NHS: Winter 2017-18

Lord Hunt of Kings Heath Excerpts

Wednesday 18th April 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Baroness is quite right. That is one of the reasons we have taken some big decisions over the winter, one of which is to reduce the amount of delayed discharges. I think it has been reduced by about 1,500 beds. It was also the reason behind what was undoubtedly an unpopular decision and one that we did not want to take: to suspend and postpone some elective surgeries during January. That freed up a number of beds, which helped us to cope with the emergency admissions. Happily, it has not had to be reinstated since the end of January.

[Lord Hunt of Kings Heath (Lab)]

My Lords, a huge debt is owed to the NHS for the way that it has responded to the pressures this winter. However, can I ask the Minister about elective treatments and the cancellations in January? He will know that the maximum 18-week wait target has not been met for, I think, at least two years. Given that the BMA has said that winter pressures will really never come to an end—they simply continue throughout the year—does he think that we will ever meet the 18-week target again under the current Government?

Prescription Drugs: Dependence

Lord Hunt of Kings Heath Excerpts

Monday 19th March 2018 Lords Chamber

Asked by

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government whether they have plans to provide a network of support, nationally and locally, for people affected by dependence on prescribed drugs.

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

The Government take seriously the issue of dependence on prescription drugs. The Public Health Minister has commissioned Public Health England to review the evidence on the scale and nature of the problems with some prescription medicines, and how those problems can be prevented and treated. The review is due to report in spring 2019.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I very much welcome the review, but there is a real problem: many, many patients are suffering huge damage as a result of overdependence, often because they have been prescribed a particular medicine for too long a period. There appears to be woeful ignorance among many people in the health service about this impact of dependence. There are no national programmes for supporting people. Instead, people rely on local charities, which are grossly underfunded. Does the Minister not think it is time for a national action plan, a national helpline and support for local charities, and to get the NHS to start taking this seriously?

[Lord O'Shaughnessy]

I agree with the noble Lord that it is a serious issue. A NatCen study found that there has been a doubling of the use of serious painkillers. Indeed, deaths due to opiates of all kinds have risen by about two-thirds in the past five years; of course, that is illegal as well as legally procured drugs. We agree that there is a problem. That is why the review is taking place. It is premature to say what the outcomes of that review will be, but undoubtedly we need a comprehensive approach to dealing with this problem, because it is getting worse.

Antimicrobial Resistance

Lord Hunt of Kings Heath Excerpts

Thursday 8th March 2018 Grand Committee

[Lord Hunt of Kings Heath (Lab)]

My Lords, it is a great pleasure to wind up for the Opposition and thank the noble Baroness, Lady Greengross, for an excellent contribution, which other noble Lords added to. I want to raise two issues. One is about the use of antibiotics in animals and the other is about incentives for developing new drugs and vaccines. First, I refer to the wide-ranging speech of the noble Baroness, Lady Greengross, in which she referred to immunisation uptake, which is a very worrying issue for health in this country, let alone in other countries. I have seen various reports that there is ever more misinformation out there undermining people’s confidence in vaccines. We saw with the MMR issue the problems arising when this gains ground. Is the Department of Health and Social Care exercised about this and is it developing a strategy?

On the use of antibiotics in animals, I know that the Government made a progress report in 2016, commented on this and particularly referred to compliance with Red Tractor assurance scheme standards and to the work of the task force Responsible Use of Medicines in Agriculture Alliance. My noble friend Lord Grantchester, to whom I have referred on this, has made the point to me that, alongside this and influenced by various suppliers, farm assurance schemes are having a positive impact in reducing the use of antibiotics in animals. Will the Minister comment on this and give a progress report in that area?

On how better incentives can be used to promote investment in new drugs and vaccines, the report by the noble Lord, Lord O’Neill, was very clear that the current pipeline of new antibiotics shows that there is a mismatch between the drugs that the world needs and the number and quality of new antibiotics that are being researched. He recommended,

“a global system of market entry rewards for antibiotics and alternative therapies”.

He suggested that the challenge really is,

“to ‘de-link’ the profitability of an antibiotic from volumes sold, reducing uncertainty and enabling reward without encouraging poor stewardship”.

This arises from the fact that it is very difficult in the current model for the industry to see how it can get any return on the development of new antibiotics, and because of that, we have this very big problem.

