Stroke Treatment

Debate between Baroness Browning and Lord Markham

Wednesday 27th March 2024 Lords Chamber

[Lord Markham (Con)]

The noble Lord is quite right. Many noble Lords will have heard me echo Sir Chris Whitty’s words that his major concern about the whole Covid period was that people missed out on blood pressure and cardiovascular checks, which can be early-warning indicators. That is why we see prevention as a major leg of what we are trying to do, through having blood pressure checks and inviting everyone to have their health check every five years. What we are working on, and will be bringing out shortly, is greater use of digital for health checks, to do precisely what the noble Lord says.

[Baroness Browning (Con)]

My noble friend wrote to me in response to an Oral Question on the subject of strokes to explain how AI is enabling many hospitals now to be able to diagnose within the three-hour timeframe and give appropriate treatment, thus enhancing the recovery of stroke patients. I mentioned it to my local general hospital, and I am sorry to tell him that it does not have this AI technology. When does he think it will be rolled out nationally?

[Lord Markham (Con)]

This AI service, Brainomix, is one of the ground-breaking services that are part of the future of the NHS. It is part of the whole service, which will include video triaging. It is currently in 65% of hospitals, and I am sorry that it is not in my noble friend’s hospital. We have a target to increase that quite rapidly to 75%. I will look into the particular hospital that she mentions. It really is ground-breaking; overall, where we have got everything in place, full recovery has gone from 16% to 48%.

Allied Health Professionals: Prescribing Responsibilities

Debate between Baroness Browning and Lord Markham

Tuesday 6th February 2024 Lords Chamber

[Lord Markham (Con)]

I will need to get back to the noble Baroness on the precise timeline. We have an SI debate taking place shortly on physician associates, and a key step is that first, you have to be part of a legally regulated body. Once you are, the formal reviews can take place, along with the training. I will write giving the details, but we are keen to allow speech therapists and others to prescribe as well.

[Baroness Browning (Con)]

My Lords, people on the autistic spectrum who need prescribed drugs for their condition and associated reasons have to have a psychiatrist prescribe them because psychologists cannot do so. I am not for one minute suggesting that all psychologists should be allowed to prescribe, because they are quite a range of people. However, in parts of the country where there is no psychiatrist—I speak from personal experience—who can prescribe to autistic patients, can we see whether certain psychologists with a knowledge of autism could be trained to fill that gap?

[Lord Markham (Con)]

Yes, I will happily undertake to do that. There are a couple of mechanisms we can use. We can give them an independent prescribing ability, or we can give patient group directions on a certain number of items. That is what we are doing with Pharmacy First, for instance, in respect of the seven conditions. Clearly, we could look at doing that with the relevant autism drugs.

National Health Service: Key Targets

Debate between Baroness Browning and Lord Markham

Tuesday 16th January 2024 Lords Chamber

[Lord Markham (Con)]

I agree with the noble Lord that prevention is key. About half the number of people who turn up at A&E do not need to go to A&E and can be seen in other settings. I completely agree that all the elements in terms of prevention and getting ahead of the problem are key, including where there are issues around food.

[Baroness Browning (Con)]

My Lords, following on from the question from the right reverend Prelate and his reference to stroke patients, given that there is a three-hour window for stroke patients during which, if certain treatments are given, the outcome is so much better, what have the Government done to ensure that, adding on the ambulance time to the time when the patient then arrives at hospital, more patients are being treated within that window? Is there a target specifically for stroke patients? It makes such a difference.

[Lord Markham (Con)]

My noble friend is absolutely correct, and strokes have been a major focus. I am glad to say that was one of the first areas where we rolled out AI everywhere, with the result that we were able to improve treatment times so much—and I will get the precise figures to my noble friend—that the recovery rate has increased by two-thirds as a result. It is absolutely right that this is an area of top focus.

Mental Health Act 1983

Debate between Baroness Browning and Lord Markham

Tuesday 21st November 2023 Lords Chamber

[Lord Markham (Con)]

Yes. I am happy for the noble Lord to come to the round table and put those points himself as well.

[Baroness Browning (Con)]

My noble friend will be aware that autism is not a mental health condition but a communication disorder. However, of course like everybody else, people on the autistic spectrum can develop mental health problems as well. What assessment has the department made or could it make, quite urgently, of just how able and experienced psychiatrists around the country are at disaggregating between an autistic person having a meltdown and a mental health condition? If they get it wrong, as often happens, the consequences of the treatment that follows are devastating.

