HIV Diagnosis: Clinical Guidance

Debate between Lord Prior of Brampton and Baroness Masham of Ilton

Thursday 1st December 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I am very happy to do that. It is extraordinary how healthcare has changed a fatal disease into a chronic disease in just 20 years. I have a quote from the PHE report that was produced today, from a white lady who has HIV. She says:

“Just a few words from someone who has been living with HIV for nearly 20 years: it’s not that bad and there are times when you forget you have HIV. Eventually, even when you remember you’re positive, it’s no longer an issue”.

That is an illustration of just how far we have come in 20 years.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister agree that it is very dangerous to go around without knowing your HIV status? Will he organise some more publicity, particularly for women, because men seem to have more help than women?

[Lord Prior of Brampton]

The noble Baroness is absolutely right. Early diagnosis is absolutely critical. We have made huge progress. The WHO guidelines aim for 90% of people with HIV to be diagnosed. We are at 87%. Sweden is the only country in the world that has hit the 90% target. I point to the It Starts With Me programme, which is based around individual responsibility and is co-ordinated by the Terrence Higgins Trust, which is making great progress.

HIV: Barriers to Treatment

Debate between Lord Prior of Brampton and Baroness Masham of Ilton

Thursday 1st December 2016 Lords Chamber

[Lord Prior of Brampton]

There is a particular problem in prisons, as the noble Baroness refers to. There is a higher incidence of HIV in prisons, for all the reasons that she has alluded to. The NICE guidance and the PHE resources report that came out today echo her point. We have to reinforce and redouble our efforts in prisons to identify HIV earlier through better testing.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister agree that the HIV virus is a very difficult virus, and that this is one of the problems of getting a vaccine?

NHS: Cancer Patients

Debate between Lord Prior of Brampton and Baroness Masham of Ilton

Wednesday 9th November 2016 Lords Chamber

[Lord Prior of Brampton]

I think I was being honest, actually. I have never hidden the fact that these targets are very tough and difficult to meet. But we have increased activity enormously. We accept that early diagnosis is critical and probably as important as the 62-day referral for treatment target, which is why the 28-day target from urgent referral to diagnosis is so critical and will be one of the four key targets that will be in the CCG assurance framework. I accept what the noble Lords says; early diagnosis is critical. We are making progress and Sir Harpal Kumar, who developed the cancer strategy a year ago, is overseeing performance and progress towards meeting those targets.

[Baroness Masham of Ilton (CB)]

My Lords, is it not the case that many patients have their cancer picked up in an A&E department, having been sent away from their GP several times?

[Lord Prior of Brampton]

The noble Baroness is right. In 2006 one in five of all new cancers was picked up in an emergency setting. That has reduced to one in four. We are making progress. I think we all accept that our performance on cancer outcomes has lagged behind the best in Europe. The strategy developed by Harpal Kumar is designed to address that. We are making progress but we have some way to go.

Medical Students

Debate between Lord Prior of Brampton and Baroness Masham of Ilton

Wednesday 26th October 2016 Lords Chamber

[Lord Prior of Brampton]

I think it will be helpful if I quote from the Health Secretary’s speech at the Conservative Party conference, talking about overseas doctors. He said:

“They do a fantastic job and the NHS would fall over without them. When it comes to … EU nationals, we’ve been clear we want them to … stay post-Brexit”.

Let us be absolutely clear: we want overseas doctors from the EU or elsewhere to stay here post-Brexit.

[Baroness Masham of Ilton (CB)]

My Lords, how many medical students drop out during training? How many, when qualified, do not take up medicine and go into other specialties?

[Lord Prior of Brampton]

My Lords, the attrition rate for students at medical school is about 5%. Some of those leave for medical reasons and come back subsequently, so the figure will be less than 5%. I do not have the drop-out rate for doctors who are further advanced in their training but I will find out and write to the noble Baroness.

NHS: Junior Doctors’ Contract

Debate between Lord Prior of Brampton and Baroness Masham of Ilton

Wednesday 6th July 2016 Lords Chamber

[Lord Prior of Brampton]

There is no indication that large numbers of junior doctors are resigning because of the introduction of this new contract. If it does happen, we will have to address that issue when it occurs.

