Pharmacy First
Baroness Finlay of Llandaff Excerpts(1 year, 10 months ago)
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Lord Markham (Con)
I thank the noble Lord and will answer his questions in reverse. On getting the ICBs around the table, I absolutely agree. This is seen as a key part of those initiatives and handling those pressures. Generally, going back to privacy, I would expect to see, as ever with these things, some pharmacies that become very good and set up really nice areas, with a lot of expertise. I am sure they will push ahead. I am making this up, to be honest—this is not policy—but I would not be surprised if it started off with a base level of ones that can do only the seven, with others that are more skilled and show that they can manage more things, such as hypertension. There will be some very successful ones. On the cap, it would be perverse if those really successful ones suddenly hit the buffers, so to speak. As I understand it, the cap looks at this much more in terms of a global presence. In the department as a whole and the Treasury, we are going into this with a budget in mind and with the appropriate safeguards. But, going back to the value for money question, overspending is actually probably good news because it shows that it is working.
Baroness Finlay of Llandaff (CB)
My Lords, I declare my role as chair of the Bevan Commission in Wales. Through the Bevan exemplars, we have supported projects with extended roles for pharmacists. That included a project on urinary tract infection treatment in remote areas, which was very successful in a farming community.
My questions relate to the way in which this will be evaluated, because this project and the rollout sounds as if they are starting off well, but some difficulties may be encountered. One may be in appropriately diagnosing something such as a sore throat when it might be glandular fever. If you give the wrong antibiotics, there could be quite a nasty reaction. But equally important—in fact, often more important—are drug interactions overall. If the pharmacist does not have a list of the medications that a person is on, there is a real risk of drug interactions. Patients often cannot remember the names of things they are taking, particularly when they have multiple comorbidities. Drug interactions can be a really big problem to manage, so I would like to know how this will be evaluated and how adverse events, such as drug interactions that had not been picked up, will be collated centrally and notified.
My other question relates to the programme we developed in Wales. I declare that I am a vice-president of Marie Curie, which has the “Daffodil Standards” for community pharmacy. Our eight standards for community pharmacists have developed the concept of a pharmacy champion for palliative and end-of-life care, to make sure that medication is available and held in stock in a format that the patient can take. This is also linked to paramedics who are trained to administer medication at home, to families being trained to administer medication, and to pharmacists themselves undertaking individual medicines reviews to see what can be discontinued as well as what can be continued or how doses should be affected. Although we start off with this list, my interest in palliative and end-of-life care obviously means that I would like to see these Marie Curie “Daffodil Standards” adapted much more widely, because we know perfectly well that out-of-hours access to medication can be a real problem for families looking after people at home.
Lord Markham (Con)
I thank the noble Baroness. Key to her first point on drug use is obviously the functionality to be able to see the whole patient record— I talked about accessing that earlier. At the same time, the plan for the data flow is to look at what is being prescribed by the pharmacies—before the team gets on my back, I will say that “prescribe” is not quite the right word, because it is patient guidance and they are not formally prescribing. What is issued will go through the same data flow as for GP surgeries so that we can generally measure whether we think pharmacy X is overprescribing—or oversupplying—a certain type of drug versus a GP surgery. The idea is that that will be monitored in exactly the same way. Generally, on the overall experience of Pharmacy First, we commissioned the National Institute for Health and Care Research to review that to make sure it is done.
If I understood correctly, the question behind the palliative care point is, as we said about the other services: can we see them extending more, particularly in terms of out-of-hours use? The beauty of all this—there are things we can learn from the services that Wales and Scotland have introduced—is that, once the principle is established and there is a track record of it working well, there will be all sorts of opportunities such as these to extend it based on capability and, sometimes, convenience, with matters such as out-of-hours care.
Premature Deaths: Heart and Circulatory Conditions
Baroness Finlay of Llandaff Excerpts(1 year, 10 months ago)
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Lord Markham (Con)
Yes. I thank my noble friend. Prevention is absolutely key, as is tackling things such as smoking—the smoke-free legislation will do this for a new generation—obesity, and high levels of sugar and fat in foods. These are all key parts of our armoury.
