Sodium Valproate and Pelvic Mesh

Debate between Baroness Brinton and Lord Markham

Monday 25th March 2024 Lords Chamber

[Lord Markham (Con)]

My noble friend is correct on this. Probably the best way to do that is to come back in detail in writing, because it is vitally important.

[Baroness Brinton (LD)]

My Lords, in response to the noble Lord, Lord Hunt, the Minister said that Minister Caulfield had commissioned this report, but he misses out at least three years of work earlier. There was the report of the noble Baroness, Lady Cumberlege, and there was a long debate during the passage of the Health and Care Act when Nadine Dorries said she would look at commissioning something and then refused to do so. This is not recent history. Will the Minister please give this House a date on which the Government will come back to Parliament with a response?

[Lord Markham (Con)]

The point I was making was that Minister Caulfield absolutely agreed with the point the noble Baroness makes that the delay had been too long, and so it was she who came forward and said that she wanted to commission the Patient Safety Commissioner to report exactly in this area. So that was her being proactive on all this. In the same way, she says that she is determined to get a response back in the next few months. I cannot give a specific date yet, because it is a complicated area which involves industry, many government departments and the devolved authorities. However, as the Chancellor said, this remains a top priority area for both the Chancellor personally and the Government.

NHS App: Medical Records

Debate between Baroness Brinton and Lord Markham

Tuesday 19th December 2023 Lords Chamber

[Lord Markham (Con)]

Absolutely; it is about getting that balance correct. I welcomed the support of all sides of the House when we were introducing the FDP. A lot of work was done with noble Lords on that. The fact that the federated data platform was as well received as it was in the circumstances is because of support from all Members of the House on all sides, knowing the vital role of data in improving health outcomes.

[Baroness Brinton (LD)]

My Lords, following the question from my noble friend Lord Allan about a red team, in the past not health data but personal financial data has been sold by subsidiaries or contractors of UK firms based abroad. I notice that we now have a deal with America on health data and GDPR. Is that true for other countries, such as India? Personal data, particularly medical data, would be seen as very valuable.

[Lord Markham (Con)]

The fundamental principle underlying all this is that none of the data leaves the control. The data controllers today—be it GPs, the NHS or the hospital—stay as they are, and any use of that data has to be approved outside of that. The noble Baroness is absolutely correct. We want to make sure that it is not used for any purposes that are not going to improve health outcomes, such as the ones we have talked about.

Suicide Prevention Strategy

Debate between Baroness Brinton and Lord Markham

Thursday 26th October 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness for her support for the suicide prevention strategy. It tries to look at the themes behind this issue, of which working to give effective support, communication and training is absolutely key—as is making sure that that is followed up on. The other thing that I want to pull out from the report is the real feeling, in terms of the seven key themes, that suicide prevention is everyone’s business and is something that we all need to be aware of and could learn more about.

[Baroness Brinton (LD)]

My Lords, the Minister has outlined how important it is to learn from the experience of people who have considered suicide. Last week, an Information Rights Tribunal asked the DWP to publish its secret report on suicide rates among vulnerable claimants; it has not yet been published despite the fact that it was written in 2019. Can the Minister explain why it still has not been published? If not—I appreciate that this falls under the DWP—can he write to me, because it is clear that we need to learn the lessons of what went wrong?

[Lord Markham (Con)]

Absolutely. I would be happy to write to the noble Baroness.

Reinforced Autoclaved Aerated Concrete: Hospitals

Debate between Baroness Brinton and Lord Markham

Wednesday 13th September 2023 Lords Chamber

[Lord Markham (Con)]

I hope and trust that most of us would think that it was sensible to prioritise the RAAC hospitals. That meant that we had to move some others to the right-hand side of the budget envelope, so to speak. It is not publicised very much, but we now have an agreement with the Treasury to move to five-year capital cycles, like the Department for Transport, which I think is a real positive because we need long-term planning cycles. We are busy developing a 2030-35 programme now, which those hospitals that the noble Lord mentioned will be placed in.

[Baroness Brinton (LD)]

My Lords, I want to follow on from the question from the noble Lord, Lord Hunt. My local hospital, Watford General Hospital, has been top of the rebuild list for 20 years. The town was delighted with the news on 23 May that it would be part of that group and is not part of the eight. Last week, the council was informed that there is still no confirmation of when funding will be approved by the Treasury. The town knows that it will run out of the chance to rebuild Watford General by 2030 unless that funding is confirmed very soon. Can the Minister say when it will be confirmed?

[Lord Markham (Con)]

In every hospital—and Watford was one of the first ones I visited—there is a programme on which the draw-down of the funding depends; there is already a new car park there, for instance. I can assure the noble Baroness that the plans are in place to make sure that the draw-down is in time. I have also said on all the hospitals I have visited over the summer—I have seen about 20 or so—that I have a quarterback role where I have to project manage across them all and, where there are issues, they can approach me directly. I will raise today’s question with the Treasury and make sure that Watford is well in order.

MMR Vaccine

Debate between Baroness Brinton and Lord Markham

Thursday 20th July 2023 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, the NHS says that susceptibility is not just among the under-twos; it is particularly high among 19 to 25 year-olds whose parents were affected by the unfounded Wakefield stories two decades ago, and many may still not be vaccinated. What is the NHS doing to reach this cohort, including at further education colleges and universities, to ensure that they are fully vaccinated before they start their own families? Catching measles when pregnant can cause miscarriage, stillbirth, premature birth and low birth weight.

[Lord Markham (Con)]

The noble Baroness is correct. The unfortunate Wakefield effect had quite an impact on that cohort of people, so the campaigns have been targeted particularly at specific communities in particular areas. Outreach campaigns are being done as part of that, looking at every area where it can be done. Sometimes that involves looking at colleges and sometimes it involves going specifically to community centres themselves.

NHS Long-term Workforce Plan

Debate between Baroness Brinton and Lord Markham

Tuesday 4th July 2023 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, while this NHS plan is welcome, can the Minister say whether this Government will undertake to commit to the plan and, crucially, to its funding and not change the number of education and training places, as happened last year and in too many previous years, causing chaos in planning for doctors, nurses and allied healthcare professionals? On hospital training places for junior doctors after they have finished their medical school courses, last year 790 medical graduates could not begin their junior doctor in-hospital training because the NHS did not have enough placements. Given that university medical school places are already capped and highly competitive, this is a complete waste of newly qualified medical graduates.

[Lord Markham (Con)]

It is absolutely a pipeline; some people might say, “Why are you not doing more earlier in this plan?”, but, as the noble Baroness says, there is no point training a lot of people at the university end if you do not have junior doctor places later in the system. That is why we are trying to get a sensible ramp-up so that we can build capacity into those places, recognising the point that the noble Baroness makes. On the numbers in the plan, we have set down £2.4 billion for the first five years of training and development, but the point about it being a live plan is that we will update it every two years. Given the data—this is an NHS document, not a Department of Health one—I would expect those numbers to change, as I would be amazed if we got it spot on first time. The whole point about making this an NHS living document that we can use and which updates is that we can all stick to the plan.

NHS Procurement: Palantir Contract

Debate between Baroness Brinton and Lord Markham

Thursday 22nd June 2023 Lords Chamber

[Baroness Brinton]

To ask His Majesty’s Government, in light of the contract awarded to Palantir, what plans it has to ensure that NHS contracts are procured through a public and transparent tender system as outlined in the Procurement Bill.

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

All NHS contracts are procured using correct procedures. This is a new transition contract with Palantir, with new and improved contract terms, including robust exit and transition schedules to support transition from Palantir to the new federated data platform supplier. This contract includes additional terms, such as termination for convenience and a six-month break clause. The contract was procured by a compliant and transparent direct award tender process, using a Crown Commercial Service framework agreement.

[Baroness Brinton (LD)]

My Lords, it is not the first closed contract used that way, particularly for Palantir, since 2020. Ministers deliberately excluded the NHS from the new rules in the Procurement Bill, giving the Secretary of State for Health the powers to create regulations, resulting in untransparent closed contracts such as the £24 million Palantir contract just granted. Unlike every other public body and government department, senior NHS leaders are excluded from any restrictions when they move to providers, as happened last year when two senior staff moved to Palantir. These NHS practices are the exact opposite of what the Government hope to achieve in the Procurement Bill. Will Ministers please reconsider bringing the NHS under the Procurement Bill?

