Hospices: Funding

Baroness Finlay of Llandaff Excerpts

Thursday 24th October 2024 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I am grateful to the noble Lord, Lord Farmer, and I declare all my interests in relation to hospices and palliative care, especially in Wales.

In 2008, the Welsh Government Health Minister Edwina Hart commissioned a strategy for palliative care. That report recommended that there must be fair access to specialist palliative care as a core service, available at all times, wherever the patient is, with patient information. I had the privilege of being asked to lead this work, and I had a budget of just over £2 per head of population. Together with my colleague, Dr Andy Fowell—who, tragically, died recently in a cycling accident—we created a funding formula to plug gaps and move specialist medical staff on to NHS contracts to ensure that they could integrate with oncology, surgery, anaesthesia, emergency departments, and so on. We stipulated a minimum number of actual or virtual beds for a population, and minimum staffing levels of specialist care in the community and in-hospital support teams. We set quality standards for rapid response to referrals, stimulated research and ensured education and training. I pay tribute to my colleague Dr Robert Twycross, who died just a few days ago. He was at Oxford and he was one of the great pioneers in research and education. The strategy has driven patient-centred care that meets the needs of every person and their family, especially when children are facing bereavement.

With encouragement, my wonderful colleagues moved on to seven-day pooled rotas to cover nights, weekends and bank holidays. As a colleague said, “We got rid of frantic Fridays and mad Mondays”. Our specialist nurses realised how many crises at nights and weekends could be intercepted when working a weekend or a bank holiday. Work with pharmacists and paramedics is improving access to just-in-case medication and care. For many years, through the Marie Curie Hospice, we have run a 24-hour all-Wales helpline for any health or care professional to get advice on a difficult situation.

In Wales, we created a floor—a minimum—but, of course, it is not enough and we still have workforce gaps, although Welsh Ministers have been unfailingly supportive of hospices and palliative care teams in Wales, despite competing demands, financing that becomes difficult and provision that is especially hard in remote and rural areas.

Research has repeatedly shown that good care costs less than bad care. No one should be told that there is nothing more that can be done. Seeking help and advice from colleagues, and being humble enough to questioningly review a situation, can find solutions to make each day better, accepting the inevitability of death for us all. Will the Government look at the Welsh data to comprehensively review the whole model of such services in England, to ensure that people’s needs are better met and hospices can once again flourish?

NHS Hospitals: Apheresis

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Wednesday 9th October 2024 Lords Chamber

[Baroness Merron (Lab)]

I assure the noble Baroness that we are more than factoring it in. We are totally committed to working to support those with sickle cell, and thalassaemia. There is ongoing work to provide the very best possible care, including boosting the number of blood donors, which is vital in improving clinical pathways and delivering treatments. There is a treatment, as I am sure the noble Baroness is aware, called Casgevy, which requires apheresis as part of the process. It is being evaluated by NICE for the treatment of thalassaemia and it is also being evaluated for sickle cell. I hope all those things will bring great benefits.

[Baroness Finlay of Llandaff (CB)]

My Lords, I am grateful to the Minister for highlighting that we are a leader across Europe with our services, but only 50% of the country is covered. Can she assure us that in all reviews of the NHS, consideration will be given to centrally commissioned, highly specialised services such as this, rather than relying on local commissioning, that the workforce plan will recognise that highly skilled nurses are needed to undertake this treatment, and that that needs to be factored in? The numbers are small but the skills are enormous.

[Baroness Merron (Lab)]

What the noble Baroness says is very true and I certainly can give the assurances she seeks.

Bread and Flour Regulations 1998

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Wednesday 11th September 2024 Lords Chamber

[Baroness Merron (Lab)]

I certainly hear the very welcome points that the noble Lord makes. As we progress, this will make us the first European country to mandate folic acid fortification of non-wholemeal flour. While some European countries, including Ireland, have voluntary fortification, mandatory fortification is not the case. I and my ministerial colleagues are keen to be in this position.

