Health: Obstetrics and Gynaecology

Lord Hunt of Kings Heath Excerpts

Monday 17th July 2017 Lords Chamber

[Lord O'Shaughnessy]

I agree that parents should be involved in such reviews—as those who are ultimately most affected by these tragedies, they absolutely should be involved. It is fair to reflect that issues around maternity deaths, brain injuries and so on have been going on for a very long time, and in certain trusts there have been acute instances of tragedy. That is why, as I said, the Secretary of State is determined to halve the number of deaths and incidents. We have had a number of reports, not only the one we are discussing today but also that of my noble friend Lady Cumberlege, Better Births, in an attempt to improve the way that services are delivered.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I want to follow on from the question about reviews. The royal college that looked at the way in which the local reviews were undertaken found wide inconsistencies between different hospitals. Not only did a majority of reviews not involve parents at all, but my understanding is that, in its initial report, it found that only 9% of the reviews involved external experts. I know that the Government are very reluctant to intervene, but surely it would be possible to issue very straight guidance to the NHS to say how reviews should be undertaken and that in all circumstances both parents and external reviewers should be involved. Will the Minister give that some consideration?

[Lord O'Shaughnessy]

I shall certainly give that consideration. There may be specific reasons why, in particular instances, that might not be possible or even desirable, but I shall certainly look into it. Take one of the instances: the tragedies at Morecambe Bay. It was found that there was a lack of objectivity in investigations and that that—along with other problems such as a lack of good data—led to the kinds of tragedies we saw, not happening once but over and over again. I completely take the noble Lord’s point, and I will look into it.

Brexit: Risks to NHS Sustainability

Lord Hunt of Kings Heath Excerpts

Wednesday 12th July 2017 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, it is a great pleasure for me to congratulate the noble Lord, Lord Warner, on this debate, which I think has been very good and wide ranging. He linked the long-term sustainability of the NHS with the UK’s departure from the EU and demonstrated amply that, even without Brexit, the NHS faces a very difficult challenge in terms of its long-term sustainability. The report of the Select Committee chaired by the noble Lord, Lord Patel, demonstrates very comprehensively some of the questions that we need to consider.

It is abundantly clear that the NHS does not have the required funding. The question we need to put to the Government is: what is their plan for the NHS? Essentially, are they engaged in a wind-down of the NHS’s activities? We know that CCGs are rationing increasingly. We know that the key targets are being missed and I do not know anyone in the health service who thinks that the health service will ever get back to meeting those targets under current circumstances.

A similar question has to be asked of the Government in relation to social care, following the débâcle over the dementia tax. I put it to the Minister that we are still waiting on an answer as to why Dilnot is not being implemented. There has not been a straight answer. We had the report; we had legislation—we spent months taking the Bill through this House. The Government announced the cap at £72,000. They then announced a postponement, but we have yet to hear one reason as to why Dilnot is not being proceeded with. I think we are owed some explanation of why we are in the position we are in.

No doubt the Minister will talk about STPs and the transformation process that is being undertaken in the health service—but there are two things to ask him about that. First, it was the Government’s intention to introduce legislation to amend the 2012 Act to allow the STP process to proceed in a legal way, because clearly it drives a coach and horses through the 2012 legislation. My question for the Minister is: what is now going to happen? I cannot see that the kinds of things that NHS is seeking to do at local level are at all legal in terms of the 2012 Act.

Secondly, the right reverend Prelate put the point very well when he asked: how can it be that in his diocese, in a hospital which is under huge demand, you can justify closing two wards without seeing the commensurate investment in the community, when we are told that if you do that, you will reduce demand on acute hospitals? By the way, I have to say to the Minister that there is no evidence that that will actually happen. No respectable institute has produced any hard evidence that suggests that investing in primary community care reduces demands on acute care. It is much more likely, as Nye Bevan found in 1948, that it deals with unmet demand, but that demand within acute care is likely to continue.

My other question for the Minister is this. The word in the service is that the Government will not support any controversial change in service locally if it will cause angst to local MPs. If that is the case, it is quite clear that the whole STP process will grind to a stop over the next few months as more and more people recognise that it is not the game in town that the Government thought it was going to be.