[Lord Markham (Con)]

This was a very sensible move to ensure that the tender process we are going through at the moment allows us to transition to whoever wins the federated data platform. That is a sensible way to do it. It was done according to the Crown Office pre-tendering framework agreement, which is very transparent and well set out. It is normal in these situations that, when you need transition arrangements, you do not want hospitals left in the lurch. You need a transition so that, whoever wins the new bid, hospitals are safe in the meantime.

Sodium Valproate

Debate between Baroness Brinton and Lord Markham

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is correct. First, the MHRA is working on guidelines which say that you must always dispense in the original packaging, come what may. In the meantime, secondly, all pharmacists should absolutely be putting leaflets in, whatever the packaging. Thirdly, everyone should have to sign an acceptance form so that they are going into this with their eyes open and understand the risks. Every year they are supposed to renew that acceptance form to make sure that, while it may be necessary in some cases, everyone goes into it with their eyes open to the risks.

[Baroness Brinton (LD)]

My Lords, in 2020 after the publication of the report by the noble Baroness, Lady Cumberlege, we had many debates in your Lordships’ House about the role of and the support for the Patient Safety Commissioner. She had not heard what her budget for the current financial year was at the beginning of May and said that, even leaving that aside, she would not be able to do her job properly. To follow the course of how patients with sodium valproate are supported and treated, she will need that resource. Will the Government review the resource needed for her to do this and many other tasks in her important role?

[Lord Markham (Con)]

My understanding from speaking to Minister Caulfield on exactly this subject this morning is that she has recently spoken to the Patient Safety Commissioner, who is happy that she has the resource that she now requires to do this part of the study.

Long Covid

Debate between Baroness Brinton and Lord Markham

Tuesday 25th April 2023 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, 2 million people currently reporting symptoms of long Covid is a shocking 3.1% of the population, with over a million people having had it for at least one year. There are some very successful models for assessment and treatment, but some clinics still assume that long Covid is like ME/chronic fatigue and do not investigate for microclots and heart and lung problems. Why is there not a gold standard for assessments and treatment of long Covid in England as there is in a number of other countries, including Scotland?

[Lord Markham (Con)]

I thank the noble Baroness. My understanding is that the 90 specialist adult centres and 14 specialist children’s centres have care pathways which they are supposed to adhere to. Therefore, I hope that the instances which the noble Baroness brings up are the exception, but I am happy to investigate because I think we all agree that a consistent care pathway is vital in this space.

Gender Identity Services: Children and Young People

Debate between Baroness Brinton and Lord Markham

Wednesday 19th April 2023 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, in reply to the question from the noble Baroness, Lady Hunt, the Minister referred to the new GID services at the Evelina and GOSH. But the original proposals were for regional clinics in Manchester and London—so when will the Manchester clinic open? Since March of this year, the waiting list and all new referrals are being held by the Arden and Greater East Midlands commissioning support unit. There is real confusion about how this list will be integrated with the existing case load as the new services open. Can the Minister explain what will happen? If he does not have the answer to hand, please will he write to me?

[Lord Markham (Con)]

As ever, I am very happy to write. In terms of the northern hub, I mentioned GOSH and Evelina just as examples. The Royal Manchester and Alder Hey are the northern sites that will be used to provide these services. The idea is that we will have eight regional centres—but I would be happy to provide the detail on both cases and follow up in writing.

Diphtheria

Debate between Baroness Brinton and Lord Markham

Tuesday 18th April 2023 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, to follow on from the question by the noble Baroness, Lady Blackwood, last week the European Congress of Clinical Microbiology and Infectious Diseases published a report on the rise of diphtheria cases, noting that:

“Linked to an increase in migrant arrivals via small boat in … 2022, the UK experienced a sharp increase in diphtheria cases”.


Its report recommends that border officials and doctors should all have training on screening and identification of symptoms of infectious diseases, such as diphtheria and others outlined by other speakers. Will the Government implement this specific recommendation? Can the Minister say whether, on arrival, all asylum seekers are now offered a full health check and vaccination with doctors?

[Lord Markham (Con)]

As I mentioned, we are doing the screening. We lead Europe on this; my understanding is that no other European country is taking the extensive measures that we are. I can also reassure the House—I was speaking to Susan Hopkins on this just yesterday—that UKHSA has deemed that there is a very low risk to the general population. The uptick in cases that we are talking about is in the migrant population, and the fact that we are vaccinating 88% of them against diphtheria shows that we are on top of the problem.

Covid Pandemic: Testing of Care Home Residents

Debate between Baroness Brinton and Lord Markham

Monday 6th March 2023 Lords Chamber

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

My Lords, for the record, noble Lords are aware of the Covid testing business that I set up at the beginning of the pandemic. We offered testing to the Department of Health and Social Care on a not-for-profit basis. That offer was not taken up and the business never had any government contracts. I wanted to make that clear at the beginning of my answer.

To answer the noble Baroness’s question on the Covid inquiry, the team is staffed to make sure that all the information that is needed is provided. Everyone agrees that we need to learn any lessons from what happened and that all the information that is available is brought to bear.

[Baroness Brinton (LD)]

Mr Hancock denies that he rejected Chris Whitty’s advice in April 2020 that everybody going into a care home should be tested. On 19 May, I said to the then Minister in the Lords:

“The Secretary of State has repeated his claim that he has prioritised testing in care homes, yet he still repeats that testing for everyone in care homes … will be only ‘offered’ by 6 June.”


My noble friend Lord Rennard asked whether the Minister had heard the programme “More or Less” and the

“total demolition of the claim that 100,000 tests were being conducted each day”.—[Official Report, 19/5/20; cols. 1086-94.]

The following day, I said that

“Dame Angela McLean said testing had been prioritised in the NHS over care homes. Today, Justice Secretary Robert Buckland said the Government had prioritised the NHS over care homes as well.”

The Minister said that

“we rolled out outbreak testing for all symptomatic care home staff and residents.”—[Official Report, 20/5/20; col. 1177.]

Two weeks later, I said that

“a number of CCGs are still pushing care homes to take block-bookings of patients coming out of hospital without having had Covid tests.”—[Official Report, 3/6/20; col. 1417.]

We all knew what was going on at the time because we were being told by care homes and by the families of residents. Will the Government now apologise to the many families who lost loved ones as a result of the delay in getting full testing into care homes?

[Lord Markham (Con)]

It is to the regret of everyone that so many deaths were caused in care homes. That is something that I know everyone feels very deeply about. At the same time, the testing capacity was expanded very rapidly. As we know, at the beginning of the pandemic in mid-March, there was capacity for only 3,000 tests a day. At that point, the decision was made that they should go to NHS front-line staff. However, it was then rapidly expanded: on 15 April there were 39,000 tests, and by May there were about 100,000 tests a day. Obviously, at that point, the Government were able to expand the tests more fully to care homes.

Was that prioritisation right? That was the subject of the Gardner review but, clearly, the body that can decide best on whether the right decisions were made at the right time is the inquiry, with which everyone will co-operate fully.

United Kingdom: Future Pandemics

Debate between Baroness Brinton and Lord Markham

Monday 16th January 2023 Lords Chamber

[Lord Markham (Con)]

I agree with my noble friend that some of the lessons learned from all this are around consequences of lockdown that we had not quite imagined. Clearly, the impacts on mental health are impacting us to this day. We need to make sure that we are learning all those lessons, so that we do not walk into situations in the future where we put in lockdowns without fully considering the impact on the whole of society, including the mental health consequences. That is what the inquiry is about.

[Baroness Brinton (LD)]

My Lords, the Minister said in his earlier response that the Government were flexible and well tested, had learned the lessons of the pandemic and were using the experience of response to emergencies. Can he explain why there are over 9,000 patients currently in hospital with Covid, over half of whom have acquired it in hospital? Could he ask the Secretary of State to reinstate the mask mandate in hospital for these very vulnerable patients?

[Lord Markham (Con)]

I know that the use of masks in hospital is being debated as we speak, to make sure that we are prepared for any new eventuality. As we are aware, 9,000 beds being taken up by Covid is a response to our seeing more waves: this is something that we see each time. Thankfully, due to the vaccines and our treatments, the death rate from those waves is very much reduced, but there is still a big impact. The House is aware of the impact that it is having on us all right now: 9,000 is a big number.

NHS Winter Pressures

Debate between Baroness Brinton and Lord Markham

Tuesday 10th January 2023 Lords Chamber

[Lord Markham (Con)]

I agree that we need a whole-system approach. Workforce is a key part of that, including the adult social care workforce. Again, as all noble Lords did, I welcome the advent of the agreement to do a workforce plan, which needs to take all these factors into account. We need to make sure that it is an attractive place to work, and that people see it as a career progression—and that it is modular so that you can start in social care and, if you want to, progress into other parts of the health service.

