NHS: Patients with Allergies

Baroness Burt of Solihull Excerpts

Thursday 12th December 2024 Grand Committee

[Baroness Burt of Solihull (LD)]

My Lords, I congratulate—with my horrible squeaky voice—the noble Baroness, Lady Ramsey, on securing this debate today. My concern is not so much adolescents as children.

In my hotel room this week, I was interested to find a card explaining what to do in the case of anaphylactic shock. This suggests to me that the concern about, and the volume of cases of, serious reactions to allergies is on the up, as well as the seriousness with which the hotel group took its responsibility towards its guests. Indeed, that is borne out by the facts: an estimated 21 million people—just under one in three of us in the UK—live with one or more allergies. For most of us, this can be managed and is not severe, but for some it can be life-threatening, as the noble Baroness has said. In the UK, between 1998 and 2018, more than 100,000 people were admitted to hospital for anaphylaxis, a life-threatening allergic reaction. While the number of hospital admissions has increased in recent years, the number of deaths, I am glad to say, has decreased.

Allergy UK advocates three policies to improve NHS services for people who suffer from allergic reactions. The first is to have an allergy nurse and dietician at primary level for each UK health region. That does not seem a huge ask to me but, apparently, there is a postcode lottery for specialist allergy services. Secondly there should be a national register to consolidate patient data across the country and track allergy diagnoses. Clearly, this would enable the identifying of areas where additional services were needed. Thirdly, prescription costs should be removed for those living with allergies to address the additional costs people face when managing their allergies. The estimated total cost is £3,000 per year; I tried to quantify that but had to give up. Suffice it to say that removing at least the prescriptions costs would be a very reasonable thing, because people live with these conditions.

Earlier this week, there was a reception for people interested in allergies by the Benedict Blythe Foundation. Benedict, a little four year-old, collapsed at school and died from anaphylaxis. Helen, Benedict’s mum, whom I met this week, has been campaigning for all schools to have the recommended allergy safeguards in place. Teachers need to be able to manage the average one to two pupils with an allergy in each class, but many feel underprepared to be able to deal with a child experiencing an anaphylactic reaction. Every teacher should feel prepared. Every parent delivers their child to the care of the school every schoolday. Surely it is the duty of the school to take care of the health and well-being of that child above all else and to hand them back to the parent at the end of the day as fit and healthy as when they went in. After all, if an individual hotel room can have a notice explaining what to do in the case of an anaphylactic reaction, should not all teachers who care for the children of others have that basic knowledge too?

National Carers Strategy

Baroness Burt of Solihull Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Merron (Lab)]

It is indeed the case that using technology and digital advance is key in all the areas where we are working, and the noble Lord will know that in the 10-year plan one of the three pillars will be, for example, going from analogue to digital. On that point, plans for going forward in dealing with social care, which is much needed in this country, will be set out in due course. I assure your Lordships’ House that it will be done through a cross-party approach, involving those with lived experience and the many voices and organisations that are part of the social care sector. We are keen that it is something that we can all get behind.

[Baroness Burt of Solihull (LD)]

As the Minister has said, the carer’s allowance was increased in the Budget by what can only be described as a modest amount, but it remains at one of the lowest levels for any benefit in the UK today. No help has been given to any carer who inadvertently overclaimed, even by £1. If the Government chose, they could stop collecting the overpayments while the independent review that they have commissioned takes place. Carers saddled with returning this money are struggling and suffering now. Why cannot the Government give them a break?

[Baroness Merron (Lab)]

I understand the point that the noble Baroness is making. Certainly we recognise that overpayments have caused people great anxiety. That is why it is important to review the circumstances independently, so we can find out exactly what went wrong and make things right, so it does not happen again. The main message I would give is to urge anyone in receipt of carer’s allowance to inform the DWP of any change in their circumstances in respect of the earnings limit, so that overpayments can be avoided. But we are seeking to work constructively to ensure that this is not an ongoing problem.

Cancer: Older People

Baroness Burt of Solihull Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Merron (Lab)]

It is important that we concentrate on the biggest ever NHS consultation, because that will lead us to the 10-year plan, and all that we are doing will sit within that. As the noble Lord will know, we are committed to getting the NHS to diagnose cancer earlier, treat it faster and improve waiting times. One of the announcements in the recent Budget, which also shifts the dial, is that we will deliver an extra 40,000 scan appointments and operations every week. The 10-year health plan will set out our approach for shifting healthcare from sickness to prevention, including reducing the incidence of cancer.

[Baroness Burt of Solihull (LD)]

My Lords, my mother-in-law died riddled with cancer that was not diagnosed until the very end of her life. We know that older people often suffer from several conditions and that frailty may minimise the treatment options available. The comprehensive geriatric assessment is the gold standard for the assessment of older patients and can make a real difference in outcome and cost, but cancer is not embedded in that assessment. Will the Minister find out from clinicians whether that might be possible?