[Baroness Masham of Ilton (CB)]

My Lords, how much of a safety issue is this? Does the noble Lord agree that there are not enough doctors as it is?

Health: Diabetes and Obesity

Debate between Lord Prior of Brampton and Baroness Masham of Ilton

Thursday 30th June 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, that issue will be addressed in the obesity strategy, which comes out later this year. The levy that has been announced will, I think, lead to the reformulation of high-sugar fizzy drinks, which is a start in the right direction. It is largely a question of diet, as the noble Lord said, but also exercise and many other factors, which will be in the obesity strategy that comes out later in the year. Clearly, making it more difficult for young people to access junk food will be an important part of that strategy.

[Baroness Masham of Ilton (CB)]

Does the Minister agree that diabetes is a very complex condition and can be very expensive to every country in the world? Does he also agree that many diabetics love sweet things? Will the Government stimulate more health education in schools so that children grow up learning about diabetes?

National Clinical Director of Adult Neurology

Debate between Lord Prior of Brampton and Baroness Masham of Ilton

Thursday 9th June 2016 Lords Chamber

[Lord Prior of Brampton]

I do not think I agree with the last part of the question. We have set up NHS England as an arm’s-length body, and a key part of the reforms—the bit that probably everyone supported in the 2012 Act—was to get politicians more out of the day-to-day running of the NHS and to give more power to clinicians. It is better that clinicians rather than politicians should make these decisions. On what the noble Lord said about decimating the influence of clinical advice in NHS England, I just do not think that that is the case. In so far as he has raised it with me, I will have a meeting with Bruce Keogh and put that point to him and get his response.

[Baroness Masham of Ilton (CB)]

My Lords, is the Minister aware that there are many very complex neurological conditions? Surely there should be a co-ordinator and an adviser. It is really very difficult. Surely it should be upgraded, not downgraded.

[Lord Prior of Brampton]

My Lords, it would be a great mistake to think this was a downgrading exercise. This is NHS England deciding to get its clinical inputs from a clinical reference group rather than having a national clinical director. It has reduced the number of clinical directors by six. We are not talking about just neurology; five others have gone in different specialties—for example, pathology. It would be a great mistake if the House went away with the impression that NHS England was in any way decimating or downgrading the importance of neurology.

NHS: Bursaries

Debate between Lord Prior of Brampton and Baroness Masham of Ilton

Wednesday 25th May 2016 Lords Chamber

[Lord Prior of Brampton]

That is a good question. Nurses spend 2,300 hours of their three-year course in clinical placements in hospitals. They are supernumerary. They are clearly supervised and mentored in that setting, but they also provide a fair amount of care in those hospitals as well. I am pretty confident that hospitals will work out an arrangement with universities to ensure that they create enough clinical placements for those nurses.

[Baroness Masham of Ilton (CB)]

My Lords, is the Minister aware that nurses used to have free accommodation and were also paid, but now they have these debts hanging over them? What is the view of the Royal College of Nursing?

[Lord Prior of Brampton]

My Lords, I think that the Royal College of Nursing, Unison and other unions have concerns about moving from bursaries to student loans; it would be idle to pretend otherwise. But we are convinced that the demand for young people to go into nursing is very strong and that the availability of more money through the loan system to nurses at university will therefore encourage more people to go into nursing.

Southern Health NHS Foundation Trust

Debate between Lord Prior of Brampton and Baroness Masham of Ilton

Tuesday 3rd May 2016 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, where does Healthwatch come in? Should there not be far more openness and participation by the public to stop such things from happening? It is all very well having management, but one wants caring people from the community who will speak out on behalf of these people.

[Lord Prior of Brampton]

My Lords, this goes back to the culture of the trust. It is important that members of the public or Healthwatch have a right to go in and visit facilities, and that they are welcomed there, but that they do not go native at the same time—that they are truly independent, looking at it from the patients’ perspective. Healthwatch has an important part to play, and the relationship that it has locally with the CQC inspection team is very important.

Wheelchair Users

Debate between Lord Prior of Brampton and Baroness Masham of Ilton

Thursday 21st April 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, I am afraid that I cannot answer that question as I do not know the answer. If it is all right to do so, I will write to the noble Lord and place the answer in the Library.

