NHS: Equitable Access

Baroness Thornton Excerpts

Thursday 5th July 2018 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty’s Government what steps they will take to ensure that National Health Service patients have equitable access to the benefits of (1) artificial intelligence, (2) genomic medicine, (3) new drugs, and (4) innovative treatments.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)]

My Lords, the NHS was founded on the principle of universal access and we are committed to making sure that that remains. To achieve this we are establishing a genomic medicine service to provide equitable access to testing across the NHS. We have commissioned the Topol review so that our staff can maximise patient benefits from technological advances and we are accelerating access to innovation across the country by expanding the role of academic health science networks.

[Baroness Thornton (Lab)]

My Lords, happy birthday to our NHS.

[Noble Lords]

Hear, hear!

[Baroness Thornton]

I thank the Minister for his detailed Answer. My Question concerns the future in the next 70 years. One of the key barriers to ensuring that NHS patients have equitable access to genomic medicine, new drugs and innovative treatment is the pressure on the workforce and lack of protected time for the workforce to develop research and to translate new research into practice. Some 25% of medics do research in their own time. This suggests a welcome hunger for innovation, but only 0.1% of NHS money is set aside for the adoption and spread of innovation. That seems modest. With the new funding agreement and the 10-year plan in preparation, will the Government support and enable our research base and ensure the continuation of clinical trials across the EU post Brexit?

[Lord O'Shaughnessy]

I thank the noble Baroness for her Question and join the whole House in wishing many happy returns to the NHS on its 70th birthday. She asked an extremely good question: how do we make sure that the NHS is equipped for the future and that everybody can benefit from the technological advances we are seeing take place? I point her in the direction of three issues. First, the National Institute for Health Research has more than £1 billion of funding and supports the translation of research into new technology every day. It is based in the NHS and uses NHS staff. I have also recently commissioned the department to look at the money spent on innovation, which we think is around £750 million in total, to make sure that it supports the uptake of effective medicines and treatments better than it does today, and to make sure that staff have time. Finally, in response to her last question, as we set out during the passage of the withdrawal Act, we will align ourselves to the clinical trials regulation as much as possible, whatever the outcome of Brexit.

Brexit: Reciprocal Healthcare (European Union Committee Report)

Baroness Thornton Excerpts

Tuesday 3rd July 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I join other noble Lords in congratulating the EU committee on its report Brexit: Reciprocal Healthcare. I suspect it was no accident that the committee turned its attention to this matter early on in its considerations about the effects of Brexit. I congratulate the Government on turning around their response in three months. This is better than the last healthcare response, which took a year, so we should be pleased and congratulate the Minister. I thank the BMA and the Nuffield Trust for providing the most up-to-date information.

I proposed and supported amendments on these matters during the passage of the Brexit Bill most recently considered, so I looked at the record to see how it compared with the answers that the Government have given. I spotted some advances but, I am afraid, not many.

In preparing for this debate, I learned from IPSOS Mori that Brexit has now joined the NHS as the top two issues the public are most concerned with—for 46% and 44% of people respectively. Today we have a confluence; it seems that as time goes on, millions may be justified in their anxiety about both Brexit and health. We heard, as several noble Lords have mentioned —including the noble Lord, Lord Balfe, and the noble Baroness, Lady Janke—that the head of NHS England is preparing plans for the supply of medicines in the event that the UK crashes out of the EU without a deal. I suppose the first question, as reflected in this report, is what happens after the implementation period? What planning is being done for a no-deal scenario for reciprocal healthcare? Indeed, the noble Lord, Lord Ricketts, mentioned the human cost of that.

Two years for implementation is not so long. Just think how the last two years have flown since the Brexit vote, with so little progress. It is, of course, important, as other noble Lords have mentioned, that the negotiations so far have enabled the Government to achieve their aims for reciprocal healthcare in the first and implementation phases of negotiations. These include access to the European health insurance card for those visiting the EU on exit day and continued access to the S1 scheme for existing retirees living abroad. But does the Minister agree that the next phase of negotiations needs to secure ongoing access to EHIC and reciprocal healthcare arrangements, either through retention, or comparable replacement of existing reciprocal healthcare arrangements with the EU after Brexit?

Some 27 million people hold a UK-issued European health insurance card and 190,000 UK pensioners living elsewhere in the EU are registered to the S1 scheme. The Nuffield Trust has calculated that, if the 190,000 UK state pensioners signed up to the S1 scheme and, living within the EU, needed to return the UK to receive care, it would incur additional costs to health services of between £500 million and £1 billion per year.