These are major questions that the Government need to consider. How much worse does the problem become when we come to Brexit? Noble Lords have eloquently described some of the issues that we face—but I put to the Minister the point made by his noble friend Lord Cormack: why are the Government so reluctant to support a Joint Committee of both Houses to consider these matters? After all, part of the debate on Brexit was about the so-called sovereignty of the UK Parliament. Why are the Government so resistant to the UK Parliament exercising sovereignty over the biggest decision this country has faced in 50 years?

The Prime Minister has talked about bringing the country together. How do you bring the country together when your interpretation of a very narrow majority for Brexit is to take an obdurate view that the red lines are around migration and the European court? How on earth is that bringing the country together? Surely a consensus approach would be to find some kind of middle way through the Brexit negotiations, rather than the cul-de-sac the Prime Minister has got herself into—which, of course, in the end she will have to get herself out of because she does not have a majority in the other place for the proposals that she is putting.

We then come to the issues facing the health service. The noble Baroness, Lady Ludford, has already raised the seemingly simple issue of our rights to health treatment in the EU and vice versa. But we are told by the Brexit Secretary that this is now an aspiration. I ask the Minister: what is our policy on this in the future?

We then come to the workforce. We have reached the ludicrous position where the pay policy and the way that professional staff are treated in the health service mean that we have fewer people from this country coming into nursing in the NHS than are actually leaving. We have completely choked off people coming from the EU because of the atmosphere the Government have created with their wretched approach to Europe. My chief exec contacts in the health service tell me that we have dozens of teams in the developing world—India and the Philippines—recruiting nurses to substitute for the nurses we would have had, happily, from the EU. How can that possibly be a sensible approach to the way the NHS is run? It just beats me; it is bizarre. The end of the line is that the Prime Minister will not get anywhere near her immigration target because she will desperately have to approve the recruitment of thousands of nurses from the developing world. Is there any more nonsensical position than that taken by this Prime Minister?

Then there are the life sciences. There are problems around European research. Already universities are losing out on research bids because other European universities will not go into partnership with them. This can have a devastating effect on our life sciences. Our universities are reeling under the ludicrous position taken by the Prime Minister—both as Home Secretary and as Prime Minister—over students coming from overseas to study in our universities. They are a huge earner. Britain has a fantastic reputation. Why on earth are we trying to prevent these people coming to this country? It again defies all understanding.

We then come to medicine regulation. The risk is that if companies continue to develop drugs in this country, they have to have an assurance that when they get a licence from our regulator, the MHRA, it will be recognised throughout the whole of Europe. If they do not get that, we will lose drug development in this country—that is £4 billion of investment. We have seen the letter that the Minister’s right honourable friend the Secretary of State and Mr Clark wrote to the FT a week ago, which makes the right noises in relation to regulation, safety and the interrelationship between what we do in this country and what happens in the EU, but does the Minister agree that in the end the only way forward is an agreement on mutual recognition, even if that involves the European court, as it may well do?

Finally, my noble friend Lord Clark speaks with great authority on Euratom. Why are we risking our energy supply, in many cases, and the safety of patients? For what? It is for some bizarre view that anything with any relationship to the European court is completely out of court.

I fear for the future of the NHS and for the future of this country if this is the Government’s approach. I am confident that Parliament will assert itself to ensure that the Government will have to change course. I hope the Minister will give us a little bit of movement on this in relation to the NHS.

NHS: Working Conditions

Lord Hunt of Kings Heath Excerpts

Wednesday 5th July 2017 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I just do not understand the Government’s response to this very pressing question. Already, recruitment from other EU countries has ground to a halt because of the anti-EU rhetoric of the party opposite. In this country we now have a net loss in the number of nurses coming into the NHS. Is the Government’s policy to recruit nurses from overseas countries other than the EU, as we have for generations? If it is, and I hear that the NHS is recruiting hugely in those countries, does that not make a mockery of the Prime Minister’s ludicrous target to reduce immigration?