[Baroness Masham of Ilton (CB)]

My Lords, I declare an interest as president of the Spinal Injuries Association. Is the Minister aware of the very complex needs of some people who break their necks, are completely paralysed and operate a wheelchair by pushing the back of their head or by their mouth? Will he assure the House that the specialist hospital units are able to advise CCGs on this issue?

[Lord Prior of Brampton]

The noble Baroness raises a very important point. I will do what I can to ensure that we retain that specialist knowledge that can be provided to local CCGs.

Access to Medical Treatments (Innovation) Bill

Debate between Lord Prior of Brampton and Baroness Masham of Ilton

Friday 26th February 2016 Lords Chamber

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

My Lords, it has been a fascinating debate. I was not here when we have had debates about this Bill or the Bill that preceded it, so I am not as familiar with the arguments as many noble Lords are. However, it has been a very insightful and high-quality debate.

I first thank my noble friend Lord Saatchi. This is his Bill really. Before I was in this place, I remember listening on the radio in a casual way to the arguments being batted around, and, without knowing the details of his earlier Bill, the need for a quantum change in the rate of innovation and adoption of new medicines and products in this country resonated with me.

I have just come back from a trip to the USA, and one always comes back feeling that there is such a sense of dynamism, speed and pace in America that we simply do not have in this country or in Europe, or anywhere else in the world. Partly, of course, that is because they have much more money in the US, but it is a state of mind. Even in a highly litigious society such as America, there is an entrepreneurial, innovative drive and that is something we need. We have so much research capability in this country and yet we seem to be so slow at bringing products to the market for the benefit of patients. The speech by my noble friend Lord Ryder absolutely nailed this issue once and for all.

I also thank Chris Heaton-Harris, who is still here—he has stood here throughout this whole debate. The work that he and my colleague in the Department of Health, George Freeman, have done to win cross-party consensus for this Bill has been hugely impressive. I also pay tribute to the noble Lord, Lord Hunt, who brought an amendment for a registry in the previous Bill. That has been changed in the new Bill but, nevertheless, has been very important in bringing the Bill to us today.

Before I come to my main speech, I will pick up a few of the particular questions asked by noble Lords. The noble Baroness, Lady Masham, raised the critical point in many ways, which is this balance between innovation and patient safety. That went to the heart of the debate on the original Bill. She raised a particular question about the guardianship of the database. The database will be established with a quality-control mechanism to ensure its oversight. HSCIC is very experienced in databases of this kind and it will have responsibility for that guardianship. It will establish an independent committee to overview the database to make sure that it will not breach patient confidentiality and the like. That is obviously critically important.

The noble Baroness also raised the issue of who could have access to the database. This may disappoint some noble Lords, but access to the database, certainly to start with, will be for doctors rather than members of the public. Again, that is largely based around the need for proper information governance and patient confidentiality. There is a risk, particularly with rare diseases, which the noble Lord, Lord Freyberg, raised, that individuals can be identified if one is not careful.

The noble Lord, Lord Murphy, and others raised the issue of off-label drugs. I can assure noble Lords that the database can include medicines being used off label as well as the use of unlicensed or off-patent medicines.

The noble Lord, Lord Patel, asked what was the definition of medical innovation—or “innovative medical treatment”, which is the right expression. The short answer to that is that, under the Bill, an “innovative medical treatment” is defined as,

“medical treatment for a condition that involves a departure from the existing range of accepted medical treatments for the condition”.

There is clearly a much longer, more technical answer to his question, but I hope that that will satisfy him today.

My noble friend Lord Blencathra raised a number of important issues. It will cost money to establish this database. The estimate is between £5 million and £15 million. That money will be found by HSCIC and ultimately through the Department of Health. Both my noble friend and the noble Baroness, Lady Masham, thought that it would be wonderful if this database could extend to the USA and worldwide. They are absolutely right—in time, but not immediately.

The noble Lord also raised an important issue about whether, if doctors put their results on to a database and they had failed, it would open them up to legal challenge. The establishment of the database will not change whether or not a doctor would face a successful negligence claim. If a doctor acts responsibly, they will not face a successful claim even if the outcome for that patient is negative. I hope that I will pick up other issues that were raised by noble Lords in what I had pre-prepared to say.