Baroness Finlay of Llandaff (CB)
My Lords, I declare that I was a member of the Times Health Commission, which today published a report in which we highlight that a large proportion of disease is lived with silently, long before it presents. Therefore, prevention for cardio- vascular problems needs to start right from school age; simply screening people later in life is already too late. When people have an out-of-hospital cardiac arrest—I think there are about 30,000 a year—they have only a one in 10 chance of surviving. Will the Government undertake to work much earlier with schools and universities and young people to help them identify whether they are at particular risk through smoking, inappropriate alcohol use, living with obesity, inappropriate diets and so on, which will stack up problems into the future?
Lord Markham (Con)
Yes. Those are all key measures that we need to take and, I like to think, are making progress on. I thank the noble Baroness for her work and all the noble Lords who have been working on the Times Health Commission, which is a valuable contribution to this debate. I mentioned digital health checks. I have seen technology where holding your phone up in front of you can test your blood pressure and your heart rate. We need to verify that, but I think that is definitely the way of the future as well.
NHS: Fracture Liaison Services
Baroness Finlay of Llandaff Excerpts(1 year, 10 months ago)
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Lord Markham (Con)
Again, the use of hubs and their importance for getting people back to work is recognised. That is why in 2023, in the major conditions strategy, we announced the £400 million workforce programme to get 100,000 people with employee support back into work. It is absolutely recognised that what we can do with fracture liaison clinics is a major help. We are also looking at digital therapeutics—the app is close to my heart—that can help with MSK as well. There are a range of measures.
Baroness Finlay of Llandaff (CB)
My Lords, I declare my role as president of the Chartered Society of Physiotherapy. Will the Government undertake to work with the physios and Public Health England to look at prevention? This is a public health issue because people have trip hazards in their homes, and a decrease in exercise means that people’s balance generally is not as good, and therefore they are more likely to have a fall. When people do have a fall when they are older, they are more likely to sustain a fracture. Avoiding trip hazards and increasing people’s mobility can be a very important preventive measure.
Lord Markham (Con)
The noble Baroness is correct. As well as using a physio to strengthen people’s use of their limbs, there is a strong investment case behind home improvements because of the payback from them. This is all part of the prevention agenda, and we are looking to see if we can put a package of measures together because our feeling is that prevention is the best way to go.
Care of Critically Ill Children
Baroness Finlay of Llandaff Excerpts(1 year, 10 months ago)
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Lord Markham (Con)
First, I thank my noble friend and the noble Baroness, Lady Finlay, for their work in this field. Of course I will very happily meet to talk about progress. Minister Caulfield has agreed to chair the task force itself, and we have agreed the constituent parties; we are including the Ministry of Justice, the Royal College of Paediatrics and Child Health, the Royal College of Nursing and health qualification providers, which will all take part in the task force.
Baroness Finlay of Llandaff (CB)
My Lords, I am grateful for the compliment paid; it was a privilege to be involved. I declare my interests in palliative care. Given that the number of children with life-limiting and life-threatening conditions has more than doubled in the last 20 years, particularly in the nought-to-19 age group and especially in the under-ones, do the Government recognise the importance of early involvement of multiprofessional specialist palliative care teams, which can support families to come to terms with what they have to come to terms with, help other clinicians to understand the families’ perspectives and avoid some of these disputes happening in the first place? Can the Minister tell us how many of the integrated care boards have commissioned specialist palliative care services that work between hospitals, ICUs and wards, out into the community and into hospices?
Lord Markham (Con)
The noble Baroness is correct: the number of young people with life-limiting conditions has gone up, from about 33,000 around 2001-02 to about 87,000 more recently. A lot of that is, conversely, good news in that we have more and more treatments that can keep these children alive for longer. Clearly, that requires the wraparound-type service that the noble Baroness is talking about. It is the responsibility of the ICBs to provide that; I will provide details of the progress of individual ones when we meet.
NHS Winter Update
Baroness Finlay of Llandaff Excerpts(1 year, 11 months ago)
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Lord Markham (Con)
The noble Lord is correct; London is always our most challenging place. I have found that across the board, funnily enough. He is right in terms of Covid and flu vaccinations, but it is also the case for the take-up of all sorts of different services. We see technology as a key enabler; in fact, the number of people who have booked their vaccinations and follow-up through the app has multiplied significantly. I do not have the precise figures in my head, but they really have gone up. A lot of that is through people seeing their reminder through the app as well. It is recognised that London in particular needs more targeted action—in fact, noble Lords will see an advertising campaign come out in the next couple of weeks or so. We are really trying to promote usage of the app, which is a tool for all these sorts of things as well.
