HIV Care: Access

Baroness Barker Excerpts

Wednesday 11th September 2024 Lords Chamber

[Baroness Merron (Lab)]

I can confirm to my noble friend that we are, and say how grateful we are to a number of charities, including the Terrence Higgins Trust and the Elton John AIDS Foundation. As she says, there have been pilots for emergency department HIV opt-out testing since 2018. A pilot that began in April has expanded that to 47 additional sites, and we will be looking closely at the impact of that.

[Baroness Barker (LD)]

My Lords, if that pilot in the 47 areas shows, as it did in London with the Elton John work, that such testing finds people who not only do not know their status but are lost to care, will that form a basis of the national plan the Government are working on? Will there be a particular emphasis on extending services to people in rural areas, who do not have the access to clinics that people in metropolitan areas do?

[Baroness Merron (Lab)]

Yes, and I thank the noble Baroness for making those points, which I certainly agree with. The challenge for us now is to reduce the number of people who live with undiagnosed HIV, but also to reduce the number not seeking care and treatment. For the first time, the latter has exceeded the former, which suggests that we have a challenge we must focus on in the new plan, and we will do so.

NHS Continuing Healthcare

Baroness Barker Excerpts

Monday 2nd September 2024 Lords Chamber

[Baroness Merron (Lab)]

I thank my noble friend for that observation and certainly agree that, in all these areas, it is very important that people understand what might be available and how they might best apply. As I said to the noble Lord, Lord Crisp, the assessment is potentially a gateway to other NHS funding. I feel quite strongly that that needs to be clarified, so that people know what they are going into. I will take my noble friend’s comments on board and discuss this within the department.

[Baroness Barker (LD)]

My Lords, this issue has been a football between health and social care for many decades. We have never sorted out whose responsibility it is to do assessments and to make sure that those who are assessed know about the local services to which they can apply. How will the Government sort out that fundamental part of the problem?

[Baroness Merron (Lab)]

As the noble Baroness is aware, the responsibility for this lies with integrated care boards and a framework applies to both adults and children and to young people. It is for NHS England to ensure that the framework is properly applied. Certainly, the framework for children and young people has not been revisited since 2016 and we need to look at whether it is doing the job it is intended to do, because we want people to be getting the care they need. Each case is unique and complex and, as a person-centred service, that brings its own complexities. We should therefore ensure that the frameworks are applied correctly and get to the right people at the right time.

Integration of Primary and Community Care (Committee Report)

Baroness Barker Excerpts

Thursday 9th May 2024 Lords Chamber

[Baroness Barker (LD)]

My Lords, I too pay tribute to the noble Baroness, Lady Pitkeathley. She and I have sat on a number of Select Committees in recent days, and I have to say that she was excellent as the chair of this committee. She steered us through the depression of weeks on end of people coming to tell us how the IT problems in the NHS were really difficult—and somebody else’s fault. She also took us through the days when people came from NHS England to tell us how perfect the situation was, and how our fears were groundless.

The noble Baroness, Lady Redfern, and I, week after week, bowled questions to people about IT, data-sharing and data governance, and I do not think we ever got a straight answer. Nor does the Government’s response deal with a critical question: who is responsible for the co-ordination of patient data? We can talk about anything we like, but until that question is answered and can be answered by everybody, we are going round in circles—and so are patients.

In preparation for this debate, I went on to the new NHS information portal. There is a lot of good stuff and good guidance on there, but nothing sufficiently definitive, as yet, to lead us out of the central problem: the responsibility of GPs to be the guardians of data. Such is the amount of patient data they have to deal with and co-ordinate that they are drowning in the system. As we have heard, they are having to deal with different IT systems. I know the noble Lord, Lord Altrincham, talked up Manchester, but I urge him to recall that, while Greater Manchester was recording increased health outcomes, two of the boroughs were not. Those boroughs were Oldham and Rochdale, areas I happen to know extremely well, and where for decades there has been a lack of GPs and community health staff.

In London we still have major hospitals that cannot talk to each other because they run on different IT systems. It is as simple as that. Therefore, unless and until we can go back and deal with some of those issues, which we flagged up in our report, we are on a hiding to nothing.