[Lord Markham (Con)]

My noble friend is absolutely correct, and from personal experience I know the importance of getting that early diagnosis right. I am quite happy to write in detail exactly what we are doing in this space.

Autism: In-patient Care in Mental Health Hospitals

Debate between Baroness Browning and Lord Markham

Tuesday 14th November 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord for his kind words about me; I understand the situation. The Government are committed to implementing those changes and we are looking for opportunities to introduce them. I understand his disappointment that the Bill is not in the current programme of legislation. What I am committed to doing is making sure that as many features as possible from the Bill are implemented through action on the ground; the care and treatment reviews are a vital part of that today. Following the report from the noble Baroness, Lady Hollins, we are also making sure that we have regular CQC reviews over the next few years. We are delivering good action in this space, but I understand his feelings.

[Baroness Browning (Con)]

My Lords, like the noble Lord, Lord Touhig, I am a vice-president of the National Autistic Society. I also remind the House of my interests in the register and my family interest in this subject. The reason why a lot of autistic people become in-patients in mental health hospitals is the lack of real understanding and training of healthcare professionals in that field. It is a lot better in the big conurbations than in the countryside. Autism is not a mental health condition but, as my noble friend the Minister will know, one of the problems that the Government will face if they are to help to get people out of these institutions is that, like the rest of us, people with autism can develop mental health conditions; autistic-related anxiety is a very common one. Psychologists—one finds more of them than psychiatrists out in the community—cannot prescribe; it has to be a psychiatrist who prescribes. Until you get the right number of trained professionals out in the community—namely, psychiatrists with a specialism in autism; it is no good having just your average jobbing psychiatrist—those people are doomed to stay. I urge my noble friend to look at the levels of availability for the right professionals, to release these people from the incarceration they should never have suffered in the first place.

[Lord Markham (Con)]

I and the whole House would agree with my noble friend that having the right people making the right assessments on the right place for those people to be treated is key to all this. We are rolling out training through the National Autism Trainer Programme, in which we have invested £20 million to ensure improvements in autistic diagnostic pathways and people’s capability to achieve them. We are now rolling out the Oliver McGowan training to over 1 million people and looking at rolling out stage 2. However, I agree with her that these actions are vital.

Suicide Prevention Strategy

Debate between Baroness Browning and Lord Markham

Thursday 26th October 2023 Lords Chamber

[Baroness Browning (Con)]

I remind the House of my personal interest: I have family members claiming ESA. I advise my noble friend the Minister that I am awaiting an appointment with DWP Ministers following Questions that I tabled before the Summer Recess about the suicide rate among disabled benefits claimants—in fact, among all benefits claimants. My concern is not only around the way the DWP collects data but around the way it sometimes does not disseminates the information that it has. Will my noble friend pause in relying totally on the way in which the DWP produces data at present? For example, I am particularly concerned about how it collects information from coroners’ courts. This is something that I think is ongoing; I hope that my noble friend regards it in that way as well.

[Lord Markham (Con)]

We are definitely always looking to improve, get access to better data and learn lessons from that. I will make sure that that is understood and follow up with DWP Ministers accordingly.

Community Health Services: Waiting Lists

Debate between Baroness Browning and Lord Markham

Wednesday 12th July 2023 Lords Chamber

[Lord Markham (Con)]

Unfortunately, as we know, we have a backlog in quite a few areas, often as a consequence of the pandemic and the period when we could not see as many people as we would have liked to. I wish I could say there was a quick solution; we all recognise the long-term solution is the long-term workforce plan, where we need to address the vacancies and have more staff to increase the output and supply. We are putting in a record investment of £2.4 billion behind this, but I freely admit it is not an overnight solution.

[Baroness Browning (Con)]

My Lords, I draw attention to my interest in the register and my association with the Alzheimer’s Society. My noble friend will know that, when asked, most people will say that when they die, they would like to die at home in their own bed. There is one group of people for whom there seems to be no structured plan to make that possible, and that is for people with dementia and Alzheimer’s. They are cared for at home until the end of their life, but the end of their life very often ends up in a hospital ward—the most inappropriate place for somebody with dementia, unless there is a genuine medical need to be there. Could my noble friend look to see if we can put together a structured plan that would be of help to families in planning the end of life of close relatives? I particularly do not mean something that follows the way the Liverpool care pathway was put together.

