by the noble Baroness. In terms of the conduct of the trials that I referred to earlier, they will largely be organised and shaped by Public Health England.

[Baroness Jay of Paddington (Lab)]

My Lords, I have to declare an interest because my husband chaired the Medical Research Council committee that oversaw the original trial on this. The trial was suspended because it was so successful. It was suspended on ethical grounds because it was thought that the people in the control group must receive the drug. Do the Government agree that it is unethical, whatever the legal or financial situation, not to make the drug more available now, particularly given the alarming rise in new cases of HIV in gay men?

[Lord Prior of Brampton]

I am not an expert in this area, but having thought and read about this issue a lot over the past few days, it seems to me that the number of people who have not been diagnosed with HIV is a critical issue. As those people are not aware that they have HIV, their behaviour is not adjusted and because they are not taking treatment, they have a greater amount of the HIV virus. It is estimated that 18,000 people have not been diagnosed so, if one had to make a choice, increasing our rate of diagnosis must be crucial. However, I do not disagree with the noble Baroness that the evidence around PrEP as a prophylaxis is strong.

Health

Baroness Jay of Paddington Excerpts

Thursday 26th November 2015 Lords Chamber

[Baroness Jay of Paddington (Lab)]

My Lords, I thank the noble Lord, Lord Crisp, for introducing this debate in such an informative and authoritative way. It is obviously a very important issue. I wholeheartedly agree with the terms of the noble Lord’s Motion and support his points about the way in which the determinants of health in today’s society are often driven by matters such as alcoholism, obesity and other concerns, which are obviously not the sole responsibility of the NHS, however much we support it.

I think that the way that the noble Lord has proposed is the only way to improve the stark health inequalities in this country. As he reminded us, we are all familiar with the really disgraceful record of discrepancies in morbidity and mortality between different social and economic groups in this country. It has become almost a truism of health economics that low income and low social status are major contributors to ill health, and probably the determining factor in more rapid ageing.

The proposal of the noble Lord, Lord Crisp, for working towards a “health-creating society”—I am still finding it a little difficult to put those three words together—must be the right approach, but my concern this afternoon is: if the ideas and the vision he describes gain general support, how are they to be delivered? How will we make it happen? As noble Lords are aware, there is enormous emphasis nowadays on localism and finding solutions and organising action as near as possible to the communities involved. I worry that there are difficulties in relying primarily on the local approach to tackle some of the somewhat intractable problems of public health.

Of course, community-based alliances of public service, private enterprise and the voluntary sector can often unleash especially effective energy, and there have been some interesting and radical ideas put forward recently on this ground. I was intrigued, for example, by an article by the chief executive of the Royal Society for Public Health, who wrote about the local high street as “an untapped resource” for promoting health. She picked up on the WHO statement that modern society is actively marketing very unhealthy lifestyles, which the noble Lord, Lord Crisp, has already referred to, and argued that stricter local planning laws and differential business rates could drive businesses such as fast-food outlets, betting shops and payday loan shops out of the high street and reduce the tempting opportunities for unhealthy lifestyle choices. I can see the attraction of this proposal, but in the broader picture I fear that the huge reductions in the budgets of local authorities, combined with a lack of local expertise in specialist problems such as sexual health, may make local projects inadequate and sometimes even increase inequalities.

I hope I will not be labelled a centralist dinosaur for saying that national government and a senior Minister must take the lead responsibility for promoting change in this area and achieving the necessary collaboration to build a health-creating society. I was proud to be a Health Minister when the very first Minister for Public Health, my noble friend Lady Jowell, was appointed to that post. She was a senior Minister of State with a wide remit and, although the post has continued in successive Governments, it has not always had the authority of the original appointment and, very importantly from my point of view, it has always been based in the Department of Health. In my view, a Cabinet post should be created—we will have to think of a good title—to take forward the cross-cutting policies we are discussing. This Minister should be based in the Cabinet Office, with co-ordinating powers across government.

My enthusiasm for this approach is partly based on my experience as Minister for Women, when I was based in the Cabinet Office and worked with several departments across Whitehall and with outside agencies. It was a largely successful arrangement. My Cabinet Office team acted as a kind of internal pressure group within the Government; we legitimately raised issues of women’s employment, education, health and pensions across Whitehall and had the authority to do so. I think that the interesting and imaginative proposals for a health-creating society can only be delivered by an imaginative approach from the machinery of government, and I would like to see a Cabinet Minister leading the initiative towards this vision.

