Child Health: Play

Baroness McIntosh of Hudnall Excerpts

Monday 12th October 2015 Lords Chamber

[Baroness McIntosh of Hudnall (Lab)]

My Lords—

[Baroness Finlay of Llandaff (CB)]

My Lords—

--- Later in debate ---

[Lord Addington]

My Lords—

[Baroness McIntosh of Hudnall]

My Lords—

[Baroness Jones of Moulsecoomb]

My Lords—

Health Funding

Baroness McIntosh of Hudnall Excerpts

Thursday 9th July 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, the NHS is facing a challenge over the next five years to achieve productivity savings of some £22 billion. If we wish to have a sustainable, tax-funded health service in the long term, we have to make these savings. I have no doubt that over this time this will cause difficulties, but, again, it has to be seen in the context that we have a national debt of more than £1 trillion and a public sector borrowing requirement that must come down.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, does the Minister not agree that, of all the places to cut the National Health Service budget, it is incredibly short-sighted to do so in areas to do with prevention because, although there may be short-term savings to be made there, in the long term it will build up problems which will cost a great deal more in the future?

[Lord Prior of Brampton]

I repeat my earlier response that prevention is extremely important. We are looking at a relatively small reduction of £200 million out of a total public health budget of more than £5 billion.

NHS: GP Clinics

Baroness McIntosh of Hudnall Excerpts

Thursday 25th June 2015 Lords Chamber

[Lord Prior of Brampton]

I agree with the sentiments of the noble Baroness. There are indeed many GP practices that are collocating outside or very close to A&E departments. For example, I saw one at the Royal Free only last week. It is one of a number of new models of care that we should be exploring.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, may I press the Minister a little more on recruitment? In an answer to me earlier in the week, he made the same reply—that the Government were committed to recruiting more GPs—but he has not yet told us what incentives would make a newly qualified doctor wish to go into general practice, and whether those incentives are financial or otherwise. In particular, the idea that part of your commitment would be to a seven-day week is possibly not quite as alluring as he would like it to appear.

[Lord Prior of Brampton]

The right answer to the noble Baroness is twofold. First, we have to paint a picture that inspires young doctors to go into general practice. There is no doubt in my mind that the solution to the health needs of today’s population depends on a different model of general practice. We can paint that picture, and I hope that leaders of the BMA might wish to help paint it as well. Secondly, on the seven-day week issue, we are living in 2015 and people expect to be able to see GPs at the weekend. People get ill at weekends, and if we want good quality of care, we have to provide that care seven days a week. If we wish people to be treated outside hospitals, we have to provide good access seven days a week in primary care.

General Practitioners

Baroness McIntosh of Hudnall Excerpts

Monday 22nd June 2015 Lords Chamber

[Lord Prior of Brampton]

The Government are committed to seeing 5,000 new GPs. This is probably the biggest expansion of primary care that we have seen for many years. It is not just 5,000 GPs but a further 5,000 people working in primary care, including physician associates, practice nurses, physiotherapists and other allied health professionals.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, is it not the case that, although the analysis that the noble Lord has given us is very accurate, the solutions that he seems to be putting forward are not very clear? Can he say what incentives he and his colleagues will offer young medical students beginning their training to encourage them to go into general practice? It is fine to say that we will train 5,000 more doctors, but we cannot force them into general practice if they do not want to go.

[Lord Prior of Brampton]

The noble Baroness is quite right. After five years as a medical student, they then do two foundation years before making the choice whether to become a GP or to go into specialist medicine. That is a crucial time to persuade young doctors that there is a good, long-term career in general practice. Health Education England and NHS England are putting huge resources into persuading young doctors at that stage in their career that there is a good future in general practice. I say to the noble Baroness that there is no doubt at all in my mind that, if we run the clock forward five years, more care will be delivered in primary practice and in the community than in acute hospitals.

Gender-based Violence: Screening

Baroness McIntosh of Hudnall Excerpts

Monday 9th March 2015 Lords Chamber

[Earl Howe]

Most certainly. Gender-based violence is one of the issues which sexual health clinics, and indeed all parts of the NHS, are now alert to. New guidance from NICE was issued in February last year on domestic abuse and how health and social care services and the organisations with which they work can spot and respond to abuse earlier in a more joined-up and preventive way.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, does the noble Earl agree that not all domestic abuse results in physical symptoms? In his Answer, he mentioned mental health services. What is being done to deal with emotional abuse and to discover and refer people who suffer from it?

Jimmy Savile: NHS Investigations

Baroness McIntosh of Hudnall Excerpts

Thursday 26th February 2015 Lords Chamber

[Earl Howe]

My Lords, I cannot give a specific undertaking on the timescale that we envisage for the consultation or on any legislation that might ensue from it because that raises the question of whether any legislation is necessary. That is what we want to know from the consultation process. However, I can tell my noble friend that the Home Office will be leading the consultation in conjunction with all the other relevant government departments.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the noble Earl repeated a phrase in the Statement referring to Jimmy Savile as a one-off. Although that is qualified in the sentence that follows, nevertheless the reference is made. Does he consider that describing these incidents as a one-off characteristic of an unusual individual is tremendously helpful? We know that he was not a one-off because a number of other people working in NHS settings engaged in similar behaviour and have already been convicted. Many other people who were not working in NHS settings but doing other kinds of job—for example, in the rock music business—were also engaging in this kind of behaviour. Perhaps we need to take more account of the fact that, hard as it is for us to recognise, there are circumstances in which people, given the opportunity, will engage in this kind of behaviour and will continue to do so. Thinking of them as, as it were, bad apples does not help us to grapple with that reality.

