Antimicrobial Resistance

Baroness Redfern Excerpts

Thursday 2nd May 2019 Lords Chamber

[Baroness Redfern (Con)]

I thank the noble Lord, Lord Lansley, and congratulate him on securing this debate on the incredibly important topic of addressing AMR. It is absolutely essential to see AMR as the economic and security threat that it is.

I will talk first about animal husbandry. The Government must make a clear commitment that any future trade deals will require any meat and dairy produce imported into the UK to meet at least the same standards relating to antibiotic use that apply to meat and dairy products produced in the EU, because over 40% of the UK’s total antibiotic use is in animals.

Contamination can occur from animal waste, human waste, pharmaceutical manufacturing and the use of antimicrobial pesticides on crops. There is no doubt that more funding is needed on AMR to kick-start early research into new antimicrobials and diagnostics. We must conduct in-depth research to better understand the impact of AMR pesticide exposure on humans, animals and the surrounding environment, and identify and promote best management practices to minimise exposure when applying antimicrobials as pesticides. There should also be more global transparency over antimicrobial use on pesticides, by collecting and sharing information on the amount and types used on crops each year. Sharing knowledge is so important.

We now see antibiotics reaching the environment in many ways, such as through sewage run-off and the run-off from food producing units such as farms. In particular, there is the impact of effluent from factories on our nearby water systems. Action is needed, too, so that regulators can set at least minimum standards for the treatment and release of manufacturing waste, and drive much higher standards through supply chains. It is vital that we have better commercial return on R&D; it is little wonder that firms are not investing in antibiotics, despite the very high medical needs. We need new ways to reward and enhance innovation.

What matters now is that action should support reducing the unnecessary use of antimicrobials and, I emphasise, revive investment in their development. Rapidly growing global demand for antibiotics is necessary to improve access to life-saving medicines, along with economic development. But all too often it reflects excessive and unnecessary use, rather than genuine medical need, so by reducing unnecessary consumption we can have a powerful impact on resistance. Educators, farmers, the veterinary and medical communities and professional organisations need to pledge to make better use of antibiotics and help save vital medicines from becoming obsolete.

The rise and spread of antimicrobial resistance is, as we have heard this afternoon, creating a new and potentially dangerous generation of superbugs. The UK needs to help ensure that AMR remains a global priority by continuing to lead international policy. As we have been informed, by 2050 it is estimated that AMR will kill 10 million people per year—more than cancer and diabetes combined. That is the scale of the threat that we face. The ambition for AMR is, by 2040, to have new diagnostics, therapies, vaccines and interventions in use, together with a full AMR research and development pipeline for antimicrobial alternatives, along with diagnostics, vaccines and infection prevention across all sectors.

Government and other funders must act to ensure that the market can offer sufficient commercial incentive to keep pharmaceutical companies active in this space. They should conduct studies to evaluate the effectiveness of existing wastewater treatment processing in the removal from it of antimicrobials before its discharge into environmental waters, and investigate and identify the factors that result in treatment inefficiencies and failures in processing methods, or the infrastructure failures. Studies have found APIs in rivers, treated and untreated manufacturing wastewater, and sediment downstream of industrial wastewater treatment plants.

We have evidence, too, of the clear priorities that will support greater progress in addressing antimicrobial-resistant microbes in the environment. As I mentioned earlier, high-risk areas, such as the disposal of waste from healthcare facilities and manufacturing, could be prioritised and addressed at local and global levels to reduce the potential risks to human health posed by having those microbes in the environment. Unfortunately, we have not seen a new class of antibiotics for decades, because an overuse of antimicrobials has increased the rate at which resistance is developing and spreading. Again, we lack the new drugs to challenge these new superbugs. Governments and other funders must act to ensure the antimicrobial market can offer sufficient commercial incentives to keep pharmaceutical companies active in this space. Where testing is clinically appropriate and recommended by NICE, action should be taken to address the perverse financial incentives that may discourage use. I emphasise that we must work in collaboration to improve national and international understanding. We have a major global challenge ahead of us.