I know that the Government have acknowledged the principle of de-linking, particularly in their endorsement of the 26th UN declaration on AMR but, just to reflect on the problem, STOPAIDS, which is a UK network of agencies which have developed a global response to HIV and AIDS, set out the de-linking issue, stating that the incentive to innovate is still tied to the price that pharma companies can charge for the products they create and therefore there is still a risk of continuing this problem of high price. The ABPI, the trade association for the pharma industry, is continuing to work with the noble Lord’s department on this to explore reimbursement and evaluation models, which could perhaps be piloted in the UK, but I wonder whether the noble Minister can say a little bit more about whether progress is being made.

I refer noble Lords to a recent—2018—report by the Access to Medicine Foundation, which is an international NGO based in the Netherlands. Very recently it produced an anti-microbial resistance benchmark. The report states that despite some progress being made by some companies, there are still too few in the pipeline and we need to strengthen that pipeline. I wonder whether there are other actions that now need to be taken to provide the right incentives.

Emergency Hospital Admissions

Lord Hunt of Kings Heath Excerpts

Wednesday 7th March 2018 Lords Chamber

[Lord O’Shaughnessy]

One of the issues the NAO reports is that we do not yet have good enough data on what is happening in the community. The creation of the community services dataset will enable us to track precisely what is available in the community in every area. Concerns have been raised in this House before about the number of district nurses, which unfortunately has fallen over recent years. It has now shown a small increase year on year and we hope we are starting to turn the corner on community nursing numbers, too.

[Lord Hunt of Kings Heath (Lab)]

My Lords, there are two stark facts from the NAO report. First, the real problem has been the reduction in social care funding. Surely the real answer to this problem, above all else, is to restore what has been cut. Secondly, I refer the Minister to the chart in that report which shows that, despite the increase in demand, bed capacity has been cut by 6,000 beds since 2010-11. I understand that in February the occupancy rate reached a dangerously high level of 95%. Does the Minister accept that, while we need to prevent avoidable admissions, it is very unwise to reduce acute care capacity at the moment?

[Lord O’Shaughnessy]

I agree with the noble Lord about funding. The Government have now made £9.4 billion of extra funding available to local authorities over three years, including in the most recent local government funding settlement. The noble Lord makes a good point about bed capacity: it had shown a downward trend for a long time before stabilising in recent years. I point to two successes this winter. The first is the improvement in delayed transfers of care—we have really started to get some traction on that. The second is about £60 million, I believe, of funding that went into providing extra bed capacity over winter. Occupancy levels are too high. The NHS is getting better at managing it more efficiently, but we certainly need to do better.

National Child Obesity Strategy

Lord Hunt of Kings Heath Excerpts

Monday 26th February 2018 Lords Chamber

[Lord O’Shaughnessy]

I reassure the noble Lord that the national curriculum, through PSHE, includes elements around nutrition and healthy eating. Indeed, many schools offer the kind of classes he is talking about.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I refer the noble Lord to your Lordships’ Select Committee on the Long-Term Sustainability of the NHS, which said that the Government,

“should not cite unwillingness to behave as a ‘nanny state’ as an excuse for inaction on the major public health issues, including obesity”.

If the study that is being undertaken at the moment shows that outcomes are poor, will the Government move from their current voluntary approach to take more decisive action?

[Lord O’Shaughnessy]

The point here is that we know that these are difficult decisions and, of course, children have decisions made on their behalf by their parents, people in schools and others, so there needs to be a combined approach of statutory action and voluntary action. We should applaud the voluntary action that many people have taken—supermarkets, food producers and others—but clearly there is a continued role for the Government and I do not think questions of nanny statism come into it.

Medicines and Medical Devices Safety Review

Lord Hunt of Kings Heath Excerpts

Thursday 22nd February 2018 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I thank the Minister for repeating the Statement. I should also like to thank him personally for meeting representatives from the mesh campaign group two weeks ago, which is much appreciated.

Today’s announcement is an acknowledgement that there are major issues which go back decades in areas that concern safety and a lack of proper scrutiny and research. We have heard how mesh implants have left women in permanent pain, unable to walk and unable to work. Welcome as the Statement is, the Government need to do much more to support those affected. Mesh has been suspended in Scotland and banned in other countries. The most recent interventional procedure advice from NICE on prolapses states that it should be used only for research purposes and not as a front-line treatment, but I ask the Minister whether he thinks we need to go further and suspend the use of mesh until NICE has completed its review into the safety and efficacy of the product. If the Government are not prepared to go as far as suspension, will he at least write to all trusts and indeed private hospitals to remind them that the Health and Social Care Act 2015 requires them not to cause avoidable harm? The review in itself signals that mesh is now acknowledged to cause harm.