[Lord O'Shaughnessy]

As the noble Lord knows, we have talked about one of the reasons for the drop-off in nurses coming from the European Union; it is because of the stricter language testing. Stricter language testing was brought in for reasons of patient safety and was supported by the noble Lord when the regulations went through in 2015. Indeed, I think there was cross-party support for that. As for anti-EU rhetoric, I do not recognise that in anything that we have said. We absolutely value the contribution of anyone who is living and working here in the UK, and indeed have made a very generous offer to solve this problem as part of the talks for leaving the European Union. As for recruitment, of course we want to recruit as widely as possible. We want the brightest and the best to be here, and that is an absolutely core part of any immigration strategy.

Health: Medically Unexplained Symptoms

Lord Hunt of Kings Heath Excerpts

Tuesday 4th July 2017 Lords Chamber

[Lord O'Shaughnessy]

I congratulate the noble Countess on the important work that she does through Forward-ME on behalf of the illness’s sufferers. On who takes responsibility for the care of those suffering from CFS/ME, it is of course clinicians. They work to evidence of best practice, which is guided by NICE. She alluded to the fact that the NICE guidelines are being reviewed to make sure that we have the best possible understanding of what is effective in the treatment of the illness, but I reiterate to her the point that the Government’s acceptance of the WHO classification of it as a neurological disease has not changed.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the approach taken by the NHS and child protection services to CFS/ME and other unexplained symptoms has had a sorry history. Some clinical commissioning groups state with great authority that graded exercise and CBT are the appropriate response. The point made by the noble Countess is that in many cases they are not, and can cause damage. Unfortunately, where children are involved, patients who resist such therapies often find themselves in problems with child protection agencies—there was an excellent programme about this on Radio 4 over the weekend. Prior to the NICE guidance coming out, will the Minister look with his officials at whether CCGs might be given some rather more authoritative advice, because it is clear that some CCGs have got this wrong?

[Lord O'Shaughnessy]

I am certainly happy to investigate CCG practice and commit to write to the joint panel to make sure it understands both the nature of the classification of the illness and the fact of the NICE guidelines. Of course, those are guidelines for clinicians; they are not mandatory in themselves.

Queen’s Speech

Lord Hunt of Kings Heath Excerpts

Thursday 29th June 2017 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, as we have covered so many subjects, I remind noble Lords of my interests in the register, specifically as a self-employed consultant, president of GS1 and trustee of the Royal College of Ophthalmologists—and my wife is a consultant with the Education and Training Foundation.

We come to an end of a spirited, five-day debate on this Government’s rather threadbare legislative programme. The Brexit election has been followed by the Brexit Queen’s Speech, which, despite the Government’s loss of majority and authority, still, unbelievably, focuses on a crude and unrealisable determination to cut immigration, whatever the consequences to our economy, jobs and public services. Of course, Brexit is hugely important. However, as my noble friend Lord Whitty said, and anyone who campaigned in the recent election will know, many of the matters that really concern the public are to do with the subjects that we have debated this afternoon.

What is so disappointing is the Government’s response to that election. Although they have dropped some of their more contentious proposals, they have not signalled an end to austerity, nor shown any recognition that our young people, schools, hospitals and older people need urgent support. There is no answer whatever to the noble Earl, Lord Kinnoull, my noble friend Lord McKenzie and others, who spoke about the need to improve social mobility.

I turn first to education. The Minister promised more money for education. However, the IFS has confirmed that the supposed extra money this will amount to will still leave schools with a cut in per-pupil spending of around 7% between 2016 and 2022. The Education Select Committee has been abundantly clear what this means: larger class sizes and more reliance on unqualified teachers. That is why parents are so concerned.

The Secretary of State for Education has told us that no school will lose out. But she has not said where the money will come from, given the free school meals debacle. I hope it will not come from technical further education, because the one risk of putting that back into the Department for Education is that it has always been targeted within that department as an area regarded as softer than other areas of education expenditure. Given the fall in further education budgets between 2010 and 2015 of 14% in real terms, this is a legitimate concern. The ambitious target for apprenticeships, with which we all agree, is also a concern; my noble friends Lady Cohen and Lord Young made this point. The risk is that the Government will simply go for the numbers at the expense of high-quality apprenticeships. I hope the Minister can respond on this point.