[Baroness Brinton (LD)]

My Lords, I declare my interest as a vice-president of the LGA and vice-chair of the All-Party Group on Adult Social Care. Nearly three years ago, the Government created Nightingale hospitals, which were much vaunted and had millions spent on them. Virtually all of them were useless because there was no staffing available for them at short notice. I listened to the question from the noble Baroness, Lady Merron, about the short, medium and long-term workforce plan. We are now in emergency time: there are 160,000 social care vacancies and 40,000 nursing vacancies, which includes those in social care. How is this unblocking of beds going to be staffed and by when?

[Lord Markham (Con)]

Obviously, prior to this, we were in touch with the adult social care sector to make sure that there was that capacity within the system for it. We have been assured that the capacity exists, but we wholeheartedly agree that we need to recruit the staff to fill those vacancies, which is why we have taken measures to recruit internationally as well as in the domestic recruitment programme. Those are all key components of the longer-term plan to solve this issue.

Hospital Beds: Social Care

Debate between Baroness Brinton and Lord Markham

Monday 19th December 2022 Lords Chamber

[Lord Markham (Con)]

I will happily write on the detail, but, yes, it includes everyone who could be provided a space, either in a care home or a mental health home, and those who are fit to go home but need domiciliary care.

[Baroness Brinton (LD)]

My Lords, Our Plan for Patients, which was published at the end of September, says:

“This winter, the NHS will open up the equivalent of 7,000 beds so that every hospital has space to see and treat patients more quickly.”


Winter is clearly here, so how many of those virtual beds are in operation now?

[Lord Markham (Con)]

I thank the noble Baroness. She is absolutely right that the target of 7,000 beds is a key part of this. All Ministers have been talking about it with every ICB over the last few days to see exactly where they are on the target for both real beds and virtual beds. I will happily provide exact information on the target, but I know that we are making good progress.

Food (Promotion and Placement) (England) (Amendment) Regulations 2022

Debate between Baroness Brinton and Lord Markham

Tuesday 6th December 2022 Lords Chamber

[Baroness Brinton (LD)]

My Lords, it is a pleasure to follow the noble Baronesses, Lady Walmsley and Lady Merron. They have said practically everything I wanted to say, and as the Minister may find it depressing for me to say it a third time, I will not.

What I do want to focus on is the key role of Parliament, and in this case your Lordships’ House, in scrutinising statutory instruments. We all have to accept that the period during which Liz Truss was Prime Minister was a somewhat extraordinary, though very short, one. I note in parenthesis that the Minister was appointed on 10 October, after these incidents had happened, so I think we need to recognise that he is responding to something that happened before he was in post. He was, however, appointed by Liz Truss.

The key thing is the sleight of hand in turning something that was absolutely openly discussed during the passage of the Health and Care Bill, and which was only to be used as a very short-term emergency measure, into what has clearly become a highly political move. While I have perhaps been slightly harsh on the time during which Liz Truss was Prime Minister, her successor has chosen not to reverse this, which tells me that this is a move by the Government.

I have to echo the points made by the noble Baroness, Lady Walmsley, about the evidence to our eyes during the passage of the Health and Care Bill of those who had heard the lobbyists and were fighting hard against the amendments the Government wanted.

I have just a couple of questions. We do need to see the evidence. The Secondary Legislation Scrutiny Committee was right: it is not appropriate to ask Parliament to scrutinise something without the evidence. Where is it, when will we see it and why do claims about the cost of living contradict the Government’s own evidence in the impact assessment available at the time? It is important that Parliament sees the detail of the responses to the Government’s consultation from every sector—food and drink, supermarkets, health bodies, not-for-profit organisations and charities—and the public, in whatever way they responded. Do the Government plan to publish that consultation?

Given the concern expressed by everyone who has spoken this evening, and indeed the Secondary Legislation Scrutiny Committee, and the evidence of our own eyes in your Lordships’ Chamber during the passage of the Health and Care Bill, it might be helpful if Ministers could publish all the meetings that all Ministers have had with food and drink industry members this calendar year, which about ties in with the beginning of the passage of the Health and Care Bill—at least, the first consultations prior to legislation arriving here in your Lordships’ House.

Finally, I suspect this may be slightly beyond the power of the Minister, but I do hope he will go back to the usual channels and seek guarantees that this sleight of hand will not be used again, especially given the delay on advertising HFSS products on TV and online before the provisions are due to come into effect on 1 January 2023. We absolutely must have that 21 days to decide whether we want to pray something in aid and bring forward regret Motions. However, there is a bigger issue here: the reputation not just of your Lordships’ House but of the Executive, and the power of the Executive just to ignore the systems that are in place. We need to make sure that scrutiny can be done effectively.

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

My Lords, I thank the noble Baronesses, Lady Merron and Lady Walmsley, for securing this important debate to discuss the Food (Promotion and Placement) (England) (Amendment) Regulations 2022. I also pay tribute to the Secondary Legislation Scrutiny Committee for its 15th report of the 2022-23 Session, which considered the amendment.

I thank noble Lords for their constructive and thoughtful contributions to the discussion on tackling the significant challenge of obesity. From this debate and our previous discussions, the good news is that we are all agreed on the need to take action. We are all aware of the stats: 40% of kids are overweight when they leave primary school, 25% are obese and, as the noble Baroness, Lady Walmsley, said, there is a huge impact on the economy of £58 billion per annum and a huge impact on the NHS of £6.5 billion. That is notwithstanding the huge impact on individuals’ personal health and well-being as well.

We are also all agreed on the strategy that we need to take: reducing overconsumption of food and drink high in calories, sugar, salt and fat. I think we all know the main levers available to achieve that but, to paraphrase the OECD, there are four key steps: information/education, increasing healthy choices, modifying costs and restrictions on promotions and product placements. We have made good progress on each of those. We have extensive education programmes and traffic-light labelling on food, we are working with industry to reformulate food recipes, we are putting calories on menus to signal healthy choices and we are ensuring a healthy start to life through nutritionally balanced school recipes. Furthermore, the sugary drinks tax levy has had a huge impact, with a 47% decrease in sugar.

Finally, the introduction of restrictions on product placement has had a high impact on the look and feel of our supermarkets. It is early days but a year-on-year change in the consumption of these types of products—two months into this, I guess—shows an 8% fall in sugar content, a 5.7% fall in salt consumption and a 6.4% fall in fat, which shows that these restrictions on product placement are working. Furthermore, analysts calculate that the steps we have taken here will account for 96% of the reductions in calorific intake. I repeat: the actions that we have taken, thanks in large part to all of us in the House, account for 96% of the projected reduction in calories. The early signs from the evidence that I gave show me that those actions are working.

I turn to the 4% and the thing we have not done, the subject of the regret Motion tonight: the delay to the ban on promoting foods high in fat, sugar and salt—the so-called BOGOF, or “buy one, get one free”, promotions. I emphasise that this is just a delay to the ban to give people time to adjust. I am delighted to say that Tesco and Sainsbury’s, accounting for 42% of the market, have already voluntarily banned BOGOFs of these types of food products. I am confident that the rest of the market will voluntarily follow, whether they are supermarkets following the lead of Tesco and Sainsbury’s or food companies reformulating their recipes to reduce fat, sugar and salt to avoid the so-called BOGOF ban.

By working with the food industry, we have taken action to address 96% of the problem, and we are working collaboratively with industry to implement the remaining 4%. Those figures probably give the best answer for the delay, though I concede that maybe I say that as a data analyst—and it was before my time.

I agree with the noble Baronesses, Lady Merron and Lady Brinton, that the so-called sleight of hand clearly was not great. I am pleased to take that from this debate, and I commit to doing better for as long as I am here.

The noble Baroness, Lady Walmsley, asked about the benefits challenge. The action that we have taken is focused on 96% of the forecast decrease in calorific intake, which again shows that we have acted where the benefits are most likely to accrue. My rough maths says that, if 42% of the market—Sainsbury’s and Tesco—voluntarily introduce this, we are now looking at addressing about 98% of the calorific intake that we had forecast to reduce. By any measure, that shows very strong analytical evidence of good reasons for doing so, and for giving people time to adjust and make the other changes.

