NHS National Health Inequalities Improvement Programme

Baroness Finlay of Llandaff Excerpts

Thursday 25th May 2023 Lords Chamber

[Lord Markham (Con)]

Absolutely. Again, there are also very good grounds for locally sourcing in that way in terms of the environment and reducing the carbon footprint. I must admit to not being very familiar with some of the pilots mentioned, so I will find out and get back to the noble Baroness.

[Baroness Finlay of Llandaff (CB)]

My Lords, the latest data from the National Child Measurement Programme showed that among 10 to 11 year-olds at school, almost 38% were overweight, of whom nearly two-thirds were obese. Do the Government recognise that this represents severe malnutrition in that cohort and that public health should be involved in the planning and inspection of school meals to try to improve that figure? These children will become health problems for the whole of the nation going forward unless their malnutrition is corrected.

Pharmacies: Medicines at Home

Baroness Finlay of Llandaff Excerpts

Wednesday 17th May 2023 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend. She is right to stress the importance of how we support Pharmacy First as a way of delivering primary services and supporting pharmacies in and of themselves. Technology will play a key part in that, both in terms of navigating the patient, when appropriate, to use the pharmacy and by allowing them to book pharmacy appointments.

[Baroness Finlay of Llandaff (CB)]

My Lords, an estimated £300 million-worth of prescribed NHS medicines are wasted every year. Over half of those come from medicines either disposed of in care homes or returned to pharmacies. Do the Government have plans to ensure that, where terminally ill patients are being cared for at home, “just in case” medication, which is personalised, is available so that if a crisis arises out of hours it can be dealt with rapidly and appropriately, and so that some of that wastage could be decreased?

[Lord Markham (Con)]

Absolutely. That is one of the major reasons why blister packs are not always the right solution, because there are many cases of wastage in exactly the way that the noble Baroness has mentioned. Wastage is one of the many reasons why both NICE and the Royal Pharmaceutical Society have come out against the blanket use of blister packs.

Diphtheria

Baroness Finlay of Llandaff Excerpts

Tuesday 18th April 2023 Lords Chamber

[Lord Markham (Con)]

We are all aware of the rumours and allegations about the safety of the MMR vaccine, which we are all delighted to know were totally unfounded. As my noble friend says, it has been quite a task to regain confidence in it, but we are doing so and vaccination rates have gone up. I will provide her with the exact details of those new take-up rates.

[Baroness Finlay of Llandaff (CB)]

How are the Government working with those countries through which migrants pass when fleeing for their lives from war zones, given that many of them are held in very poor conditions where they pick up infectious diseases, including such things as scabies—which are parasites—TB and other diseases? They may also be exposed to chemicals because they take on farm work or factory work in a desperate attempt to get some money prior to arriving in this country. By working with other countries, we may decrease the burden on our NHS and prevent people presenting late with conditions such as diphtheria or even cutaneous diphtheria, which is extremely rare in this country but is now being seen in some of these very deprived populations.

[Lord Markham (Con)]

To be honest, I think the most effective method is to have the screening when people enter. Refugees come in from across the world so, to concentrate resources, it is best done on entry. The record speaks for itself; an 88% take-up rate is very high, comparable to that of the general UK population. I think we have got it right.

Patient Deaths: Ambulance Waiting Times

Baroness Finlay of Llandaff Excerpts

Tuesday 14th March 2023 Lords Chamber

[Lord Markham (Con)]

Local ICBs—integrated care boards—are integral to this, understanding the need for ambulances in each of their areas. As noble Lords have heard me say before, often, having a fall does not require an ambulance response at all, but it is much better to have a full service. Now, it is the responsibility of every ICB to set up a full service so it can respond more appropriately. Additionally, we are tasking each ICB with getting on top of ambulance wait times.

[Baroness Finlay of Llandaff (CB)]

My Lords, the Royal College of Emergency Medicine’s February report says:

“The crisis in emergency care is relentless and staff are burned out and exhausted. The significant shortfall of beds and staff is driving this crisis.”


In February there were 1.2 million A&E attendances. More than 126,000 patients waited more than four hours from the decision to admit them—these are trolley waits —and nearly 35,000 of those were delayed by more than 12 hours. What are the Government doing in their workforce plan to look at projected workload and figures and ensure that the plan has minimum staffing levels and staff numbers overall?