[Baroness Merron (Lab)]

I give my sincere condolences to the noble Baroness and her family. Yes, I will raise that. It is a good point to look at, and I thank her.

NHS England: Ovarian Cancer

Baroness Burt of Solihull Excerpts

Thursday 2nd May 2024 Lords Chamber

[Baroness Burt of Solihull (LD)]

My Lords, I totally agree that the wording looks a bit odd, to say the least, and that we should give special consideration to the wording for people for whom English is not their first language. However, there are tens of thousands of trans and non-binary people who would be missed out if we did not spell out that trans men can still get ovarian cancer and trans women can get prostate cancer. Does the Minister agree that what we need is clear, incisive language, so that everyone can be aware of the health risks that apply to them?

[Lord Markham (Con)]

Yes, absolutely. We all come at this from the perspective of making sure that health is front and centre, which is why the primary descriptors should be “man” and “woman”, as I think we all agree. Beyond that, we should clarify that “woman” may mean a “person with ovaries”—but the primary descriptor is “woman”. I hope that we can all agree on that.

Cass Review

Baroness Burt of Solihull Excerpts

Wednesday 17th April 2024 Lords Chamber

[Baroness Merron (Lab)]

My Lords, Dr Cass and her team are to be thanked for their rigour and their care with this report, in which they have navigated many complex and sensitive issues. This review into the NHS’s gender identity services concludes that children and young people have been let down by inadequate research and evidence on medical interventions, and they have been failed by inadequate services amidst a debate which has, sadly, been marked by extreme toxicity.

At the same time, at the heart of the complexity around gender identity services are two aspects that are simultaneously true. There are trans adults who have followed a medical pathway and say that, for all the pain and difficulty involved, it was not just life-affirming; it was life-saving. There are also people who followed a medical pathway and say that it has ruined their lives irreversibly and ask how anyone could let that happen. For those children, young people, and now adults, but particularly those who are being referred into gender identity services today, there is a duty to get this right.

The Cass review refers to many scandals, which exposes both the inordinate amount of time that children and young people are waiting for care while their wellbeing deteriorates, and medical interventions that have been made on what could be called shaky evidence. Can the Minister say how it came to be that NHS providers refused to co-operate with this review? How was it allowed that adult gender services would not share data on the long-term experience of patients? What accountability does the Minister feel that there should now be?

The Minister will know that the discussion around the substance of the review has been highly toxic. People have felt silenced, and it has required investigative journalism to prompt this review to take place. Tribute should be paid to journalists, including Hannah Barnes, and to the whistleblowers, who together helped shine a light on the Tavistock clinic. It is concerning to note that Dr Cass said that the

“toxic, ideological and polarised public debate has made the work of the review significantly harder”,

and that will

“hamper the research that is essential to finding”

a way forward. This particularly vulnerable group of children and young people is at the wrong end of the statistics when it comes to mental ill health, suicide and self-harm. They have been badly let down, so we owe it to them to approach this discussion with the sensitivity it demands.

Parts of this report today will sound very familiar: services unable to cope with demand; significant staff shortages; a lack of workforce planning; and unacceptably long waits for the mental health support and assessments that children and young people need, such that in some cases children become adults before they even get a first appointment with the gender identity services. To this point, the Cass review recommends a follow-through of services up to the age of 25, to ensure continuity of care. Will the Minister indicate how long it will take to establish these services, and could the Minister set out what plans there are to cut waiting times for assessments for mental health and neuro- developmental conditions?

Last month’s decision by NHS England to stop the routine prescription of puberty blockers to under-18s is welcome. However, the loophole that exists for private providers risks illegal trading. In the other place, the Secretary of State said that she expected private clinics to follow the report’s recommendations to follow the evidence. I underline our support for these expectations on compliance. Does the Minister consider that further regulation might be needed to enforce the recommendations? Could he say something more about the timescales involved in making progress, both for the CQC to incorporate the recommendations into its safe care and treatment standards and for NHS England’s urgent review on clinical policy for cross-sex hormones?

Children’s healthcare should always be led by the evidence and be in the best interests of their welfare. Dr Cass’s report has provided the basis on which to go forward. This report must also provide a watershed moment for the way in which society and politics discuss this issue. There are children, young people and adults, including trans children, young people and adults, who are desperately worried and frightened by the toxicity of the debate. There are healthcare professionals who are scared to do their job and make their views known. I hope that we can now put children’s health and well-being above all else.

[Baroness Burt of Solihull (LD)]

My Lords, I believe that the Cass review is an extremely thorough summary of where we are now and of the pathways available to young people that we need to explore. Most importantly, this report gives a way forward for young people and their clinicians who feel anxious and frightened because they find themselves at the centre of a political maelstrom.

