National Health Service (Pharmaceutical and Local Pharmaceutical Services) (Amendment) Regulations 2017

Baroness Redfern Excerpts

Thursday 19th October 2017 Lords Chamber

[Baroness Jolly (LD)]

My Lords, I am happy to lend my support to this regret Motion. For many years, pharmacies have been the lynchpin of our health service. Before the NHS was formed, the pharmacist was the expert who those without means went to for advice and medicine. With the advent of the NHS and a free general practice service backed up by free prescriptions, the role of the pharmacist began to change. The last couple of decades have seen further change. Pharmacists began to reassert their role of offering advice to customers, being commissioned locally and nationally for public health and medicines support.

In 2015 the Government proposed 6% cuts to the pharmacy service and suggested the ways in which this might be achieved, including a reduction in the number of pharmacies and the adoption of internet supply. This was solely a budgeting exercise and lacked any evidence base or indeed impact assessment. The Chief Pharmaceutical Officer suggested that we have 3,000 too many pharmacies without offering supporting evidence.

Apart from the pharmacy being a place where we collect our prescriptions and buy over-the-counter painkillers and cough medicines, the public ask advice from the pharmacist on things they would not trouble a doctor with. Women access emergency hormonal contraception, while needle and syringe programmes are managed, as is the supervised consumption of medicines.

Pharmacies offer specific public health services, support with self-care and medicines support, including checking prescriptions and the New Medicine Service. In addition, they arrange deliveries of prescriptions to patients. That might be stopping in some parts of the country but in Cornwall it is ongoing. In 2015, there were nearly 12,000 community pharmacists dispensing a billion prescription items to the value of £9.3 billion. They are funded by both local and central government to provide essential, advanced and local services.

The PSNC was so concerned at the lack of evidence base for the Government’s decision that it commissioned PwC to look at 12 specific services and determine their net value. In 2015, more than 150 million interventions were made, along with 75 million minor ailment consultations and 74 million medicine support interventions. They also served more than 800,000 public health users, for example with supervised interventions and emergency hormonal contraception. PwC determined that patient benefits totalled £612 million, that the wider societal benefits were £575 million, and that the NHS benefits to the tune of £1,352 million. There are other benefits to the public sector of £452 million. That is a total just shy of £3 billion of benefit which, in one way or the other, comes to us all from having community pharmacists. That is just the financial benefit and does not include the benefit of Joe Bloggs or Mary-Jane being able to walk in and ask their pharmacist a quiet, discreet question and get support, help and advice.

I suggest that when not only our GPs but our A&E services are under immense pressure from patients presenting with conditions that do not require prescriptions or that level of advice, this is not the time to take away from the high street the welcome and expertise of the neighbourhood pharmacist. Will the Minister persuade his colleague to stop, look at the evidence and protect these services which are so vital to the communities they serve?

[Baroness Redfern (Con)]

My Lords, in debating this regret Motion I listened intently to the noble Lord, Lord Hunt. He agrees that more pharmacies should be more engaged and that people should have more choice. I agree with him, but in today lies an opportunity to acknowledge the unique contribution that community pharmacists make to the health and care sector by providing easy access to clinical advice. I refer at this point to my entry as listed in the register of interests.

We should acknowledge that the Government are spending over £150 million a year more on pharmacies than the last Labour Government did, with over 11,500 community pharmacies—up by 18% over the last 10 years—together with the growth in the service budget of 40% over the last decade, to £2.8 billion in 2015-16. We now see over 40% of pharmacies in clusters of three or four, which means that in some cases two-fifths of pharmacists are within 10 minutes’ walk of two or more others. So it is right and proper that the Government are having this review to make absolutely sure that no community, whether in urban or rural settings, will be left without a pharmacy.

I want to pay tribute to the people who work in those pharmacies. In many cases, they are located at the heart of our communities with trusted professionals on-site who reflect the social and ethnic backgrounds of their residents. They are not only a valuable health asset but an important social asset, because they are often the only healthcare facility located in an area of deprivation and play a critical role in improving healthcare. Maintaining community pharmacies is crucial to keeping older and frail people independent. Going forward, we certainly do not want to see those people forced to travel, potentially over long distances, to pick up vital medicines and receive health advice. I very much hope that many rural communities, where travel distances can be a lot longer, can receive some sort of protection to ensure that patients can still access those services.

In 2017, it is right and proper to support a better payment structure and to be more efficient in the allocation of precious NHS resources—particularly by payment for the quality of service, not just for the volume of prescriptions dispensed—and to support the continuous improvement of those services to patients. That in turn will relieve pressure on many other parts of the NHS, particularly with a commitment to a national minor ailments service delivered through pharmacies so that patients who need urgent repeat-prescription medicines will be referred from NHS 111 directly to community pharmacies, rather than a GP out-of-hours service. We need to move from clusters of pharmacies to protect access for patients through a new pharmacy access scheme where there is a higher health need in a particular community.