This simultaneous increase in cost and demand would place even greater strain on the UK health and social care sector. There is some anecdotal evidence that indeed people are returning from France, Spain and elsewhere since the Brexit vote and the ensuing lack of assurance and clarity. Are the Government monitoring the numbers who are coming home already?

As reflected in this report, ending reciprocal arrangements may also require the application of existing cost recovery methods for non-EEA patients to EU and EEA patients in the UK, or the development of a new, alternative system. This could increase the complexity of the cost recovery process, so well described by the noble Lord, Lord Balfe, as well as the administrative burden on clinical staff. Does the Minister agree with the BMA’s long-standing position that doctors and clinical staff should be able to devote their attention to treating patients and not to recovering the cost of care?

If the UK loses access to these arrangements, or fails to agree comparable alternatives, it could severely impact on the healthcare arrangements of UK and EU nationals and place additional strain on our already stretched NHS. Healthcare affects all of us who travel, work and live in Europe and, just as we might legitimately expect post-Brexit that we can take for granted the supply of the most up-to-date, clinically approved medicine and remedies, we expect to continue to travel and work all over Europe and for our healthcare to be assured, without having to take out insurance. On a scale of 1 to 10, with 10 being the most likely, what is the Minister’s best estimate of this being the case post the implementation period?

The ease with which people can continue to do what they are used to doing is what will colour how people will judge whether Brexit is succeeding and whether it has been worth while. In many ways, the most important recommendations in this admirable report, most of which I agree with, are those which concern clarity and transparency. Recommendations 5 and 6 concern free movement, and recommendation 11 asks if reciprocal healthcare will be included in the objectives set out by the Government, which we hope will emerge in a White Paper, with white smoke, some time next week.

This paragraph also concerns our children and grandchildren and their ability to work across Europe, which will be curtailed, as was so well explained by the noble Lord, Lord Jay. He said we have a long way to go and he is absolutely correct. The problem is, we have a long way to go but we do not have a great deal of time. I thank noble Lords for their usual high-quality contributions and I look forward to the Minister’s reply.

Health: Endoscopy and Bowel Cancer

Baroness Thornton Excerpts

Monday 2nd July 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is right to highlight the importance of waiting times. The 62-day standard is unfortunately not being hit at the moment. The NHS has pledged to get back on that standard this year. We are also piloting a faster, 28-day diagnosis standard in five areas at the moment with the idea of rolling that out so that there is a higher standard of care and fewer people have to wait longer.

[Baroness Thornton (Lab)]

We should probably be grateful that the Minister did not choose to bring a FIT as a visual aid, as his honourable friend did on the “Andrew Marr Show” yesterday. I welcome the Government’s announcement that that test will be in introduced in England in the autumn, but will the Minister confirm that all eligible people will receive the FIT kit in the autumn rather than through a phased introduction across England? How long will that take?

[Lord O’Shaughnessy]

I will not be rummaging around in my pocket to reveal something; nobody wants to see that. My understanding is that FIT will be introduced from the autumn and the intention is to get national coverage. I do not believe that it will be achieved immediately, but I will write to the noble Baroness with the specific timeframe.

Nursing and Midwifery (Amendment) Order 2018

Baroness Thornton Excerpts

Monday 25th June 2018 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for his excellent explanation of this order, which provides the Nursing and Midwifery Council with the necessary legal powers to regulate the nursing associate profession. On these Benches, we will be supporting the order, and I thank the Nursing and Midwifery Council and the RCN for their excellent briefs.

We are ready to accept that the creation of nursing associates is a welcome addition to building capacity. Some of us who are long in the tooth—there may be one or two in the House today—will remember SRNs and SENs and wonder whether we have gone full circle to move forward. However, I accept that there is some urgency to get this on the statute book because, initially, 2,000 nursing associates were training at 35 Health Education England test sites, with a further 5,000 starts planned for this year. The first nursing associates will qualify to apply for registration with the NMC from January 2019, so I accept the urgency to implement this order.

The Minister says that the nursing associate role is a defined care role to act as a bridge between unregulated healthcare assistants and the registered nursing workforce. Now that that role has been created, we agree with the Royal College of Nursing that,

“there must be absolute clarity that the nursing associate … is not a separate profession, but a new role within the nursing family that works under the delegation of the Registered Nurse”.

It went on to ask for “urgent guidance” to be published on “the precise relationship between” nurse associates and registered nurses,

“in terms of delegation and accountability”.

I hope that the Minister has taken that on board.