I refer the Minister to Owen Smith’s comments in the other place; he chairs the All-Party Group on Surgical Mesh Implants. He said that:

“Lessons must be learned from the awful complications many women have experienced since undergoing mesh surgery and proper processes must be put in place to stop this happening in the future … The mesh scandal shows what can go wrong when devices are aggressively marketed to doctors and then used in patients for whom they were unsuited or unnecessary”.


Will the review chaired by the noble Baroness, Lady Cumberlege, look into that particular aspect?

The Minister mentioned in the Statement the investment of £1.1 million, part of which will go to improving clinical practice. Clearly, one should always seek to improve clinical practice, but mesh campaigners would say that the real issue is not the clinical practice but the product itself, which is not fit for purpose.

The retrospective audit is very welcome indeed, but there is a real question about whether it will capture all the women affected. I have certainly received evidence to suggest that some women suffering greatly from mesh implants are not aware of the reasons and therefore do not approach the health service. Will the Minister also say whether the mesh audit concerns only hospital statistics and records or whether it will cover GPs and primary care as well? Also, will the review extend to when men and women are affected by hernia mesh?

The Secretary of State has said that the review will not go into the science of mesh. But most studies do not use quality-of-life questionnaires, so they do not pick up the devastation of pain, lost sex lives or constant urinary infections. Studies concentrate on whether the mesh has cured the problem of prolapse or incontinence. Many studies are short-term or compare mesh to mesh. Trials should compare mesh to the old-fashioned natural tissue repair to get a proper evaluation of whether the use of these products should be continued in the future. Many trials have low numbers and any woman who has had a mesh implant can feel like a ticking time bomb, as the product can shrink or twist years down the line. No amount of surgeon training can counteract that.

Will the review extend to those with mesh bowel prolapses? Will it also look at what help the NHS needs to give to people currently affected as mesh sufferers? Obviously each country in the UK is taking a slightly different approach but, in his role as the Minister responsible, will he work with Scotland, Wales and Northern Ireland to pull together research and co-ordinated action, which would make great sense?

I hope that the noble Baroness, Lady Cumberlege, will be asked to look at whether device regulation needs to be tightened up. As the Minister knows, it is much less stringent than medicines regulation and there has been an ongoing debate about that. I hope that that will be included within her review.

On Primodos, the Minister indicated that the department would drive forward and accept the recommendations of the expert working group. But in the other place when the report was published in October, it was met with concern from all sides of the House. I hope that he will take that into account.

I am grateful that the Secretary of State has included sodium valproate in this work. The Minister will know that last year a charity found that almost one-fifth of women taking the drug still did not know the risks that this medicine could pose during pregnancy. I therefore welcome government efforts to raise awareness of the dangers of valproate. I also hope that the House can be offered an assurance that the review will gain access to medicine regulation files held in national archives, access to any valuable evidence cited in unsuccessful legal actions and access to documents and information held by pharmaceutical companies, and that all such material will be made public.

I ask the Minister to invite the noble Baroness, Lady Cumberlege, to meet victims to see whether consensus can be agreed on the terms of reference, to maintain trust and confidence in it. That would be a very valuable first step to gaining the confidence of campaigners who have worked so hard and have been gratefully acknowledged by the Secretary of State in his Statement.

[Baroness Brinton (LD)]

From the Liberal Democrat Benches, I am very grateful and thank the Minister for the Statement. I am particularly pleased about its tone, which moves on the Government’s debate with campaigners, families and clinicians about these very serious issues. It makes a break with the past.

I am particularly concerned that there should be regular assessments and updates for people with problems from Primodos and sodium valproate, because we know from our experience with thalidomide that everybody thought that everything had been sorted from the initial diagnosis of the children, but as they entered adulthood and more mature years further medical issues appeared. It will be important to recognise that we need to make sure these young people—and adults as they are now—get that protection.