NHS Funding: Mental Health Services

Baroness Redfern Excerpts

Wednesday 1st May 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

As usual, the noble Baroness’s expertise shines through in her question. She is right that we must ensure that the money allocated to children and young people’s mental health gets to exactly where it is intended. The dashboard is extremely valuable in tracking through the effectiveness of the funding priorities in this manner. We will be holding to account CCGs and mental health trusts in ensuring that the money allocated to trusts is spent on exactly what it is intended to be spent on.

[Baroness Redfern (Con)]

My Lords, can the Minister tell us what part of the ring-fenced mental health budget will be allocated to recruiting appropriately trained probation staff for the 39% of offenders who have mental health issues and ensuring they receive access to effective support?

[Baroness Blackwood of North Oxford]

I shall have to write to my noble friend in order to answer her question with the best accuracy possible. However, my understanding is that the ring-fenced funding will be spent on health professionals rather than probation professionals. One of the most effective measures introduced under the five-year forward view, which has delivered very effective outcomes, has been liaison services. I shall investigate the point that she has raised and come back to deliver the response that she deserves.

Child and Adolescent Mental Health Services

Baroness Redfern Excerpts

Monday 25th March 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is right: those with particular needs, where autism or learning disabilities cross over into mental illness, must be taken into account. Some distressing figures show that those with learning disabilities do not get the physical health assessments that they need either. This must be taken into account and is in part why the children and young people’s Green Paper puts in place designated senior leads for mental health in schools and mental health support teams in and around schools, so that those needs can be identified as early as possible, and we can prioritise prevention and early identification of mental health needs when they arise.

[Baroness Redfern (Con)]

My Lords, the first mental health support teams will be set up in 25 trailblazer areas, of which 12 will also trial a four-week waiting time. Will those teams be in partnership with local authorities and the relevant CCGs, and who will monitor and evaluate the outcomes?

[Baroness Blackwood of North Oxford]

The outcomes will be monitored by NHS England, but also by the CCGs. Of course, they will be taken into account by local authorities as well.

Health: Pancreatic Cancer Treatment

Baroness Redfern Excerpts

Wednesday 19th December 2018 Lords Chamber

Asked by

[Baroness Redfern]

To ask Her Majesty's Government what plans they have to ensure that patients with pancreatic cancer begin treatment within 20 days of diagnosis.

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

My Lords, NHS England will soon introduce a faster diagnostic standard of 28 days for all cancer patients, including those with pancreatic cancer. Taken together with the 62-day referral-to-treatment standard, this will mean that all patients should expect to start their treatment within 34 days of diagnosis. This is a maximum, and trusts should continue to treat patients more quickly where there is a strong clinical need.

[Baroness Redfern (Con)]

My Lords, I thank the Minister for his comments, but the need for a paradigm shift on pancreatic cancer is now urgent. It is the deadliest cancer, with a dismal prognosis that has hardly changed in the last 45 years. It remains both the least survivable and the quickest killing cancer. It is hard to diagnose and, once it becomes clinically detectable, there is a rapid progression to an advanced stage. Therefore, for people facing a pancreatic cancer diagnosis, every day matters. For potentially curative and life-extending treatments such as surgery and chemotherapy, there is an optimum window of 20 days from diagnosis, when people with pancreatic cancer will have the option to be treated and the chance to live longer. It is ambitious to aim for 2024 but, for those people waiting, each day has deadly consequences. With a forecast of an extra £20 billion being injected into the NHS, does the Minister agree that it would be pleasing if some of that extra funding could be put towards improving those dismal survival rates?

[Lord O’Shaughnessy]

I agree with my noble friend and am grateful to her for raising this topic. The truth is that outcomes of pancreatic cancer are very poor, and have not improved, as she said. We are determined to change that through a number of routes. The Prime Minister has committed herself and the Government to improving early diagnosis of cancer, so that more cancers are caught earlier, which will be critical for those often caught at a late stage, such as pancreatic cancer. The faster diagnostic standard that I mentioned will help, as will a series of rapid diagnostic centres that have been rolled out around the country. I take the point that we need to do a lot more, and the NHS long-term plan gives us an opportunity to do that.