On the 21-day rule, a consultation on this instrument was conducted between 3 and 17 August 2022. This was a short consultation shared with key stakeholders, including trade industry bodies and organisations, non-governmental organisations and enforcement officers. We sought views on the proposed text of the instrument. A summary of the outcome of the consultation was provided in the published Explanatory Memorandum. We explained that the consultation received 11 responses, including from organisations that represent over 50 health organisations, and industry trade bodies that represent manufacturers and retailers. All proposed changes suggested as part of the consultation were considered in the light of ensuring that this instrument served the intended purpose of delaying the implementation of the volume price promotion restrictions by 12 months.

[Baroness Brinton (LD)]

My question was whether the detail of the consultation responses would be published in the future. I appreciate that the Minister may not be able to answer that now, but even though there may not have been responses from many people—and it sounds as though there were not—it would still be useful for us to see that to do our job. Can he take that back? It is the normal convention that the results of public consultations are published; if not word by word, there is certainly more of a summary provided than there was in the Explanatory Memorandum.

Invasive Group A Streptococcus and Scarlet Fever

Debate between Baroness Brinton and Lord Markham

Monday 5th December 2022 Lords Chamber

[Baroness Brinton]

To ask His Majesty’s Government what assessment they have made of their guidance to doctors and to parents in light of the increase in Strep A, iGAS and Scarlet Fever cases.

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

The UK Health Security Agency has declared a national standard incident to co-ordinate the public health response. It is working with schools and GPs where there are outbreaks to provide information on scarlet fever and iGAS. A rapid surveillance report and communications to the health system have been published to ensure heightened awareness among front-line clinicians. We are also putting out key messages for parents to understand the trigger points for urgent referrals of children with more serious cases.

[Baroness Brinton (LD)]

My Lords, UKHSA has reported today that, in the last 10 weeks, it has received 4,622 notifications of scarlet fever, compared to an average of 1,200 for the same period over the previous five years—that is more than three times. Parents with very sick children report being turned away from hospitals or GPs not prescribing antibiotics. Local directors of public health are talking to schools and GPs, but can I ask the Minister what else can be done to ensure that all cases of potential strep A and scarlet fever are tested for, and treated as appropriate at the earliest moment, to avoid serious illness and death?

[Lord Markham (Con)]

I thank the noble Baroness for bringing this important issue before us today. To give context and answer the point, there were about 850 cases in the latest week, compared with about 186 in previous years. Generally, in peak years such as 2018, we had as many as 2,000 cases per week. We are not at those levels at the moment, but we seem to be seeing an earlier season: we normally expect levels to be higher in spring. At the same time, it is essential that we are alert. We have given instructions to doctors that they should proactively prescribe penicillin where necessary, as it is the best line of defence, and that they should be working with local health protection teams to look at whether to sometimes use antibiotics on a prophylactic basis where there is a spread in primary schools, which we know are the primary vector.

NHS Dental Contract

Debate between Baroness Brinton and Lord Markham

Thursday 1st December 2022 Lords Chamber

[Lord Markham (Con)]

I agree, and I understand the problem. I also agree that we need to look at a broad range of measures. I was delighted that we passed the statutory instruments on water fluoridation recently, and we should look at new ideas. I was also delighted to see oral health advice included in the new family hubs being set up. We are willing to look at measures that work elsewhere as well, such as free toothbrushes in Scotland.

[Baroness Brinton (LD)]

My Lords, the British Dental Association has proposed four simple emergency measures—changes which could be made to the dental contract that would make an enormous difference. The Minister referred to the regulations. Regulations in respect of the workforce will make significant changes too. They were in Forthcoming Business and then removed. When will they be heard in this House? This reform is urgently needed.

[Lord Markham (Con)]

As mentioned, the new package of measures, which is all about encouraging dentists into the NHS space, will be brought forward next year. The workforce plan is now under way. However, central to all this is not the budget but making sure that it is fully utilised. As the noble Baroness said, that will happen by having more NHS dentists. We currently have 3,500 in training, which is working towards that, but, clearly, we need to work further.

Covid-19: PPE Procurement

Debate between Baroness Brinton and Lord Markham

Wednesday 30th November 2022 Lords Chamber

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

I thank the noble Baroness, and I commit to write with the precise figures. To put it into context, we should remember that this was at a time when unprecedented action was required. Of the 38 billion PPE items ordered, 98% were delivered and just 3% were unfit for purpose. Within that, clearly there is action that needs to be worked on and action is being taken to pursue those damages. I will put those in writing, so that the noble Baroness can understand them all. As I say, it is good if noble Lords recall that the priority at the time was clearly getting equipment to help protect and save lives, and that was what was done. Were mistakes made? Of course. Are we seeking to address those now by going back to take action against those people? Yes, of course we are, but we need to keep it in the context that the undoubted priority was to buy PPE and protect lives.

[Baroness Brinton (LD)]

My Lords, from these Benches we echo the questions that the noble Baroness the Leader of the Opposition has asked. We note that at least 71 PPE deals were awarded to firms, of which at least 46 were put into the VIP lanes by Conservative Ministers and officials during the Covid pandemic, as well as by some MPs and Peers, before a formal eight- stage due diligence and checking process was put in place. There were also deals made not for PPE during that period, including for testing and some non-health ones.

I think we all agree that the wastage and profiteering should never happen again, but we warned from these Benches, as did other Members across the House, in the early stages of the pandemic that all the right contracting arrangements, protocols and scrutiny needed to continue. The Minister has said that the pandemic posed problems, so will he push for a separate, independent-led inquiry able to examine the whole procurement process, including the VIP lanes, and analyse forensically the bids, profits, wastage and catalogue of links to Ministers, MPs, Peers and others who had influence on them?

[Lord Markham (Con)]

I thank the noble Baroness. My understanding is that there have already been three NAO reports and three PAC reports on this, so it has been covered in depth. I think people have accepted that mistakes were made and that the high-priority lane, so to speak, should not have been on the basis of referrals but more burden of proof should have been put on the applicants, so we could get more information and sift it that way. Again, to put it all into context, there were 19,000 applicants at the time. This was led by officials, and they put the high-priority lane in place to try to sift those. Also, of the 430 that went into the high-priority lane, only 13% actually ended up in contracts. Are there lessons to learn from this? Of course, but the NAO and PAC reports have outlined those lessons.

Care Homes: Severely Disabled People

Debate between Baroness Brinton and Lord Markham

Wednesday 30th November 2022 Lords Chamber

[Baroness Brinton (LD)]

My Lords, the Minister just referred to mental health funding and referred earlier to the increased funding to cover delayed discharges and get more people coming out of hospital into social care. Neither of those affects severely disabled adults; funding for them from central government to local government has not been increased. I repeat the question of the noble Baroness, Lady Pitkeathley: does the Minister think that the provision and arrangements for this particular group of people are broken?

[Lord Markham (Con)]

No—it is for local authorities to decide how best to use the funding we have put in place, as I said. That means looking at the needs of local people and how best they will put this in place. The 22% increase in funding can be channelled to exactly these types of places and people if a local authority believes that that is in the best interest.

Adult Social Care

Debate between Baroness Brinton and Lord Markham

Thursday 24th November 2022 Lords Chamber

[Lord Markham (Con)]

Obviously, the central grant is raised through general taxation and so is distributed and raised in the way we all know. We can all have a question as to what the balance should be between the two. At the same time, I think we all believe in localism and we all believe, as part of that, that local authorities are the best placed to make decisions. That means that they have some of those fundraising abilities, so they can put more funds into the area where it is required. Whether we have the balance right is something we need to keep under control, but right now the most pressing thing is putting in more money for next year and the year after, and I am very glad—and I hope the whole House will welcome—that we have committed to do that. We put our money where our mouth is to create 200,000 new care packages.

[Baroness Brinton (LD)]

My Lords, surely the most pressing thing is the emergency winter fund to help remove and reduce delayed discharges this year. The Secretary of State for Health has said that he wants to reduce the bureaucracy, so why are the rules for accessing the emergency winter fund so complex that the Health Service Journal is full of local authority and senior NHS staff saying that they do not understand why the Government are insisting on this bureaucracy?

[Lord Markham (Con)]

Believe me, I am no fan of complexity. At the same time, I want to make sure, as I am sure we all do, that the funding goes to the places of most need and is really being spent on the areas that it is being spent on. Having said that, I will take away those comments at face value and will look into the complexity because, clearly, that is in no one’s interest.