The NHS has to be much more integrated. Pharmacists can make opportunistic public health interventions and provide advice on healthy lifestyles, thereby preventing or delaying the onset of long-term conditions and fulfilling a commitment to support people to keep healthy outside hospitals within the wider health system and a more integrated approach.

Finally, with the NHS asking for a £10 billion budget increase, there is an overriding need to see reforms to make sure that every pound spent goes as far as it can for patients and for the taxpayer as well. This package of reforms will ensure much greater use of community pharmacies as a first port of call by more fully integrating working with the rest of the NHS so that more people benefit from the skills of pharmacists and their teams. I am pleased that the Government are investing £112 million to deliver a further 1,500 pharmacists in general practice by 2020. I hope this review of the regulations, although delayed, will bring about the beginning of a longer-term transformation of the sector, expanding it to provide public health services such as health checks and immunisations as well as dispensing and selling medicines. There is no doubt that we all want to see a strong future for community pharmacy, but only if we can move with the times, because any delay brings uncertainty.

National Health Service (Mandate Requirements) Regulations 2017

Baroness Redfern Excerpts

Wednesday 6th September 2017 Lords Chamber

The Minister could reverse that tonight by giving us a little help and announcing that he will make absolutely sure that, whatever the other pressures, the time that people in this country who desperately need an operation have to wait for it will be maintained at an outer limit of 18 weeks. That is not ideal and it is not what I would have wanted during my time as Secretary of State, but in a civilised society it is the maximum time that people should wait to be relieved of the pain, the disturbance and, above all, the fear and insecurity that comes with prolonged waiting for a necessary operation.

[Baroness Redfern (Con)]

My Lords, I rise to speak on this regret Motion tabled by the noble Lord, Lord Hunt, who I am sure, like me, together with all users of the NHS, will acknowledge that the NHS has a unique place at the heart of our society and is by some distance the institution that makes us most proud to be British. However, it is regrettable that the NHS has become a bit of a political football year-in, year-out.

I would like to talk about the many positive areas in the NHS and about how people are working very hard to move towards these targets. Yes, pressures, including seasonal pressures, are all in the mix, yet despite these pressures the NHS approaches its 70th year delivering outstanding care, and it is important today to acknowledge and thank all staff who work in the health service, as well as encourage and support a healthy morale for our future workforce. As we all know, the NHS depends on a strong economy. A strong NHS can contribute to the growth of that strong economy, especially in health and life sciences, not just now but in the future.

We see plenty of pluses. We are getting healthier but we are using the NHS more, with life expectancy rising by five hours a day, as the noble Lord, Lord Reid, alluded to. The need for care in a modern NHS continues to grow apace. The number of people aged over 85 has increased by 40%, and the number of patients receiving elective treatment grew from around 14.2 million in 2012-13 to 15.7 million in 2016-17—an increase of 11%. That is a fantastic result. Calculations indicate that over the next 20 years we shall see the percentage of people over the age of 85 double. I note also that the total number of people on the elective waiting list in April 2012 was 2.5 million. By March 2017 this had increased to 3.7 million—an increase of 51% and another fantastic result. I note also that when Labour left office, including Members on the Benches opposite, more than 18,000 people were waiting more than 52 weeks to start treatment. Now, the figure is under 1,700.

Only last year, the CQC in-patient survey showed continuous improvement over the past five years, with 62% of respondents saying that they were satisfied with the running of the NHS. NHS funding is being increased and we will see over £0.5 trillion being injected from 2015 to 2020, but with more cash injection the NHS must show that it can spend that cash wisely and efficiently. Therefore, I look forward to a strong and sustainable NHS fit for purpose and fit for the future, where all parties can work together, so that we have a safe, patient-focused health service that is the best in the world.

[Lord Clark of Windermere (Lab)]

My Lords, the noble Baroness is absolutely right to sing the praises of the National Health Service, and she is quite right to point out that we are undertaking more operations than we have in the past. She is also right to say that, as we grow older, more of us will need the health service. That is a fact that we have to face and accept and about which we have to persuade people—who do not need much persuading—that something has to be done. My noble friend Lord Reid and I served in the Blair Cabinet and we spent hours trying to bring about the political will to make sure that waiting times, which caused so much grief and pain in the 1990s, were cut. So we are talking about political will.

There is an interesting public opinion poll produced by YouGov and published today on behalf of the Royal College of Nursing. It shows that 72% of the general public believe that the NHS lacks sufficient staff to enable them to do their job properly. When we talk about altering waiting times, it is worth remembering that healthcare is a labour-intensive industry in all its aspects. We all know that, and we all know that the NHS achieves what it does only through the dedication and commitment of the staff and the hours that they work, from the consultants through to the nurses, the healthcare assistants, the porters and everyone. We have to try to assist them because they are getting towards breaking point. The Royal College of Nursing has balloted its members and is talking about taking industrial action. Therefore, we look to the Government to have the political will to act.