[Earl Howe]

My Lords, the noble Baroness is right. It is with that thought in mind that Kate Lampard did not simply pigeonhole Savile as a one-off but has come forward with recommendations, most of which we have accepted, as to the wider lessons we should learn from this sorry saga. We know that, while the scale of Savile’s activities was probably unprecedented, there are others who have been found guilty of similar offences.

NHS: Financial Tariff for 2015-16

Baroness McIntosh of Hudnall Excerpts

Wednesday 4th February 2015 Lords Chamber

[Earl Howe]

It is the view of Monitor and NHS England that providers of specialised services should make every effort to deliver care that is both clinically appropriate and cost-effective in order to manage demand—where, after all, their clinicians have significant influence. NHS England considers the proposed rule to be warranted—this is about the 50:50 split in the tariff—because rapidly growing expenditure that exceeds population prevalence growth is unlikely to reflect efficient and effective services, which, when one thinks about it, are in patients’ best interests overall.

[Baroness McIntosh of Hudnall (Lab)]

Going back to the question asked by the noble Baroness, Lady Barker, I am sure the Minister will have seen recent reports showing that there is a serious shortage of mental health beds in the health service at the moment. Indeed, I believe that at one point in the very recent past there were no more than four or five available in the entirety of the UK—or certainly in England. Parity of esteem is a fine phrase, but is it really being played out in practice?

[Earl Howe]

My Lords, it would require a full-scale debate for me to lay out in full all the things that we are doing to promote parity of esteem in the health service. The noble Baroness is right that in certain parts of the country there has been acute pressure on bed numbers, but bed numbers have been increased in some of those areas, and NHS England is paying close attention to the need to ensure that those who need in-patient treatment receive it.

HIV

Baroness McIntosh of Hudnall Excerpts

Thursday 15th January 2015 Lords Chamber

[Earl Howe]

My Lords, I pay tribute to the work of the Halve It coalition in raising awareness about the importance of increasing HIV testing. My noble friend is right that apart from ignorance often GPs are reluctant to discuss HIV testing or are unaware of the importance of early diagnosis and possible indicator symptoms. My department was pleased to fund the Medical Foundation for AIDS and Sexual Health’s HIV testing in primary care project that provides a web-based interactive resource for GPs in primary care to help make testing easier in GP surgeries.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, does the Minister agree that one of the biggest disincentives to testing is the amount of stigma that still remains against those who are known to have HIV? Alongside encouraging people to have tests, can he say what Public Health England is doing to combat that stigma?

[Earl Howe]

The noble Baroness is absolutely right. If we were to single out three things that are important in this context, they would be prevention, testing and tackling stigma and discrimination. The NHS, local authorities, government, community and faith groups, the media and individuals themselves all have a part to play in eliminating HIV-related stigma. Our framework for sexual health improvement is clear that action needs to continue to eradicate prejudice based on sexual orientation. That depends on building an open and honest culture where everyone can make informed decisions and responsible choices about relationships.

NHS: Accident and Emergency Services

Baroness McIntosh of Hudnall Excerpts

Wednesday 7th January 2015 Lords Chamber

[Earl Howe]

I am grateful to the noble Baroness. It is worth observing that while the standard is that 95% of people arriving at A&E should be seen and treated within four hours, that standard has not been met in recent weeks. Nevertheless, on average, hospitals are seeing and treating around 90% of patients. The department is working closely with the College of Emergency Medicine. Indeed, I have the college’s paper in front of me. I am well aware of the issues that it has identified, but it is worth noting that the college says that the latest figures show that in England hospitals and their staff have coped extraordinarily well.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, can the Minister confirm that staffing, particularly of emergency medicine doctors, is acute in the sense that probably enough are being recruited but not enough are being retained in emergency medicine and that there is a significant loss of those qualified practitioners overseas? What is being done to address that?

HIV: Stigma

Baroness McIntosh of Hudnall Excerpts

Monday 1st December 2014 Lords Chamber

[Earl Howe]

My Lords, sex and relationship education plays an important part in exposing young people to the whole subject. Guidelines are available that schools must follow. They include sections on HIV and sexually transmitted diseases generally. As I say, secondary schools must follow those guidelines.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, building on the question from the noble Baroness, Lady Brinton, does the noble Earl agree that stigma starts very young? It builds on attitudes that are adopted by young people. The importance of PHSE programmes in schools is therefore very great. In what ways are his department and the Department for Education working together to ensure that these programmes are delivered—not just that they are recommended, but that they are delivered? Does he further agree that it would be a good thing if they were a regular and statutory part of the curriculum?

[Earl Howe]

I shall expand on my previous answer. Sex and relationship education is compulsory in maintained secondary schools, although not in academies. All maintained schools and academies have a statutory requirement to have due regard to the Secretary of State’s sex and relationship education guidance, which dates from 2000, when teaching sex and relationship education. The guidance makes it clear that all such education should be age-appropriate and makes the following points about HIV and sexually transmitted infections:

“information and knowledge about HIV/AIDS is vital; young people need to understand what is risky behaviour and what is not; young people need factual information about safer sex and skills to enable them to negotiate safer sex … Young people need to be aware of the risks of contracting a STI and how to prevent it”.

They also need to know about the diagnosis and treatment of HIV and STIs.