Baroness Finlay of Llandaff (CB)
My Lords, I should declare that I am a registered doctor with the GMC. I live in Wales, but I do not want to get into data-hurling over Wales, but I do have a comment to make. I would like to follow up on the question from the noble Lord, Lord Allan of Hallam, about virtual wards. The Minister may be unable to tell us now, but how many of those patients were actually terminally ill; how many of the virtual wards were providing 24/7 effective cover for these patients; and what is happening across the whole country in relation to 24/7 palliative care cover? All the evidence that is emerging is that it really is grossly inadequate. Families are left unable to access the care and support they need.
Ten years ago, NICE recommended that every area in England should have a helpline so that families can phone if there is a crisis, 24/7, when they are looking after someone with palliative care needs at home; yet the Marie Curie report Mind the Gaps—I should declare that I am a vice-president of Marie Curie—which has been developed with the Cicely Saunders Institute—again, I should declare my interest there as an international adviser—has shown that only one in three areas has such a helpline available. Two-thirds of the country has nowhere for people to phone.
Is the Minister prepared to meet me and others from palliative care to mirror what is happening in Ireland now? From this February, the Irish Government will be funding 100% of hospice clinical services, because they have recognised the inadequacy of relying on voluntary sector funding. We know that good care costs less than poor care. We know that where there is good palliative care in place, with 24/7 support, the number of emergency admissions goes down, the pressure on acute beds goes down and inappropriate transfers drop. Although I am not expecting an answer today, I hope the Minister will seriously consider looking at that situation.
I shall just make a comment from Wales and point out that in Wales, paramedics are now being trained specifically in palliative care. Some consultant paramedics are now attached to palliative care teams and are able to administer palliative care drugs out of hours as required.
My other question for the Minister is on what discussions he has had with the GMC over retention. Those doctors who were temporarily registered have received notice that, as from March, for those who had retired, their temporary registration because of Covid will cease. I just wonder, with the figures we have seen come out today, whether it would be wise to negotiate with the GMC, first, for that to be deferred and, secondly, for all those doctors to be contacted and asked directly how they would like to contribute to improving some of the services. There is a lot of skill there which is currently being unused and underutilised. Again, I guess I should declare an interest because my husband is a dermatologist and has been in that position but has never been called up and would have been quite willing to go and help with clinics. Those are some of my questions for the Minister.
Lord Markham (Con)
I thank the noble Baroness for those points. Absolutely, I will need to come back on some of the detail on the virtual wards and how they are being used. One thing I will say about them, though, from my knowledge, is that the ability of people to communicate on a regular basis is one of the key advantages. On the point she makes about palliative care and the ability to have 24/7 communication, the beauty of the virtual wards is that they have that inbuilt, for want of a better word—they have that advantage. As noble Lords know, I am always eager to learn from practices all around the world, so I will very happily meet people and learn from them.
On retention, absolutely, we all know that the supply of doctors and medics is the key thing that we need, so I personally feel that we need to look at every avenue to make sure that we can maximise that supply. Again, it is something that I will inquire into as a result of that, and maybe when we have our meeting we can discuss that further.
NHS App: Medical Records
Baroness Finlay of Llandaff Excerpts(2 years ago)
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Lord Markham (Con)
The noble Baroness is absolutely correct. While I think everybody would say that 90% digitisation is pretty good—it is not 100%, but it is pretty good—always making sure people are talking to each other is often the issue. I am sure we have all had examples of that. That is what the federated data platform helps to do, in terms of drawing it all in. For example, Chelsea and Westminster has put what was on 10 different spreadsheets and records into one place. We are getting a lot better at that, but is it perfect and seamless? No, there is still some work to be done.
Baroness Finlay of Llandaff (CB)
My Lords, given the importance of medical research, for the development of advances in knowledge and for inward investment into this country in research, what consideration is being given to ensuring that patients in different disease groups can be asked whether they would consent to being informed about clinical studies that may be relevant to their condition? This is so that pre-consent to being approached is being built into the system, because we know that one of the big delays in recruitment into clinical studies is the process of case finding and consent, particularly for less common conditions and when patients are living in more rural and remote areas.
Lord Markham (Con)
It is fair to say that we have made massive improvements. At the beginning of the year, we only had around 10% of patients with GP records available in the app but today it is 80%, which is a massive change. That allows us to do things like “Be Part of Research” which we have had hundreds of thousands of people volunteer for. We have not yet taken it to the next stage, so that you can get ahead of the curve for approvals for certain types, as the noble Baroness said, but the beauty of all this is that it gives all the opportunities for the future. As it is my last time standing up this year, I would like to finish by wishing everyone a happy Christmas.