[Lord Markham (Con)]

The noble Baroness is correct that capacity is key to this, as are the workforce and the workforce plan. I am pleased to say that a more advanced version of that will be published shortly, hopefully showing that we are getting on top of it. At the same time, we have put 7,000 extra beds into the system, which is starting to have an impact. Category 2 wait times are down by an hour compared with last month, but clearly there is more that we need to do.

Physiotherapy: Rehabilitation Services

Baroness Finlay of Llandaff Excerpts

Thursday 23rd February 2023 Lords Chamber

[Lord Markham (Con)]

As I said, physio is key to rehabilitation, whether for strokes, as we have discussed, or for any one of the number of reasons that people are in hospital and trying to come out. As I mentioned, we have seen increases: there are about 7% more people now in training each year, and that figure increases each year. We now have about 50,000 physios in the public and private sectors who are providing those types of services. Clearly, there are examples where we need to do more, but we are also making progress.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my interest as the president of the Chartered Society of Physiotherapy. Do the Government recognise that almost three-quarters of physiotherapists feel that they cannot do their job properly now, and that, as well as a workforce plan, there needs to be a workplace plan for adequate rehabilitation that goes way beyond cancer and stroke services? All orthopaedic operations, and many other interventions, will not be successful without adequate, immediate physiotherapy in the post-op period, so, by failing to provide physiotherapy, we are stacking up problems for the future with long-term physical dependency and not maximising the benefit of interventions provided early.

Maternity Services

Baroness Finlay of Llandaff Excerpts

Thursday 9th February 2023 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is quite right to point out those figures, and they are something that none of us is happy with. That is exactly what the Maternity Disparities Taskforce was set up to deal with, so I am happy to make a commitment to talk through with the noble Baroness the progress of that.

[Baroness Finlay of Llandaff (CB)]

My Lords, running through the reports that my noble friend Lord Patel referred to are two strands: one is workforce, which relates to numbers and qualifications, but the other is dysfunctional teams and a failure of teamwork across the different disciplines, both within maternity services and relating to general medical services, for providing support to women, particularly those with multiple comorbidities who are then going through pregnancy and delivery. I wonder whether the Government are commissioning a specific piece of work to look at ways in which these teams can alter their behaviours internally and be supported to improve on this dysfunctional behaviour within them, which is having an adverse knock-on effect on the experience of mothers and on the clinical outcomes which, as has been said, are sometimes fatal.

[Lord Markham (Con)]

Yes, one of the Kirkup recommendations—recommendation 3, I believe—was about an improvement in teamwork, and that is what will be done under the guidance of national and regional maternity safety champions. I should say that while there is much improvement that we want to do, the overall context is a 19% decrease in stillbirth since 2010 and a 36% decrease in neonatal mortality over 24 weeks since 2010. So it is an improving picture, but it is something that we want to improve further.

Hospitals: Maintenance

Baroness Finlay of Llandaff Excerpts

Thursday 9th February 2023 Lords Chamber

[Lord Markham (Con)]

I can speak clearly on the subject of the new hospital programme, which I think the noble Lord will find is world-class. I will happily demonstrate that to him; indeed, people will see how ground-breaking this project actually is. We will see standardised designs with improved clinical standards, and more efficient productivity and costs as a result. It will be world-class, and we will export it around the world.

[Baroness Finlay of Llandaff (CB)]

My Lords, if the Government are saying that these are to be world-class hospitals, what is the comparison? Is it hospitals such as those in the Netherlands, which are extremely well designed and function very well, versus the many hospitals here which do not function well and have appalling design features? As soon as the staff move into them, they deteriorate rapidly.

PPE Expenditure

Baroness Finlay of Llandaff Excerpts

Wednesday 25th January 2023 Lords Chamber

[Lord Markham (Con)]

Right now, less than 1% of stock is held in China—to answer that question directly. In terms of cost, we are currently paying about £700,000 per day, which is why we are writing off the stock and effectively disposing of it. We have tried to donate as much of it as possible to people who want it, but we have to bite the bullet on the rest and say, “You know what? It’s no longer required so we are disposing of it as rapidly as possible.” We are bringing down those costs; we will be saving £200 million a year through that rapid disposal.

[Baroness Finlay of Llandaff (CB)]

How many health and social care staff are now off long-term sick with long Covid? What correlation has there been between long Covid and their perception that they did not have adequate PPE for the job to be done?