NHS: Specialist Services in Remote Areas

Baroness Redfern Excerpts

Tuesday 11th December 2018 Lords Chamber

[Lord O’Shaughnessy]

The noble Lord is right. Of course it is possible for us to do it in England; it is happening all over the country. Telemedicine offers fantastic opportunities, such as Skype-based GP consultations. Indeed, there is the example of Morecambe Bay’s remote clinician pilots in a variety of specialisms, such as gastroenterology and mental health care. Clearly, that is important. I point the noble Lord to the tech vision published by my relatively new Secretary of State this autumn, which points out the massive potential for digital health in reducing these kinds of inequalities.

[Baroness Redfern (Con)]

Within limits, a shifted out-patient model allows specialists to provide the same kind of consultations, investigations and procedures as in regular settings. Does the Minister not think a possible way forward would be to develop larger PCTs, as they would be more financially able and therefore have the capacity to provide that service in areas remote from the hospitals?

[Lord O'Shaughnessy]

My noble friend makes an excellent point. The number of CCGs is reducing over time, as they tend to merge. Of course, they are increasingly coming together into integrated care systems, which cover a larger geographic community. Every one of those makes sure that people have not only community care but specialist care available.

Breast Scans

Baroness Redfern Excerpts

Monday 19th November 2018 Lords Chamber

[Lord O'Shaughnessy]

Absolutely. I completely agree with the noble Baroness. Indeed, breast cancer screening saves 1,300 women’s lives every year. It is an essential part of our health system. On why women do not turn up, Professor Sir Mike Richards is reviewing all the cancer screening programmes at the moment. I will specifically put that question to him to ask him to investigate it.

[Baroness Redfern (Con)]

My Lords, we are told that pain or fear of pain is one of the main reasons why women decline screening. I ask the Minister: what initiatives have been investing to address the decline in breast screening uptake and to help ensure equality of access to screening?

[Lord O'Shaughnessy]

In addition to investigating some of the reasons through the review, a primary way in which we are encouraging women to take part in screening is through public health advertising and marketing campaigns. They have been demonstrated to have an impact. Public Health England had such a campaign on breast cancer screening this year; there will be a further campaign on cervical screening next year.

NHS: Healthcare Data

Baroness Redfern Excerpts

Thursday 6th September 2018 Lords Chamber

[Baroness Redfern (Con)]

I thank the noble Lord, Lord Freyberg, for initiating this debate. It is a pleasure to take part in a debate about how data will improve the health of the nation. It is not only crucial but has huge potential for the future of the NHS. I take this opportunity to congratulate my noble friend Lord Bethell on his maiden speech and look forward to his future contributions.

I welcome the £400 million-plus investment in new technology in hospitals, making patients safer, reducing cost and, importantly, linking people to access their health services at home. I also welcome the £75 million available to trusts to help them put in place state-of-the-art electronic systems. Those again save money but, crucially, have the potential to reduce medication errors by up to 50% compared to the previous paper systems, and to cut bureaucracy, making life better for staff, showing how electronic health records and other smart tools can support nurses both in and out of hospitals, benefiting patients who may have many health problems while ensuring that doctors are clear on their legal responsibilities.

Today, the Minister is setting out plans to make the NHS the most cutting-edge system in the world for the use of technology by investing a further £200 million to transform a group of NHS trusts into internationally recognised centres for technological and digital innovation. As he says, we are setting a gold standard for others to follow. Is that extra money? The future is to see more technology available to all, not just a select few areas of the country and not subject to a postcode lottery, thereby avoiding variations in patient outcomes and seeing all hospitals digitised as soon as possible, with healthcare becoming more integrated. In social care, for instance, the use of data is even more essential.

In developing a culture in which innovation can be rapidly adopted and rolled out across the country, we need a clear, robust strategy to take the NHS forward and not fall behind other nations—a culture that empowers to help make that change happen. As I said earlier, the UK certainly has a real opportunity to be a global leader in health data research by capturing all this potential, including artificial intelligence, the application of genomics to medicine, and the development of a range of new diagnostic tools and therapies for conditions that will enable more healthy ageing.