The Bill we have considered today is not the same as my noble friend Lord Saatchi’s original Medical Innovation Bill, but it shares the same desired outcome—to create a culture that promotes greater use of innovative medicines and gives us the best chance of improving outcomes for patients. In response to a point that my noble friend made in his introduction, it is very much going in the same direction as the accelerated access review, which is being conducted by Sir Hugh Taylor. We will see that later in the year. That will, of course, address some of the issues raised by my noble friend Lord Ryder.

The Bill before us today seeks to give doctors access to a database as a source of learning where they can both share their innovations and search for those that other doctors have used. The purpose of the database is to promote access to innovative treatments for patients by giving doctors access to information that they may not otherwise be aware of. Doctors will be able to search the database for innovations, see who else is using new techniques, and which ones are effective for patients. The database could ultimately result in better care and health outcomes for patients, and potentially in the fast uptake of new treatments which are shown to work.

I do not think any of us should be under the illusion that this is going to solve the problem; rather, this is us setting out our stall and saying how important the issue is. It will facilitate things, and it is a stake in the sand to show that we, the Government, and the country take this matter seriously. It is also important to state for the avoidance of doubt that the Bill does not contain any provisions relating to the law of clinical negligence. Those provisions have been removed and are not part of this Bill. The Access to Medical Treatments (Innovation) Bill is concerned solely with conferring a power on the Secretary of State to make regulations requiring the HSCIC to set up and manage a database of innovative treatments.

There are two matters that I would like to address in a little more detail, given the degree of discussion there has been around them. The first is how the database will operate and the consultation that will surround it. The detailed design of the database will be worked out by the HSCIC as the expert organisation in this field working in conjunction with professional and patient bodies, a point raised by the noble Baroness, Lady Masham, and others, and other interested stakeholders. On Report in the other place, the Minister for Life Sciences gave an assurance that should the Bill receive Royal Assent before the establishment of such a database, there will be a period of consultation to inform its detailed design. I would like to clarify that this would not take the form of a government consultation, but rather, engagement to be worked out jointly between the HSCIC, the relevant statutory bodies and stakeholders from the medical community representing those who will be using the database.

The second matter is compulsory recording in the database. I am aware that during the passage of my noble friend Lord Saatchi’s original Bill, the issue of mandatory recording and the data registry was the subject of lengthy debate. I know that the noble Lord, Lord Hunt, tabled an amendment seeking to ensure that doctors would be required to record all outcomes, positive and negative, in the registry. I also understand that the Government opposed the amendment on the basis that including a mandatory registry would change the test of negligence under the Bill. As has been covered extensively, the Bill we are discussing today differs significantly from the Medical Innovation Bill. On the issue of recording, it is important to highlight that the principal difference between the data registry and the database of innovative treatments is that the database will both capture and disclose information, while the data registry is concerned with the registration of a patient linked to a disease, or a specific cohort. Crucially, it is intended that information relating to innovative medical treatments and the outcomes of those treatments carried out by doctors in England will be passed to the HSCIC through the use of coding in patient notes.

While there is nothing in the Bill to compel doctors to record their innovations on the database, it is intended that policy guidance on implementation will be issued to providers of NHS-funded services requiring them to ensure that their staff record information on the database. The Government have subsequently liaised with NHS England as to whether this could be made a contractual requirement. NHS England has confirmed that once such guidance has been issued, it could consult on introducing a new condition in a future version of the NHS standard contract with the intention of making compliance with the guidance a contractual duty for provider organisations. Providers of NHS services need to demonstrate to their commissioners that they are complying with their obligations under the standard contract, so they would need to be able to show that they are implementing any condition that required doctors to record in the proposed database.

I hope that what I have outlined will satisfy noble Lords on the issues associated with mandatory recording.

[Baroness Masham of Ilton]

My Lords, before the noble Lord finishes, will he agree that the excuse of confidentiality can be a stifling block to innovation? Les Halpin was an example of openness. Surely patients and doctors should be sharing and working together. Therefore, they should have the information.

[Lord Prior of Brampton]

My Lords, all my experience over the last 15 years is that openness and transparency are critical to get improvement and innovation into the NHS, but we have to accept that patient confidentiality is also extremely important. If we in any way compromise or give people reason to think that patient confidentiality will be in any way intruded on, we may unwittingly undermine everything else that we are trying to do. We have seen that in other areas in the health service in the last year or so. We have to be very careful in this area, but I understand the importance of the noble Baroness’s point.