It is important to recognise that this new role is not the answer to the huge workforce challenges faced by the NHS and the social care system. Last week when the Government announced their funding proposals for the NHS, and the creation of a 10-year plan, many noble Lords said—we agreed—that it would be meaningless if this does not cover healthcare workers and social care workers together, given their importance in the future of our healthcare and social care system. Given that Health Education England has had its budget slashed, that we have a huge decrease in healthcare workers from the European Union, and the soon-to-be-removed—I hope—ridiculous visa system for non-EU health workers, the fact is that more nurses are leaving the profession than joining it, and there is a demographic challenge in that one in three nurses is due to retire in the next decade. In that context there is a well-founded anxiety that nursing associates could be used as a substitute for registered nurses.

Also in that context, has this new role been thought through, or is it a quick response to nursing shortages, with unfilled nursing posts which, as we know, are at a record high? Linked to that, how do we ensure that this new role does not impact negatively on the social care workforce? The head of Health Education England has highlighted that problem.

The role of a nursing associate was created before this SI was even introduced. Has there been enough time to consider the standards and levels of training for nursing associates to be registered with the NMC? I have to say that I am comforted by two things. One is the comprehensive brief from the NMC which suggests that it is on top of this, and indeed the notes accompanying the amendment order itself. I want to raise two things with the Minister, which are on page 5 of the accompanying notes and concern the cost-benefit impact analysis and the regulation of the nursing associates. Two risks are identified:

“First, there is a financial risk that the agreed initial set up costs escalate beyond those currently agreed with NMC. Second, the unquantified costs mentioned above relating to setting up and/or amending existing nursing associate courses as well as the accreditation of education providers”.


Those risks need to be mitigated before this moves forward in an orderly fashion. Finally, I think that there is provision in the order to take account of European Economic Area nursing associates, but I understand that this is not a uniform description or role that fits the narrative across the board. Will the Minister also comment on that?

[Lord Willis of Knaresborough (LD)]

My Lords, I rise from the second Bench—I am not quite trusted to be on the front yet—

Childhood Obesity Strategy

Baroness Thornton Excerpts

Monday 25th June 2018 Lords Chamber

[Baroness Thornton (Lab)]

I thank the Minister for repeating the Statement. The last time we discussed childhood obesity in your Lordships’ House it centred on chapter 1 of the Government’s policy, which scored a C-minus at best among noble Lords. Today we have chapter 2, which we can probably score as a C. It offers 13 consultations, a review and a great deal of promotion.

My questions are as follows. First, does the Minister believe it is possible for voluntarism to deliver even in the generous time the Government have given themselves to reduce childhood obesity? For example, Alpro soya growing-up milk contains unnecessary fructose and sugar, but the packaging will tell you it is good for your child, particularly if your child is lactose intolerant, where there are fewer choices. Will that be on the noble Lord’s agenda for legislation or persuasion, and what would be the timeline? Secondly, given that the evidence is clear, why does the Statement not include a proposal and a timetable for legislation and regulation to ban the advertising of high fat and sugar content products on TV and social media? When will we see a draft Bill?

Long-term Plan for the NHS

Baroness Thornton Excerpts

Tuesday 19th June 2018 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, I thank the Minister for repeating this Statement. I also declare an interest as a member of a local clinical commissioning group.

It would indeed be churlish to say that an injection of funding into our NHS is not welcome right now. However, the 70th birthday present is an uplift in funding of below the 60-year average—from 1948, the birth of the NHS, to 2010, it is just on 4%. Of course, we would all, not least the patients and staff, welcome not having to face another winter crisis like the one we have just had. After what, I suspect, were some serious tussles within the Government about quantum, timing and explanation of where the funding will come from, the Minister and his colleagues must be a little disappointed in the headlines that have been generated so far. The IFS said, with respect to the Brexit dividend that,

“over the period, there is literally zero available”.

Sky News has done a data poll which suggests a majority of people do not believe there will be a Brexit dividend to help to boost NHS funding, a reaction made more unpalatable to the Government because the same polls show that a majority of people, 54% to 38%, say that they would be happy to pay more tax to fund the NHS, which we in the Labour Party have known for quite some time. In 2002, when the then Prime Minister Tony Blair made a commitment to massively increased funding to the NHS, he also announced an increase in national insurance to pay for it. He and then Chancellor Gordon Brown had spent two years preparing for that announcement and preparing the plans for the investment in the NHS that was necessary to turn it round from the previous 18 years of Conservative neglect and underfunding and to deliver the waiting list targets, cancer treatment targets and A&E targets which then followed. So when Theresa May says, as she did over the weekend, that Labour spent only half of the increased expenditure on patient care, that is completely misleading and plain wrong. If she means that replacing falling-down buildings and worn-out equipment, paying staff decent wages, and investing in massively increasing the number of doctors and nurses available is in some way not spending money on patient care, one has to question the right honourable lady’s understanding of what the NHS is and what it does.