NHS: Waiting Lists and Increased Spending

Debate between Baroness Brinton and Lord Markham

Tuesday 22nd November 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord. For the record, there are 29,000 extra nurses since 2019-20, so we are well on course for the 50,000 increase. At the same time, we do need to recruit from overseas, and that is very much part of the plan. Again, this will go into the workforce strategy, but I completely agree that we should be looking to recruit from around the world, which we are. I am delighted that we are adding more and more people to the essential workers list, so to speak, to enable us to do that, because we all know that the workforce plan will show that we need to recruit people and retain them.

[Baroness Brinton (LD)]

My Lords, the last time the figure of 92% of patients being seen within 18 weeks was achieved was in 2016. Since then, the numbers who are waiting have doubled: it is now 7.1 million. What does the Minister say to the 16 year-old in Shrewsbury who has just been told that he has to wait nearly three years for a first appointment at his local hospital? The hospital says that it has recruitment problems. When will we see the details of this workforce plan, particularly for rural areas?

[Lord Markham (Con)]

I thank the noble Baroness. As I say, we have committed to that workforce plan, and it will be detailed. We will look at every place in every part of the country because we understand that that is needed, and it is part of the critical plan to get on top of the 7.1 million waiting list. As I think we have accepted, it is not a quick win; it will get higher before it gets lower again. Clearly, however, we need to get on top of it, and we are focused on it. It is very much about the plan and the new spending plans that we put in place to address it.

NHS Waiting Times

Debate between Baroness Brinton and Lord Markham

Tuesday 22nd November 2022 Lords Chamber

[Lord Markham (Con)]

I agree with the noble Lord that cardiovascular is one important area in which, over the last few years, patients have not received the number of check-ups that we want, so it is an area on which we want to focus—not just through checks in GP centres but in the community. We all know that it is very easy to take blood pressure and have blood pressure machines. As a team, we are looking at precisely those kinds of measures to make sure that we can get the preventive screening in up front, so we can identify these people before problems occur.

[Baroness Brinton (LD)]

The Minister referred to the worst-performing hospitals and ambulance trusts, but news from the Health Service Journal today has shown that the longest waiting times are mainly in rural, deprived areas, with an elderly population that is much higher than in the rest of the country. Can the Minister say what special resources will be provided for those areas—rather than just using words like “worst”, which punish them unnecessarily?

[Lord Markham (Con)]

I thank the noble Baroness. If I have used a poor choice of words, I apologise. What we are looking at is identifying the areas where we most need to focus resources to solve wait times. That might be because it is a rural area or it might be, candidly, because it is not performing so well. The point that I was trying to make is that there is targeted support. We spent £150 million on ambulance performance and new facilities last year, and it is something that we will continue to do if those rural areas and other areas need the spend.

Social Care Sector: Staff Shortages

Debate between Baroness Brinton and Lord Markham

Monday 21st November 2022 Lords Chamber

[Lord Markham (Con)]

I agree and have often made the point that solving this part is key to the flow and to getting people through discharge quickly, which has a knock-on impact on A&E and ambulance wait times. That is why I was delighted to hear the Chancellor recognise this specifically and mention £2.8 billion of funding in 2023-24, which will account for 200,000 new care packages in this space, as well as £4.7 billion in 2024-25 to resolve the exact problems that the noble Baroness brings up.

[Baroness Brinton (LD)]

My Lords, the Minister has now referred three times to the money that the Chancellor has said he will invest in social care from April next year. But the crisis is now and the Government’s own plan for patients says this must be resolved and there must be more social care workers immediately to help with the pressure on hospitals. What will the Government do over the next six months to ensure that there are more workers and help to relieve the problems with both discharges and A&E?

[Lord Markham (Con)]

I thank the noble Baroness. In the past few days, local authorities have been notified of the £500 million discharge fund. That funding will go out in December and January, so it is very much going out there. It is very much designed to address the issues of discharge, creating new places and helping to recruit.

Health: Pancreatic Cancer

Debate between Baroness Brinton and Lord Markham

Monday 21st November 2022 Lords Chamber

[Lord Markham (Con)]

We are very clear on the need for speed in cancer treatment; that is one target that will not change, because we know its importance in all this. With pancreatic cancer, we are where we were with prostate cancer about 10 or 15 years ago, and I am glad to see that we have made great strides on that with initiatives such as the Movember campaign and the action on that. Candidly, we are not where we need to be on pancreatic cancer, and we need to adopt those sorts of awareness campaigns, as well as fast action on screening, to improve our performance.

[Baroness Brinton (LD)]

My Lords, 30 years ago cervical screening was developed and introduced; prior to that, cancer of the cervix was as impossible to detect and to find as pancreatic cancer. Will the Minister say whether research will be provided to ensure that screening for pancreatic cancer can be introduced as soon as it is confirmed, because screening was the real game-changer for cervical cancer?

[Lord Markham (Con)]

I agree that screening programmes are, without doubt, the way forward. I mentioned earlier the 73 different pancreatic cancer research studies, of which screening is a very important element, so I totally agree that that should be our top priority.

GPs: Anti-depressants and Alcohol

Debate between Baroness Brinton and Lord Markham

Wednesday 16th November 2022 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend and agree. It should always be down to the GP, working closely with the patient, to decide the best form of treatment, whether talking therapies or drugs, and that is why we are quite clear in the guidance that first and foremost it has to be the local clinician who makes the decision.

[Baroness Brinton (LD)]

My Lords, the noble Baroness, Lady Blackwood, made the very important point that there are differing results with different anti-depressants and different reasons for depression. A 2007 study showed that the use of anti-depressants reduced alcohol intake in those who drank a lot while they were very depressed. However, a 2011 study showed that SSRIs and alcohol often produced disinhibition. The one thing those two studies both showed was that where the physician was able to talk to the patient and explain, the patient reduced their alcohol. When will more time be available for GPs to talk these things through properly with patients?

[Lord Markham (Con)]

We all agree that GPs are best placed to do this. I think the House is aware of our commitment to increase the number of GP appointments by 50 million, and we are well on course to meet that target. At the same time, we have the independent review of drugs by Dame Carol Black, which looks at mental health, drugs and drink and how they are closely related, to make sure we have the best advice. First and foremost, I totally agree that the best-placed person is a GP talking to their patient.

NHS: Nurses

Debate between Baroness Brinton and Lord Markham

Tuesday 1st November 2022 Lords Chamber

[Lord Markham (Con)]

I totally agree. I am proud to say that we have 72,000 nurses and 9,000 midwives in training at the moment. There is no cap on the number of people who can join the programme, so that is very much the spirit of what we are trying to do. Key to that was a £5,000 grant each year for nurses to attract them into the profession. It is working.

[Baroness Brinton (LD)]

My Lords, the comment about the figures by the noble Lord, Lord Clark, was entirely accurate. The Minister gave us the truth, which is that the net increase is 9,000, whereas the manifesto promise of 2019 was for 50,000 extra. Does this explain why the Royal College of Nursing reported last week that 75% of shifts did not have the planned number of nurses? When will the NHS see 50,000 extra, on top of the 2019 figures?

[Lord Markham (Con)]

To be very clear, today, there are 29,000 extra, over the 2019 figures. That is more than half way towards the figure of 50,000. I will quite happily write to noble Lords so that they can see the figures clearly in black and white, but I can assure the House that we are talking about increases in nurse numbers. We have achieved a 29,000 increase on the 2019 levels.

Nursing: Recruitment

Debate between Baroness Brinton and Lord Markham

Wednesday 26th October 2022 Lords Chamber

[Lord Markham (Con)]

I would hope and trust that such a respected person would see this position as the vocation that it is and the support that they give. We accept that there are some agency workers being used in this space, because obviously, in terms of safety, we need to make sure we cover that number of people. The whole recruitment plan—which, again, we are on target to achieve—is all about making sure we have enough nurses so that we do not have to use agency workers.

[Baroness Brinton (LD)]

My Lords, following on from the question from the noble Baroness, Lady Harding, can I ask the Minister if there are plans to increase the number of student nursing places at universities and student apprenticeships over at least the next decade? While there is a short-term crisis, there is also a longer-term sustainability crisis, especially with current demographics.

[Lord Markham (Con)]

The noble Baroness is correct that this is a long-term pipeline. We have 72,000 nurses in training at the moment. To be clear, there is no cap at all on student places. We are seeking to increase them as much as possible, and we put a £5,000-a-year grant in so that trainee nurses could enjoy superior levels of financial support than other students. The fact that we have a pipeline of 72,000 shows that this is working, but that pipeline is not capped, so if we can get more people in, we definitely want to do that.