On grammar schools, it would be good if the Minister would confirm that plans to return to the wretched 11-plus and the reinstatement of secondary modern schools are at an end. Will he also reject back-door proposals through the ability of existing grammar schools to open satellite campuses or annexes miles from their original site, as happened in Kent? Will the Minister put an end to that?

I also want to ask the Ministers about exam results this summer. Ofqual has said that schools should expect more variability in exam results this year. What on earth are parents and children to make of that? The fear is that they have become guinea-pigs on the altar of the ideological experiment to satisfy the bizarre notions of Mr Gove when he was Secretary of State.

I also hope that the Minister will respond to my noble friend Lady Lawrence about the value of overseas students to our universities. When, oh when, will we take student numbers out of the migration statistics? It is causing huge concern in our university sector.

I turn to welfare. What is the Government’s policy on the triple lock? The new Work and Pensions Secretary said this week that it is unlikely to last in the long term. I think that Parliament is entitled to some response from the Government on this. My noble friend pointed out their silence on many other aspects of social services. There is nothing to address the falling value of benefits and tax credits, nothing to restore work allowances in universal credit—which, of course, were put in to make work pay—nothing for WASPI women who find themselves in unexpected financial circumstances after a lifetime of work, and nothing for the noble Earl, Lord Listowel, who spoke so movingly about young people caught in the trap of getting a job and then finding they lose their housing benefit. It is a scandal. Let us hope that the Government have an answer to it.

I turn to health. I do not always agree with the BMA. I certainly have not always done so in the past, but I thought that its chairman, Dr Mark Porter, put it well this week when he said that the NHS was at breaking point. Talk to anyone who knows anything about the health service and they will agree. My noble friend Lord Pendry talked about the situation in the north-west. But Ministers seem to be in total denial. Waiting times increase, staff shortages grow, CCGs ration ever more vital services, yet Ministers carry on as if nothing is happening and it is not their responsibility. They have not met their targets for month after month after month. When is the 18-week elective care target to be met, or the 95% four-hour A&E department target? Do those targets stand? The chief executive of the NHS has said on a number of occasions that he does not expect them to be met. What should we understand the Government’s policy to be?

I want to ask the Minister about the internal document of 25 May. It focused on trusts in London. Trusts with the biggest deficits were officially advised by the system to deny patients treatment, lengthen waiting times and close hospital units in the interests of a capped expenditure process. How does that square with the mandate for this year, which says that those targets are to be met? It simply does not stand up. On funding, the King’s Fund has said that the amount we spend on healthcare as a proportion of GDP has fallen and must now be increased. Will the Government respond?

On mental health, will the new draft Bill be subject to pre-legislative scrutiny? I took through the Mental Health Act 2007 after pre-legislative scrutiny—I shared a little of it with the noble Lord, Lord Warner, who did the Second Reading speech with great eloquence and then quickly disappeared stage left. That legislation gained enormously from pre-legislative scrutiny. I urge the Government to consider the merits of putting a draft Bill into pre-legislative scrutiny. It will certainly ensure the passage of the eventual Bill will go more smoothly, and will certainly be more informed.

The other point to make on mental health was made by the right reverend Prelate the Bishop of Peterborough. It is that over the past few years, Ministers have made very welcome statements about the priority that mental health is to be given. We do not dispute any of that, but it does not happen. We know that clinical commissioning groups are cutting mental health budgets. In the end, Ministers have to take responsibility. They cannot simply say that they have made these edicts and CCGs have been told to do it, and then we have a situation where clearly CCGs cannot do it because they do not have the money, they have conflicting priorities and they are left in an impossible situation. So any further statement by Ministers on mental health will be treated with a touch of scepticism in your Lordships’ House until we get to the point where we see the additional money ring-fenced and guaranteed to be spent on mental health.