National Health Service

Baroness Jay of Paddington Excerpts

Thursday 8th January 2015 Lords Chamber

[Baroness Jay of Paddington (Lab)]

My Lords, I congratulate my noble friend on his timely debate, which has become even more relevant in the face of the tsunami of so-called special incidents which are apparently swamping the NHS at the moment. On the face of it, the A&E tsunami is rather unlike the other winter crises that we have experienced. After all, the weather is not particularly severe and we are not experiencing a threat from a new infectious illness, such as SARS, or even a normal seasonal flu epidemic. Indeed, as was rightly asserted in this House yesterday, much of the primary cause of the present situation is government policy—and, specifically, the reduction in social care and the fragmentation of health services to which the noble Lord, Lord Horam, referred.

The only possible political silver lining that I can see is that the Secretary of State Mr Hunt seems to recognise that he is accountable and responsible for what is happening. I was surprised and somewhat relieved to hear him say yesterday in Commons Hansard:

“I take responsibility for everything that happens in the NHS”.—[Official Report, Commons, 7/1/15; col. 277.]

That is in sharp contrast to his attitude last autumn when the Secretary of State received the Five Year Forward View as though it was a rather interesting contribution from an independent think tank. In exasperation in response to that, the shadow Secretary of State, my right honourable friend Andy Burnham, commented:

“I do not know who runs the NHS these days, but I do know that it is certainly not him”.—[Official Report, Commons, 23/10/14; col. 1045.]

He also said that this was a clear illustration,

“of the serious loss of public accountability”,

following the 2012 reorganisation Act.

Those of your Lordships who took part in the long drawn-out proceedings on that Act in this House will remember the battles that we had to retain the central responsibilities of the Secretary of State in the legislation, responsibilities that had after all been there since 1948. We eventually succeeded so that the Act now reads:

“The Secretary of State retains ministerial responsibility to Parliament for the provision of the health service in England”.

The noble Lord, Lord Mawhinney, a previous Conservative Health Minister, said in our debate that everyone now knew that the,

“Secretary of State is the boss and is held accountable”.—[Official Report, 8/2/12; col. 303.]

I certainly hoped that this meant that in spite of the determination to transform the NHS into a regulated but independent competitive industry, the personal statutory accountability would prevent the most harmful results that we feared from the Act. I was wrong. Now I can only hope that the present damaging crisis may suggest to Ministers that they should exercise greater responsibility and accountability, not just for expenditure but for at least some of the policies proposed in the forward view.

I want to focus in my remarks on paragraph 3 of that report, which says:

“The future health of millions of children, the sustainability of the NHS, and the economic prosperity of Britain all now depend on a radical upgrade in prevention and public health”.

I certainly accept that clarion call; my concern is that the 2012 Act has made it difficult to fulfil. Noble Lords will be aware that public health programmes are often rooted in community-based, sometimes voluntary organisations. These can be very useful, particularly when informal outreach schemes dealing, for example, with problems such as drug or alcohol abuse, can be much more successful than statutory services. but today the competitive reorganisation has led to a hugely expanded pool of non-NHS community providers—a staggering 69% of the new contracts agreed. In my estimation, that must lead to enormous fragmentation and great difficulty in achieving national goals.

In particular, I draw noble Lords’ attention to very real problems in delivering good sexual health and HIV prevention and treatment services under this new system. In recent months, as the noble Lord, Lord Fowler, has just done, we have rightly focused on the Ebola virus, but the latest figures for HIV in this country are a cause for a new concern. In the past 12 months, the numbers of gay men newly diagnosed are the highest since the figures were first collected 20 years ago. During the intervening years, of course, we have developed world-leading clinical care in this complex field and created much-admired prevention programmes, but those are now threatened. Part of the problem is that the public health commissioners in local authorities simply do not have the relevant specialist knowledge and experience. I have learnt, for example, of a particularly stark case in Chester, where the hospital-based specialty services created and led by a very senior consultant are to be replaced by a consortium of GPs. There the Countess Of Chester Hospital put forward a comprehensive tender for an integrated sexual health service led by five consultant doctors costing £2.4 million. This has been rejected in favour of an exclusively GP service with no hospital specialist input, costing £2.8 million. It is very hard to see any financial or clinical logic behind this. I wish it was just one example, but it is not.