[Lord Markham (Con)]

I thank my noble friend. This was actually a conversation of a big task force summit that we had just last week. We commented that a lot of people have pregnancy plans, for instance, which might say that they want to have birth planned at home; a lot of people will have “Do not resuscitate” plans; what we do not have enough of are frailty plans, which say, “I don’t want to go into hospital. I’d rather be cared for at home. I know it might mean that I don’t live for quite as long, but that’s my preference”. I think there is a whole debate that we need to have to start to move towards that, and to make sure we have that support in the community to do it as well.

Autism: Diagnosis Targets

Debate between Baroness Browning and Lord Markham

Tuesday 16th May 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord, both for his question and for his interest and work in this space. The House will know that this topic is quite close to my heart as well. It is an area of challenge. We have more demand than ever. We are committed to recruiting more staff. We have a recruitment target for next year of 27,000. Very promisingly—I hope I will have time to go into this in more detail later, or I will speak to the noble Lord afterwards—there is a pilot scheme in Bradford looking at children’s early years scoring and how that can be used as a precursor to screening and testing.

[Baroness Browning (Con)]

My Lords, I too declare an interest as a vice-president of the National Autistic Society—I am always pleased to work alongside my colleague, the noble Lord, Lord Touhig, on these matters. Very often, parents, in desperation, particularly want an autism assessment when their teenagers get to the stage where they are leaving school and going on to further education or other types of study. Without that assessment, no decisions can be made. We have many excellent centres around this country, particularly places such as the Lorna Wing Centre, where assessments can be made. Is it not time that the Government outsourced some of this, as long as the NICE guidelines are followed in giving that assessment, to ensure that the list that the noble Lord announced to the House is reduced much more rapidly than is happening at the moment?

[Lord Markham (Con)]

Yes, absolutely, we need to look at all areas where we can increase and expand supply, including use of the private sector. I am sure I will be asked about ADHD later on and the “Panorama” programme, which shows that there are some pitfalls in all that, but provided they are assessing according to the NICE guidelines, it clearly has to be sensible to use as much supply as possible.

Gender Identity Services: Children and Young People

Debate between Baroness Browning and Lord Markham

Wednesday 19th April 2023 Lords Chamber

[Lord Markham (Con)]

The points are well made, and they are understood and accepted on this side. My understanding is that the northern and southern hubs, as recommended in the Cass review, have already been set up, so patients are being seen as we speak at the Great Ormond Street and Evelina centres, and a transition programme is being put in place for all those people who are currently there. I will happily pick up with the noble Baroness afterwards to discuss this further.

[Baroness Browning (Con)]

My Lords, the number of autistic children and adolescents at the Tavistock clinic was greater than the number of those in any other group. Would my noble friend just clarify his reply a little? I think this is going to require more than normal counselling, because there is a trait within the autistic mind that often focuses very strongly on a particular issue and, once an autistic person believes something is true, it is quite hard to get them to see it another way. So it is going to need expertise. What is being done to find those experts?

[Lord Markham (Con)]

My noble friend will be aware that I do have some personal knowledge in this area, and I recognise very much the point that neurodiverse people can become fixed on a certain outcome. In terms of the statistics, yes, as many of a third of the people seen at Tavistock do have those sorts of conditions. So, it is something that is understood. Again, I am happy to pick up afterwards. The key point of the Cass review in all this is that these people need to be seen by medical doctors who are considering everything in the round and not just coming at this through a gender identification lens. That is the key thing we need to make sure happens going forward.

Covid Pandemic: Testing of Care Home Residents

Debate between Baroness Browning and Lord Markham

Monday 6th March 2023 Lords Chamber

[Lord Markham (Con)]

I do not know the said ex-Minister, so cannot comment on that. If we cast our minds back, it was a very pressurised environment in which lots of decisions had to be made very quickly. Mistakes were undoubtedly made as part of that. As to how we did overall, it is best for the inquiry to make findings rather than for me to give my opinion.

[Baroness Browning (Con)]

Can my noble friend confirm that, when the results are published, the contingency plan brought forward by the Government will include, quite clearly, what will happen with care homes in future situations? We are all concerned that this was very last-minute.

Can I ask my noble friend to reflect on my own circumstances? My aunt Vicky, aged 99 years and nine months, died in April 2020 in a care home that she had been in for some time. The death certificate said “Covid”. She was symptomless and not tested. When the family challenged it, it was changed to “died of old age”. I ask my noble friend to reflect on that.

[Lord Markham (Con)]

I am sorry for my noble friend’s loss, albeit one of too many losses in those circumstances. Yes, we absolutely need to learn the lessons around social care settings. Most people would accept that, of the many things that were done well during Covid, that was probably one that we would have done differently, in the early stages, if we had our time again. The Covid inquiry is all about making sure that we learn those lessons, going forward.