My noble friend Lady Donaghy and others talked about the importance of public servants. That applies as much to the defence forces and the police as other public services. NHS pay has been held down for a long time—frozen in 2011-12 and subject to a 1% cap. Why should public-sector workers be treated so badly? Is this not a key reason for current recruitment difficulties? Downing Street yesterday morning briefed that the pay cap was coming to an end, but this incoherent Government then similarly briefed in the afternoon that it was not. What is happening to the pay cap and when will the Government realise that they cannot artificially hold down the pay of public sector workers year after year?

A number of very important points have been made about public health, which I endorse. On social care, we have the immediate issue of funding. We need extra funding now. On the dementia tax, I ask the Minister this. The Government, with their Lib Dem colleagues in coalition, set up the Dilnot commission. They accepted recommendations. They then legislated; we spent months in your Lordships’ House legislating for Dilnot. They even said what the cap would be— it was higher than Dilnot at £72,000, but it was accepted as a reasonable response. Even when they then delayed its implementation, they said it would be implemented in 2020. The question remains of why the Government ran away from the Dilnot commission. Why are we having a consultation? What is there to consult about?

The one thing I say to the Minister is this: he will talk about the need for consensus, but he should look back to 2010, to just before the election, when Andy Burnham put forward proposals on a consensual basis for funding long-term care, and Cameron and Osborne and the rest of the crew attacked it as a death tax. He will find that his Government have no credibility in this area. Frankly, any old person who is concerned for the future has everything to fear from this Government’s approach.

I want to finish on culture. I very much warmed to the speech of the noble Lord, Lord Grade. I am sure the Minister would cause great joy in God’s own city of Birmingham if he were to announce this afternoon that Channel 4 is coming—it is the logical place, and I expect the Government to insist that Channel 4 moves out. Given the loss of broadcasting facilities in our city when compared to the great days of ATV, if I may say so, Birmingham is the right place, and I hope that will happen.

We welcome the data protection Bill, and there will be much discussion on it. However, I end by coming back to the point that I link education to creativity. A number of very important points have been made about our concern that, in many schools, creativity has been sacrificed on the altar of what is now an obsession with exam results. Like my noble friend Lady McIntosh, I was hugely impressed by the sensible comments made recently by the Chief Inspector of Schools. She made it clear that, in her view, the obsession with schools chasing exams at the expense of other activities that would give young people a rounded education has to stop. I hope that the Minister will say that the Government accept that view and support the chief inspector in more rounded inspections to ensure that children get a much wider education, in which these cultural issues are given huge importance.

This has been an excellent debate. We look forward to the response from the Minister, but I hope that over the next year or two, or for as long as this rather chaotic Government carry on in a half-light existence, we will get to debate more of these very crucial subjects.

NHS: Shared Business Services

Lord Hunt of Kings Heath Excerpts

Tuesday 27th June 2017 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to the Minister for repeating that. Clearly, this is a serious matter. More than 700,000 letters with patient information were waylaid, with more than 1,700 cases of potential harm to patients. The correspondence lost included blood test results, cancer screening appointments, medication changes and child protection notes. I will put just three quick points to the Minister.

I noticed that the Secretary of State, in this Statement, referred a lot to advice that he received from civil servants. I find it rather odd that a Secretary of State should announce to Parliament the advice given by civil servants, which usually is not disclosed. Why can he not stand on his own two feet in relation to the decision made to delay an announcement to Parliament by four months? Secondly, I am still not clear from the Statement why such a perfunctory Written Statement was made the day before Summer Recess last year. Why was a full Statement not made?

Thirdly, I understand that Shared Business Services makes £80 million a year from this NHS contract, and that so far the exercise of trying to discover where the letters have gone and to put this right has cost £6 million. Can the Minister confirm that the entire cost will be paid by Shared Business Services? Can he also say what other penalties the company will pay? Finally, the NAO points out that the Secretary of State has a conflict of interest, as he is a major shareholder in this outsourced company. Is this why he was so reluctant to come to Parliament to give information?