The evidence is out there showing how we can use technology better to create more efficiencies in passing information around and, importantly, in improving quality. The public and healthcare professionals must have confidence that access to patient data is appropriately managed so they can plan services and research new treatments. It must be clear to the public that their data matter, and that the data on research on new treatments to the NHS are stored safely. We need to bring together patients’ trust in the data in making informed choices from among other healthcare options.

Every time we go to a doctor we receive a diagnosis and, when we start a new treatment, the information goes into a database. The introduction of electronic patient records means that a patient’s journey in the health system is more accurately recorded and easily accessed, with patients receiving more effective care by having a digitised record. When we put all that together, it is a database combining millions of data points which then can be used for research purposes. Researchers are now harnessing vast amounts of information to assess what works in medicine.

There must be adherence to very strict protocols to prevent any leaks of personal information, and provision for the public to opt out, if requested. It is regrettable that some areas of the NHS have been slow to adopt information technology but we know that new technologies are changing what type of care can be provided and how it is delivered. We must support those trusts, while challenging others which are slow to engage, and help them to remove barriers. It is vital to support organisations which want to make changes in driving up productivity, bring on board new innovations, use data and welcome new technologies.

Medicine and public health are constantly evolving as new research and technology open the doors to new ways to treat or prevent diseases, so we are able to live longer—and, importantly, live well for longer.

Children: Obesity

Baroness Redfern Excerpts

Thursday 19th April 2018 Lords Chamber

[Lord O'Shaughnessy]

I completely agree with the noble Lord. I believe that he chairs the National Citizen Service, which has been a massive initiative to encourage such habits in teenagers. I completely concur with him: the Government take a number of approaches to encourage youth social action, and that is something that we will continue to support.

[Baroness Redfern (Con)]

My Lords, does my noble friend agree that families need to be presented with clear information about the food they buy and how important clear labelling is? Does he agree that when the UK leaves the EU, that will give us a greater flexibility to determine what information should be presented on packaged food and how it should be displayed?

[Lord O'Shaughnessy]

My noble friend is absolutely right: this is one of the many opportunities which this country will enjoy after we have left the European Union. We will have the flexibility to vary food labelling to ensure that we can use the very best, and latest techniques to encourage people to eat more healthily.

NHS: Staff Pay

Baroness Redfern Excerpts

Wednesday 21st March 2018 Lords Chamber

[Lord O’Shaughnessy]

Like the noble Baroness, I think it is right to pay tribute to all the organisations involved in striking this deal. These things are never easy but it is a true partnership agreement that tries to work for everybody.

The Statement is explicit about linking pay progression with appraisals, which indeed means higher skill levels. I will write to her with the specifics of the skills and knowledge framework; I am not cognisant of that specifically, but clearly the intention is to move away from automatic progression to skill-based progression. One of the advantages of that is that it not only works for patients, but puts the onus on employers—she will see more detail of that—to make sure that there is proper professional development to help skill levels rise, so that staff can go through those gateways and progress.

[Baroness Redfern (Con)]

My Lords, in welcoming the Government’s response and the 6.5% pay rise for 1 million NHS staff, particularly in recognition of their dedication and hard work, I am pleased that the Government have recognised that the lowest full-time salaries are paid to cleaners, porters and catering staff. These groups will receive a 15% increase—£2,500—bringing their salaries up to £18,000. The fact that this is backed with new money is welcome.

[Lord O’Shaughnessy]

I thank my noble friend for making that point. It is not only about the lowest paid staff whom she has described. It is also worth dwelling on the fact that a newly qualified nurse will see a significant increase in his or her pay, which will be 12.6% higher in 2020-21. This is a package which takes account of the fact that starting salaries have been too low. We are trying to address that because it is one of the ways we can attract more people into the profession.

Prescription Drugs: Dependence

Baroness Redfern Excerpts

Monday 19th March 2018 Lords Chamber

[Lord O'Shaughnessy]

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

[Baroness Redfern (Con)]

My Lords, I welcome this major review of prescription drug addiction. Does the Minister agree that the review must also look at the provision of alternatives to prescription drugs and the culture change needed to make that happen?

[Lord O'Shaughnessy]

My noble friend is absolutely right. It is not just about getting people off these drugs who are wrongly on them, it is about making sure that they do not go on them in the first place unless that is absolutely necessary for their treatment.