Maternity and Neonatal Services

Debate between Baroness Brinton and Lord Markham

Tuesday 25th October 2022 Lords Chamber

[Lord Markham (Con)]

I agree. We are putting the money into the training programmes. We have actually put £95 million on top of the £127 million investment into this area. As ever though, what is most important is outcomes not investment. Alongside the tragic instances we have seen, we have seen a reduction in stillbirth of 19% since 2010, a reduction in neonatal mortality over 24 weeks of 36%, and a reduction in maternal mortality of 17%. Alongside these tragic findings of individual trusts, we have an improving picture of maternity care overall.

[Baroness Brinton (LD)]

My Lords, in yesterday’s Statement on Dr Kirkup’s report, the Minister told us that 23 hospitals are in maternity safety support programmes—special measures—and that, while four are coming out, another 10 are due to go in. Can he assure the House that extra resources, including extra supervision, will be there to ensure that mothers and babies in those hospitals are absolutely safe?

[Lord Markham (Con)]

Yes. Resourcing the special measures programme—for want of a better name—is vital to all of us. I am pleased to see in the case of East Kent that, of the 67 special measures recommended, it has now passed 65 and the two remaining ones will be completed by the end of November.

East Kent Maternity Services: Independent Investigation

Debate between Baroness Brinton and Lord Markham

Monday 24th October 2022 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I want to start from these Benches by sending my deepest sympathies to the bereaved families and to say that we admire the parents for their campaigns over many years against the dreadful treatment by the east Kent hospitals trust for more than a decade. I echo the thanks and gratitude from the noble Baroness, Lady Merron, to Dr Kirkup and his team. Once again, he has risen to the challenge of providing a very clear picture of what has gone wrong at a hospital trust.

The trust failed to read the signals over an 11-year period. The Kirkup report puts this very bluntly and is exceptional in the way it uses evidence. Yes, there is the evidence of the voices of mothers and their families and the evidence from staff, but equally important is the use of data, especially the CESDI data from the Confidential Enquiry into Stillbirths and Deaths in Infancy. In the section headed “What happened to women and babies”, paragraph 1.16 says that

“we have not found that a single clinical shortcoming explains the outcomes. Nor should the pattern of repeated poor outcomes be attributed to individual clinical error, although clearly a failure to learn in the aftermath of obvious safety incidents has contributed to this repetition.”

This short paragraph encapsulates how failings have become cultural in the trust. Paragraph 1.19 says that

“we have found that the origins of the harm we have identified and set out in this Report lie in failures of teamworking, professionalism, compassion and listening.”

It is really worrying to have the report from the CQC of a few days ago, which echoed these exact points but more broadly across maternity services in England.

As has been mentioned, there is a wider problem. We know that. The reports on Morecambe Bay, Shrewsbury, Telford and now Nottingham, where Ms Ockenden is now working, show that systemic and cultural failures, especially with the complexity of regulators, are creating real problems. There is the idea that clinical staff will allow favouritism and the opposite of growing and supporting staff, while letting things fester and not caring to drag patients into their concerns.

Can the Minister outline the timescale for the independent working group report referred to in the Statement? The creation of the group is welcome; its main remit is to advise the maternity transformation programme in England—but by when? Is the work of the group revealing that other maternity services have problems, even if we do not know how severe they are or if they are as severe as East Kent?

In the section on the actions of the regulators on page 9, at paragraph 1.50, Dr Kirkup identified that

“the Trust was faced with a bewildering array of regulatory and supervisory bodies, but the system as a whole failed to identify the shortcomings”.

It is good that it is reported that NHS England and Innovation sought to bring about improvements, but every other trust is also facing that same complexity of different regulators. Are the Government looking at the roles of regulators and how their competing demands can be streamlined to avoid this problem?

The Commons Minister said that she would review all the recommendations and provide a full response once she has had time to consider it. I think we all appreciate that the NHS has a very large workload at the moment, but can the Minister say roughly what timescale we are looking at?

One key problem in many maternity services is with the workforce, especially midwives. Although NHS England made an exceptional grant in March of £127 million as a boost for

“safer and more personalised care”,

can the Minister say—I echo the point made by the noble Baroness, Lady Merron, which he will not be surprised to hear—where the workforce plan is for the next decade for maternity services? A year’s extra money is not going to help with training the midwives of the future and ensuring that maternity units are professionally and adequately staffed.

Dr Kirkup also criticised NHS England for firing chairs and chief execs too frequently, indulging in a blame game that reinforced the culture happening inside East Kent. It is no longer good enough to say, once again, that this must never happen again. This is the third devastating report in under seven years, and another is now being prepared in Nottingham. What will the Government do in the next three months to ensure that further appalling practice will be uncovered and dealt with immediately?

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

Dr Kirkup’s report, published last week, contains some stark and upsetting findings. As mentioned, the report examined more than 200 births in east Kent between 2009 and 2020 and found that, had care been given at nationally recognised standards, 45 babies might not have lost their lives and many more families might not have experienced such distress at what should have been a time of joy. He also found a toxic culture in the trust, with a disturbing lack of kindness and compassion, and victims’ families even blamed for their devastating losses. The report underlines that the NHS needs to be better at identifying poorly performing units and at giving care with compassion and kindness, as well as team working with a common purpose and responding to challenge with honesty. I take all the findings and areas of concern extremely seriously.

I want to thank Dr Kirkup and his team; his experience has been invaluable and I know that his approach to putting families first has been welcomed. I also know that hearing the accounts of families has been a harrowing experience at times, yet, as he said, it is difficult to imagine just how hard it was for the families as they relived some of their darkest days. I am profoundly sorry to all the families who have suffered and continue to suffer from these tragedies. I pay tribute to the families who have come forward to assist the review; it is thanks to the tireless efforts, courage and determination of families in east Kent that we have been able to shine a light on maternity failings in East Kent Hospitals University NHS Foundation Trust.

Before directly addressing the recommendations, I want to put the tragic findings in the context of an improving service overall. Since 2010, stillbirths have declined by 19%, neonatal mortality over 24 weeks by 36% and maternal mortality by 17%. That is not to undermine the seriousness of the circumstances.

On the recommendations, I echo the comments already made. I know that it is top of Minister Johnson’s agenda in making sure that there are speedy, but also measured, responses. As part of that, I want to touch on some of the points made, particularly by the noble Baroness, Lady Brinton, about the use of data as part of the early warning indicators. I think we all agree that that is key to this area. This is exactly the work that the national maternity safety surveillance and concerns group was set up for: to make sure that there is methodical oversight in this area. It is in its power to recommend that people are put into the maternity safety support programme; 23 hospitals are currently in it and it is recommended that four have progressed enough to come out again, but another 10 have been identified that may need to be put into it.

It depends on how you look at it, and whether you take solace in these trusts being identified, or whether you are concerned about the number out there. Personally—I hope I echo the comments of all of us in the House—I believe it is much better that we identify them and deal with it, however uncomfortable that might be in the meantime. The lesson we have learned from these unfortunate cases, as recognised by the noble Baroness, Lady Merron, is that we have seen a failure of leadership and accountability here.

I am glad to see that, in responding, the trusts have been unequivocal in accepting unreservedly the failings on their part and have apologised wholeheartedly. As we know in these times, when dealing with these situations the first thing that has to happen is recognising that the problem exists.

I will need to write to the noble Baroness about the extra investment and how that spend is being allocated. It is very much on the agenda of Minister Johnson to look at that and at the improvements that have been made.

On the shortage of midwives, the picture as I understand it right now is that we have had a stable number of midwives—around 21,500—over the last four years. Within that, we do have the target, as mentioned, to increase it by 1,200, and that is part of the £95 million investment towards this. I accept that doing that is more than a one-year plan and needs to be part of a much larger picture.

I welcome the CQC focus on this area. It is something that we all agree needs to be an area of focus; if that makes for some uncomfortable findings then so be it. It is only when we understand those areas that we can really get on and make sure that we deal with them. I hope that we are looking to move on in these areas.

The Maternity Safety Support Programme is a force for good, and I am glad to say that, in East Kent, they have been working on the improvement plan as part of the support programme, and 65 of the 67 actions have now been completed, with the final two to be completed by the end of November. That is not to be complacent: that work should have been done a lot earlier, but I am glad to see it is being worked on now.

I have tried in these answers to respond to the questions, but I will follow up in any areas where I have not. In summary, I again thank and pay tribute to those families whose tireless determination to find the trust in telling their stories has brought us to this important point. The Government will be reviewing and considering all the recommendations from the report. We will listen, learn and act to ensure that no other family has to ever experience the same pain in the future.