We know that the Pharmacy First programme is being rolled out. Only last week, in a report in the Guardian, pharmacists were cited as saying that they are not being given data. I think this is because GPs are being highly cautious and reluctant to pass on information in case they are held responsible for a data breach.

There are other parts of the health service in which that same problem comes up again—ophthalmology and audiology. Most people who have a problem with their eyes go to an optician, not a GP. The opticians do tests, then they refer somebody to a GP and, if there is a problem, they are sent to the ophthalmology department where, several months later, they go through exactly the same tests and get the same results. The same thing happens in audiology. The story of audiology is not one of the private sector and the NHS working together in a triage system; it is a story of delay, duplication and waste. If we cannot get it right for two conditions for which we have systems that could be put together quite easily—provided a data protocol was established—how will we do it for something such as complex neurological conditions, or some of the conditions that the noble Baroness, Lady Redfern, referred to in connection with old age?

I take the opportunity to say that noble Lords should listen to Hanif Kureishi talking this morning on the “Today” programme about what happened to him when he had a blocked catheter, and how he nearly ended up being unnecessarily blued and two’d into A&E, all because somebody could not find a community nurse. They did at the last minute, and he was sorted out.

One of the things we did not manage to get down to in the report, because we were so busy talking to all the GPs who could not sort out these data problems, is the lack of community health staff and the lack of local authorities that know where the health deficits are in their area, working in partnership with primary healthcare staff. I was sitting in an NHS hospital yesterday and I noticed a screensaver that read, “Confidentiality of patient data is everybody’s responsibility”. What it did not say is, “Co-ordination of patient data is nobody’s responsibility”. That is the issue we looked at and on which we came up with several recommendations. It is a great shame that the Government did not listen.

Foetal Sentience Committee Bill [HL]

Baroness Barker Excerpts

2nd reading
Friday 22nd March 2024 Lords Chamber

[Baroness Barker (LD)]

My Lords, I wish to put on record that although my noble friend and I have very different views, as a matter of principle I defend her right to make her views known, and I hope she will understand why I respectfully disagree with her. I absolutely agree with the noble Baroness, Lady Kennedy of The Shaws: she is spot on. This Bill is part of a far wider anti-gender, anti-LGBT attack on human rights, a campaign which is international and largely but not exclusively put forward by national Conservatives and Christian nationalists.

The noble Lord, Lord Moylan, in his introduction said two things, both of which I think have subsequently been shown to be not true. This Bill is neither modest, nor not about abortion. It is far from that. It is unprecedented government interference in the ethics and practices of abortion care. It seeks to circumvent expert clinical guidelines, not because of another body of clinical evidence but because of an ideological disagreement with the conclusions of the work of the Royal College of Obstetricians and Gynaecologists. I should say to noble Lords opposite that the RCOG is duty-bound to provide evidence-based clinical guidelines, and to think that it would do so without talking to anaesthetists and other relevant professionals is to do that college a great disservice.

This Bill is focused solely on the foetus and says nothing about the rights of women. It is from the same stable that has brought similar legislation about in American states such as Arizona, Kansas and North Carolina, and it absolutely is a precursor to further legislation which will limit and outlaw abortion in full. Setting up a committee in this way, which has no remit to consider the rights of women or their experiences and healthcare, speaks volumes about the real motivation behind this legislation. I have to say to noble Lords opposite, and on the Cross Benches, who have repeatedly drawn parallels with the use of analgesia in animal scientific experimentation that they have ignored the fact that in this Bill we are talking about foetuses that are carried in the bodies of women—who are sentient beings capable of expressing not only their own healthcare needs but those of others.

This has been presented as being a method by which we can get to objective evidence. It is nothing of the sort. This is about setting up a committee to consider selective evidence—evidence that, I put it to the noble Lord, will inevitably lead towards a diminution of women’s rights. Far from being humane, the Bill has considerable scope for unintended consequences. The threats to women, not just during pregnancy but during childbirth, were this to go ahead, are considerable. We have already seen that throughout the United States, in states where these sorts of measures have been introduced.

I put it to you that this Bill does pretty well the opposite of what has been claimed for it. It is actually about picking and choosing selective evidence in order to lead down a path, as has happened in Alabama, towards the complete abolition of abortion. It is a Trojan horse. I really hope that we will not be fooled, and that we will put this in the context of that wider campaign against women’s rights and human rights.