Interestingly, the most balanced response I have seen to the report came from Stonewall, which was consulted by Cass, and I have used some of its points here. Cass says that these youngsters have been sorely neglected by the NHS, which sidelined them away from mainstream care to services that have fallen short. She points to how we can start the process of making it up to them, by giving them the holistic care that they need and deserve.

Despite the way in which the report was received by certain gender-critical individuals, it does not question trans identities or recommend rolling back healthcare access. It does not say that puberty blockers are unsafe or dangerous. It does say that there is insufficient and inconsistent evidence about some of the effects of puberty suppression. In addition, it notes that cross-sex hormones are well established and have transformed the lives of trans people, and supports their use from the age of 16. Importantly, it does not, at any stage, suggest a ban on social transition for any age of child or young person, but recommends that this be done with the support of parents and clinicians.

Cass says that gender incongruence is a result of a complex play between many biological, psychological and social factors, of which sexual orientation can be one. There are many factors, and no simple answer. For example, saying that such young people are simply confused gay people, unhappy teenagers, or that it is all the fault of social media, is all too simplistic. Regrettably, this has not stopped the Government spinning their own version of who is to blame.

For example, this week’s Statement by Secretary of State Victoria Atkins said that Tavistock clinicians “almost always” put children on an irreversible path of blocking puberty, then prescribed cross-sex hormones and on to surgery as an adult. This is not my understanding of the situation. In 2019-20, only 161 under-19s were referred by gender identity development services for puberty blockers. It was estimated that only around one in six GIDS patients ended up being prescribed puberty blockers. Is not the picture bad enough, without painting something even worse?

There are currently more than 5,000 children on the waiting list for treatment. The NHS has confirmed that everyone currently on puberty blockers via the NHS—fewer than 100 children—will be able to continue on them. These children, and any new recommendations for puberty blockers, will not be prescribed unless they agree to take part in a clinical trial to test the effectiveness of puberty blockers properly. How long does the Minister estimate that it will take for this clinical trial to be set up? Speaking of waiting lists, I understand that it currently takes three years for a child on the list even to be seen. How will the trial ever be set up, except for the few now on puberty blockers, while the rest languish for years on waiting years while their puberty seeps away? Does the Minister not agree that it is time to make up this shocking treatment which has, or rather has not, been given to children by the NHS and put them immediately on a par in priority with other NHS services?

These are our children. They, and the clinicians who want to treat them, have been intimidated by the toxic environment that we have all helped to create. I have heard the Cass report described as a rock that we can now all cling to. We will never all agree about some quite fundamental issues regarding trans and the nature of trans, but we must never make our children suffer for it; we must never make them pawns in a zero-sum game. We must rise above it and argue well, with more light than heat, to protect our children, who, after all, must be at the centre of all we seek to do.

Midwives: Bullying

Baroness Burt of Solihull Excerpts

Tuesday 16th April 2024 Lords Chamber

[Baroness Burt of Solihull (LD)]

My Lords, among the very disturbing elements in this report is the way that midwives are bearing the brunt of the toxic culture and dangerously low staffing levels, which are causing over half of midwives to consider leaving their organisation. Despite what the Minister just said, the Ockenden report was over two years ago. Is he satisfied with this rate of progress? Should we not consider a statutory inquiry—a recommendation of this report—before more midwives leave and more babies die?

[Lord Markham (Con)]

We have the highest level of staffing ever in midwifery, 5% up on last year and 21% up on 2010, against a background of static births. I want to address that point on staffing; staffing levels are high. However, as the noble Baroness says, there are issues around culture. On the national inquiry, again, every one of those 150 trusts was visited by the CQC in the last year or so and action plans made on how to address this. We know what we need to do; we just need to get on and implement it.

Sodium Valproate and Pelvic Mesh

Baroness Burt of Solihull Excerpts

Monday 25th March 2024 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness. I was actually speaking to Minister Caulfield about this just this morning, because she is in regular touch with the affected patient groups. They were talking precisely about some of the things around the Scotland NHS scheme in place in terms of redress. It is fair to say that there are some concerns in patient groups on some aspects of this, but underlying what the noble Baroness says is making sure that, whatever we do, we are trying to do it consistently across the UK because there should be one consistent approach. Likewise, we are learning lessons from these things as well.

[Baroness Burt of Solihull (LD)]

My Lords, an ex-constituent of mine, after years of excruciating pain, the onset of returning cancer and no care plan, finally borrowed $47,000 to have the failed mesh implant removed in America. She now has her life back but is in deep debt. However, we learn that the Government will consider redress only in 2025. Can the Minister hazard a guess as to how many more mesh-induced deaths will have occurred by the time a single penny is paid out in compensation at this rate?

