The NHS

Lord Naseby Excerpts

Thursday 5th July 2018 Lords Chamber

[Lord Naseby (Con)]

My Lords, it is an honour for all of us in this place to speak in this debate on the 70th year of the NHS. We owe a great thanks to the noble Lord, Lord Darzi, for showing the initiative. We also owe him a thank you for when he was the Minister on the Benches for the Government, over a number of years, because he certainly got a grip of things when he was there. I also pay tribute to my noble friend sitting on the Front Bench, as it is a long time since we have had a Conservative Member sitting there who has tried really hard to get a grip of the issue.

I am a marketing man by profession and I am looking at the things on which we need action on a practical basis. I start with the GPs; I am married to a retired one. It is not working at GP level today, on the whole. I exempt the GP practice where I am a patient at Greensands in Potton, which is pretty good, but it is not working because there are not enough GPs. There are also not enough district nurses. Those are the two key areas. Just look at the figures for district nurses. The graph has gone down for the last X number of years, certainly the last 10 years. We have to double the number of district nurses, because they are the people who visit patients at home and keep them out of hospital and the GPs’ surgeries. That is point number one.

Secondly, my wife was a full-time GP and she looked after me and three children in our constituency, and all the rest. Initially, she had a small practice and she built up to a very large practice in Bedfordshire. There were night calls and weekend calls. One of the doctors did minor surgery and it worked well. None of that happens today. Why do we not have minor surgery from our GPs? That would relieve our hospitals a little. Why do we not have more GP hub units like the one in Biggleswade today, which works at weekends? It is looked after not by doctors who are running their normal practices, but other doctors do the work and that unit works well.

Thirdly, we need to look at the number of doctors. We have about 50% of what we need. I hope nobody thinks that I am biased, but there is something wrong with the gender balance. Nearly 60% of the medical school intake is female now. The net result, as ladies across the medical profession will know, is that 5% never work, 80% work half-time and about 15% work full-time. Against that background we need two women for every man, so that is a challenge. Moreover, my son works as an Army doctor and he had it in his contract to work for five years. In Singapore, if you take a medical degree you have to work full-time for five years. Not surprisingly, if you leave early you have to pay back the money that has been spent on you.

As a further point, in Bedfordshire there is the Luton and Dunstable Hospital. It has a unit where, when you arrive, they assess you and you go either to its GP unit or to A&E. Seventy per cent go to the GP unit. That is the situation.

Finally, on payments, I am fed up with looking in my surgery at the number of people who do not turn up. Somehow, we have to find an answer to that. Personally, I think we should trial a £10 fee for those who fail to turn up.

NHS Winter Crisis

Lord Naseby Excerpts

Monday 8th January 2018 Lords Chamber

[Lord O’Shaughnessy]

I thank the noble Baroness for her good wishes, and I wish her and all noble Lords a happy new year. She asked several questions, and I will try to deal with them all. Her first question was about being well prepared. Those were the words of Sir Bruce Keogh from NHS England, not mine. I should also point out that Keith Willett, the director for acute care for NHS England, said that the service is better prepared than ever. Of course, that does not mean that there are not challenges. We know that this happens every year.

One of the ways that we see challenges happen is that there are cancelled elective procedures. I have been looking back over the data for the past 20 years. In quarter 4 of each year—January to March—those cancellations do happen. In fact, I was looking back at 2000-01 and there were 24,000 cancelled or postponed operations that year, which is actually one of the highest over that period. These things do happen during winter, and that is one of the ways of coping. The Prime Minister has apologised for that, and I endorse that. Of course, it is not a state of affairs that we want to happen, but it is necessary to make sure that the most urgent cases are treated. It should be pointed out that the direction about elective procedures made it clear that time-critical procedures around cancer operations and others can go ahead. We will see over time what the impact of that was.

I will mention one other thing about preparedness. The noble Baroness talked about bed occupancy. Of course, we know that high levels of bed occupancy are a concern. Bed occupancy was below the target of 85% going into this period—on Christmas Eve it was 84.2%, I believe—so that was put in place. We know it is going to be challenging. We know that flu is going to continue to have an impact over the next few weeks, and we will see what we can do, but we know that the NHS has put in unprecedented levels of preparation to make sure that we can get through what is always a difficult period.

[Lord Naseby (Con)]

My Lords, is it not encouraging that at least this year there was preparation for winter? The fact that it was not an enormous success everywhere is a lesson that I hope Her Majesty’s Government will take on board. Against that background, will my noble friend be preparing a report on the experience this winter? Will he confirm that next year there will be a plan which takes on board the experience of this year? I can quote only from local experience but is it not a fact that Luton and Dunstable University Hospital, which has had a special A&E unit for some years, did not have difficulty, whereas other hospitals that were not prepared to that extent appear to have had difficulty? If that is the case, is it not time we brought the other hospitals up to a better standard—the sort of standard that Luton and Dunstable University Hospital gives to its community?