I accept that there is no magic wand. This Government bear a lot of responsibility because they were the key partner in the coalition that cut the number of nurses in training after 2010. The onus is now on them, and they are beginning to increase the numbers, but they must do more. However, it obviously takes a long time to train consultants, doctors and GPs. There are shortages everywhere, including a shortage of 40,000 nurses. I do not know the figure, but there is a shortage of GPs running into the tens of thousands. There is a shortage of hospital consultants and shortages everywhere.

So what do we do? It is not easy, because more nurses are leaving than entering the profession. We cannot do anything about the training, as that will take a number of years, but we can do something about retaining people in post, by persuading GPs to carry on a bit longer and persuading nurses to stay in post as it is worth while doing what they do. That is what we should be doing. It would be a great help if the 1% cap on wages could be lifted, because that has meant that the average nurse is probably 12% worse off than they were a few years ago. That would be one way of making it easier to retain people.

Then there is the other point that was made by my noble friend who introduced the debate, whom I thank, about the number of nurses and doctors who have worked in the health service who are from the European Union. Can we offer them something to persuade them that we want them to stay in our country? For example, as the Minister knows, anyone from the European Union who has spent five years working in this country, which includes people in the health service, can apply for the right of permanent residency. But we cannot get the Government to say what that means. Does permanent residency mean that they can stay here, or will they be sent back to Europe? That increases the uncertainty and anxiety. I urge the Minister to go back to his colleagues and say, “All right, if we can’t or won’t make a commitment to the European Union citizens to stay in the health service, let us say that at least those who have gained permanent residency can stay”. That would help the issue.

I return to my basic point. This now requires political will. I do not doubt the Minister’s commitment. I know where the Minister stands and how much he believes in the health service. He has made that quite plain in a number of debates that we have taken part in. But we need political will and we are looking to the Minister to try to argue his corner and punch above his weight and give every support that he can to try to make health staff in the health service more satisfied so that they stay in their jobs and help us to reduce waiting times.

NHS and Adult Social Care

Baroness Redfern Excerpts

Wednesday 5th April 2017 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is quite right about the importance of public health. It is worth pointing out that it is not just an issue of money. This country was the first in Europe to act on cigarette packaging, to introduce a soft drinks industry levy and to develop a childhood obesity plan. As we have talked about previously, if you look at the risky behaviours displayed by young people, you will see good evidence that this approach is working.

[Baroness Redfern (Con)]

My Lords, as the population ages and the financial pressures on the health and care system increase, evidence tells us of the need to be better at providing proactive, preventive care to ensure that people can live independent, fulfilling lives for longer. Will the Minister do all he can in expressing these concerns and look at ways to address, as a priority, the uptake of innovation and technology, together with data sharing across the NHS, to emphasise the need to develop a credible strategy?

[Lord O'Shaughnessy]

I thank my noble friend for that and for her contribution to the work of the committee. She speaks with great experience and authority from her role in running a local authority. She is quite right that technology offers huge opportunities. The key is to make sure that the NHS and social care systems see technology as an opportunity to improve productivity rather than as providing an additional cost. That is why we are taking a variety of actions through the life sciences industrial strategy, the accelerated access review and other routes to make sure that technology is improving outcomes.

Mental Health: Young People

Baroness Redfern Excerpts

Thursday 9th February 2017 Grand Committee

[Baroness Redfern (Con)]

My Lords, I thank the noble Baroness, Lady Massey, for securing this debate. I declare my interests as in the register.

Parents and carers play a huge part in supporting any young person, especially, as we have heard, one who is struggling with mental health difficulties. Parents have more personal, intimate knowledge than a professional would, and therefore can greatly support their child’s recovery. Maternal instinct can quickly pick up changes in a young person that the young person may not be aware of. Motivating a young person even to take their medication can be very challenging in many instances, as can supporting them in attendance of classes. Attendance at school or college offers greater independence in managing their mental health and providing continued support as they become an adult.

It is important for parents to be able to take time to care for themselves, too, and they need help, support and reassurance that they are doing the right thing. The question is: where would we be without our carers in the NHS system? Many parents and carers have no mental health qualifications. They are not mental health professionals. Sometimes it is hard for them to know when they, too, need extra support. In many cases they can feel isolated. That is where organisations such as Young Minds come into play, as well as other organisations such as parent support groups.

Time is of the essence for assessments and referral times. As we know, in many cases early intervention prevents a young person falling into crisis. This debate provides an opportunity to raise the profile of and highlight our young people’s mental health issues, keeping them to the fore. Mental health training for teachers and staff is to be welcomed but I would like to see a much more co-ordinated approach to training, developing strong links with schools, communities and mental health staff, and hope to see a reduction in rollout time.

