My Lords, the specialist guidance on the management of non-coronavirus patients needing acute treatment, issued on 20 March, put senior decision-makers at the heart of triaging patients referred for admission. To assist them, what role would testing for Covid-19 play on admission, and what proposals are there to utilise the Nightingale hospitals as a step-down facility for Covid-19 patients, thus reducing their numbers in NHS hospitals and allowing those hospitals to deal with the backlog of cases?

My Lords, the specialist guidance on the management of non-coronavirus patients needing acute treatment, issued on 20 March, put senior decision-makers at the heart of triaging patients referred for admission. To assist them, what role would testing for Covid-19 play on admission, and what proposals are there to utilise the Nightingale hospitals as a step-down facility for Covid-19 patients, thus reducing their numbers in NHS hospitals and allowing those hospitals to deal with the backlog of cases?

My Lords, two years ago, Sir Simon Wessely, then president of the Royal College of Psychiatrists, identified a serious problem with psychiatric recruitment, particularly among trainees as the Minister has mentioned. As it takes five years to get a trainee through to becoming a doctor, and bearing in mind that we are nearing Brexit or the effects of it and that many doctors come from the European Union, what action are the Government taking now to deal with this problem?

My Lords, two years ago, Sir Simon Wessely, then president of the Royal College of Psychiatrists, identified a serious problem with psychiatric recruitment, particularly among trainees as the Minister has mentioned. As it takes five years to get a trainee through to becoming a doctor, and bearing in mind that we are nearing Brexit or the effects of it and that many doctors come from the European Union, what action are the Government taking now to deal with this problem?

My Lords, I declare an interest as a riparian owner. Abstraction is an issue in any area with reservoirs, and particularly with rivers designated as being of special scientific interest. Of equal concern is abstraction for commercial purposes to clean salads. In particular I point to Bakkavör, a company in Alresford, which imports salads from Europe and cleans them, and the water then goes back into the river system. My question to my noble friend the Minister is: what steps can we take to ensure that water that goes back into the river after cleaning processes is of the same quality as the water abstracted in the first place?

My Lords, I declare an interest as a riparian owner. Abstraction is an issue in any area with reservoirs, and particularly with rivers designated as being of special scientific interest. Of equal concern is abstraction for commercial purposes to clean salads. In particular I point to Bakkavör, a company in Alresford, which imports salads from Europe and cleans them, and the water then goes back into the river system. My question to my noble friend the Minister is: what steps can we take to ensure that water that goes back into the river after cleaning processes is of the same quality as the water abstracted in the first place?

My Lords, as has been pointed out, it is not about the time to treatment but the time to diagnosis. Clearly, early diagnosis is the key. In Europe, the outcome for pancreatic cancer is often better than in the UK because patients have access directly to specialist care, whereas we rely on our GPs to be the gatekeepers, and that is where the problem lies. What measures will be taken to ensure that patients can have access to specialist care much earlier?

My Lords, as has been pointed out, it is not about the time to treatment but the time to diagnosis. Clearly, early diagnosis is the key. In Europe, the outcome for pancreatic cancer is often better than in the UK because patients have access directly to specialist care, whereas we rely on our GPs to be the gatekeepers, and that is where the problem lies. What measures will be taken to ensure that patients can have access to specialist care much earlier?

Following the theme of alcohol, the Minister was kind enough to meet me and members of the Alcohol Health Alliance on 30 April. We stressed that accepting a minimum unit price, as in Scotland, would do much to remove alcohol—and, particularly, cheap alcohol—from vulnerable people, some of whom are responsible for the attacks to which we are referring. When will England accept a minimum unit price and implement it?

Following the theme of alcohol, the Minister was kind enough to meet me and members of the Alcohol Health Alliance on 30 April. We stressed that accepting a minimum unit price, as in Scotland, would do much to remove alcohol—and, particularly, cheap alcohol—from vulnerable people, some of whom are responsible for the attacks to which we are referring. When will England accept a minimum unit price and implement it?