[Baroness Smith of Newnham (LD)]

How does my noble friend account for the disparity between the views of the BMA and of the Royal College of Obstetricians and Gynaecologists?

[Baroness Barker (LD)]

It is not uncommon for health professionals to have different views and for their views to develop over time. However, I would much rather listen to either of those than to a hand-picked political committee making political decisions on what should really be a health matter.

This is a Trojan horse, and I really hope we will see through it. I thank the noble Lord, Lord Moylan, for unveiling, yet again, a little bit more of this wider campaign against women’s rights and human rights. He has done us a service.

Sexual and Reproductive Healthcare

Baroness Barker Excerpts

Tuesday 19th March 2024 Lords Chamber

Asked by

[Baroness Barker]

To ask His Majesty’s Government what assessment they have made of the current level of provision for sexual and reproductive healthcare in England and the case for a workforce plan in this sector.

[Baroness Barker (LD)]

My Lords, I thank all noble Lords and the Minister. Their participation at this late stage is very much appreciated. I also thank the British Association for Sexual Health and HIV, the British HIV Association, the Terrence Higgins Trust and the National AIDS Trust for their briefings for this debate. I draw the House’s attention to my role as co-chair of the All-Party Parliamentary Group on HIV/AIDS and the All-Party Parliamentary Group on Sexual and Reproductive Health. My ongoing involvement in those APPGs reflects my very strongly held belief since I was a young woman that giving people, particularly young people, scientifically correct and fully inclusive sex and relationship education information not only protects them and enables them to study, work and live their lives to their full potential but benefits the whole of society in terms of health and economics.

I want to have this debate because sexual and reproductive healthcare in the UK is in a crisis. That is not me saying that but the Local Government Association, the British HIV Association and the British Association for Sexual Health and HIV—that is, those on the front line trying to hold these services together and make them work. Data from the UK Health Security Agency shows that demand for SRH services has been increasing year on year and hit a record high in 2023, with no signs of abating this year. That increasing demand has not been mirrored in an increase in resources and staffing. The recent Local Government Association report showed that services throughout the UK are at breaking point, with people being turned away from services, which are often open for very minimal times due to a lack of capacity.

Due to the deterioration in numbers of people trying to be genitourinary medicine physicians in the UK, there is a real possibility that very soon we will be without adequately trained experts in out-patient management of complex and complicated STIs. That is worrying for us all. There are huge issues about recruitment, training and staff that can be traced back to commissioning changes that were made under the Health and Social Care Act 2012. Those reforms, which put public health back into local government, were right in principle; public health and prevention and surveillance of disease should start not in the NHS but in communities, where people live. The problem was that this reform coincided with a plummeting of local government finance and, consequently, the commissioning of services has been so severely depleted that services have deteriorated to the point where we have reached the highest levels of cases of gonorrhoea since the 1920s and the highest rates of syphilis since 1948.

The high rate of those diseases, and the lack of capacity for people to be seen in SRH services, has resulted in people presenting late and with levels of infection so high that they may have irreversible harm that could have been treated properly had they been seen earlier.

There has also been a resurgence in neonatal syphilis in the UK—something that we thought was history is now back. We have significant neonatal morbidity. In addition, reduced NHS service capacity has reduced the access to preventive SRH services, including vaccinations and the provision of HIV PrEP, both of which are critical to reducing future transmissions of STIs. In some areas of the UK, particularly outside London, there has been a disproportionate effect, as small clinics have been hit more than others.

It is important to understand in this debate that there are two types of specialists who deliver the majority of SRH and out-patient HIV care in the UK: first, GUM clinics, and HIV physicians who are trained in medicine and specialise in STI and HIV diagnosis and management; and, secondly, community sexual and reproductive health specialists, who train predominantly in women’s healthcare and who specialise in the gynaecological and reproductive care of women across their life course. Most provision of specialist contraception and training of other healthcare workers in contraception, and the leadership of systems across secondary and primary care, is done by community SRH consultants.

Dame Lesley Regan has done tremendous work in the development of the women’s hubs. I ask the Minister whether the Government plan to build on that work to make those into one-stop shops for women, where they can have their reproductive and sexual health issues dealt with all at once.