[Lord O'Shaughnessy]

I will answer the noble Lord’s four questions. The first was on taking advice from officials. I think the noble Lord would probably be alarmed if the Secretary of State was not taking advice from officials. That should be welcomed. It is clearly the case that he was thinking on his own, because he took the decision to follow that advice in the first instance in March, but was of the view by July that enough was known and that it was important to update Parliament before recess.

The second question was about the timing of the Statement. The noble Lord will remember that summer 2016 was a reasonably busy period after the EU referendum. The main point here is that the Statement was made before recess and was not held back until the autumn. As regards NHS Shared Business Services and the consequences for it, those consequences have been severe: it no longer has this contract and will, as my right honourable friend confirmed in another place just now, pay its share of the costs.

Finally, as my right honourable friend said, it could appear that there was a potential for conflict of interest, but in his view there was not one, because at all times—as confirmed in the NAO report—patient safety was the driving force behind the actions of the department and NHS England. It will always be the case, whatever arrangements the department has with an ALB—whether a standard agency, a joint company or whatever it is—that patient safety must come first. That was confirmed in the NAO report today.

Brexit: Nursing Staff

Lord Hunt of Kings Heath Excerpts

Tuesday 27th June 2017 Lords Chamber

Asked by

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what assessment they have made of the impact on the NHS of figures released by the Nursing and Midwifery Council showing a 96 per cent reduction in the number of nurses registering to work in the United Kingdom in the year since the referendum on leaving the European Union.

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

My Lords, the Government are aware of a reduction in the number of European Economic Area trained nurses applying to register with the Nursing and Midwifery Council. The department’s assessment suggests that this is largely a consequence of the NMC introducing language testing, rather than the vote to leave the European Union. The number of European nurses working in the NHS increased by more than 400 between June 2016 and March 2017.

[Lord Hunt of Kings Heath (Lab)]

My Lords, what the Minister did not say is that there has been a 96% fall in the number of nurses coming from EEA countries in the space of nine months. This comes on top of a shortage of thousands of nurses in the NHS. The RCN has today issued a statement which absolutely disproves the Minister’s argument that it is to do with English language testing. It is quite clear that it is to do with the Government’s obsession with migration control at the expense of our public services and the imposition of a pay cap on nurses and other NHS staff. He and his fellow Ministers have found £1 billion to bung the DUP; when are they going to find the money that is needed to get rid of the cap on nurses’ pay and pay them what they deserve?

[Lord O’Shaughnessy]

I am afraid the noble Lord is mistaking cause for correlation in this instance, and let me explain why we think that is the case. The General Pharmaceutical Council introduced language testing in November 2016; it had experienced no significant drop-off in applications from EEA member countries after Brexit but before that point and a big downturn in applications after that point. So it is language testing; it also happened with the GMC as well when it introduced language testing. I know this is something that the noble Lord supports—he said as much in a debate on this very issue in 2015—because it is an issue of safety. That is why language testing has been introduced. I would like to say, however, that of course we value the work of EU staff who come here, and, indeed, all nursing staff. As the Prime Minister set out yesterday, we want them to stay and have offered a generous package to allow them to do so, and there are more EU nurses here than there ever have been.

Health: Electronic Patient Records

Lord Hunt of Kings Heath Excerpts

Thursday 27th April 2017 Lords Chamber

[Lord O'Shaughnessy]

My noble friend makes an important point about the use of data. There is a balance to be struck. The first point to be made about the use of data is that patients need to be part of any decision about sharing them. In 2012, the NHS Future Forum published an independent report on this issue and used the phrase,

“No decision about me without me”,


to describe the role of patients. There is of course a need to share data among clinicians, particularly when they treat a patient themselves. There can also be wider concerns: for example, in a public health pandemic or some such incident data would need to be shared more widely. But that can be done only with patients being informed and offering their consent.

[Lord Hunt of Kings Heath (Lab)]

My Lords, is there not a problem here? If all the focus is at national level, that usually takes a long time and it inhibits local progress. Does the Minister agree that one of the great challenges is being able to share information between the health service and social care if integrated care, particularly for older people who are discharged from hospital, is to be delivered? Is any progress being made in getting full integration at local level, which is clearly a challenging area?