My Lords, liver disease, unlike cancer, is the only major cause of premature death that has increased since 1970. As the Minister rightly says, the Scottish Government have this week introduced minimum unit pricing. Would the Minister be willing to meet me and the chairman of the Alcohol Health Alliance to discuss what we in this country can do to follow the Scottish lead?

My Lords, liver disease, unlike cancer, is the only major cause of premature death that has increased since 1970. As the Minister rightly says, the Scottish Government have this week introduced minimum unit pricing. Would the Minister be willing to meet me and the chairman of the Alcohol Health Alliance to discuss what we in this country can do to follow the Scottish lead?

My Lords, we need to do something to tackle this issue much more urgently as the total cost of the litigation in the pipeline is some £65 billion—half the NHS budget. Until and unless we do something about changing Section 2(4) of the relevant Act we will have a continuing problem with patients claiming for private care when they should have their care provided by the NHS.

My Lords, we need to do something to tackle this issue much more urgently as the total cost of the litigation in the pipeline is some £65 billion—half the NHS budget. Until and unless we do something about changing Section 2(4) of the relevant Act we will have a continuing problem with patients claiming for private care when they should have their care provided by the NHS.

My Lords, following on from the question about the role of general practice, and mindful of the fact that we recently combined the Department of Health with social care, is it perhaps not time to redefine the role of general practice to

ensure continuity of care between the two sectors and avoid some of the problems we saw in our A&E departments over the Christmas and new year period?

My Lords, following on from the question about the role of general practice, and mindful of the fact that we recently combined the Department of Health with social care, is it perhaps not time to redefine the role of general practice to

ensure continuity of care between the two sectors and avoid some of the problems we saw in our A&E departments over the Christmas and new year period?

My Lords, the only way in which to increase staffing levels in anticipation of the flu epidemic is through agency staff, which is going to cost a huge amount of money. Surely, the better thing to do would be to ensure that all health staff are vaccinated so they are at least healthy when the epidemic hits us—if it does.

My Lords, the only way in which to increase staffing levels in anticipation of the flu epidemic is through agency staff, which is going to cost a huge amount of money. Surely, the better thing to do would be to ensure that all health staff are vaccinated so they are at least healthy when the epidemic hits us—if it does.

My Lords, the Lancet commission highlighted deficiencies in surgical care across the globe. Recent investment by the National Institute for Health Research, charities and the research councils has increased the number of clinical trials in the UK, particularly in surgery. Does the Minister support investment in surgical and clinical research to improve care in the UK and across the globe?

My Lords, the Lancet commission highlighted deficiencies in surgical care across the globe. Recent investment by the National Institute for Health Research, charities and the research councils has increased the number of clinical trials in the UK, particularly in surgery. Does the Minister support investment in surgical and clinical research to improve care in the UK and across the globe?

My Lords, in a recent survey the British Thoracic Society found that 72% of hospital patients who smoked were not asked if they wanted to

quit. Will my noble friend assure me that the promised tobacco control plan will ensure that hospital patients who smoke will get the support they need to quit?

My Lords, in a recent survey the British Thoracic Society found that 72% of hospital patients who smoked were not asked if they wanted to

quit. Will my noble friend assure me that the promised tobacco control plan will ensure that hospital patients who smoke will get the support they need to quit?

My Lords, mindful of the fact that we have taken the decision to leave the European Union and realising that many of our nurses come from overseas, and more recently from Europe, surely the time to start increasing nursing numbers is now, to make sure that we deal with any shortfall that may come after 2020.

My Lords, mindful of the fact that we have taken the decision to leave the European Union and realising that many of our nurses come from overseas, and more recently from Europe, surely the time to start increasing nursing numbers is now, to make sure that we deal with any shortfall that may come after 2020.