The Bill does not seek to add an extra burden on doctors, as the GMC’s guidance already sets out requirements on doctors to record their work clearly in clinical records. Doctors are required to have regard to such guidance as part of maintaining their licence. However, through the use of NHS contract guidance, doctors will be required by their providers to have regard to the requirement to record their innovations and, crucially, all associated outcomes.

Health: Zika Virus

Debate between Lord Prior of Brampton and Baroness Masham of Ilton

Thursday 4th February 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, that strays slightly away from the brief that I have on the subject today. May I take that on consideration? I will raise it with my honourable friend in the other House, the Minister for Public Health.

[Baroness Masham of Ilton (CB)]

My Lords, are the aeroplanes coming from the countries where there are these mosquitoes being sprayed?

[Lord Prior of Brampton]

My Lords, that is something that is under consideration at the moment. It varies from airline to airline—that is the truthful answer at the moment—but we are considering whether all flights from areas that have Zika virus should be sprayed.

Failures of the 111 Helpline

Debate between Lord Prior of Brampton and Baroness Masham of Ilton

Tuesday 26th January 2016 Lords Chamber

[Lord Prior of Brampton]

My Lords, the facts of this case demonstrate that a lot of things went wrong. That is the real tragedy of it. Had one of those things not gone wrong, the tragedy may not have happened. The noble Baroness referred in particular to medical education but it is wider than that. As I said, a whole stream of things went wrong and we must learn from that.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister agree that confusing messages are coming out? One is that antibiotics are being given too liberally. The other is that they are desperately needed for serious chest infections—and this boy had pneumonia, which was missed. Cases of meningitis are also missed. Such illnesses really need antibiotics. Does he agree?

[Lord Prior of Brampton]

My Lords, in a sense there are mixed messages—but there is a common-sense message here as well. We do not want to overuse antibiotics but, on the other hand, clearly where there is a serious infection, antibiotics are absolutely necessary. At one level it is a mixed message but there is a common-sense way through the two.

Health: Liver Disease

Debate between Lord Prior of Brampton and Baroness Masham of Ilton

Wednesday 9th December 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I understand that that is precisely one of the issues that the responsibility deal has studied and addressed.

[Baroness Masham of Ilton (CB)]

My Lords—

--- Later in debate ---

[Baroness Masham of Ilton]

My Lords, thank you. Is the Minister aware that the UK is the worst country in Europe for liver disease? Is he not rather worried about cutting funds for public health?

[Lord Prior of Brampton]

My Lords, we clearly have a major problem with liver disease—I think that we can all agree on that. The report by the Lancet commission has some very useful recommendations that we must take seriously. It is true that other countries in Europe have had more success in tackling this. I cite France as a case in point. We will take on board the number of recommendations made by the Lancet commission, as well as other initiatives we are taking.

Sex-selective Abortion

Debate between Lord Prior of Brampton and Baroness Masham of Ilton

Monday 7th December 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, I am not aware that we are giving consideration to that, but I will find out and write to the noble Baroness.

[Baroness Masham of Ilton (CB)]

My Lords, can the Minister confirm that unborn babies are covered by the discrimination Act?

[Lord Prior of Brampton]

My Lords, I am afraid I cannot confirm or deny that. I will write to the noble Baroness.

Junior Doctors Contract

Debate between Lord Prior of Brampton and Baroness Masham of Ilton

Monday 30th November 2015 Lords Chamber

[Lord Prior of Brampton]

I am delighted to do that, having been the chairman of an NHS trust for 12 years myself and knowing that my noble friend was chairman of the Imperial NHS trust and that the noble Lord, Lord Hunt, who is opposite, was chairman of the Heart of England NHS Foundation Trust. Given the pressure and stresses on management and the complexity of its day-to-day role, I think that no other organisation is as challenging as a large acute hospital. Managers have to do their work in the full glare of publicity as well and it is extremely difficult, so I certainly join my noble friend in paying tribute to the extraordinary work that many of them do in the NHS.

[Baroness Masham of Ilton (CB)]

My Lords, the Statement says that the Government’s ambition is,

“to make NHS care the safest and highest quality in the world”.