[Lord O’Shaughnessy]

I thank my noble friend. He is right to point out that there is variation across the country. He mentions Luton and Dunstable University Hospital. It has been a pioneer of how to make sure that people coming into A&E are properly dealt with. Indeed, the £100 million that was invested in A&E services to support better triaging was based on the Luton and Dunstable model. Obviously, we need to make sure that those high standards are replicated across the country.

I will give one further example of an area where that planning has taken place. We know that there has been pressure on ambulance services and that there has been a variability of performance there. There is now a national ambulance control centre which is keeping real-time data and looking at how to manage that performance so that we can get a proper national grip on this picture.

NHS: EEA Doctors

Lord Naseby Excerpts

Tuesday 12th December 2017 Lords Chamber

[Lord O'Shaughnessy]

I think I may have detected a qualified welcome from the noble Baroness for the achievements of last year in providing that reassurance. Clearly, we want to make sure that there is the best possible working environment for our medical staff, wherever they come from, and that involves, as the Prime Minister has set out, having world-leading employment rights.

[Lord Naseby (Con)]

My Lords, is the Minister as concerned as I am that this Question refers to the EEA as well as the EU? I am mystified about why any Norwegian or Icelandic doctor should be concerned about Brexit. In addition to that, is my noble friend not absolutely correct? I went to Bedford Hospital a week ago on a Sunday with an EU doctor. That doctor made it quite clear to me that the reassurance that had been given by Her Majesty’s Government was sufficient for her—and, I believe, her husband—to continue to work in the NHS.

[Lord O'Shaughnessy]

I thank my noble friend for pointing that out. It is extremely reassuring to know that the message is getting through. We as a department and as a Government have a job to do in making sure that everybody hears that message of reassurance, because we want those EU workers to stay and contribute to our NHS.

Nurses and Midwives: Numbers

Lord Naseby Excerpts

Monday 4th December 2017 Lords Chamber

[Lord O'Shaughnessy]

My Lords, the rules as they are apply, so those who are eligible to apply for a right to remain can do so. We are talking about providing a path for those who are not yet at that point, now or in the future, to achieve settled status to provide the kind of certainty that we know. I understand that this causes some people to pause for thought about whether they should stay.

[Lord Naseby (Con)]

Will my noble friend ensure that the answer he has just given is publicised in every NHS hospital in the United Kingdom? There is not that depth of understanding in the average medical practitioner, nurse or administrator in our hospitals that he has so clearly communicated. Will he also reconfirm that the number of training nurses is going up, as I think he said, and is considerably higher than it has been during the previous decade? If that is the situation, it is surely to be greatly welcomed.

Care Homes: Hospital Discharges

Lord Naseby Excerpts

Monday 16th October 2017 Lords Chamber

[Lord O'Shaughnessy]

I know of the issue that the noble Lord raises about withdrawing beds. As we discussed last week, there has been a small reduction in the number of nursing and residential care home beds. However, there has also been an increase in the number of domiciliary care packages. The noble Lord may also be interested to know that we are creating 6,000 new supported homes through the Care and Support Specialised Housing Fund. It is a changing market. I understand the funding pressures on local authorities, which is why we are putting in more funding.

[Lord Naseby (Con)]

In the broader context, would it not help my noble friend if we looked at the role and number of district nurses who, in the past, kept people out of hospital and ensured that GPs were relieved of some of their work?

[Lord O'Shaughnessy]

The noble Lord is right to highlight the issue of community nurses, where in particular there has been a reduction in numbers even though the total pool of nurses has increased in recent years. He will hopefully have noticed an announcement at the Conservative Party conference from my right honourable friend the Secretary of State about more nurse training places—25% more—to address the kind of issues he is talking about.

Medical Students

Lord Naseby Excerpts

Wednesday 26th October 2016 Lords Chamber

Asked by

[Lord Naseby]

To ask Her Majesty’s Government whether they intend to review the number of students studying medicine.

[Lord Naseby (Con)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and, in doing so, declare an interest in that my wife is a retired full-time GP practitioner.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, my right honourable friend the Health Secretary announced on 4 October that the Government plan to increase the number of medical school places by up to 25%. From September 2018, the Government will fund up to 1,500 additional medical school places each year. Students will be able to apply for the extra places from 2017 in order to take them up from the academic year 2018-19.

[Lord Naseby]

Is my noble friend clear that the Secretary of State is to be congratulated on beginning to grasp this nettle? In the last three years, we have lost 3,500 medical students, but the problem goes deeper, does it not? Today, 56% of the intake of medical students is female. Furthermore, 70% of female GPs today work part-time, and a recent survey by the King’s Fund says that 90% of all medical students in training want to work part-time. Given that it costs £200,000 to train anybody as a medical practitioner, surely the time has come to consider a minimum full-time commitment of at least four years after qualification, similar to what they do in Singapore and, indeed, in our own Armed Forces.

[Lord Prior of Brampton]

My noble friend is absolutely right that more than 55% of those who go to medical school are now women; that is a fantastic change that has happened over the past 20 years. It is true that more women than men tend to work part-time, as they have children and bring them up, and that is taken into account in the planning done by HEE. When my right honourable friend the Health Secretary made his announcement, he said that we will be looking in our consultation at requiring people whom we have paid to go through medical school to give at least four years back to the NHS, which I think is reasonable. The figure is actually six years if you become an Army doctor, so four years is not unreasonable.