The yellow card system was not available in its current format for these two drugs. One of the things that concerns me most about the Statement is the assumption that the only people involved with the yellow card are clinicians. Speaking as a patient who has been on a drug that has very serious yellow card incidents, I have been trained to recognise that if I get a side-effect I do not just go back to my hospital; I report it to the pharma company. The pharma companies are notable by their absence in this Statement. Will there be specific links back for clinicians and patients on some of the side-effects of drugs? That is easy to say for those who are formally expert patients. I absolutely accept the point made by the noble Lord, Lord Hunt, that some patients are inexpert for all the right reasons.

There needs to be a real focus on all the other health professionals that these patients come into contact with. Reporting a yellow card incident to a GP when it is very difficult to see your own GP these days means that it could quite often be missed. In the case of sodium valproate this certainly needs to include midwives and people involved in the obs and gynae departments as well. What training is to be provided for these non-specialist healthcare people to make sure that they understand, when a patient talks about a problem, that this may need to trigger a yellow card response? To that end, I welcome the proposal for an electronic yellow card. That will be extremely helpful. Printing out a yellow card, filling it in and sending it in is an absolute deterrent to it happening.

On Primodos and sodium valproate, will the longer-term effects also be covered by the Cumberlege review? It is important to have a reference back there. I am also concerned about the vaginal mesh issues, specifically those reported in the Statement. It would be useful to know what percentage of those who have had vaginal mesh implants have faced problems. It is fine to say that many have benefited. I completely accept that, but one needs to understand what the ratio is between those facing problems and those for whom it has benefited them, to understand whether a ban should be in place. What is the date for publishing the retrospective audit? It is fine to say that it will be done. I have no idea how far along the line the process is. Then there is the timescale for creating that computer database for vaginal mesh to improve clinical practice. When will it be not just commissioned, but completed and used in analysis? Will interim reports go to the noble Baroness, Lady Cumberlege, by the people doing this review if evidence emerges that she will need to take account of?

I am concerned about the idea of the creation of a patients’ champion. We already have panels and expert groups. Yet another person that patients may or may not know about, and may or may not be able to turn to, seems problematic. I urge the noble Baroness, Lady Cumberlege, to look at what is available now rather than creating yet another body.

Finally, I echo the concerns expressed by the noble Lord, Lord Hunt, about whether we should move to a public inquiry at this stage. I wonder whether the evidence that the noble Baroness, Lady Cumberlege, will undoubtedly turn up means that she may come back to Ministers and say, “Actually, this is the point at which this needs to go public”. Campaigners have highlighted for years that there are problems.

Health: Pelvic Mesh Implants

Lord Hunt of Kings Heath Excerpts

Tuesday 6th February 2018 Lords Chamber

Asked by

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government whether they intend to review the safety of the use of pelvic mesh implants.

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

My Lords, NHS England’s mesh working group report outlined recommendations to optimise care when surgical mesh is used to treat stress urinary incontinence and pelvic organ prolapse. We continue to implement those recommendations. NICE has now published eight pieces of updated interventional procedure guidance related to vaginal mesh. Updated clinical guidance covering urinary incontinence and mesh will be published in February 2019. The MHRA continues to review available evidence to make sure that our regulatory position is up to date, liaising with EU and non-EU partners.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I thank the Minister for his personal involvement in the decision to conduct a retrospective audit into vaginal mesh surgery, but will he go a little further? He will be aware that an increasing number of women have reported suffering from complications that include debilitating pain, infection, inflammation, the loss of sex life and mobility issues. A number of countries have now banned the use of mesh implants completely. On the precautionary principle, will he suspend the use of mesh until the audit that he has announced has been completed and new guidelines issued by NICE?

Dental Care

Lord Hunt of Kings Heath Excerpts

Thursday 1st February 2018 Lords Chamber

[Lord O'Shaughnessy]

We have talked about fluoridation a lot in this House recently. My noble friend knows the position: it is up for local areas to come forward with proposals. On his particular issue about dentists, they are doing a fantastic job in the NHS. We have more of them than ever. I want to point out that the 1% cap that was applied—we know that was because of the fiscal retrenchment that has had to take place in this country—no longer applies; indeed, we are waiting for dental review bodies to report on it so that we can arrange future payments for dentists.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I remind the House of my presidency of the British Fluoridation Society. The noble Lord says that we have talked a lot. We have not quite talked enough, because the problem is this: fluoridation would deal with a lot of the areas with high numbers of oral health issues. The local authority is responsible for this and for paying the revenue costs, but the benefit falls to the health service. The cost annually for an average local authority is £300,000. Would the noble Lord be prepared to convene a discussion between himself, NHS England and Public Health England to see whether there could be a way to find some resources to help local authorities implement schemes?