King’s Speech

Baroness Burt of Solihull Excerpts

Thursday 9th November 2023 Lords Chamber

[Baroness Burt of Solihull (LD)]

My Lords, in the time available to me, I would have liked to address my remarks to the effect that the new legislation will have on two of my main areas of interest: equalities and prisoner welfare. However, that would have made a very short speech indeed. The word “equality” does not feature once in the gracious Speech and one government equalities pledge, made more than five years ago, has still not found its way into proposed legislation. I refer, of course, to a conversion therapy banning Bill.

I should not have been surprised. After coming first as the most LGBTI-friendly country in the Rainbow Europe rankings between 2011 and 2015—this coincides with the time when the Liberal Democrats were in the coalition Government—we have since slumped to 17th place today. But do not worry: I have a cunning plan to help the Government out. Reading the runes, I feared that this Bill might drop off the parliamentary agenda, so I entered the ballot for Private Members’ Bills to bring in my own Bill—and guess what? My conversion therapy prohibition Bill came first in the ballot. This is definitely meant to be; we will be able to debate this issue in Parliament, as we should.

It is a shame that a mental health Bill has also been omitted from the Government’s agenda. I do not need to take up the House’s time to spell out how much of an effect poor provision and lack of resources are having on those suffering from mental illness as my noble friend Lord Allan has already more than done that issue justice today. Compared with crowd-pleasers such as pedicab regulations and a football regulator, which I am sure are important to many—well, football is at least—the Government have chosen to put mental health in the “too difficult to tackle” box before they lose the next general election.

However, we have the criminal justice Bill, some aspects of which are very welcome, such as taking steps to equip our police and criminal justice systems to better tackle violence against women and girls, criminalising the sharing of intimate images and introducing a statutory aggravating factor at sentencing for offenders who murder partners at the end of a relationship. However, long sentences and mandatory terms of imprisonment may well be contrary to some of the Government’s other worthy aspirations for prisons. You cannot grow your way out of an increasingly overcrowded penal system by locking up more and more people for longer and longer periods. In this country we lock up more people per head of population than many other countries, even those more right wing than this one. In fact, we lock up 50% more per head of population than the EU average. While mandatory sentencing and increased length of sentences might look good to right-wing voters on an election leaflet, they will be counterproductive in the longer run—not that this Government need necessarily worry about the longer run.

Every pound we spend housing prisoners is a pound less to spend on rehabilitation and support to help ensure that, on release, prisoners can take their place in society as citizens and do not end up back in prison, costing the taxpayer even more money and causing victims of crime even more suffering in future.

Finally, I want to tackle race hate, which is of course an equality issue. This feels particularly timely given the impact the horrific Israel-Gaza conflict has had in the UK. The Home Secretary has only added fuel to the fire with her divisive rhetoric and declarations of “hate marches”, which have incensed our Muslim communities and many others, while British Jews continue to feel unsafe, as well they might. Since 7 October anti-Semitic incidents have increased by more than 600%, while Tell MAMA, an organisation that measures Islamic hate crimes, has recorded a similar sixfold increase. This month is Islamophobia Awareness Month, and perhaps the Government should realise that backing one side against another here in the UK is harmful, not least further damaging their prospects in the next general election with the votes they will lose from the Muslim community. All our communities deserve our protection and support, not only in times of conflict. At this time, when we remember all those who suffered and continue to suffer in war, please let us learn the lessons of the past. Never forget what war can do to humanity.

General Medical Council: Internal Guidance

Baroness Burt of Solihull Excerpts

Tuesday 17th October 2023 Lords Chamber

[Lord Markham (Con)]

Yes, I am very happy to do that and to make clear the feelings of this House.

[Baroness Burt of Solihull (LD)]

My Lords, I welcome the Minister’s comments on the GMC and endorse its independent role. I commend its wish to treat all patients with dignity and respect. Even though there are only a relatively tiny number of trans men giving birth each year, they all matter and they all deserve to be treated with respect and dignity. If he can, will the Minister tell the House how both women born as women and trans men are to be treated with equal respect, without offending either group?

Gender Identity Services: Children and Young People

Baroness Burt of Solihull Excerpts

Wednesday 19th April 2023 Lords Chamber

[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.

[Baroness Burt of Solihull (LD)]

My Lords, whatever one’s views on trans issues, surely the first imperative is to ensure that young people are properly looked after. Would the Minister agree with me that every young person suffering from gender dysmorphia, whether they have attended the Tavistock or not, should receive professional counselling and support? If he does agree, can he ensure that the resources are available in a timely manner, so that these young people do not have to wait years while they try to unravel the complex set of issues they face concerning their gender identity?

[Lord Markham (Con)]

Again, my understanding—and I freely admit that the benefit of having these questions is that you then delve into them, which I very much support in terms of how this process works very well —is that these people who have been through these services need to be looked after and catered for, so that is something we are very much on.