HIV treatment is different—HIV services are open-access and anybody can come into them—but there is a huge problem in the HIV workforce. Not only is there huge demand; there are so few consultant specialists around to help other staff to train and develop that we are now having a real problem recruiting trainees into genitourinary medicine. That means that those services are becoming ever more fractured, and there is a knock- on effect back to general practice and to pharmacies, which simply do not have the specialist knowledge and training to deal with those more complex cases.

Nurses and allied healthcare professionals are doing much more than they did a year ago, but they cannot deal with the sorts of complex cases that are now being presented to them. We have an inadequate number of consultant specialists working in the field and that is having an adverse effect on training.

Commissioning arrangements are at the root of the problem in all of this. No one is taking responsibility for ensuring that the next generation of doctors and nurses in sexual health services are being trained. No local authority has a training plan and there is no cohesion nationally to drive accountability where it fails. Services that offer no training and education are inherently cheaper and those are the ones being commissioned more and more—for short-term gain for cash-strapped councils, but with long-term harm to public health.

I ask the Minister to address three critical issues: first, making sure that all sexual health medical training posts are 100% funded through NHS England in the same way that posts in primary care oncology and public healthcare are funded; secondly, that NHS England is accountable on its plan to ensure improved recruitment, with the publication of a corresponding action plan to deliver improved recruitment in sex and reproductive health; and, thirdly, that no service is allowed to operate without a GUM consultant within it, no matter how much it depends on lesser-qualified staff.

It is worrying that we are going back to levels of sexually transmitted diseases that we thought were a thing of the past. It is deeply frustrating, because we now have the medicines to deal with these cases, and we know there are new technologies and ways of delivering services that could make the system so much more efficient. If we had nationwide home testing kits for HIV, if we had a greater use of pharmacies for the management of people with HIV in their local areas, rather than them having to go to specialist clinics for ongoing treatment, we could be making great progress. In this field, as in many other parts of medicine, were staff to have the time to sit and think through the ethics and potential of the use of AI, we could make huge strides forward in these public health matters. As it is, these services are stretched to breaking point.

I want the Minister to answer two simple questions. First, what are the Government going to do to stop the crisis and the downward spiral of stretched services relying on staff who are not sufficiently well trained? Secondly, what have the Government made of the lessons that can be learned from the GP recruitment crisis and the opportunities to apply those to increasing recruitment and retention in urinary medicine and HIV, including fully funding training posts? We need to get this workforce back up to the levels we know we can manage in order to deal with a crisis which need not have occurred in the first place.

Cancer: Staffing

Baroness Barker Excerpts

Thursday 14th March 2024 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend and totally agree that GPs are the front line of our medical services. We are trying to do everything we can to make sure that they feel valued and are retained. The recent change to the pension law was all about addressing that very point, answering GPs’ number 1 concern in order to keep them. Their hard work has seen a 25% increase in the cancer referral rate: we treated 3 million people, up 600,000, over the last year, thanks to their work and the expansion in the diagnostic centres we have set up.

[Baroness Barker (LD)]

My Lords, does the Minister agree with us on these Benches that there should be a statutory two-month period between diagnosis and access to appropriate treatment for any cancer patient? In order to achieve that, there needs to be further investment in radiography training and an equitable distribution of trainee radiographers and qualified radiographers across the country. How will the Government ensure that that happens?

[Lord Markham (Con)]

As I mentioned, that was very much the big feature of the discussion that I had with the president of the Royal College of Radiologists just the other day. We have been growing the number of radiographers by about 3% every year, which is a good rate, and we look to increase that even further. The CDCs are about that. However, the actual demand is increasing by about 5% every year. Clearly, as well as recruitment, we need to make sure that we have effective diagnosis, and this is where the field of AI is very exciting. The radiographers are 100% behind it, because they really see the revolutionary effect it is bringing.

NHS: Neurology Care

Baroness Barker Excerpts

Monday 26th February 2024 Lords Chamber

[Lord Markham (Con)]

Yes, that is precisely what I was referring to: the progressive neurological condition toolkit is all about the pathways for that integrated approach to it all. Again, there are 15 million people affected—I think this statistic was mentioned earlier—and one in five deaths come from related conditions, so making sure we have that integration with palliative care as well as the other services is key.

