On the 6th of September 2018 the House of Lords debated the motion ‘that this House takes note of NHS and healthcare data and how that data could be used to improve the health of the nation.’ The Bishop of Southwark, Rt Revd Christopher Chessun, spoke in the debate:
The Lord Bishop of Southwark: My Lords, I too express appreciation to the noble Lord, Lord Freyberg, for securing a debate on a subject so full of possibilities for enriching our knowledge and improving the lives of fellow citizens. In England alone the National Health Service deals with more than 1 million patients every 36 hours. The potential use of data is enormous.
The right reverend Prelate the Bishop of Carlisle, who takes a special interest in health matters, is particularly sorry not to be able to participate in this debate. I also congratulate the noble Lord, Lord Bethell, on the quality of his maiden speech. I was, furthermore, particularly grateful for the wisdom of the noble Lord, Lord Kakkar, who spoke from his great expertise in this field. My focus is on mental healthcare data, which was recently highlighted in the Church of England’s toolkit on minority ethnic mental health issues, launched at our General Synod in July.
We know from the Adult Psychiatric Morbidity Survey, conducted every seven years, that one adult in six has a common mental disorder. By gender this breaks down to one woman in five and one man in eight, with the rate for women increasing since 2000 and the rate for men largely static. It is important to know why this is the case. Most mental disorders are more common among those living alone, in poor physical health or unemployed. One should avoid simple remedies, but esteem, living in a community, relational contact, activity and purpose seem to correlate with better mental health.
It is also important to note that there are wider demographic inequalities in who receives treatment for common mental disorders. According to the 2014 survey, after controlling for need, people who were white British, female or in mid-life, which in this instance means 35 to 54—rather younger than the average of fellow Peers—were more likely to receive treatment. Black ethnic groups had particularly low treatment rates. That is a serious matter. Analysing the data by socioeconomic variables demonstrates fewer inequalities in treatment, although people in low-income households were more likely to request a particular treatment but not to receive it.
I appreciate that even a debate as lengthy and as valuable as this is not going to solve systemic issues. It is clear, however, that there are discrepancies in how people are served. In a very different arena from this one—criminal justice—the Lammy report, addressing disproportionality, proposed a standing order of “explain or change”: if the disproportionality cannot be justified, action must be taken to remedy it. In this instance it would be good to know what action will address the failure to treat a category of citizens on the basis of ethnicity.
One of the outworkings of the gospel is the creation of a new society where distinctions do not matter. That is no easy thing, since so much of our security, identity and understanding is based on distinction and difference. Ultimately, however, this is not healthy, and in an area of pathology and treatment where provision is as sadly lacking as in mental health, to make less treatment available where the key variable is ethnicity is not a justifiable way to ration the system. I have said before, in respect of public service reform, that a failure to include a clear relational element is a great deficit in any programme. I trust that in the wake of the Windrush scandal we may yet be learning that lesson.
Baroness Walmsley (Libdem):[extract]…We have heard about many issues of concern. First there is patient consent and privacy, about which the noble Lord, Lord Hunt, was so eloquent. We have heard about the need to prevent exploitation and discrimination from the right reverend Prelate the Bishop of Southwark. We have heard concerns about how data is made available to commercial companies, how value can be realised and about the ownership of private data by a few large corporations. The noble Lord, Lord Mitchell, asked us to maximise that value and he is absolutely right, but there need to be enormous safeguards. I very much agree with him that the NHS, too, needs experts. If it does not, the experts in the big data companies will, as he put it, “crawl all over us”.
The Parliamentary Under-Secretary of State, Department of Health and Social Care Lord O’Shaughnessy (Con):[extract]…The noble Lord, Lord Hunt, was right in saying that first and foremost it is about the transformation of direct care. The primary uses of data must come first and secondary uses second. Patient outcomes are the most important goal. It is also the case, as the noble Lord, Lord Kakkar, pointed out so wisely, that without technology we cannot achieve the goal of personalised medicine. Personalised medicine is essential, because we now understand so much about disease that no disease presents itself in one person in the same way that it presents itself in another. We cannot achieve that goal without technology and the use of data. As the right reverend Prelate, the Bishop of Southwark, and my noble friend Lady Redfern pointed out, it is also critical in overcoming some of inequities and discrepancies in health outcomes that clearly exist in all disease areas today.