I want also to explain my concern about the particularly bad situation in relation to HIV prevention. The Government have now said that the programme for national HIV health education will be cut by a staggering 50% in the next financial year. We cannot afford complacently to allow the prevention and treatment of infectious, dangerous diseases to slip from the effective grasp of a national health service. I fear that that is likely to happen.

Overall, I would like to be optimistic about the future. I agree with many of the ambitions in the Five Year Forward View and respect Simon Stevens, who was a special adviser when I was a Minister in the Department of Health. However, he is far too complacent about the encroachment of independent advisers and the resulting fragmentation of important services. Overall, we must retain the national leadership of the NHS not only through the executive managers but essentially through the Secretary of State. His accountability to Parliament and responsibility for the provision of health services should always be the keystone of the health service.

NHS: Keogh Review

Baroness Jay of Paddington Excerpts

Tuesday 16th July 2013 Lords Chamber

[Earl Howe]

My Lords, the historical culture of that particular trust has been focused on financial targets, and the tone from the top now needs to focus on improving quality and long-term sustainability. There is a string of issues identified in Sir Bruce’s review, all of them urgent. The good news is that I know that the current management is addressing those issues. I am naturally sorry to hear of the personal experiences of my noble friend’s family.

[Baroness Jay of Paddington]

My Lords, I wonder whether I can assist the noble Earl, and indeed the House, by quoting directly from the letter from the noble Baroness, Lady Young of Old Scone. The noble Earl referred to it earlier and said that he was not aware of the details. This is a letter to the Prime Minister from the noble Baroness, dated yesterday, in which she says that he has been “misled” in the response that he gave in Prime Minister’s Questions. She says that the CQC, of which she is a former chair,

“was not pressurised by the previous Government to tone down its regulatory judgments or to hide quality failures”.

She goes on to say:

“So I am afraid neither my evidence to the Francis Inquiry nor my current recollection … can be interpreted to support the view that, in the words of your answer at PMQs ‘there was a culture under the previous Government of not revealing problems in the NHS’”.

She finishes the letter by asking:

“How can this misapprehension best be corrected for the record?”.

Perhaps the noble Earl can suggest that.

[Earl Howe]

I am rather sorry that the noble Baroness should have raised that, as I was rather keen to protect the noble Baroness, Lady Young, from any embarrassment, because I think that the whole House respects her. All I can say is that the substance of the letter to which the noble Baroness refers is diametrically opposite in content to the evidence that the noble Baroness, Lady Young, gave to the Mid Staffs public inquiry.

NHS Commissioning Board: Mandate

Baroness Jay of Paddington Excerpts

Tuesday 13th November 2012 Lords Chamber

[Earl Howe]

The noble Lord has alighted on an extremely important area. We have been very careful in constructing the outcomes framework to make sure that we define deliverable outcome indicators. The NHS Commissioning Board is satisfied that the indicators are realistic but I have to be candid with him. This represents work in progress as the precise way in which the board will demonstrate that it has made progress against each of the indicators has not been defined in every case. I can assure him that it will be. It will be up to the board, however, to construct a system of local accountability to ensure that the clinical commissioning groups are held to account against realistic demonstrable indicators which match those of the NHS outcomes framework, not least in the area of chronic conditions. The patient pathway is work in progress, too, but much of its quality can be measured by reference to the patient experience. That is one of the central domains of the outcomes framework, on which a lot of work has been done. I would be happy to write to him on that.

[Baroness Jay of Paddington]

My Lords, perhaps I may press the noble Earl a little further on the part about IT in the mandate. My noble friend Lord Warner also referred to it. Would he develop a little the expectation in the mandate about developing the electronic patient record, which I feel is an aspiration rather than a practical reality if it is going to take place within two years? Can he help me by describing the way in which progress can be measured, and how is this to be achieved in a period when the pressure is on local resources and there is a dispersal to local responsibility which earlier he described as being a problem?

[Earl Howe]

There are several objectives around our wish to see more patients having access to their records, not only to enable them to order repeat prescriptions and make appointments with their GPs online, which many practices already enable, but also to access their own personal health records where they wish to do so. This, too, is a work in progress. Noble Lords do not need me to tell them that there are clear confidentiality issues involved in this area. What we cannot have is a system that is open to breaches of security. However, work is going on with the Royal College of General Practitioners and the British Medical Association on that point. We have said that it is our ambition that everyone should be able to access their GP records online by 2015. That is the ambition and we think that it is achievable. However, once again I would be happy to keep the noble Baroness updated as work continues.