[Lord O'Shaughnessy]

The truth is that there is patchy use of data within the health service. Practically all GPs now offer electronic patient records and something like 9 million people have registered to make appointments online. But it is not at the same level in acute trusts, mental health trusts and so on; there is still paper usage. The intention has been to have a paperless NHS by 2020. This means that with patient consent based around clinical need we would have the ability to share data around the patient pathway, whatever part of the health service they were in.

Health Service Medical Supplies (Costs) Bill

Lord Hunt of Kings Heath Excerpts

Ping Pong (Hansard): House of Lords
Wednesday 26th April 2017 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, I congratulate the Minister on his hard work on the Bill and his helpfulness. I have one question. As this is a global matter, how can the Government assure us that the prices of drugs will come down?

[Lord Hunt of Kings Heath (Lab)]

My Lords, I look forward to the Minister’s answer to that last question. From the opposition Benches, I very much welcome the agreed amendment that has come forward from the Government today. It is good to see how wash-up can concentrate minds no end, and we have reached a very satisfactory outcome. I am very grateful to the Minister and his officials for their co-operation on this.

The Opposition have been in no doubt whatever that it is absolutely right to take action against those companies that have clearly been abusing the system. We should also pay tribute to the Times newspaper for its campaign, which has opened up some transparency in a pretty murky area.

There are two key issues that need to be taken forward. First, the key message of debates in your Lordships’ House is that, in seeking to deal with this particular problem, we must not underestimate the contribution of the pharmaceutical industry to this country, to the economy and to the life sciences sector. We have a problem in that we are incredibly innovative in the number of new drugs that are developed in this country, but the NHS is finding it increasingly difficult to invest in them and patients are not getting the benefit.

The second is the whole question of balance between the statutory and voluntary schemes—the noble Lord, Lord Lansley, referred to this. I have reached the conclusion that the current arrangements are simply not up to scratch in relation to how government should negotiate with the industry in the future. The patent lack of transparency about the real price paid by the NHS for individual drugs means, in my view, that the arrangements are no longer fit for purpose. I hope that the Government—whichever Government are in power post election—will look afresh at the need for new arrangements in negotiation which get a fair price and also lead to the adoption of innovative new drugs for NHS patients.

Can the Minister say when he thinks the Government will be in a position to implement the key provisions in this Bill in relation to prices?

[Lord O'Shaughnessy]

My Lords, I thank all noble Lords for their warm words and I reciprocate those feelings: it has been a very interesting, challenging and enjoyable experience working with noble Lords on this Bill on what is—as the noble Lord, Lord Hunt, has pointed out—a critical matter. It is critical not just that we get the best possible prices for drugs and that we crack down on those who are trying to rip off the system, but that we make sure we are also supporting the life sciences industry and are improving access for patients.

I am particularly grateful for the work done by the noble Lord, Lord Warner, and I appreciate his support for this amendment. My noble friend Lord Lansley and the noble Lord, Lord Hunt, made the point about the equivalence between the voluntary schemes and statutory schemes. There is equivalence in law and equivalence in spirit. It is in the nature of voluntary schemes that they take into account issues around access and life sciences, because that is, in a way, why they come about. You would not have one if you could not have some agreement on that. By making this amendment today we have provided something that was taken into account by the voluntary schemes by moving it into the statutory schemes and providing that equivalence.

My noble friend is quite right about the need to work in a constructive manner. It is possible to create a system in which the interests of patients, industry and the NHS align. There is no necessary reason for them to be in conflict and, indeed, we all want a system where we have improved access and keen prices that raise the standard of care available on the NHS.

I join the noble Lord, Lord Hunt, in congratulating the Times on its investigations, which continue. Indeed, I think that there was a story at the beginning of the week or the end of last week about that. It has put a turbo boost under this, but clearly there is more to do. This Bill will allow us to get up stream and not have to wait until things get to the Competition and Markets Authority many years down the track; it will allow us to improve things up front.