Leaving aside the issue of how the £20 billion will be raised, we do indeed need to address how it can best be spent. We recognise that it will take time and planning to work out how to make the best use of this funding over 10 years. The challenge is huge because the prevailing state created by a combination of cuts for both health and social care, and the overcomplex bureaucracy of the NHS as a result of the Health and Social Care Act, make this a serious challenge. Waiting lists of 4 million last winter in the NHS were so severe it was branded a humanitarian crisis. Some 26,000 cancer patients are waiting more than 60 days for treatment. There have been billions in cuts to local government and social care.

My questions to the Minister start with three basic ones about the legal obligations of the NHS. These were also asked by my honourable friend Jonathan Ashworth. Will the waiting list for NHS treatment be higher or lower this time next year than the 4 million it is today? This time next year, will there be more or fewer patients waiting more than 60 days for cancer treatment? This time next year, will there be more than 2.5 million people waiting beyond four hours in accident and emergency or fewer—a target not met since 2015?

If the Secretary of State wants, as he says he does, to transform the health and social care system, how will he do this when every economic expert, from the Institute for Fiscal Studies to the Health Foundation, tells us that with a growing ageing population—which the Minister mentioned—increasingly living with long-term conditions, this announcement will do nothing more than see the NHS stand still? As my honourable friend Liz Kendall put it yesterday:

“We cannot put the NHS on a steady financial footing without a proper funding settlement for social care, yet the Secretary of State now says that that will not happen until the spending review, which in reality means no substantial extra money for social care until 2020 at the earliest. We cannot transform care for older people or reduce pressure on the NHS until we look at the two together”.—[Official Report, Commons, 18/6/18; col. 63]


Why are the Government still ducking that vital integration issue?

Why is the social care Green Paper delayed yet again, and how can this funding be used to mitigate the £7 billion in cuts and 400,000 people losing care support? How will the Government bring together health, social care, parity in mental health and the essential preventive work of public health, when they are scattered across different delivery bodies, often with differing commissioning regimes and accountable sometimes to different regulatory regimes? How will that be done under the proposals for the 10-year plan? Will this injection of funding ensure that we have a service with new models of care fit for the 21st century? Finally, we have a £5 billion repair bill facing our NHS right now, and outdated equipment. When will the Government start investing in the fabric and equipment of the NHS?

[Baroness Jolly (LD)]

My Lords, I too thank the Minister for his Statement. I welcome any increase in funding. Should the Chancellor be wondering how to pay for it, we on these Benches would be quite happy to see a 1% increase on income tax, for starters. The IFS has said that increases of close to 4% are needed for social care, as well as a funding boost for the NHS. Yet the Statement had nothing to say on this vital issue. We all know that the NHS cannot function efficiently unless social care is working well too. Many local authority leaders are indignant that the Green Paper has been moved further down the track, so when the new funding does arrive there is already a sizeable deficit to claw back. They are extremely anxious about the situation with adult social care funding being insufficient for this financial year.

What conversations have been held with the LGA, local council leaders and the Ministry of Housing, Communities and Local Government in advance of these statements? We are also dismayed about the silence on mental health, public health and community health funding. One in four of us will be affected by mental illness, there is an obesity epidemic among our children, too few health visitors, and we are critically short of psychiatric social workers. Is the Minister confident that these issues can wait until the autumn NHS plan and the Budget?

Hospices: Impact of NHS Pay Increases

Baroness Thornton Excerpts

Monday 18th June 2018 Lords Chamber

[Lord O'Shaughnessy]

I will certainly do everything that I can. I agree that hospices are a fantastic example of the kind of mixed economy that this country does so well, with philanthropic and public contributions, and we must make sure that both those continue.

[Baroness Thornton (Lab)]

My Lords, I am sure that the Minister will be aware that this affects not just hospices, which of course are an integral and very important part of the health service, but the pay of those who work in all the charities and social enterprises which contract with the NHS. I would like to broaden the Question slightly from hospices and ask what the Minister’s reaction is to the Royal College of Nursing, which has called on the Secretary of State to establish a non-NHS national staff council to facilitate a more integrated way of looking at the pay of all nurses and healthcare staff in health and social care settings across the piece.

[Lord O'Shaughnessy]

I was not aware of that proposal but I will certainly look at it and write to the noble Baroness with our response.