Care Homes: Staffing

Debate between Baroness Browning and Lord Markham

Wednesday 11th January 2023 Lords Chamber

[Lord Markham (Con)]

Since the question yesterday, I have had a chance to talk to colleagues further about domiciliary care and understand its vital role. I talked to one ICB today, which has its own arm’s-length body, set up by the local authority, which does exactly what was suggested by employing domiciliary care staff full-time. They know the patient best and are ready to take them back out of hospital and put them in place. This is central to what we are doing.

[Baroness Browning (Con)]

When people are transferred, either to home or residential care places, part of the delay is caused by the need, quite rightly, for a proper and appropriate assessment of their needs before a transfer is made. What work have the Government done to assess who is going to carry out those proper assessments, either at the hospital or the care home end, and what the likely delay at that stage will be? It is delaying a lot of people now and no doubt will continue to do so.

[Lord Markham (Con)]

That is absolutely right. In our weekly meetings as Ministers, we look at the reason for the delays in terms of the 13,000 beds. That assessment of delay is one of the key criteria that we monitor each week. The best ICBs that I have seen have teams on this—they are absolutely SWAT teams—who make sure that they do it, and measure the time in which they can do it; for example, they have got to have that assessment within 24 hours. When the patient goes in, they have an estimate of the day that they are leaving, which they will target and work towards. The best do that, and the task force is set up to make sure that it is rolled out to all the other places.

Invasive Group A Streptococcus and Scarlet Fever

Debate between Baroness Browning and Lord Markham

Monday 5th December 2022 Lords Chamber

[Lord Markham (Con)]

I would advise—and again this is personal advice—that, if they have not got a response and they are concerned about their child, it is probably better and quicker for them to drive, if they are able to. Clearly, if there is a 999 ambulance response because they cannot get to the hospital quickly, then that is a fallback, but if they are able to drive with their child and they are concerned in that way, my advice would always be to go for safety first in this. Again, as a parent of a four year-old and seeing the chatter on social media over the weekend, I know this is an area of concern. Clearly, we need to make sure that reassurance is there for everyone.

[Baroness Browning (Con)]

My Lords, I had scarlet fever twice as a child, two years running. I seem to recall a doctor called at my home, diagnosed and prescribed. Also, at that time—it was the late 1950s—my library books were taken away for fumigation, and I was kept in isolation. Why can we not have that sort of service today?

[Lord Markham (Con)]

That is a serious question, and I think many of us would love that kind of service, but we know we are living in an age where the community doctor in that way does not exist. It was way before my time, but I think changes were made to GPs’ contracts which means that, unfortunately, that is not part of the standard service that people have any more, which is why we rely on 111 and other services as back-up.

Care Homes: Severely Disabled People

Debate between Baroness Browning and Lord Markham

Wednesday 30th November 2022 Lords Chamber

[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.

[Baroness Browning (Con)]

Does my noble friend accept that many disabled people in residential and nursing care are of an age such that there are no parents or close relatives left and there is no one with a lasting power of attorney? How can that vulnerability be coped with by the state in a way we would all approve of?

[Lord Markham (Con)]

My noble friend identifies an ageing demographic, the challenges that brings to all of us and the pressure on adult social care and the centres. As I have said, this is a challenge, but there are high levels of satisfaction in the sector: 89% of people are satisfied and 64% are very satisfied. So, although we have not got this right in every case, we are broadly on the right track and getting good results.

GPs: Anti-depressants and Alcohol

Debate between Baroness Browning and Lord Markham

Wednesday 16th November 2022 Lords Chamber

[Lord Markham (Con)]

My Lords, as set out in the draft mental health Bill, mental health activities are very focused on where help can be given in areas of inequalities. As to the position in the White Paper, I am afraid that the answer is the same as in the previous case: I do not have any information at the moment on any date.

[Baroness Browning (Con)]

My Lords, the medication for mental health conditions, including addictions, can be vastly improved in outcome and the proper use of that medication if the doctor is able to test the DNA of the patient to marry up the correct medication. When is genetic testing going to become an integral part of the NHS?

[Lord Markham (Con)]

We all see the great promise in genetic testing, and I know that this is something very close to my noble friend Lady Blackwood’s heart. It is a progressive area, where we are seeing new treatments all the time that can be helped by the use of genetic testing. As they come down the stream, this is very much on the agenda of NICE as well to make sure that those are available as required.