[Lord Markham (Con)]

I will write to the noble Baroness with the statistics. I can be clear that the endeavours undertaken to buy the PPE were to make sure that we did not run out. Again, there is quite a bit of hindsight going on in saying, “Ah, we bought too much of it”, when at the time everyone was scrambling to say, “You need to buy more.” That was the result of the situation, and to try to apply hindsight now is quite wrong. They did a pretty good job regarding the amount that they bought; they got 97% of it right, which I think we would agree is a pretty good result.

Health and Social Care Information Centre (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023

Baroness Finlay of Llandaff Excerpts

Wednesday 25th January 2023 Lords Chamber

Finally, I return to the timing and the speed. This feels very much like a rerun of the closure of Public Health England and the creation of the UKHSA when a Covid surge was still going on; officials in the department and NHS staff were working at full tilt and had to change the way in which they worked in order to cope with the UKHSA as a new body. Can the Minister reassure us that that will not be the same when NHS Digital moves into NHS England? My fear is that the pressure on the NHS at the moment means that the situation could be similar to the pressure that the UKHSA has faced over the past year in trying to create a new organisation and new structures at a time of immense pressure.

[Baroness Finlay of Llandaff (CB)]

My Lords, I am grateful to the noble Lord, Lord Hunt of Kings Heath, for having put this amendment before us. I am not going to repeat the important points made by other noble Lords who have spoken but I have a few questions for the Minister. I should declare that I am a member of the BMA’s ethics committee and I am slightly concerned—if I heard the Minister right—that there has not been a comment back from the BMA, because there have been concerns about the potential monetisation of NHS data.

There were a lot of discussions within NHS Digital at the time of the passage of the legislation about pharma companies possibly having early access to some data and negotiating discounted prices as a result, particularly for expensive medication and early access. Can the Minister tell us how much discount has been achieved by some of those arrangements, whether those discounts have applied across the whole United Kingdom or whether they have been only of specific benefit within NHS England? As health is a devolved issue, we now have a problem particularly between Wales and England, where there is effectively a porous health border and many people are going from Wales to England for parts of their treatment cycles. That means that data moves across the border. So my next question is: what has happened in discussions with NHS Wales and what is being done to ensure compatibility for data transfer?

My next question relates to our experience last year when an NHS trust had its systems hacked and the whole system went down. How will the security of the new, larger holding of data be ensured? Obviously, if you have a lot of data held together, there are benefits but also risks. How are those risks being looked for and, as much as possible, mitigated against?

The other issue, again in relation to Wales, is somewhat historical but I have not been able to track down exactly what happened to some data. The Health and Social Care Information Centre merged with Connecting for Health in the 2012 Act. At that time, the data side was a UK-wide database. I wonder what happened to the data that was being held for Wales; whether NHS Digital still holds any data relevant to Wales; what discussions have been had with Wales over the transfer of relevant data; and what arrangements are being made for the future transfer of patient data—again, to allow the transfer of data while, importantly, preserving patient confidentiality. Of course, one of the problems when data is transferred between organisations is that there is a potential risk in terms of confidentiality and a possible leak.

My last question for the Minister is quite simple: why were these regulations not laid earlier? As I understand it, the processes are now well under way—indeed, they are almost complete in terms of the staff, the merger and so on. It would have been helpful for everyone to have been able to have sight of these regulations, as well as all the supporting documentation, earlier.

Social Care: Integrated Care Systems

Baroness Finlay of Llandaff Excerpts

Wednesday 11th January 2023 Lords Chamber

[Lord Markham (Con)]

Clearly, it is early days. These were set up last summer and we must ensure that they bed in properly and learn. I am confident that that is the right approach, but, as the noble Lord mentioned, we must make sure that regulators in this space ensure that that is the case. It is probably a question for a few months’ time, when we can be sure.

[Baroness Finlay of Llandaff (CB)]

My Lords, according to Hospice UK, of which I am a vice-president, up to half a million people last year had a palliative care phase before they died. In many of those cases, a failure of social care resulted in a breakdown of care in the community and hospital admission. Following on from the question asked by the noble Lord, Lord Touhig, when these patients are seriously ill or disabled children, they need access to respite care during their illness, as well as at the end, with rapidly responsive care. How are the Government monitoring whether the needs of these people are being met and that the timeframe to put in place the social care that they need does not just slip to the point of becoming a meaningless exercise?

[Lord Markham (Con)]

Those monitoring processes are in place, but to give sufficient detail, it is best that I write.