Menopause

Debate between Baroness Brinton and Lord Markham

Tuesday 18th October 2022 Lords Chamber

[Lord Markham (Con)]

I agree that we want to make sure that there is national access. I understand that, whereas we had 30% take-up as long ago as the 1990s, with the incorrect scare around some of the causes since then, that rate is only about 15% today. There is clearly a need to increase awareness and the ability for people to receive treatment.

I am aware of the issue around formularies; I have heard that they believe that it can be resolved. I will take it away and write to the noble Lord to make sure that it is properly dealt with.

[Baroness Brinton (LD)]

My Lords, in the initial Answer that he gave to the noble Baroness, Lady Thornton, the Minister said that access to support during the menopause is vital. Does he therefore agree that, for health and economic reasons, the menopause should be added to the quality and outcomes framework to encourage doctors to investigate and treat patients who present with symptoms associated with the menopause?

[Lord Markham (Con)]

Yes. The noble Baroness will be aware that only 55% of women showing symptoms felt able to talk to GPs about it and another 30% felt that there were delays in diagnosis. Clearly, more work needs to be done. I know that it is part of the core curriculum—that is not the proper phrasing; please excuse me. The whole point of appointing a women’s health ambassador is to make sure that every avenue and channel is used to maximise access, whether at the level of GPs or as part of the education or formularies.

Edenfield Centre: Treatment of Patients

Debate between Baroness Brinton and Lord Markham

Thursday 13th October 2022 Lords Chamber

[Lord Markham (Con)]

My Lords, I completely agree with the question in making sure that this does not happen or is not happening elsewhere. We have been in touch with the CQC, as one would expect, which has made significant changes to protect people in specialist services, people with learning difficulties and autistic people in mental health patient settings. These include making it mandatory for all staff to undertake specialist training before inspecting these settings and introducing a new single assessment framework, which would allow more frequent inspections of the worst-performing providers. The CQC is doing a number of things around that framework, including six key evidence categories, which set out the type of evidence that will be collected. These categories are: people’s experiences; feedback from staff and leaders; observation of care; feedback from partners; processes; and outcome of care. The new assessment means that more targeted time can be spent on site, taking longer to talk to people using services and making every minute count.

Those are some of the standing replies. On a personal level, there clearly need to be questions about how the CQC can go in on an ad hoc basis because, when an investigation or inspection has been announced, a place has an opportunity to put things right. One area of my interest—and I do not claim to be an expert on this—is how we can pick up those ad hoc cases quickly. Clearly, we should not be expecting people such as “Panorama” to be doing that; we want to pick those up ourselves.

[Baroness Brinton (LD)]

My Lords, despite the Minister just commenting on the way it is possible for some organisations to game-play inspections, it is noticeable that the CQC inspection of 2019, published in 2020, was “Good”, despite the finding that,

“In acute wards … records did not show that supervision of staff in the service was effective”,


which was a “breach of regulation”. This is really concerning.

Reform of the Mental Health Act is long overdue. It was created over 40 years ago, and many noble Lords have been fighting for that to happen. It was good to hear in the Queen’s Speech that there will be a draft mental health Bill, but there are real concerns that it is about to be shelved. My honourable friend Munira Wilson MP asked the Minister responding to this Urgent Question whether it was going to come forward. She did not get a straight answer. I ask the Minister whether Parliament, and this House in particular, will see the mental health Bill this Session.

[Lord Markham (Con)]

My Lords, like the noble Baroness, I am aware that the White Paper is in draft, but I have not seen its latest status. I know it will address some of the issues that we all agree are not to our satisfaction. At the moment, I can undertake only to understand the position of the White Paper and come back to her, if I may.

Skills for Care Report

Debate between Baroness Brinton and Lord Markham

Thursday 13th October 2022 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is correct that a number of people are on zero-hours contracts. As I am sure she is aware, their employment is through a number of agencies and local authorities, but it is an issue in a number of places and goes to the wider conversation about how we make this sector an attractive place to work. Earlier, my colleague mentioned the Skills for Care working group, which found that a significant proportion of all employers—around 20%—have a turnover rate of only around 10% versus the 29% average. So, clearly there are areas where certain employers do a fantastic job of not only recruiting but retaining, and making the sector an attractive place to work. I believe that the whole emphasis of the conversation we are having now is exactly about how to make this sector an attractive place to work because, as we all know, it is a vital part of our care and health system.

[Baroness Brinton (LD)]

My Lords, the Minister referred to the £500 million investment in social care but this is only his fourth day in the job. Many people in your Lordships’ House know that that money is for winter pressures and was omitted from the budget for the NHS and social care at the beginning of the year. Without it, social care would be in even deeper trouble than it is now. The noble Baroness, Lady Chakrabarti, made an extremely important point about zero-hours contracts. The problem of staff working in domiciliary care is that there is not enough money even to allow them to be paid for travelling between clients. There is a real shortage of money. This is a group of dedicated workers who are being treated very badly. Will the Minister undertake to look at this particular problem?

[Lord Markham (Con)]

Any industry with the sort of turnover rate that was mentioned earlier demonstrates that there is a need to look further into it, so I absolutely accept the premise of the question and, as I mentioned before, the importance of this area. As I have said before, this is also about looking at areas of best practice because we can always look to spend more money but we know that there are limitations on the public purse. I would not be doing my job if I did not try to see where we can learn from good employers, employ those practices and see whether we can spread them wider so that everyone has the same level.

The other point that I made previously was about opening this up. We know that our healthcare system is founded on good workers from all around the world. They can be a bedrock. I am delighted that we are looking into that area now. We are starting to see good numbers of people coming in from abroad. It is an excellent level of entry into our country. There are a number of things we can do to improve the situation but I completely agree with the noble Baroness on the importance of tackling it.

NHS: Winter Challenges

Debate between Baroness Brinton and Lord Markham

Monday 10th October 2022 Lords Chamber

[Lord Markham (Con)]

We are facing unprecedented challenges, as the noble Lord states. We also have unprecedented investment, a plan for patients which is focused on the key elements that will make a difference—ambulances, the backlog, care, and doctors and dentists—and a group of Ministers who are focused on making a difference where it really counts. We have record investment, and a record number of doctors, nurses and people ready to face those challenges.

[Baroness Brinton (LD)]

My Lords, the plan for patients refers to the expansion of virtual wards in hospitals this winter. My local hospital, Watford General, pioneered this in 2020, but it put considerable pressure on GPs, community nurses and social care. Will there be extra funding for those areas that have virtual hospitals this winter to make that work?

[Lord Markham (Con)]

I had the pleasure of visiting Watford General just a week ago, and I saw the virtual wards first hand, so I agree on the excellence we saw there. To give the House a sense of that, the wards have reduced 90-day readmission rates from around 45% to 7%. When I talk about performance improvements, those are precisely the sorts of areas in which I wish to see investment made, so that we can roll that out across the NHS. It is in those areas that we can make a real difference.

Health and Social Care Update

Debate between Baroness Brinton and Lord Markham

Monday 10th October 2022 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I echo the comments of the noble Baroness, Lady Merron, about the nature of the plan. It is full of warm words and aspiration, light on detail, especially on funding, and seems to disregard the reality on the ground at the moment. I also echo her concern about the rumours of the White Paper on inequalities being shelved. That is really important. Many of us spent a lot of time in your Lordships’ House during Covid hearing about the problems of people with Covid, particularly those from ethnic minorities and deprived backgrounds. There is a lot of data to say that those people have really struggled.

The workforce plan is something else that from these Benches we asked for consistently long before work started on the Health and Care Act, but absolutely consistently since then. Turning to the plan itself, on ambulances, the announcement in July was welcome but three months on—and this was an emergency announcement—it feels as if nothing has changed. The number of delayed discharges remains stubbornly high, and we know that there is a new wave of Covid rising: the ZOE study figures today suggest around 230,000 new daily cases and 2.2 million active cases. That is going to continue to rise: all the medical experts in this area say we are now definitely at the beginning of this wave.

B stands for backlogs, and I am afraid that that is not really improving either. Although it is good to see that the two-year waiting list is reducing, the under-two year list continues to grow: 6.8 million at the end of last month. The plan talks about patients being redirected from hospitals, but our primary care system—GPs, community nurses, physios, speech and language therapists in the community, and especially social care—is already at breaking point. It is good to be offering Covid boosters, but why are under-12s excluded unless they are immunocompromised? Children at schools without proper ventilation were drivers of the last two waves of Covid, and it just seems ridiculous that they have not been included, because that would be an easy win.