Psychiatrists: Referral Fees

Baroness Thornton Excerpts

Thursday 7th June 2018 Lords Chamber

Asked by

[Baroness Thornton]

To ask Her Majesty's Government what steps they will take to address concerns that psychiatrists treating patients suffering from addiction have been receiving referral fees from private clinics.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord O'Shaughnessy) (Con)]

My Lords, the General Medical Council is the independent regulator of doctors in the United Kingdom. Its guidance is clear that doctors must not allow any financial interest to affect the way that they treat patients. The GMC is aware of the allegations in the media, will consider the evidence and, if it finds that doctors have breached its guidance, will take action. Serious or persistent failure to follow the GMC’s guidance may put a doctor’s registration at risk.

--- Later in debate ---

[Baroness Thornton (Lab)]

I thank the noble Lord for that Answer. Like many noble Lords, I am sure, I was alarmed to read allegations that people suffering from addiction were being used for what sounded like profiteering, which is absolutely against the rules. However, the wider issue seems to be that there is a shortage of mental health experts in the system at all levels and cuts in budgets, so there is vulnerability in the system that is being exploited. What are the Government doing to increase the number of psychiatrists and other physicians in mental health, and to increase funding given the amount lost in the mental health system?

[Lord O'Shaughnessy]

If these allegations are substantiated, there must obviously be serious consequences for the doctors concerned and clearly it is right that the GMC investigates that. In terms of the noble Baroness’s overall question, there is of course local authority-commissioned alcohol and drug treatment available; it does not need to be purchased privately. More generally, in terms of mental health support, she will know that there is a commitment to recruit 21,000 more mental health staff and that, through the new mental health investment standard, CCGs have to continue increasing their mental health spending year on year.

Abortion

Baroness Thornton Excerpts

Wednesday 6th June 2018 Lords Chamber

[Lord O'Shaughnessy]

Our intention—that of the Government and the Northern Ireland Office—is to restore a power-sharing agreement and arrangement in Northern Ireland so that it will be up to the people of Northern Ireland and their elected officials to decide on abortion policy.

[Baroness Thornton (Lab)]

My Lords, the Northern Ireland Assembly is not meeting at the moment. This matter, which is the issue of the Question put by the noble Baroness, is not a devolved matter. Could the Minister give the House an indication of the Government’s response to the debate led by my honourable friend Stella Creasy in the Commons yesterday? A cross-party amendment will be tabled to the upcoming Domestic Violence Bill that will seek to decriminalise abortion across England, Wales and Northern Ireland through the repeal of Sections 58 and 59 of the Offences against the Person Act 1861. That is not a devolved matter.

[Lord O'Shaughnessy]

I merely reiterate the point that abortion policy is a devolved matter. Indeed, that has been the policy of successive Governments of all hues. Of course, it is ultimately up to Parliament to make a decision, and any move that came from Parliament would emanate from within Parliament, from the Back Benches, on the basis of a free vote, as I set out in my first Answer.

Health Inequality: Autism and Learning Disabilities

Baroness Thornton Excerpts

Thursday 10th May 2018 Grand Committee

[Baroness Thornton (Lab)]

My Lords, I congratulate my noble friend on introducing this important debate, made particularly poignant by the learning disabilities mortality review, which we discussed yesterday. I also congratulate all noble Lords on sticking to the time limit, on being succinct and on being informative and moving in their remarks. I also thank the National Autistic Society, Mencap and SeeAbility for their briefings.

I was going to talk about eye care because I was so taken by the brief that we got on that. SeeAbility points to a gap and I hope that the Minister will be able to assist with that. The National Autistic Society quite rightly wanted to know when the autism pathway will be progressed. That has been mentioned by many noble Lords and I echo that. It is important also that the department looks at whether the Transforming Care programme meets the needs of autistic people and takes action to ensure that it does. Given that the Government are reviewing the Mental Health Act, will the Minister commit to look explicitly at how the Act works for autistic people?

I shall finish with something also to do with eyes. Desmond’s story, which came from the National Autistic Society or Mencap, is worth reading into the record:

“My learning disability means I grasp things more slowly and I need people to communicate clearly. Normally I go to my local hospital for my eye care—they are good with me. But in 20113 they referred me to another hospital to get an operation. That is where the problems began. I had a new doctor looking at my eye before the operation and he didn’t explain anything to me about what would happen. In the past, the hospital staff sedated me for operations on my eyes. I thought this would happen again. But instead, the doctor immediately started operating on me, while I was still awake. I was scared, and they were telling me not to close my eyes. It was a horrible feeling. I didn’t have a chance to explain what would make me feel more comfortable. There was no-one to talk it through and no time for the doctors to get to know me. I wish the doctors could have told me what was happening and why—it’s what anyone should expect. I hope staff get better training in the future to make sure they communicate better with people with a learning disability”.