[Baroness Finlay of Llandaff (CB)]

I am grateful to and congratulate the Minister on her perseverance on this issue and on decreasing neural tube defects. Can she also ensure that products are appropriately labelled with warnings that they are not fortified and that any woman who might become pregnant should take additional folic acid supplementation? Without that, we will not tackle the ongoing problem of neural tube defects. I do have a concern that there is inappropriate fear over toxicity, given that in 1991 there was a very good randomised controlled study. People were divided into groups, given fairly high doses, including with multiple vitamins, and compared with those on a placebo. There were no adverse neurological or other effects.

[Baroness Merron (Lab)]

I am grateful for the noble Baroness’s contribution and can reassure your Lordships’ House, and anyone else who may be concerned, that, as noble Lords have said, this has been gone through over many decades. Safety is paramount. On products that are non-fortified, I will have to look into this, but for those that are fortified, there will be a transition period for industry because the equivalent of some 11 million loaves of bread are sold in the UK every day but only 65% of the flour used in their manufacture is produced in the UK. We have to look at this huge diversity of food products, including biscuits and cakes, and where it is a food ingredient in ready meals and soups. It is quite an undertaking, but your Lordships’ House can be assured that we are on it.

Government Policy on Health

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Tuesday 10th September 2024 Lords Chamber

[Baroness Merron (Lab)]

My noble friend makes an important distinction, and I would certainly share that view. It is worth reminding your Lordships’ House that ministerial meetings that are attended by third parties are declared in a quarterly transparency publication in the established way. Of course, this will be done. I can tell your Lordships’ House that I had a meeting with the right honourable Alan Milburn, and it was very useful.

[Baroness Finlay of Llandaff (CB)]

My Lords, I should declare an interest because I was on the Times Health Commission. We took evidence from a wide range of people, including the person mentioned. Can the Minister provide assurances that, whenever people are consulted, they are routinely asked to declare their interests; that any declaration of interest is repeated not only at the first meeting but whenever other people are present so that it is well known; that the consultation goes widely; and that there is no overreliance on a small number of people? We at the Times Health Commission found that, by consulting widely, we were able to hear very conflicting views, which was helpful and formative.

[Baroness Merron (Lab)]

I thank the noble Baroness for sharing her experience of consulting widely. It is certainly entirely legitimate for government departments to do just that. However, those who do not have a formal role are not required to declare interests; it is different for those who have a formal role. Requiring them to do so would mean, for example, us sending forms in advance to Cancer Research UK before it comes in to talk to us about cancer and to assist us. Would we want that? We would not. Of course, where there is a formal role, we absolutely do that.

It is probably worth saying that a particularly high-profile invitation went from the Secretary of State to the noble Lord, Lord Darzi. He will report shortly on the true state of the National Health Service. He does not have a specific role in the department but he has been invited by the Secretary of State to assist; I believe that he will assist both your Lordships’ House and the other place.

Support for Infants and Parents etc (Information) Bill [HL]

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2nd reading
Friday 6th September 2024 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I am most grateful to the noble Lord, Lord Farmer, for having brought this measure back to the House and indeed for all the work that he has done in looking at the investment in new life for the next generation.

Clause 5 is particularly helpful by defining what an infant is and being clear that the first 1,001 days of life are particularly important. Of course, there is the time before the child is born as well, before that clock starts ticking, which is very important. As the noble Lord, Lord Blunkett, has said, this builds on communities. We live in an increasingly fragmented society, and many women are pregnant a very long way away from any relatives or even friends. They may find themselves in a community that they do not know well, and those community attachments and links can be established if there is somewhere to go.

Another important point, which I will cover as I go through, is that this will take some of the burden away from the NHS. The panicking parent who does not know what to do phones 111 and gives a bizarre description of what is going on and then ends up in an emergency department. That is not an appropriate place for a panicking young mum, particularly one with feeding difficulties.