How is this to be achieved without enough high-quality doctors? Do the Government agree that, regarding the teams—the therapists and nurses, as well as the doctors—we need hard-working but contented staff?

[Lord Prior of Brampton]

The noble Baroness is absolutely right that the biggest asset in the NHS is the people who work in it. That is not just doctors and nurses but therapists, allied health professionals and all those people such as porters, caterers and the like. We have an extraordinary workforce, which, sadly, we often take for granted. I am always struck by the results of the NHS staff survey, which are nothing like as good as one would expect to see in many other businesses, so I agree entirely with the noble Baroness.

Gender-based Violence: Women with HIV

Debate between Lord Prior of Brampton and Baroness Masham of Ilton

Wednesday 25th November 2015 Lords Chamber

[Lord Prior of Brampton]

I think I am right that there are some 16 million women worldwide who suffer from HIV/AIDS so it is a huge problem, particularly in sub-Saharan Africa. I am not familiar with the innovation fund to which the noble Baroness referred, but I will investigate that and write to her.

[Baroness Masham of Ilton (CB)]

My Lords, is the Minister aware that there are many African men living in the UK who deny that they may be HIV positive, refuse to have a test and therefore put women at risk? What will the Government do about that?

[Lord Prior of Brampton]

I believe that some 103,000 people are HIV positive in England, of whom two-thirds are men. The majority of people who are HIV positive come from sub-Saharan Africa. The noble Baroness made the point that some who know they are HIV positive are not taking appropriate action and asked what we can do about them. It is also worth pointing out that some 18% of people who are HIV positive are ignorant of the fact. We have a very big communication programme ongoing to try and educate and inform these men, and we will continue putting the necessary resources into those programmes.

Health: Children

Debate between Lord Prior of Brampton and Baroness Masham of Ilton

Thursday 10th September 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, the causes of childhood poverty are profound. They are to do with employment, family relationships and education. The work that the DWP is doing with its troubled families programme and the work that the Department for Education is doing in improving educational standards will have a much greater impact on childhood poverty than, for example, focusing solely on things such as tax credits.

[Baroness Masham of Ilton (CB)]

My Lords, are there enough paediatricians across the UK to look after the under-fives, and is prevention of cerebral palsy a priority?

Health: Skin Cancer

Debate between Lord Prior of Brampton and Baroness Masham of Ilton

Wednesday 22nd July 2015 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, are there enough dermatologists in England?

[Lord Prior of Brampton]

The noble Baroness makes a very interesting point. It is recognised that there are not enough trained dermatologists in England—I think the figure I have seen is 177. To put it in context, there are 650 consultant dermatologists in England, so the answer is that there are not enough. The growth in the problem, if I can put it that way, seems to be running at about 3.5% a year. We are behind on this and need to catch up.

Health Funding

Debate between Lord Prior of Brampton and Baroness Masham of Ilton

Thursday 9th July 2015 Lords Chamber

[Lord Prior of Brampton]

I repeat my earlier response that prevention is extremely important. We are looking at a relatively small reduction of £200 million out of a total public health budget of more than £5 billion.

[Baroness Masham of Ilton (CB)]

My Lords, does this mean that campaigns on alcohol and drug abuse will be cut? Is the Minister aware that there is a great increase in liver disease and hepatitis C?

[Lord Prior of Brampton]

The decisions about which services to reduce must lie with local authorities.

NHS: Whistleblowing

Debate between Lord Prior of Brampton and Baroness Masham of Ilton

Tuesday 30th June 2015 Lords Chamber

[Lord Prior of Brampton]

The noble Baroness is absolutely right. The duty of candour, which puts an obligation on organisations to show candour, is making a difference. I congratulate the GMC and the NMC, which have spelled out clearly in their codes that the professional duty of candour is equally important.

[Baroness Masham of Ilton (CB)]

My Lords, if one was going to whistleblow, who would one contact?

[Lord Prior of Brampton]

There are a number of organisations that the noble Baroness might wish to contact, but most important is to raise the matter first in the local organisation. All organisations should have their own whistleblowing procedures, and that is the right way to raise concerns. If any individual finds that not to be satisfactory, the right way to proceed is through the Care Quality Commission, which has a dedicated hotline in its service centre in Newcastle.