I shall give two brief examples. The first is of a young person’s esteem using Snapchat. She took 15 images before she could make a choice. She self-harmed and wanted to change her body image so she enhanced the snap chosen, giving herself a tan, using soft focus, et cetera, giving a much better outward appearance until she felt better about herself. The second example is of a young person suffering from loneliness, sleeping intermittently, desperately wanting to answer a text quickly if sent very late at night, or even during the night, so as not to miss out or be left out the next time.

Finally, I feel that by debating issues of young people suffering mental health problems we are making sure that mental health problems are everyone’s problems. Much more needs to be done.

Health Service Medical Supplies (Costs) Bill

Baroness Redfern Excerpts

Committee: 1st sitting (Hansard): House of Lords
Monday 23rd January 2017 Grand Committee

[Baroness Finlay of Llandaff (CB)]

My Lords, I support this amendment. I have a real concern that the whole process of pricing and costing of drugs is very poorly understood. I was lucky enough to hear a lecture at the weekend by Jack Scannell, an economist who understands quite a lot about drug pricing. He pointed out that there are four reasons why drugs are expensive: one is cost; one is perceived value; another is power; and the fourth is the prize that they can deliver. It is all in a paper that he wrote about the four reasons why drugs are expensive, two of which he labelled as false: the cost and the so-called value. The reason is that a company will start to explore different chemical substances that might have an effect; 90% of these never progress but remain in various test tubes and are stored. One day they might be of use.

The problem then is that, even if they develop something and take it through the different trials, there are fairly arbitrary examples of where the benchmark is set in different sectors. A clear example of this came up with the drug Campath, which came from Cambridge. It was developed for leukaemia, but was found to be remarkably effective for multiple sclerosis. The drug company then withdrew the drug because it was being prescribed off-licence: it was not licensed for multiple sclerosis. It took the trials through, licensed it for multiple sclerosis under a new name—Lemtrada—and the price was much higher because the benchmark of prices for multiple sclerosis was much higher than that for drugs for leukaemia. The chemical was the same. Actually, when a drug goes out and is priced, it really is, in a way, a guess on behalf of the pharmaceutical industry at the outset.

Another problem arises that relates to the importance of having trials in this country. Trials have to be done on the population to which the drugs are going to apply. It is quite interesting that with different healthcare systems, clinicians see patients at different stages of disease, so with a late diagnosis, you might have a much larger disease burden requiring treatment than you would have had if there had been an earlier diagnosis.

If the trials are conducted in this country, therefore, within the NHS and the real care system—the real world in which these drugs are going to be used—and as near as possible on the very population on which they are going to be used, you get the most accurate results. They can guide NICE in determining how effective a drug really is.

If you have a study on a population with a very early diagnosis, and therefore a relatively low disease burden, you might get a false impression of efficacy, which could lead NICE to believe that the drug was being actually more effective than it will turn out to be in our population. The converse is also true.

That leads me to stress the importance of supporting a flourishing life sciences sector, because we need to be developing drugs in this country, within the care setting in which they will be prescribed and for the population to whom they will be supplied. Any attempt at pricing must, importantly, not disincentivise the pharmaceutical industry to develop the 90% of drugs that go nowhere to find the 10% that will go somewhere.

I hope that the Government will take the new clause very seriously, because it signals an important intention up front in the Bill.

[Baroness Redfern (Con)]

My Lords, I declare my interests as recorded in the register and formally welcome my noble friend Lord O’Shaughnessy as the Minister this afternoon. Although the Bill is modest in size and has few clauses, it will deliver an important role in securing better value for money not only for the NHS but for patients.

Pressures on the NHS increase year on year because of our ageing population, new technology, and development of new procedures with advanced drugs, resulting in an increase in spending over the past five years of 20%. We spend more than £15 billion a year on pharmaceutical products, and we are acknowledged by those companies to be a reference market for many other countries that do not have such a large or well-organised supply chain as we do.

Patients request access to innovative and cost-effective medicines, so the Bill delivers value for money and does not support the drug companies, which have a commanding monopoly position, to push up their prices. I am pleased to see a strengthening of the ability to collect data on the cost of medicines, medical supplies and other related products from across the supply chain, which the Bill would amend by extending the provisions of the 2016 Act.

The statutory scheme has delivered significantly lower than expected savings for the NHS, with concern as to whether competition in the market is sufficient to control prices, so with new powers to be established under the Bill, there will be opportunities for more competition for unbranded generic medicines and to apply price controls for companies that are members of the PPRS. Particularly when companies can charge unreasonably high prices for unbranded generic medicines when competition does not keep the prices down, the Bill closes a current loophole in the legislative framework.

Clause 6 requires information from more producers and companies but, importantly, any information that they supply which may be commercially sensitive cannot be disseminated beyond the prescribed bodies. We may therefore be better informed on a more consistent basis, particularly to assess whether the supply chain as a whole or a specific sector provides value for money for the NHS. The world is changing, and personalised medicine is an important development for us all—but, again, it needs to be delivered both effectively and affordably.