I am most grateful to the noble Baroness, Lady Miller of Chilthorne Domer, for covering breastfeeding, so I will not repeat the very important points that she has made. Many women think that they will try breastfeeding, they start and then they give up. There are huge pressures to give up, as if it is somehow better or more fashionable to use formula when, actually, the convenience of breastfeeding, particularly in the long term or if you are travelling and going places, is really never advocated.

Mothers are not told what they are doing well; they keep on being given advice as to what they should do differently. Certainly, for myself, the most helpful thing when I was breastfeeding was my mother-in-law saying, “You are doing really well, dear.” That was very reinforcing, because I was worried about what I was doing. A friend of mine just said, “Why don’t you put the baby in a different position, on a cushion under your arm, and you’ll be more comfortable.” Those were really simple things, but the thing about that peer support is that it needs to be available out of hours, at nights and weekends—somebody you can contact.

Concern has been expressed—I am grateful to the NSPCC for its briefing—about messaging and the problem with the digital divide. As the noble Lord, Lord Blunkett, said, people have mobile phones and we are very used to getting advertising messages on the mobile, or messages about NHS appointments, so once a woman is known to be pregnant, some of the messaging can just go in short messages by mobile phone, with who to contact, where to contact them and where to go locally. This should not involve any great expenditure.

On hubs, the work done so far has already evaluated very well. On investment, the Sure Start programme has shown that individual educational outcomes, especially for disadvantaged and racially minoritised children, have seen a huge benefit. Those eligible for free school meals who grew up near a Sure Start centre outperformed their peers by three grades at GCSE, so this is a really long-term investment in society and in the future for these children.

Worryingly, a recent survey of over 1,000 expectant mums by the Parent-Infant Foundation found that 73% of women surveyed said the information and advice they had about bonding with their baby was not given throughout their pregnancy, and that 71% would have liked much more support to help them bond with their baby. Yet this is a crucial time. We know that perinatal mental illness is a real scourge: 27% of new mums end up with some mental health problem. That is a huge number, and we know that suicide is the leading cause of maternal deaths. We cannot ignore that distress and the need to do something about it in our communities.

There is also evidence that one in 10 fathers experience depression during the time of pregnancy or after a birth, and we know that that is a time of high risk of domestic abuse as well, both towards the mother and the new baby, and any other children in the family. There is evidence that the attachment, which can be enhanced by good support, of mums and dads to the unborn baby also has an effect on siblings and the emotional relationship between siblings. There is a real need to make sure that support is available right the way through so that, by strengthening our communities, this does become an investment for society.

I turn to financial investments. Insecure attachment to mothers costs one-third more than cases where children have secure attachments, and that amounts to an average difference of about £3,500 a year. The cost difference for insecure attachment to fathers is even more substantial, running at about £12,700 a year. Insecure attachment is fundamentally linked to an increase in antisocial behaviour, conduct disorders, violent offending, drug misuse, teenage parenthood and reliance on state benefits. The estimated cost in adulthood for typical conduct disorder cases in the UK is £260,000 per person—more than a quarter of a million pounds per person. This makes financial sense, quite apart from the emotional and societal impact.

I should declare that I chair the Commission on Alcohol Harms, and it would be remiss of me not to remind your Lordships that the UK is estimated to have the fourth highest rate of alcohol use during pregnancy in the world, with an estimated 41% using alcohol during pregnancy. All the evidence around foetal alcohol syndrome and all the harms that go along with alcohol intake is really powerful, but the messages are not getting through to the parents, and they are not accessing the support they need to tackle alcohol and drug abuse during early pregnancy. Research from the Alcohol Health Alliance UK indicates that one-third of people are unaware that it is safest not to drink while pregnant.

I hope that the Bill progresses and that we do not try to over-amend it, which might result in it not progressing. There may be some imperfections—we can always want something slightly better somewhere—but this is a really important initiative and we need to support it as it goes through, because all the evidence is that these programmes work for the child, for the parents, for the siblings and for the future of our society.