As to whether the current arrangements are up to scratch and what might happen in the future, noble Lords will understand if I resist making a comment on what might happen in the future, or what a future Government might do. My own observation—this is my way of answering the question from the noble Baroness, Lady Masham, which I will avoid slightly—is that any new system ought to be trying to rebalance spending towards innovative drugs, which can of course be done in any fiscal envelope; it is not necessarily a point about spending per se but about the balance of spending. Any system would probably benefit from being both simpler and quicker. I am sure that is something that Ministers in the Department of Health, whoever they may be after the next election, will want to grapple with.

I thank my officials who have done a fantastic job and have worked very hard with noble Lords across the House on the Bill and on amendments. I am very grateful to them. I think that 24 government amendments have now improved the Bill.

On a personal note, I have very much enjoyed taking my first piece of legislation through your Lordships’ House. Pending the election result, it may be my last, but I hope it will not be. Others may disagree.

[Lord Hunt of Kings Heath]

My Lords, I will not comment on that last remark. The key clause is Clause 5. Can I take it that once the Bill receives Royal Assent the Government can implement that straightaway?

[Lord O'Shaughnessy]

I believe that would be the case. Of course, there is a difference between what officials can do and what Ministers can give instructions to do in a period of purdah. However, as soon as the measure is in law, it is enforceable.

Health Service Medical Supplies (Costs) Bill

Lord Hunt of Kings Heath Excerpts

Wednesday 5th April 2017 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, I am all in favour of bringing down the price of drugs where possible, but patients’ access to new drugs is very important. For a long time, NICE has been very slow to approve drugs and that has caused great frustration for patients and the industry. What can the Minister do about orphan drugs? Not having them can be life-threatening for patients, but NICE has taken some of these drugs off the list. That is really serious for patients for whom they are a lifeline. Does Scotland not have a better system?

[Lord Hunt of Kings Heath (Lab)]

Well, that’s a question, my Lords. First, I declare an interest as president of the Health Care Supply Association and of GS1, the barcoding organisation.

I support the Motion in the name of the noble Lord, Lord Warner. I note what the noble Lord, Lord Lansley, says—that it is not a remedy for the problem being described—but it would send a powerful message to the Government. It is a message which, judging by the debate in the Commons on this matter, I am afraid Ministers in the Commons have not really heard, although I acknowledge that in his opening remarks today the Minister certainly turned to the crux of the issue.

Essentially, with a Bill that gives the Government huge power over drug prices—indeed, it gives them absolute power—the real concern is that NHS patients will not get access to new medicines as they would in other countries. This in turn puts at risk investment in R&D by the pharmaceutical industry in this country, which in turn threatens to undermine the life sciences sector. It is one of the most crucial sectors in this country and in our economy, and post Brexit must become even more important. Essentially, we are seeking to turn this into a virtuous circle whereby the NHS is seen to want to invest in new medicines and treatments, industry feels that the UK is therefore a good place in which to invest, and our life sciences sector grows and becomes even more important.

The problem is that over the last few years we have seen increasing rationing or restrictions on access to these new and effective drugs. We have had a short debate on NICE. I was the Minister first in charge of NICE, going back some years now. When it was set up, it was, first, deemed to be wholly independent of the NHS in its judgments, and secondly, designed to speed up access to new technologies and medicines. However, in the past few years the remit has changed. It seems to have been pushed almost into part of NHS management and budgetary control. The noble Lord, Lord Lansley, put his finger on it when he said that after NICE has reached a judgment that a medicine is both clinically and cost effective, NHS England has, in a number of ways, sought to put in additional controls. That is why there is concern about the new proposal: that if a NICE-approved treatment exceeds or is expected to exceed a cost of £20 million in any of the first three years, NHS England could ask for a longer period for its introduction. The Minister said that the budget impact test, as it has come to be known, is not a cap but a negotiating tactic. I understand that, but I put it to him that in the past few years NHS England has shown neither the willingness nor the capacity to do anything but reduce access for patients. It is very difficult not to see this as another hurdle.