National Health Service: 75th Anniversary
Baroness Finlay of Llandaff Excerpts(2 years ago)
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Baroness Finlay of Llandaff (CB)
My Lords, I declare all my interests as listed in the register, including having worked throughout my life in the NHS. I congratulate the noble Lord, Lord Hunt of Kings Heath, both on securing this debate and, more so, on all the work he has done in his many years of service to the health of this nation.
Perhaps we should have called this debate “In Place of Fear”, the title of Bevans’s own short book. As Gordon Brown said:
“The astonishing fact is that Bevan’s vision has stood both the test of time and the test of change unimaginable in his day. At the centre of his vision was a National Health Service … a uniquely powerful engine of social justice”.
To know where you are going, you must know where you have come from. Bevan had seen directly how the mother in the average family suffers when there is an absence of a free health service and how financial distress excludes those with the greatest need from accessing even minimal care. Yet poverty still blights our health and care, particularly when serious illness hits and the main carer in the household is a child or young person. According to Bevan:
“The collective principle asserts that the resources of medical skill and the apparatus of healing shall be placed at the disposal of the patient, without charge, when he or she needs them; that medical treatment and care should be a communal responsibility; that they should be made available to rich and poor alike in accordance with medical need and by no other criteria”.
Seventy-five years ago, so many physically and mentally wounded were returning from war, penicillin had only just become available and, compared to today, there were relatively few interventions in medicine. The concepts of evaluating the efficacy of clinical audit and the frontiers of medical research that have revolutionised practice were just a dream for many. People now want to be cared for and know that they will get better care in research-active services.
My mother-in-law, as a young GP, gave penicillin injections to a critically ill woman with pneumonia; the response was miraculous. This recovered patient gave her a teapot as a wedding present, and we still have the “penicillin teapot” in the family today. Yet now we face huge threats of antimicrobial resistance, as these precious resources have been misused. Over-the-counter sales of antibiotics in some countries and their use in animal husbandry are threatening our survival from life-threatening infections. Drug-resistant TB is now a major threat.
Some of our failure to value adequately the importance of health to the country’s economy has resulted in too little effort being put into health promotion and public health, as others have said. Yet amazing advances have been made. The polio of my childhood has almost been consigned to history, diphtheria is rarely seen here, and other vaccines have transformed disease incidence, from measles to carcinogenic HPV, and many more. Yet we still see Dr Julian Hart’s inverse care law in play, that the availability of good medical or social care tends to vary inversely with the need of the population served.
With so much more that is treatable, and with social problems creating more avoidable disorders, we must tackle the social determinants of health if we are even to begin to tackle growing waiting lists. The NHS cannot be the final repository for all that is going wrong in society. Our collective responsibility is through care and well-being in communities, better nutrition, and through supporting people to look after their own health and to respect a health service that is not simply a demand service—it is not like online shopping.
As we push for more care in the community as people are moved out of hospital, we have to remember that the local family structure that previous generations depended on is just not there. Discharging people from hospital to loneliness does not aid recovery. Does the Minister acknowledge and value the excellent work undertaken by all those in the community, particularly district nurses and care staff, and the ever-increasing pressure on them?
We need to tackle public health more than ever, and the misinformation that blights its use and interventions. Prevention runs through everything, including preventing complications and care failures. Nye Bevan recognised that it is obviously preferable to prevent suffering than to alleviate it. We often know what to do but are just not doing it. We understand analgesics yet too few people with advanced disease are accessing the expertise they need, including in my own discipline—I declare an interest in specialist palliative care.
Our emergency departments are under such pressure that staff talk of leaving as we hit a downward spiral in access for those with greatest need. Disease does not respect the clock or the calendar. If we do not use our resources better—the greatest resource being our staff—we will never tackle increasing waits.
We live in a seven-day society so we need to make it easier for staff with children to work on different rotas, use term-time flexible hours and weekend childcare resources so that we can use our theatres with high-intensity teams, and use diagnostic scanners and so on much more efficiently. These are human resource issues. Staff at every level can care only if they feel cared for, supported in difficult decisions and valued for all they do, with meals available, on-call rooms, and private areas to have private conversations. Without the tools and the space they need to treat people and care for people, we cannot expect them to do well.