At all times, we must make sure that the UK is seen as an attractive place for the life science sector—research being seen as a vital component in the sustainability of the NHS, as we have heard from previous speakers. To balance the control of the price of medicines and innovation for pharmaceutical companies, there should not be a lack of motivation to invest in the extensive R&D that we all want. In order to stimulate continued investment, it is appropriate for the industry to see a stable marketplace here as significant and important.

If we are to create a level playing field for drug companies, should we not be trying to do the same for patients? I therefore ask my noble friend whether one measure to tackle the issue could be ring-fencing possible rebates or a percentage from the sector to invest in improving access to medicines and treatments—particularly when we read that a fifth of new drugs face rationing under tighter NHS cost-cutting plans. With a budget impact threshold, that has the potential to slam the brakes on the most effective new treatments and technologies just before they get to patients.

Finally, although we promote innovation, that is not only a priority in the NHS for the Government but for many other stakeholders in the industry. As I said, the Bill is modest in size but it carries the opportunity to ensure that this country is not left behind in access to the newest and best treatments, and that it delivers best value for money.

[Lord Lansley (Con)]

My Lords, I am pleased to have the opportunity to contribute in Committee. I join in welcoming our noble friend the Minister to his new responsibilities on the Bill. I also draw attention to my interests as recorded in the register. I think only one of them might be regarded as specifically relevant to the Bill, although it is a company which would not benefit directly from it.

As the noble Lord, Lord Warner, said, Amendment 1 raises quite a number of issues, which we will have the opportunity to return to on further amendments. If I may be so bold, the structure of Amendment 1 would insert a clause which is really designed to express hope and intention, rather than to provide a statutory provision having any effect. Some of the other amendments would have the necessary statutory effect to back up some of the intentions encapsulated in Amendment 1, but it does no harm to realise what we are trying to do.

On the amendment’s first limb of supporting,

“a flourishing life sciences sector”,

it is a very apposite day as that is one of the clear intentions of the consultation on an industrial strategy. Listening to the reports this morning, it was clear that in so far as there is a focus on sectors where this country has a comparative advantage—I think we were discussing comparative advantage in the Chamber only last week—pharmaceuticals and life sciences is clearly one of those areas.

A number of noble Lords talked about the strength of our research base in this country and, as the noble Lord, Lord Warner, said, the proportion of new discoveries that have emanated from our research base is striking. It is considerably in excess of our relative importance as a market. We are only about 3% of the global market in pharmaceuticals but we have more than 10% of the new chemical entities—and as my noble friend Lady Redfern said, we often represent up to 25% of the international reference pricing. That is one of the reasons why there is a noted sensitivity on the part of the industry about its strength in the UK.

Where the life sciences sector is concerned, from my experience around Cambridge—in my former constituency and where I live—we probably have the strongest cluster of life sciences in Europe. As was raised by the noble Baroness, Lady Walmsley, when you talk to the industry at the moment its principal concern is simply its capacity to recruit and retain some of the very best researchers and staff. It is often specifically about retaining them and is all to do with the current situation relating to our future relationship with the European Union.

The sector recruits staff from all over the world, way beyond the European Union, but is only too aware of the reaction there has been among its staff—something like 15% of whom are on average from elsewhere in the European Union—to the prospect of our leaving the EU. It is one of those classic situations: if Britain had never been in the European Union, staff attracted from elsewhere within it would have come here understanding under what circumstances they came. Having had the expectation of being EU citizens enjoying access to all the British circumstances, they find the prospect that those might be taken away from them very difficult. It is very important for us to be clear about not only accrued rights but the circumstances in which people come here.

Social Care

Baroness Redfern Excerpts

Thursday 1st December 2016 Lords Chamber

[Baroness Redfern (Con)]

My Lords, I declare my interests as set out in the register. I congratulate my noble friend Lady Cavendish on her maiden speech, which was very welcome.

I welcome the opportunity to take part in the debate and thank the noble Baroness, Lady Pitkeathley, for tabling it because I feel passionately about the sustainability of our NHS, which is of vital national importance to all of us. I acknowledge people’s expectations of ever-higher standards in the NHS. I too welcome the Government’s commitment and investment of new money, but at the same time we cannot simply call for more when current health arrangements can in some circumstances be a little institutionalised in terms of assessing funding and staffing requirements.

If we are to have a first-class NHS and a fully integrated social care system for the future, much work needs to be done to explore the opportunities offered by new technology and data sharing to improve the way public services work and address the needs of our increasing population. The technology revolution is very real and should enhance more productive use of our scarce healthcare resources now and in the future. We should also invest in transdisciplinary research capacity and use the evidence gained from that to the full, thereby avoiding duplication.