Junior Doctors: Industrial Action

Lord Naseby Excerpts

Monday 5th September 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the noble Lord makes a very good point. The changes that are coming upon the NHS, whether from technology or forced upon us, in a sense, by demographic change in the UK— meaning that much care that has traditionally been delivered in hospitals will need to be delivered outside hospitals in people’s homes and much care will be delivered by technology rather than directly by people—are all going to have a huge impact on a whole range of different staff levels, not just junior doctors.

[Lord Naseby (Con)]

Is my noble friend aware that I am in a doctors’ family? My wife worked full-time in a big practice. She worked every weekend and did her share of out-of-hours work. My son is a doctor. I hope some of the grandchildren will be. These young men and women volunteer to enter this profession, do they not? They take an oath, do they not? What the public find incomprehensible is that after several years of negotiation, they understood there to be an agreement and a recommendation from the then leadership of the junior doctors—agreed to by even the present leadership of the junior doctors—but once again the public are back on the rack. Is that not totally unacceptable?

I am afraid that I draw an analogy with the three-day week. I was the director of an advertising agency, responsible for the standby advertising. The miners’ strike required the Government of the day to publish the terms that they were offering to the miners on that occasion. I urge my noble friend to consider whether the time has not come for the public—the people, the patients—to be told exactly what was agreed in the summer and what additional benefits will be put forward to the junior doctors; I understand there are some. The public are the ones who will suffer. I do not want—as I am sure the rest of the House does not—to see patients suffer.

[Lord Prior of Brampton]

My Lords, the contract that has been offered to the junior doctors is not confidential. It can be made available to the public. Indeed, I think the main terms of that contract have been made available to the public. My noble friend is absolutely right that members of his family—and, indeed, my family and others we know—enter the medical profession as a vocation or a calling. It is an awful shame that that seems to have been lost in the dispute that has been happening over the past few months.

Junior Doctors: Contract

Lord Naseby Excerpts

Thursday 5th May 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I wholly, 100% agree with the words of the noble Lord.

[Lord Naseby (Con)]

Is my noble friend aware that the public will greatly welcome the magnanimity of Her Majesty’s Government in willingly moving forward and having further discussions over a short period? At the same time, though—I can only speak from having talked to some of my former constituents in Northampton—the public want to know what the benefit is to both the public and the junior doctors from this new contract. Maybe the time has come to publicise, through the standby agency of the COI, in an advertisement, exactly what the benefits are to both parties.

E-cigarettes: Regulation

Lord Naseby Excerpts

Monday 7th March 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, as I said, there is no proposal for an excise duty as part of the tobacco directive, as I understand it. I would agree entirely with the intent behind the question, which is that we should be promoting this product not discouraging it.

[Lord Naseby (Con)]

My Lords, is my noble friend aware that, following on from what my noble friend said at the beginning, these vapers ensure that there is no harmful effect from passive smoking, which you normally get from cigarettes? In addition, research in New Zealand shows that they are a far better way to come off smoking than placebos or patches, which saves the NHS money. Is this not just another example of a badly thought through draft directive?

[Lord Prior of Brampton]

My Lords, I think there is evidence that e-cigarettes are more effective than, or as effective as, nicotine replacement therapies, and that my noble friend is right that there is no danger from passive smoking, which is why the inability to smoke in public places does not apply to e-cigarettes.

NHS: Costs of Operations

Lord Naseby Excerpts

Monday 9th November 2015 Lords Chamber

Asked by

[Lord Naseby]

To ask Her Majesty’s Government whether the National Health Service will publish the average cost of all operations and procedures undertaken (1) by general practitioners, and (2) in hospitals.

[The Parliamentary Under-Secretary of State, Department of Health (Lord Prior of Brampton) (Con)]

My Lords, the department has published the average cost of operations and procedures in hospitals for the past 17 financial years. These reference costs are the average unit costs to NHS hospital trusts of providing acute, ambulance, mental health and community services, covering £58 billion, or 55%, of revenue expenditure in 2013-14. Reference costs for 2014-15 will be published this month. There are currently no plans to collect similar information from general practitioners.

[Lord Naseby (Con)]

Does my noble friend recall that one of the features of GP fundholding was that GPs had a budget, the patient could choose what hospital they went to and the hospital to which they were referred then sent a bill to the GP? If we introduced a new system whereby GPs and hospitals actually knew the cost of what they were or should be charging, would that not enable GPs and hospitals to stick to their budgets, and some of the overspend would then disappear?

[Lord Prior of Brampton]

My Lords, hospitals do know their costs; they know their reference costs and their HRGs. Increasingly, we will want to get patient-level costing into all our hospitals, as is already the case in some hospitals. If you know the actual cost by patient, the hospital management can have a much better discussion with hospital clinicians. Patient-level costing is important going forward in hospitals. For GPs, we have a calculated payment, as my noble friend will know: currently £75.77 per capita on the list, adjusted for various matters. A capitated figure for GPs is probably better than a much more detailed breakdown of costs.