There are many apparently high-cost interventions now available that result in remarkable long-term savings. Failure to invest in these is short-termism at its worst. Investing in capital and training, as the noble Lord, Lord Hunt of Kings Heath, said, is essential. We need to rethink our health economics model to ensure that we meet need, in the short and long term. There are different ways of working. Technology can help but it is not the only answer to current issues. A healthy nation is a productive nation.
Children’s Hospices: Funding
Baroness Finlay of Llandaff Excerpts(2 years, 1 month ago)
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Baroness Finlay of Llandaff (CB)
My Lords, I declare my interest as having set up training in paediatric palliative medicine in the UK and internationally. Together for Short Lives data shows that about £15,000 per annum is spent on children and young people in the active caseload, which is probably almost 10,000 young people having care from hospices, some of them for many years. Given that there are service specifications and guidelines, can the Minister be a bit more explicit as to how those are monitored to ensure that service specifications really do meet the needs of the children and that hospice services are integrated with local paediatric services, given that such children often have multiple and complex needs?
Lord Markham (Con)
As I said, it is a responsibility for all of them, but I will happily give the noble Baroness a detailed reply so that it is very clear exactly what they are doing to make sure that happens.
Suicide Prevention Strategy
Baroness Finlay of Llandaff Excerpts(2 years, 1 month ago)
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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.
Baroness Finlay of Llandaff (CB)
My Lords, I declare my interests in medicine. The new suicide prevention strategy is most welcome, but do the Government recognise that the ONS data shows that the time of diagnosis and first treatment of those with severe health conditions can be a high-risk time when they feel devastated and often do not have adequate support? The way in which news is communicated and bad news is given to them alters their risk of suicide, particularly in those who have been bereaved by suicide previously. Will the Government therefore put pressure on NHS England and the GMC to ensure that communication skills are included in revalidation and appraisal processes so that patients get better support and are steered towards the new SR1 benefit, which is designed specifically for people with poor prognoses and can play a really important role in relieving financial pressures?
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.
Adult Social Care (Adult Social Care Committee Report)
Baroness Finlay of Llandaff Excerpts(2 years, 2 months ago)
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Lord Polak (Con)
My Lords, it is a great honour to follow the right reverend Prelate. In the same way, it was a great honour to have been a member of the Adult Social Care Committee. I pay tribute to the noble Baroness, Lady Andrews, and the other members of the committee who took me along with them.
It was a learning experience for me, and there are one or two points that I would like to pick up. I notice that the noble Baroness, Lady Barker, is, sadly, not in her place. The thing I learned from her is something that we do not always think about: she talked a lot about the issue of ageing without children. I thank God that I have family and that we looked after my mother, who I will come on to in a minute. It is something that you do not appreciate until you hear it. The noble Baroness is a great champion for understanding that this will affect many, many people across the country. I was glad to learn that from her.
Similarly, I was very much a supporter of the suggestion, as mentioned by the noble Lord, Lord Bradley, that we ought to have a commissioner for care and support. Just as the noble Baroness, Lady Barker, is a champion for her issue, we need a champion who can help my noble friend the Minister and other members of the Government to focus on this. Otherwise, it gets trodden down and nobody really takes responsibility; it is too big and, in the end, nothing really happens.
I made a plea last time I spoke on this subject and I make no apologies for repeating it. Looking around the House, I say to everybody: the one thing I learned is that it is important to take politics out of social care. Let us get politics out of it and let us try to help.
In the end, for me, it was an experience that suddenly became practical. During the time that we were sitting as a committee, my mother took ill in Liverpool; she sadly passed a few months ago. What is overridingly important is to have something that we missed—we did not understand what to do as a family; I have just made a note to call it a “guide for the ignorant”. We need a guide so that, when people find themselves in a situation like this, they know what to do, who to ring, where to go, who to ask. Currently, it is a lottery.
As it happens, I am from Liverpool and the organisation there was pretty impressive. There was a STARS scheme, which the Marie Curie centre had put on, and they came in to see my mum four times a day while she needed help. Without that, I do not know what we would have done. I live here, my sister lives in London and my mum was in a flat in Liverpool.