New ways of working and new technologies are out there and our workforce needs not only to catch up with them but also to speed up their use. I understand that that takes time, and time is a very precious commodity. However, if we focus on innovative high-tech solutions, involving redesigning workflows, we will see rewards in terms of improved patient care. Investing in this area will, importantly, improve patient outcomes and save time and money. It is a case of saying, “We understand and we get it and we should go for it”. Initiatives are available that encourage innovation and take-up of digital technologies, with pump priming of financial incentives to enable bodies to undertake a shift in culture and forge ahead and be bold in developing services.

As regards saving to spend, many estates and buildings in this sector have become outdated and, unfortunately, are inadequately maintained. In some cases there are huge maintenance backlogs. They present opportunities to raise capital for reinvestment in the NHS through selling off prime estates where buildings are no longer fit for purpose. The land can be exceptionally valuable in many cases. It makes sense financially to acquire these capital receipts. Collocating brings improved closer clinical interaction. That again benefits NHS patients and the workforce.

The importance of working collaboratively in back-office services cannot be stressed enough. It again offers scope for more efficiency. Again it is important to make sure that the workforce understand it, are up for it and can relinquish the desire sometimes to be too protective of their own back-office functions. Everyone needs to be on message. We want a first-class NHS service and a fully integrated social care system for our population.

Health: Cancer

Baroness Redfern Excerpts

Wednesday 20th January 2016 Lords Chamber

[Baroness Redfern (Con)]

My Lords, I, too, thank the noble Baroness, Lady Walmsley, for introducing this debate this evening. Unfortunately and as we all know, cancer touches us all. Every year, more than 250,000 people in England are diagnosed with cancer and, sadly, around 130,000 of these die as a result of the disease.

However, more people are now surviving cancer and I take this opportunity to pay tribute to all those healthcare professionals and volunteers—and dentists—who dedicate their lives to finding cures and caring for patients. The sad fact remains though, that our survival rates are still worse than those for other countries that are as wealthy as us. If we want the best for cancer patients, we have to invest in treatment but our priority also needs to be prevention through early diagnosis, as we have heard from earlier speakers.

I welcomed the Government’s strategy on cancer in 2011 and efforts to raise awareness of symptoms, with £750 million allocated to support this. If we take bowel cancer, for example, which is the fourth most common cancer in the UK and where survival rates are closely associated with the stage at diagnosis, it is estimated that up to nine in 10 people could survive if they were diagnosed in the earliest stages of that cancer. There is a huge variation in survival between cancer types and we have the staggering statistic that one in five cancers is not spotted until A&E.

This Government made a manifesto commitment to continue to support tackling cancer through campaigns such as Be Clear on Cancer. Many noble Lords will be familiar with radio and television advertising that encourages people with possible symptoms or concerns to visit their GP and get them checked out. I, for one, would welcome increased media attention, with a possible monthly “focus on cancer” to promote awareness of the symptoms of a different cancer each time and what to look for.

Alongside diagnosis, access to appointments is vital. In May last year, the Prime Minister reiterated a commitment to seven-day general practice and hospital services by 2020. One initiative that I think has been particularly effective is the free NHS “midlife MOTs” for those aged 40 to 74 who do not have a pre-existing condition, which we have delivered in north Lincolnshire with GP support. These health checks mean that residents will be better prepared for the future and able to take steps to maintain or improve their health. However, we still have a stigma attached to seeking advice on health, particularly with older residents and especially men. I would welcome the Minister considering this point and explaining what further assistance may be available to local authorities to increase contact with these target groups to improve survival rates. We also need to look at lifestyles to reduce the risk of cancer, with around a third of cancers being linked to smoking, diet, alcohol and obesity. By running screening programmes, we have the chance to get an earlier diagnosis so that treatment is more likely to work.

We face a massive challenge ahead to do the best we can against the seemingly endless toll that cancer has on people’s lives. I am positive that more can be done to support those with cancer and identify the risks sooner, but at the same time I acknowledge the huge strides that have already been made.

National Health Service

Baroness Redfern Excerpts

Thursday 14th January 2016 Lords Chamber

[Baroness Redfern (Con)]

My Lords, I, too, thank the noble Lord, Lord Turnberg, for bringing this debate to the House. There are demands on our health service, and it is clear that a rapidly ageing society puts great pressure on our NHS in many different ways. My contribution to this debate will focus on local efforts to support these services.

As noble Lords will be aware, responsibility for public health now rests with local authorities, and that is working well. Councils now play a pivotal role in looking at what can be done to care for people in their own community. Integrated care is essential to meet the needs of the ageing population, to transform the way that care is provided for people with long-term conditions and to enable people with complex needs to live healthy, fulfilling and independent lives.