Bereavement Support

Debate between Baroness Browning and Lord Markham

Wednesday 9th November 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord, and I agree. I have to admit that when I was a child, I failed a friend, because I did not know what to say. As I mentioned, the DfE is part of this working group and we are training 10,000 early years practitioners in this space to try to ensure that they can provide the training that is needed in schools. The number of schools supported in this way is increasing, but today it is still only 35%, so clearly there is more work to be done. The noble Lord can rest assured that we take this very seriously.

[Baroness Browning (Con)]

Does my noble friend agree that the pain of bereavement, for all people, under whatever circumstances somebody has died, is a pain like no other? Will he consider the need to act swiftly for people whose loved ones have died—perhaps I might use the word—prematurely? Sudden death brings with it a shock that requires professional support from well-trained people, and which lasts for a very long time, if not a lifetime. Will he also consider whether registrars of death should hold in their offices a lot more localised information, with good contacts and reliable resources that can be made immediately available when a death is registered?

[Lord Markham (Con)]

Yes, and again, that is where I welcome the report, which sets out how we must all ensure that we are training people to respond in the most appropriate way possible. I see our role in this as enablers, so that we can get the right people and put the right support in place at every level and in every circumstance. Clearly, where there is a sudden death, that adds a particular circumstance that needs a different approach. Again, that is why I welcome the report and the policy team, and I look forward to meeting with the right reverend Prelate the Bishop of London later to ensure that we are covering all these different examples.

British Heart Foundation: Tipping Point Report

Debate between Baroness Browning and Lord Markham

Tuesday 8th November 2022 Lords Chamber

[Lord Markham (Con)]

We are at the forefront of trying to encourage healthier eating, as per the sugary drinks levy and through product placement in shops. We have been at the forefront of anti-drinking and anti-smoking initiatives and are very much in favour of the smoke-free agenda. These are all key elements of our five-year healthier life plan. It takes these things into account because, as I say, prevention really is better than cure.

[Baroness Browning (Con)]

Would my noble friend the Minister consider that, in the same way that people check their own bodies for the possibility of cancer developing, they should be trained to take their pulse regularly to check for atrial fibrillation? It is sometimes described as a disease that nobody notices until something dramatic happens, and it can lead to stroke and pulmonary embolisms, which can cause heart attacks.

[Lord Markham (Con)]

Yes, the more that we can educate people to self-diagnose and take a stake in their own health, the better. Again, many of us now have Fitbits, Apple watches and so on, which can be vital early-warning indicators.

Edenfield Centre: Treatment of Patients

Debate between Baroness Browning and Lord Markham

Thursday 13th October 2022 Lords Chamber

[Lord Markham (Con)]

My noble friend is correct that these are the sorts of things that we need to think about in this situation. It is a complex situation because, of course, as well as the advantages of body cameras being able to pick up things like this, these are first and foremost patients in need of care and there are all sorts of privacy issues to take into account in such a situation. I think that what this shows is that more intensive dialogue and thought on this whole area is required. I do not believe that there is an easy solution such as body cameras; that might be one approach, but first and foremost I want to feel that these are places where patients feel that their privacy is respected.

What I would violently agree on is the need for further conversations with the CQC, so that it is aware of the need to do a review on this. We need to be looking at exactly these types of things to see if a more intrusive type of system is what is required to stop these sorts of things happening again.

[Baroness Browning (Con)]

My Lords, I declare my interest, which is in the register, as a vice-president of the National Autistic Society. I welcome my noble friend, and I hope that he and I will have an opportunity in the very near future to discuss autism and learning disability. He mentioned more recent cases. I quite take his point, but these are not just recent cases. These have gone back over decades. I have listened, in both Houses, to Minister after Minister say that there is going to be change, and it does not come. In the vast majority of cases, it is totally inappropriate—in fact, I think it is criminal—for people with autistic spectrum disorders and learning disabilities to be placed in mental health institutions. It is not the place for them. There are proven records, over and over again, that it is not the right course of treatment, any more than you would think of putting someone with a coronary heart condition into such a place. So I say to my noble friend that this needs urgent attention from the Government.

[Lord Markham (Con)]

I agree with the points that my noble friend makes. I have some personal experience of people with learning difficulties, and I completely agree that the right setting for them should actually be in the community. I know that is the direction of travel of this Government, and I know that there is an objective to make sure that that is the major place where they are cared for. I have some further details on that, which I would be happy to share, and to meet with my noble friend.