[Baroness Barker (LD)]

My Lords, neurological conditions require diagnosis by a specialist. Thereafter, the individuals need the input of people from all the different disciplines of the NHS. At the moment, the expectation to manage that falls upon GPs, and they cannot manage it. The key people who can are specialist nurses, and we have a severe deficit of specialist nurses for several neurological conditions. Can the Minister say how that deficit is to be addressed by the workforce plan?

[Lord Markham (Con)]

I thank the noble Baroness. Yes, the point about epilepsy nurses was made very clear to me just half an hour ago, and I quizzed both the national clinical director of neurology and Professor Stephen Powis on that subject this morning. I was assured that the next stage of the long-term workforce plan goes into that level of detail. I have made a commitment to the House to share some of that data, so we can make sure that it really is covered properly.

Sexually Transmitted Infections

Baroness Barker Excerpts

Tuesday 5th December 2023 Lords Chamber

[Lord Markham (Con)]

Overall, we spend £3.5 billion on public health. I do not have the breakdown of the advertising within that, but I will happily follow up with that. That is a small increase over the last year. Education is key to all this. Part of the reason for the increase in sexually transmitted diseases is that people used to use condoms because they were scared about two things: pregnancy and HIV infection. As both those risks have gone down, so has the use of condoms, which has resulted in the higher level of sexually transmitted diseases—so education is key.

[Baroness Barker (LD)]

My Lords, in 2022 the rate of STIs went up by 22% and, at the same time, the public health budget has been reduced by 29%. The strain on those services is now intolerable. Is it not time to have a proper, real increase in that budget?

[Lord Markham (Con)]

The figures are slightly misleading because, of course, that was in comparison to a Covid year, when there was much less testing. In fact, if you look at it versus pre-pandemic figures, the numbers are 16% down compared with 2019; that is the real comparison we should look at here. At the same time, I think we would all agree that £3.5 billion is a big investment in this space. It has gone up slightly over the past year but, as I mentioned earlier, education is also key in this space.

Mental Health Act 1983

Baroness Barker Excerpts

Tuesday 21st November 2023 Lords Chamber

[Lord Markham (Con)]

We are all agreed on the intent behind what we were trying to do with the Bill. On learning difficulties and autism, the most important thing we are trying to do is to make sure that the CQC, within 48 hours of a person being put into segregation, is investigating and doing an independent review on whether that is the best place for them. Like the noble Baroness, I share the feeling—we all think it—that it is much better that they are treated in the community, where they can be.

[Baroness Barker (LD)]

My Lords, mental health legislation relies on good data; we do not have good enough data about the detention of people from different groups. Does the Minister agree with the committee that a step forward that could be taken now is the appointment of a responsible person in each organisation with a duty to record not only the detention of people under the Mental Health Act but the demographic data surrounding it?

[Lord Markham (Con)]

Yes. The data, and fundamentally understanding what is beneath it, is key to all this. We have put an executive lead on each trust board to look at exactly these sorts of issues, including the data, so I am happy to take that forward.

Autism: In-patient Care in Mental Health Hospitals

Baroness Barker Excerpts

Tuesday 14th November 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness for her report and the meeting that we had to follow it up. Probably the best way forward on this is that a lot of things we are doing and can do can be done absent the Bill. I should be happy to sit down with her and talk through what we can do and where we can go further to make sure that everything that we were trying to put into legislation we can effectively make happen anyway, because we are all agreed as a House absolutely on the direction of travel in which we want to go.

[Baroness Barker (LD)]

My Lords, what is being done to change the commissioning systems and contracts that currently incentivise providers of medium and long- term secure accommodation to keep people in hospital, rather than equip them to go back into the community?

[Lord Markham (Con)]

I will come back in more detail on the contractual arrangements, but the point that the noble Baroness raises on making sure that there are no perverse incentives to do that has to be right. The now CQC-led reviews that we have agreed to put in place as part of continuing the recommendations of the noble Baroness, Lady Hollins, happen frequently. In the case of adults, there is a review every six months, if appropriate, and, in the case of children, every three months to make sure that every step of the way we ask whether this is really the right place for them to be.