Locally we are delivering the better care fund programme to ensure a transformation in integrated health and social care. For example, in North Lincolnshire, we have joint senior management at clinical commissioning group and local authority level. We recognise that an enhanced out-of-hospital model, enabling health and social care professionals to provide more joined-up services closer to people’s homes and communities, should form the basis of any system-wide model of care. We connect local areas to local GP practices to offer new ways of working with social care, community healthcare, mental health services, voluntary and community organisations and other key stakeholders. We have local teams to enhance existing community services and have already delivered, as I have mentioned before in the House, five well-being hubs, which are fully operational, and are currently developing satellite hubs. These hubs target the most vulnerable people and provide interventions on a one-to-one basis. They actively work with hospital teams to create support links for service users admitted to hospital, helping with discharge. We are also looking at ways to work differently with the intermediate care services. We engage with users to make sure they have the confidence to access services and work, in order to reduce any delays in processing care which could damage that confidence. We are also piloting the healthy and active passport, which will give citizens access to services and schemes aimed at improving health and well-being.

We simply cannot ignore the impact of an ageing population and the pressures it puts on healthcare, both local and national. The current efforts to address projected pressures offer a way to a brighter future for older and vulnerable people, and I welcome the Government’s initiatives to support local areas. They are fundamentally about moving away from a sickness service and towards a system that enables people to live independent and healthy lives in their own communities. We must create wellness, not just treat illness. Through hard work, imagination, commitment, and not working in silos but together, we can meet head on the challenges presented by our increasingly elderly population and aspire to make this country the best to grow old in.

Residential Care: Cost Cap

Baroness Redfern Excerpts

Thursday 10th December 2015 Lords Chamber

[Baroness Redfern (Con)]

My Lords, I, too, join other noble Lords in congratulating the noble Baroness, Lady Wheeler, on introducing this very important debate this afternoon.

I know all too well, through my own local authority in North Lincolnshire, the pressures the sector faces, both locally and nationally, in providing high-quality and affordable residential care. As Members of this House are aware, the first stage of the Care Act 2014 came into force last year, providing a single, modern statute that puts an individual at the centre of their own care. The introduction of a cap on care costs is welcomed by many. However, without going over ground already covered this afternoon, concerns were raised regarding the cost to public sector spending of a cap.

As a result, Her Majesty’s Government announced in July that there would be a delay until April 2020, particularly to allow further consideration on the implementation and sustainability of what will perhaps be the biggest reform of the payment of care since 1948. I strongly believe that Her Majesty’s Government wholeheartedly support reforms to assist those requiring care, and I look forward to further announcements on this.

That said, let me turn to my authority and add an important local dimension to this debate. As a local authority we have looked at the best way to implement these reforms to care and support under the new rules of the Care Act 2014. We put people at the heart of what we do and constantly work from that position to help those in need. We work hard to ensure that they remain safe and properly supported. We want to work with those who receive care and, importantly, their families to transform their lives for the better.

I am pleased to inform your Lordship’s House that North Lincolnshire continues to be a high-performing authority and we continue to develop and enhance a vast range of care and support services to meet local needs. Although the changes to the Care Act aim to give greater choice and control to those in need of support, we found that we are already fulfilling some of these duties. We said that we would increase the number of vulnerable people helped to live and receive care in the community, and we achieved this through a number of different routes.

First, we did this by increasing the accessibility to advice and information at the time of choosing a care package. We also carry out regular reviews to check progress with the individual’s care. Access to information of services is incredibly important, and the adult social care outcomes framework measured the percentage of people who found this information about services in North Lincolnshire increased from 77.4% in 2013-14 to 84.4% this year—the joint highest result in England.

Secondly, we established community well-being hubs, which offer access to services for those with more complex care and support needs, helping individuals to identify ways to improve their independence and well-being. I am pleased to say that we now have five of these hubs across North Lincolnshire as well the Sir John Mason intermediate care centre in Winterton, which I mentioned in my maiden speech such is our belief in the excellent facilities on offer there.

By working closely with health colleagues and other organisations, more people are being supported to remain living well—that is really important—for longer in their own homes and community. A great focus has rightly been placed on adult carers, with an increase in the number supported than in previous years. The noble Lord, Lord Lansley, earlier alluded to working with partners to increase the provision of suitable and adapted housing for people with complex needs. More people than in 2013-14 now have control of their own support, through a direct payment which is personal to the individual’s need. A personal budget gives people control to choose how, where and when they will be supported.

Our ultimate intention is to ensure that everyone living in a care home receives good and outstanding services across the area, and we want to work with them to achieve this. We also said that we would increase the number of vulnerable people who have real choice over their care and the support they receive. By undertaking personal assessments, again we support people to remain independent, and we make sure we personalise the approach to their care. Independent living is, I am sure, something that noble Lords would agree that many of us at times take for granted.

Furthermore, I cannot stress enough the significance of the relationships social work teams must have with individuals, their families and carers in order to understand their care and support needs, and how they would like these needs to be met. The better care fund, introduced more than two years ago, creates a single shared budget, which encourages the council and NHS to work together.