In my question earlier today, I asked the Minister about care and particularly about virtual hospitals. It is good that the plan is picking up on some excellence in the NHS, and I am very proud of my local hospital for doing it, but the Minister did not actually answer my question, which was: given that this work of virtual hospitals creates more work for GPs, community nurses, physiotherapists in the community that in the past would have been done in hospitals, will there be extra resources for primary care? Without it, primary care is already at breaking point; they cannot just magic extra time and energy to do it.

The section about GPs is admirable in spirit, but doctors have repeatedly said that their main problem is a lack of doctors. We also know from the BMA survey back in the spring that GPs’ workload has increased by 30% on clinical administration alone. It is not Covid; it is mainly to do with digitisation and complex systems. It is all very well talking about getting administrators in to do it, but these are administrative tasks that doctors have to do themselves. Unfortunately, it is causing a problem, and I do not see any solution in the plan.

Whenever Ministers talk about doctors, they talk about the highest number ever—indeed, the Minister did so earlier—but there are two problems with that. There are more patients than ever, and that is never reflected in any comments by Ministers. Government funding for doctor training has not been sustained. This year, far too many—hundreds, just under 1,000—newly qualified doctors, fresh out of university, could not get training places because there was no funding for hospitals to be able to do it. The exodus of NHS staff was reported in the Times just last Saturday. The net change is not positive now; it is negative.

On dentists, it is very good news about the simplification of government rules regarding overseas dentists qualifying to work, and we look forward to seeing the regulation shortly, but the main problem is the drastic need to overhaul the government contract. While the Statement says first steps are being taken, I ask the Minister when the major work funding for it will be concluded. Will he also tell your Lordships’ House what provision there will be for the 3 million people who are either immunosuppressed or immunocompromised—for example, because of blood cancer or because of strong medication which has to suppress their immune systems? The government advice on the web page still says that people in this group should not mix with people who are not fully vaccinated or may possibly be brewing Covid, but a year ago all support to this group was ended. Along with other people in this group, because I am one of them, I am about to have my sixth Covid jab, but I have no idea how long I am going to be protected for—that is why I wear a mask a lot of the time in the Chamber. Half a million of the most severely immunocompromised people cannot make any antibodies in response to the vaccine. They were promised antiviral medication or Evusheld. Five million doses of antivirals were ordered, but only 50,000 were handed out, and the Government have just refused to allow Evusheld to be used. What will the Minister do to ensure that this group of people will be protected?

Finally, the Health Service Journal has said that two out of three integrated care systems have fallen off track on their financial plans because of the impact of inflation, Covid cases not being funded this financial year and higher spending on agency staff. This plan will not work if the new integrated care systems cannot work. It is vital that the Minister tells us what plans there are to make sure that ICSs will be supported properly.

The plan for patients has many warm words for delivery. I know this is something the Minister cares greatly for, and we will support him, but the words on their own will not do it. Our NHS and care sector are on their knees already. The Nuffield Trust report says that data shows that even without the pandemic, the backlog would have been well over 5 million. It says the NHS was already stretched. I look forward to hearing the Minister explain how the NHS and care sector will be able to deliver on this plan in their current state.

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

I thank noble Lords again for the warm welcome they have all given me today. I feel like an old hand already—I wish. Before I begin, I draw attention to my declaration of interests in the register as a new boy here, so to speak.

I am grateful to noble Lords for the interest they have shown in our plan for patients and will try to address the questions raised. As my right honourable friend the Secretary of State said in the other place, these measures across a number of important areas are the start, not the end, of our ambitions for health and care. They will help us to manage the pressures that health and care will face this winter and next, and they will improve these vital services for the long term.

First, I want to set down that there is record investment going into this area. In fact, we are spending about 12% of our GDP, which is the highest level ever. To answer the noble Baroness’s question directly, the 200,000 figure I gave was for FTEs since 2010. That means 200,000 more full-time equivalent employees in the health services than in 2010, so the investment is there, and we have a plan, set out in the plan for patients, to increase supply by 30% in terms of electives. I have seen some excellent examples of that already in Chase Farm Hospital, one of the new hospitals.

As I think I mentioned earlier, the new hospital build programme is one of the areas for which I am responsible; a £10 billion investment per year will go into capital programmes such as this and other initiatives. It is all about increasing supply by 30%, because we will be able to get on top of these issues only if we increase supply.

At the same time, as has been drawn out, I appreciate that we face an unprecedented challenge in the levels of Covid we are seeing and in flu respiratory issues; we have had less warning about that than ever before, because normally we can see what happens in Australia and use that as a warning. I am aware that we are likely to face more challenges there than ever. At the same time, we are putting forward the beginnings of a long-term plan to tackle this. I will talk about that and, I hope, answer the questions raised—my own ABCD, if I may.

I will start with care, because not only is it important in its own right to make sure that people are cared for in the correct place—it is much better and more cost effective for people to be in a care home than in a hospital—but freeing that up will free up the whole system. We all know the problem is often that A&E is full because it cannot put patients into hospital beds and therefore the ambulances cannot release their patients into A&E, backing up all the way through the system. That is why one of my priorities is the care side.

I will need to get back to the noble Baroness, Lady Brinton, on virtual wards in terms of support for GPs. I have seen the excellence at first hand, and the incredible reduction in figures that it can make, so to my mind we should focus on that and make sure that GPs and their surgeries have the right focus and support to help them. I will follow up with the noble Baroness with more detail on that, if I may.

I see this as key to care and the £500 million spend—again, I will give the noble Baroness, Lady Merron, details of how that is being used, because we want to make sure that we work with the integrated care boards, as she said, to ensure that it works to best effect. With that, I think we will start to see improvements come in for A&E and ambulances. As I mentioned before, we have seen a 10% increase in staff there versus 2019-20; that is what the 7,000 new beds are all about.

However, in terms of performance, we have seen great disparities. I am sure noble Lords have heard before the statistic that 15 of the hospital trusts account for 45% of all waits. I want to understand why that is. It is fair enough to trot out that statistic—I expect noble Lords to challenge me in a couple of months’ time to ask what was happening in those 15 trusts and what I have done to put it right and make sure they are performing well. My task is very much to put them under the spotlight and try to understand how we can perform much better in some areas and take those learnings to help them in others. I am under no illusions that it is tough out there. My wife is a dentist, so I have some knowledge of this; also, my mother was a practice nurse, so I understand how important and tough the role is.

Working through the backlogs and getting on top of the waiting lists will be key. There is an £8 billion programme, as we are all aware, to increase supply by 30%. I have seen fantastic examples at Chase Farm, as I have mentioned, and Watford of robotic surgery—I had the pleasure of playing with it myself, though not on a real patient—that I am sure will be revolutionary and transformative. It is about doctors, dentists and all care workers—all of them. As I say, I have a particular interest in the nursing profession.

It is all about releasing the 50 million more appointments, which I am glad to say we are making progress on. A lot of that is about making sure that you see the person best suited to meet your needs. We must make sure that we use GPs where they will best meet those needs. They are our most skilled specialist resource, so I want to make sure that they are focused on the cases that are best for them. As I say, I have experience through my mother’s role as a practice nurse of how much she could do and how much we can use them to meet a lot of the appointments targets—and make it a better job for them, because they have the skills and can be very valuable. The same is true of community pharmacies. Funnily enough, I worked at one in my first job—many years ago—so I have a little experience of that. It is all about trying to expand capacity.

I apologise, I cannot answer the noble Baroness, Lady Brinton, right now on the 3 million immunosuppressed so I will need to get back to her on that.

As the noble Baroness, Lady Merron, said, it is about trying to raise performance across all areas. The brilliant thing is that we have seen very good areas—I am sure we have all seen them when we visit hospitals—which have excellent performance, but my feeling, coming in as a bit of an outsider from business, is that it is patchy. There is an opportunity to spread that performance, really understand what good looks like and do more work to make sure that it is spread across the system. Part of my remit will very much be the performance agenda and working with the NHS executive team to make sure we see those improvements across the board.

I hope that gives noble Lords a flavour of how I hope to address what we see as our plan for patients. It is our commitment to what our patients can expect. I hope we can see that it is proactive, not prescriptive; ambitious but also achievable. We hope that, by empowering patients, they can start to challenge and drive performance as part of that, as a first step. Through that, we will be able to help, as part of the long-term plan, both the NHS and health and social care deliver for them. As such, I commend this Statement to your Lordships’ House.