[Lord O'Shaughnessy]

I recognise the benefits of fluoridation that the noble Lord has pointed out. There is no question about that. But we know that this is a very difficult and vexed issue locally—there are strong feelings either way. That is why the position was reached in the 2012 Act. The noble Lord’s idea of a discussion is a good one. I should point out that it is not a policy area on which I lead so I will have to speak to my colleague in the department, but if we can get that going and think about ways to encourage more action it would be a very clever thing to do.

NHS and Social Care: Winter Service Delivery

Lord Hunt of Kings Heath Excerpts

Thursday 25th January 2018 Lords Chamber

[Baroness Barker (LD)]

My Lords, I thank the noble Baroness, Lady Wheeler, for the opportunity, as the noble Baroness, Lady Pitkeathley, just said, to return again to this subject. I will not make a long speech as I would like to leave as much time as possible for the debate that will follow. On behalf of my colleagues on these Benches, I wish the noble Baroness, Lady Jowell, all the very best and ask her colleagues to convey that to her.

The noble Baroness, Lady Pitkeathley, is right: we have been back to this ground so many times. In preparing for this debate, I thought back to many of the debates that we have had in the past. The origins of the problem we are looking at go back to the National Health Service and Community Care Act 1990. In that Act, for the very first time, welcome things happened: we began to break down procedures within the NHS and to cost and quantify them. But the problem was that we made them into individual units of activity, and to this day, within the NHS, the systems that join up those individual units are failing. They fail completely when they have to be matched up with the social care system, which is completely different.

Those problems were identified and partially addressed in 2003 with the Community Care (Delayed Discharges etc.) Act, when the then Minister, the noble Lord, Lord Hunt of Kings Heath, was sitting there trying to answer questions from very talented opposition spokespeople such as me. We asked him a question that he never could answer, which was why the then Government thought that the answer to the problems in the NHS was to fine social services departments. I never understood that. We still have, within the whole system of discharge, a system of penalties.

[Lord Hunt of Kings Heath (Lab)]

Perhaps I can answer the noble Baroness. Surely the point is that both local government and the NHS were being properly funded at that point. Therefore it was entirely appropriate to have a system to encourage local authorities to do the right thing.

[Baroness Barker]

The issue that I think the Government were trying to solve was one for which we have never had any evidence: that of local authorities trying to game the system. It is correct that the overall amount of funding has gone down, but we have not had evidence of people gaming the system.

We have never had a system, or even part of a system, that incentivises GPs and those in charge of social care to prepare for winter pressures, invest in programmes that will see older people through the increased incidence of illness that we know happens in winter, and avoid unnecessary admissions to A&E. What has changed in that time is that we now have better data and better information systems, but in many ways we are still failing to take all that and improve those systems. At the moment we still have ambulance services being rated on completely different systems across the country so we cannot generate data.

The Government have done some things that are very welcome. Everyone agrees that the primary care streaming system, into which they put £100 million, is a worthwhile initiative. Unfortunately, the initial evidence is that it is failing simply because it takes people from another part of the system—GPs—and locates them in hospital. What are the Government going to do to properly monitor that system in its entirety as part of an overall approach to winter pressures, to see whether it is worth more investment or whether it simply takes resources from other parts of the system?

On the question of beds, we have a national system of monitoring general and acute beds and ways of measuring the overall occupancy rate. We do not have a method of assessing the number of beds in relation to need. For example, we can open up a load more beds, as the NHS always does at times of crisis, but if there are no more staff to look after the people in those beds then we are not really addressing the need. We need to refine the measurement of this so that we have a metric along the lines of “nurses per bed per day”. That is the point at which things become really bad. I remember talking to a nurse about a patient—actually my mother—and being told that she was far too good to be in hospital and would be going home. She died two days later, which was not a surprise to any of us. I say that because it is not an uncommon experience for patients.

We have been through this time and again. The one thing that we have failed to do is incentivise GPs to work with community organisations from the summer onwards to predict the people in their area who are going to be most at risk and to put in place very low-level, simple and low-cost packages of care for them that can be there very quickly when they are discharged. The biggest cause of delayed discharge is not the absence of social care but the absence of community nurses and NHS staff available to work in the community to ensure that we do not send people home only to see them return unnecessarily into acute care.