The priorities of the partnership agreement were to reduce hospital admissions, lengths of stay in hospital, delays in transfers of care from hospital and also permanent moves into care homes. To end, North Lincolnshire’s social work teams continue to ensure that people are at the heart of what we do. I hope that other local authorities, too, welcomed the reforms to the residential care sector and that they had as much success in implementing them. As we have discussed, for the first time in nearly 70 years we are presented with an opportunity to undertake a proper review of residential care. I welcome Her Majesty’s Government giving proper consideration to designing a means to support and protect vulnerable people from potentially catastrophic care costs, both in North Lincolnshire and across the country.

Health

Baroness Redfern Excerpts

Thursday 26th November 2015 Lords Chamber

[Baroness Redfern (Con) (Maiden Speech)]

My Lords, it is with a great source of pride, having spent more than 28 years in continuous service to the Isle of Axholme as an elected councillor and now leader, to be able to stand among you today as a Member of your Lordships’ House.

Preparing for today—I am sure many noble Lords are acquainted with this—I realised my predicament in speaking before so many learned and talented individuals from all sides of the House. Now that I am a Member of your Lordships’ House, I should like to say what a delight it is to observe the wealth of knowledge that this House provides, and the great kindness and warmth shown to me not only by noble Lords but by all the staff who I have encountered since I took my seat here. I would also like to register my eternal thanks to my family and long-standing colleagues. I also thank my two sponsors, my noble friends Lord Taylor of Holbeach and Lady Eaton, both of whom have aided me and provided helpful guidance in my initial few weeks here.

I will, if I may, briefly take this opportunity to share with noble Lords the historic origins of the Isle of Axholme and how the isle came into being. I moved to the isle following marriage and we started our businesses here, enabling us to integrate into what continues to be a close-knit and very friendly community.

The isle is dominated by marshland and peat, with many of the original communities, including Crowle, Epworth and Haxey, all built on what was previously the only high and dry land available. Indeed, the isle is known to many by the early influences of the Dutchman, Cornelius Vermuyden, an engineer whose work at Windsor brought him to the notice of Charles I. The King subsequently commissioned him in 1626 to drain Hatfield Chase.

The isle is known as an isle as it was previously separated by four rivers—the Idle, Don, Trent and Torn—which created a unique and strong identity. A number of notable individuals hail from the isle, and Epworth is the birthplace of Wesleyan Methodism. We have a strong appreciation of agricultural activity and the beautiful watercourses that the isle has to offer, which have produced, among other things, high-quality beetroot and celery. That said, the isle and our area more widely are very susceptible to flooding, and securing funding for proper flood defences is something that I have already championed and will continue to pursue.

It might seem appropriate to speak on health, considering my heart rate in delivering this maiden speech, and I welcome the debate secured by the noble Lord, Lord Crisp, today. Across North Lincolnshire, we have worked hard to engage all of the community and provide opportunities to improve health prospects—both physically and mentally. North Lincolnshire Council has invested in a successful programme of community well-being hubs, which provide advice and support for a wide range of individuals and groups, including vulnerable adults. This is against a backdrop of declining local government budgets and I am proud that we have achieved this by making necessary savings elsewhere to secure and improve front-line services.

The hubs work with and support older people, young adults and also carers; recognising the wide mix of people involved in healthcare. They work neatly with the national health agenda by integrating services for the benefit of both patients and the broader health economy. Indeed, the regulation of health and social care professionals not only impacts on the lives of registered and aspiring professionals but affects the lives of all those who use these services. The community hubs also provide a base for well-being checks which, among other aims, address poor nutrition and raise awareness of healthy eating and choice. Poor nutrition, which manifests itself very much in older people, is estimated to cost the NHS £13 billion a year. Looking at ways of addressing this and creating health aspirations locally is something that I am passionate about.

The latest addition to our commitment to develop health opportunities in North Lincolnshire is the Sir John Mason House intermediate care facility in Winterton, the town where I was born, and this brand-new facility was launched this year. Those using this service may stay there for a period of rehabilitation and reablement, for example following a hospital stay. With an ever-increasing older population, loneliness and isolation are key challenges for all local authorities, and North Lincolnshire Council is working hard to combat this. Like many areas, memory cafes are held across North Lincolnshire and help link residents with health services. These are shining examples of co-operation between the community and different agencies. However, we must look at ways to further integrate services and at the wider health debate as social isolation is known to increase the chances of premature death by up to a third.

Finally, the Isle of Axholme is blessed with some outstanding scenery and is a very special place. I am passionate about encouraging and assisting local residents to access this shared space with opportunities such as Walking the Way to Health, which is a project to organise walking activities. While my walking days are nowhere near behind me, I look forward to spending plenty of time sitting in on the many future debates regarding health and sharing the positive achievements across North Lincolnshire, and particularly on the isle, with this House.