My Lords, this subject has been debated in this House on many occasions and, as my noble and learned friend said, has been rejected. Should it ever be considered again, it is important that the medical profession be excluded. The majority of doctors do not wish to be associated with taking life. Their responsibility is to save lives. While it is possible that there are those who might volunteer to undertake such a task, it is important that it should not be legislated that the majority of doctors are required to undertake it.

My Lords, this subject has been debated in this House on many occasions and, as my noble and learned friend said, has been rejected. Should it ever be considered again, it is important that the medical profession be excluded. The majority of doctors do not wish to be associated with taking life. Their responsibility is to save lives. While it is possible that there are those who might volunteer to undertake such a task, it is important that it should not be legislated that the majority of doctors are required to undertake it.

As a surgeon, I had cause to cancel or delay operations on patients who were obese or were smokers, but those decisions were based on clinical grounds from the knowledge I had of the individual patient. Clinical commissioning groups can give guidance but they should not provide diktats. What assurance will the Minister give that clinical decisions will be left to those who have the best interests of the patient at heart and who know their patients?

As a surgeon, I had cause to cancel or delay operations on patients who were obese or were smokers, but those decisions were based on clinical grounds from the knowledge I had of the individual patient. Clinical commissioning groups can give guidance but they should not provide diktats. What assurance will the Minister give that clinical decisions will be left to those who have the best interests of the patient at heart and who know their patients?

My Lords, while the sugar tax for fizzy drinks is a regressive tax, the very people it would target stand to benefit from such a tax because, leaving aside obesity, which is a long-term problem, dental caries are a short-term problem. There is no doubt that sugary drinks are causing a massive amount of dental caries, the cost of which falls on the NHS, as these unfortunate children have to have dental extractions which will affect their well-being and quality of life for years to come.

My Lords, while the sugar tax for fizzy drinks is a regressive tax, the very people it would target stand to benefit from such a tax because, leaving aside obesity, which is a long-term problem, dental caries are a short-term problem. There is no doubt that sugary drinks are causing a massive amount of dental caries, the cost of which falls on the NHS, as these unfortunate children have to have dental extractions which will affect their well-being and quality of life for years to come.

My Lords, does my noble friend agree with recommendation 3 in the report, which requires the establishment of liver units in district general hospitals, acting in a hub-and-spoke network with specialist hospitals? This is important to provide access to people, particularly in the north-west, where, sadly, there is very little access to specialist hepatology units.

My Lords, does my noble friend agree with recommendation 3 in the report, which requires the establishment of liver units in district general hospitals, acting in a hub-and-spoke network with specialist hospitals? This is important to provide access to people, particularly in the north-west, where, sadly, there is very little access to specialist hepatology units.

My Lords, one category not included in the list is the independent sector treatment centres. Are these proving as cost-effective as we would like? If so, is it not time that NHS consultants have greater access to them to deal with their elective cases, many of which are often cancelled because of the need to bring in emergencies?

My Lords, one category not included in the list is the independent sector treatment centres. Are these proving as cost-effective as we would like? If so, is it not time that NHS consultants have greater access to them to deal with their elective cases, many of which are often cancelled because of the need to bring in emergencies?

My Lords, the Minister is absolutely right in referring to the research in Milton Keynes. As far as prostate cancer is concerned, a man’s best friend probably is his dog. However, there is no doubt that the molecular markers can be detected in urine, and this may be the way to go in future research. It needs to be directed in that way because just a simple dipstick might well be able to detect the markers. If it is possible to detect prostate cancers using dogs, will the Government be prepared to fund such research and carry out a proper controlled clinical trial?

My Lords, the Minister is absolutely right in referring to the research in Milton Keynes. As far as prostate cancer is concerned, a man’s best friend probably is his dog. However, there is no doubt that the molecular markers can be detected in urine, and this may be the way to go in future research. It needs to be directed in that way because just a simple dipstick might well be able to detect the markers. If it is possible to detect prostate cancers using dogs, will the Government be prepared to fund such research and carry out a proper controlled clinical trial?