The experiences we had throughout were horrendous. As I have said once before here in the House, we experienced the best and the worst. The worst was when a nurse was assessing my mum—who could not speak any more—to see what the next stage of care would be. The nurse was in Maidenhead, or somewhere in Kent, and she was in Liverpool, unable to speak, and they did it on Zoom. It was a relic of Covid, of course, but it was no help to my mum at all. It took weeks before they had to pass on their report, from Margate, to a panel of three people who had never met my mother, to decide what sort of care she would get. It is mad. I repeat: we need a guide for the ignorant. The Government need to provide something like this so that people know where to go.
To conclude that story, the Marie Curie hospice in Liverpool was amazing; the people there were amazing. They cared for my mum for three and half months, which is pretty unusual in a hospice. They could not have been nicer. I remember after she passed, I thanked them for everything they had done and then I said, “But where is the gold watch? She has been in a hospice for three and half months”. They were amazing and I shout out to them.
In conclusion, it was a deep honour to have been a member of the committee chaired by the noble Baroness, Lady Andrews, and I learned so much. Following the point made by the noble Baroness, Lady Fraser, I ask the Minister to explain the role of data and patient records, and how we can use technology to support people to stay in their homes as long as possible.
Baroness Finlay of Llandaff (CB)
My Lords, I apologise to the noble Lord, Lord Davies, that in my keenness to follow the noble Lord, Lord Polak, I jumped up too early. I was very glad to hear about the experience of the noble Lord, Lord Polak, with Marie Curie. I must declare that I am a vice-president of Marie Curie; I should also declare my co-chairing of the Bevan Commission, an independent think tank on health and social care in Wales, and my experiences in palliative care.
The noble Baroness, Lady Andrews, is to be commended for a gloriously inspiring report on adult social care which spotlights how much could be achieved by co-production with those in receipt of services and those on whom they depend. The government response has pointed out that additional funding of “up to £2.8 billion” is available in 2023-24 and “up to £4.7 billion” in 2024-25. Can the Minister explain how this funding will be distributed, whether it is ring-fenced for local authorities and how it will be allocated? Palliative care patients often need both social care and specialist palliative care involving the voluntary sector. Will they be able to draw on this funding for their integrated services, which we have already heard about this evening from the noble Lord, Lord Polak?
“We all want to live in the place we call home with the people and things we love, in the communities where we look out for one another, doing what matters to us”.
This definition, as in the report from #SocialCareFuture, explains how social care is not only about services; it is about having a life. For those with progressive disease, this desire to live to the full becomes pressing and urgent. Palliative care works to restore quality of life and a sense of personal worth. This core aim should be the same across the whole of social care: to add life to years, rather than focusing only on years to life. To achieve it, the workforce must be empowered to use their initiative to meet need and with time enough to go at the pace of the person.
Today, I was fortunate enough to meet a group of mothers who have children and young adults with multiple complex conditions. They were stressing the financial problem: they are unpaid carers who are getting burned out, and there is a huge lost opportunity. They realise that their children must be somehow prepared for independence because, as they get older and die, their children are likely to outlive them. However, the current system does not encourage that. It is simply about providing a response to the most pressing needs, rather than taking a long-term preventive approach, particularly when these young people are still able to develop.
The report highlights the ageist and disability-phobic attitudes that impede the ability of those with disability and who are older to function to their maximal ability in society. Such attitudes exist widely, sadly, including in health. Will the Government work with the voluntary sector to change attitudes and ensure that people are free to state what they need? The question “What matters to you?”, followed by sensitive listening, can guide the provision of services that empower, rather than a menu of services just given to people.
As the noble Lord, Lord Davies of Brixton, pointed out, we cannot expect the social care workforce to achieve the level of personalised care needed unless there is parity of esteem for them and without attention to their own welfare. Many have a wealth of valuable experience: the NHS could co-produce education and training with the social care workforce and with those with experience of receiving care. That would break down some barriers and improve integration.
In their response, the Government refer to the grant funding to Think Local Act Personal. Can the Minister tell us how that is being evaluated to ensure that holistic approaches reach the people on the receiving end of social care? Staff with skills need to be paid at an appropriate banding, with their managers also carrying a caseload so that they understand what is going on. Perhaps colleagues in health and management will then recognise the important job being done.
One thing I want to touch on in my closing moments is timely equipment. It can be essential to maintaining independence and decreasing the calls on hands-on care. What do the Government plan to do to decrease waste by recycling equipment such as mobility aids and so on? If equipment is not being recycled, could it then be sent to countries abroad as part of our aid programme? How much is wasted simply because things are not being used again and recycled in a timely manner?