Vol. 795 Wednesday No. 245 30 January 2019 PARLIAMENTARYDEBATES (HANSARD) HOUSE OF LORDS OFFICIAL REPORT ORDEROFBUSINESS Questions National Health Service: Missed Appointments...........................................................1041 Defence Safety Authority: Fire Safety Review .............................................................1043 Sepsis: National Register ..............................................................................................1045 Military Equipment: Sales............................................................................................1048 Overseas Aid Private Notice Question ................................................................................................1050 Trade Bill Committee (3rd day) ....................................................................................................1053 Mental Health: Children and Young People Question for Short Debate.............................................................................................1115 Trade Bill Committee (3rd day) (Continued)................................................................................1131 Grand Committee Offensive Weapons Bill Committee (2nd Day) .............................................................................................GC 263 Lords wishing to be supplied with these Daily Reports should give notice to this effect to the Printed Paper Office. 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This issue of the Official Report is also available on the Internet at https://hansard.parliament.uk/lords/2019-01-30 The first time a Member speaks to a new piece of parliamentary business, the following abbreviations are used to show their party affiliation: Abbreviation Party/Group CB Cross Bench Con Conservative DUP Democratic Unionist Party GP Green Party Ind Lab Independent Labour Ind LD Independent Liberal Democrat Ind SD Independent Social Democrat Ind UU Independent Ulster Unionist Lab Labour Lab Co-op Labour and Co-operative Party LD Liberal Democrat LD Ind Liberal Democrat Independent Non-afl Non-affiliated PC Plaid Cymru UKIP UK Independence Party UUP Ulster Unionist Party No party affiliation is given for Members serving the House in a formal capacity, the Lords spiritual, Members on leave of absence or Members who are otherwise disqualified from sitting in the House. © Parliamentary Copyright House of Lords 2019, this publication may be reproduced under the terms of the Open Parliament licence, which is published at www.parliament.uk/site-information/copyright/. 1041 NHS: Missed Appointments[30 JANUARY 2019] NHS: Missed Appointments 1042 House of Lords appointment the GP could use the time to cover another issue.It is important if patients miss appointments Wednesday 30 January 2019 because 70% or more of them will come back. 3 pm Lord Winston (Lab): My Lords, some 15 years ago Prayers—read by the Lord Bishop of Chelmsford. when I retired from the health service, we accurately costed how much the lost appointments in my out-patient clinic cost. The figure then was over £200 per patient National Health Service: Missed in a clinic that was grossly oversubscribed, so we lost a Appointments lot of patients as a result. It is not good enough to say Question that we have looked at general practitioners. Can the noble Baroness answer the important question put by 3.07 pm the noble Lord, Lord Dobbs? It is an effective drain on Asked by Lord Dobbs the health service and results in salaries being paid unnecessarily. To ask Her Majesty’s Government what is their latest estimate of the annual cost to the National Baroness Manzoor: My Lords, I agree that it is a Health Service of patients missing appointments very important issue, and the NHS is looking at it. If with their general practitioners. you miss an appointment with a consultant or GP, the costs of that service are stated very clearly. We take Baroness Manzoor (Con): My Lords, as data on the this issue seriously and are tackling it. number of missed appointments in general practice is available for only six months of the period 2017 to Baroness Walmsley (LD): My Lords, this morning I November 2018, we are unable to provide a precise had an appointment at a hospital in Wales, for which estimate of the cost. However, NHS England produced I had two reminders on my mobile phone, yet because an approximation using the limited data available, I live in Wales I do not have access to the NHS app to which suggested that the cost to the NHS of missed make appointments with my GP. First, as the app GP appointments was over £216 million a year. develops, would it not make sense to add reminder functionality to it to remind people of their GP Lord Dobbs (Con): I am grateful to my noble friend. appointments? Secondly, what discussions have taken If you add in the number of missed appointments at place with the Government of Wales to allow patients hospitals as well, the figure from NHS England—not in Wales the same advantage from digital health from the Government because they do not have figures— management as patients in England? rises to over £1 billion. It is a huge amount of money, yet recently the Government in a Written Answer Baroness Manzoor: My Lords, of course the NHS is discussing missed appointments said it did not really a devolved service, so that is a matter for Wales. It is matter because, important to have technology, and in fact some GPs “staff are able to use time resulting from missed appointments send reminders by text to let people know that they productively … This may include”, have a forthcoming appointment. giving, Baroness Lane-Fox of Soho (CB): My Lords, building “support to other patients, or spending time on personal on the last question, can the Minister please update us development”. on the ambitious targets in the 10-year plan for doctors’ I hope noble Lords will accept that perhaps that is not appointments by Skype? I believe that these will greatly sufficient. Does she accept that while of course all reduce the number of missed appointments,but investment patients have a right to the National Health Service, in infrastructure and skills for GPs and patients alike they have a responsibility to it too? I ask her to go is vital. back to the department and shake a few sticks there, so that it accepts that the department itself and not Baroness Manzoor: The noble Baroness is absolutely just NHS England has a responsibility for this problem, right that we need to ensure that the workforce is institutes some research as to why so many patients skilled enough to utilise this technology. I do not have miss their appointments, and comes up with policies the exact numbers for Skype consultations, but the that will tackle this massive drain on the resources of Secretary of State is very keen that we use technology the National Health Service. for patients who are able and have the competence to use it. However, there are other methods of contacting Baroness Manzoor: I am always happy to go back GPs, so it is not just a case of using that new technology. and shake the tree to find out the answers. I am a little bit like the Chief Medical Officer and believe that Lord Leigh of Hurley (Con): My Lords, the Minister what you can measure you can manage. To that degree, says that she is not able to disclose the numbers I agree with the noble Lord that we need greater because they are not monitored, but NHS Digital very understanding of where patients are missed and exactly helpfully gives the number of mental health service how that is managed. I also agree that there are rights appointments that are unfulfilled, as it calls them, but also responsibilities. However, some patients miss with children and young adults not turning up. In the appointments for very good reasons, and we have to year to October 2018, there were 600,000 unfulfilled understand those reasons so that we do not just think appointments. Given that the Government know the it is irresponsible behaviour; I know it is not. I agree nature of the problem, can they not take steps to with the noble Lord that if somebody misses an resolve it? 1043 NHS: Missed Appointments[LORDS] Defence Safety Fire Authority 1044 Baroness Manzoor: The Government are taking Baroness Goldie: The report in itself is an admirable steps to try to resolve this situation but, as I said, it is piece of work—thorough, analytical and robust. It not straightforward. It is not sufficient to look just at has been pivotal in ensuring and securing improvements the number of missed appointments, because patients to fire safety in MoD single-living accommodation. miss appointments for a range of reasons, particularly The specific issues to which the noble Lord referred in mental health services,and we need to better understand were indeed in the report—my recollection is that they that information. NHS England is collating that data. form part of paragraph 6.6, and led to recommendation It is not at the level at which we would like it to be but 5, which, importantly, is a priority 1 recommendation. we will of course take appropriate actions as we better I can say that the MoD has already addressed those understand it. areas of concern. The Defence Fire and Rescue