--- Later in debate ---

[Lord Hunt of Kings Heath (Lab)]

My Lords, it is a great pleasure to respond to my noble friend’s debate. As my noble friend Lord Smith mentioned oral health in the north-west, I remind the House that I am president of the British Fluoridation Society, which of course is the answer, at a stroke, to the dreadful oral health issues among children in Greater Manchester and the north-west generally.

My noble friend Lady Wheeler made a persuasive speech about the pressures that the NHS is under and the relationship between that and front-line social care. The latest figures on performance graphically illustrate this: in 2017, 16.5% of patients spent more than four hours waiting for treatment compared to 5.6% in 2012. On delayed transfers of care, there were 1.97 million delayed days in the first 11 months of 2017 compared to 1.26 million in the equivalent 11 months of 2012. The 18-week referral-to-treatment target for consultant-led treatment has not been met since March 2016. The 62 days from referral to treatment target for cancer has been met for only one month since April 2014. The number of cancelled operations is going up, as are ambulance response times—the new target of seven minutes for life-threatening calls was not met in its first month of operation. Occupancy levels in hospitals have become a hugely difficult issue. On 2 January this year, 57 of 137 trusts had bed occupancy above 98%. That means not just pressure but almost certainly unsafe practices in those situations. The Secretary of State, who has made quite a lot of noise about safety, needs to take stock of his own responsibility for the fact that there are now some very critical situations in the NHS where undoubtedly patients are vulnerable.

If the Government were at least open about this, we could have a proper debate, but, as the noble Lord, Lord Kerslake, said in quoting Chris Ham—who knows a thing or two and goes back quite some way—it is the Government’s denial about the scale of the problems faced that makes it so difficult to debate with them and have any meaningful discussion about the way forward. I think all noble Lords agree with my noble friend Lady Pitkeathley that the NHS crisis is also a crisis of social care. The information we received from the Association of Directors of Adult Social Services, saying that 90% of councils are able to respond only to people with critical and substantial needs, is telling, because we know it means that we are storing up even more trouble for the future because we are not intervening at a stage where we could help people. The report that we saw from Age UK and the chair of the Malnutrition Task Force said that only 29,000 people now receive meals on wheels, down from 155,000 a decade ago. No wonder it is said that 1 million older people are starving in their own homes. That is the scale of the problem that we face.

The noble Baroness, Lady Wheeler, in talking about the experience of carers, really brought this home to us. As she said, emergency care and hospital admission and then discharge is a make or break time for carers and their families. People like her become carers for the first time when this happens. Despite all the guidelines and good practice, most discharges take place with very little notice, particularly when there is such pressure to free up beds to make way for patients who are waiting in A&E, on trolleys or, indeed, in the ambulance, waiting to be seen in A&E.

My noble friends Lady Pitkeathley and Lord Pendry talked about the impact of carers and the problems they face for their health. I hope the Minister will respond to this question: if we cannot produce a carers’ strategy, can we at least have an interim action plan? Let us not just hide behind a Green Paper, which, frankly, I do not think we will see for many a month, if at all. I suspect the problem is that the Treasury will not agree to any proposal that is not along the lines of that which Mrs May proposed during the last election, which caused such concern.

Capacity is a major issue. The pressure is increasing but NHS capacity is reducing. Could the Minister explain why that is happening? I should also like him to reflect on STPs. There was a time when all the answers to all the problems were to be in the sustainability and transformation plans, which then became programmes. We do not hear so much from Ministers about STPs now, but the health service is trundling on because no one has told it to stop work on them. We debated here a few months ago the west London STP, which is a remarkable document. Because financial balance by 2021 is the imperative, it is essentially taking a great deal of capacity out of west London and then saying that through heroic demand management, which we have never seen before, everything will be all right. Most STPs repeat this because, basically, they have been told by the regulators that they have to come up with a plan that meets financial balance. I do not think Ministers believe in them anymore, but they used to believe in them; they used to say that they were the answer to the problem—but everyone out there knows that they are pieces of fantasy, which will never be delivered. I pray in aid the National Audit Office report, which came out in January and said:

“Local transformation of care is being hampered by a lack of resources and ongoing pressure to make increasingly tighter finances balance each year”.


So they are reducing capacity, but not producing any investment to develop other services, which would then help to reduce demand on acute care. So there is no hope whatever of achieving anything that these STPs say they will do.

We then come briefly to the new role of the Secretary of State. Will the Minister explain what that new role is? He knows that his department has been responsible for social care for decades; he also knows that the Department of Health negotiates the adult social care vote, albeit that then goes through DCLG. So what is changing? Is the Department of Health now to have the money for social care and is that then to be ring-fenced as an allocation to local authorities? If not, has there been any change at all in the Secretary of State’s responsibilities? I think we ought to know.

I accept, and my noble friend Lord Smith and the noble Lord, Lord Kerslake, explained, that it is not simply a matter of having integrated health and social care budgets. First, you have to deal with the gap between free-at-the-point-of-use NHS spend and means-tested social care spend. Until you deal with that, integration is very hard to deliver at local level. Secondly, you cannot look at social care budgets without looking at the overall spend and discretion of local authorities. Adult social care is probably the biggest discretionary spend they have: if you start to intrude on what they can do, it is very difficult to see how local authorities have the flexibility at the moment to be able to manage the rest of the local authority responsibilities. This is not at all easy.

The noble Lord, Lord Macpherson, spoke very articulately about the pressures on government finance in general. He said we could do with better management and I agree: the system needs to be reformed. I also agree with my noble friend Lord Brooke about the way hospitals are run. The hypothecated tax, informed by the OBR and based on national insurance contributions, seems to be a runner. His point about retired people having to pay national insurance was very well made. I have just been re-reading, or glancing at, the book by the noble Lord, Lord Willetts, about intergenerational fairness. Reflecting on my noble friend Lord Desai’s willingness to increase taxes, which I agree with, it is very difficult to say to younger people, “We are going to increase your taxes to be spent largely on a service that provides for older people”, when you have the current benefits for older people. This is a controversial statement to make from this Dispatch Box, but inevitably this has to be confronted. I am hoping to join my noble friend in being sacked at this point.

I come back to the report by the noble Lord, Lord Patel. It is a very good report, published on 5 April 2017. “How long, O Lord, how long” before we get a response from the Government?

NHS: Cancer Treatments

Lord Hunt of Kings Heath Excerpts

Thursday 25th January 2018 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I too thank my noble friend Lady Jowell for an extraordinary speech, full of passion, compassion and hope. I had the great privilege of following her as a Minister at the Department of Health: what a formidable reputation she had as our first Public Health Minister and what a legacy she left. Many of today’s public health programmes which are taken for granted she established in those first two crucial years. I do not know whether she knows that I have not quite forgiven her for her other big decision at Richmond House, which was to get rid of chocolate biscuits and bring in fruit bowls instead. What she does not know is that a certain Minister of State not a million miles from where she is sitting had a secret cache of those biscuits—my noble friend Lord Hutton became very popular for having meetings in his own ministerial room.

My noble friend Lady Jowell has raised a huge question about access for NHS patients to innovative treatments. In a sense, that is the great paradox of health in this country. We have an NHS that we are enormously proud of. It is still very well regarded internationally. We have an incredibly strong life sciences sector, with over £60 billion of turnover and over 200,000 high-quality jobs. We have one of the strongest pharmaceutical industries in the world: 25% of all global medicine is developed in the UK. Then, as the noble Baroness, Lady Dean, and my noble friend Lord Turnberg said, we have the great paradox; it is a British problem too. We have this great development, this great invention, but we are slow to adopt it. The experience of my noble friend Lady Jowell and so many other NHS patients is the same. If we look at other countries, such as Germany and France, we can see that their patients have much more access to innovative treatments than we do in this country.

When my noble friend was a Minister, she had the first discussions about the establishment of NICE, which was set up to deal with this British problem. It was calculated that it took 15 years for a proven new innovative treatment to be adopted generally in the health service. Here we are, nearly 20 years later, still facing the huge problem of innovation adoption. It is true that the Government have established the accelerated access review; they also have a life sciences strategy, post Brexit. However, we have to do much more. Of course finance is important, but the Minister will know that it is not just about finance—it is about attitude. I hope that the one message he will take away from this extraordinary debate and from my noble friend is that we have to do better in the NHS to adopt the huge innovation that so often takes place in our country.