Countess of Chester Hospital Inquiry

Baroness Finlay of Llandaff Excerpts

Tuesday 5th September 2023 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare that I am registered with the General Medical Council. I am a doctor and I have been involved in providing some support to the Nuffield review into disagreements in care of critically ill children, which is about to report. As the noble Baroness, Lady Merron, pointed out, this is unbearably and unbelievably terrible. I watched the whole story unfold almost with a sense of disbelief, except the awful thing is that one can believe it happened as it did, with the suppression of the whistleblowers.

That is what I want to pick up from the point made by the noble Lord, Lord Allan: we do not have a senior doctor on every board. The training of a doctor is different from the training of a nurse, a manager or an HR manager. That understanding of statistics is different. When a doctor tries to raise a concern but hits a brick wall, they need to be able to go directly to another doctor on the board to explore what they want to raise and because that other doctor is also subject to the GMC’s requirements. I quote from the GMC’s duties of a doctor:

“You must take prompt action if you think patient safety, dignity or comfort is being compromised”—


“must” being the key word. It was easier for staff to raise issues in the days when there was a senior doctor on the board. It did not always work, but I hope the Government will look at that as an action that could be taken much more rapidly. The GMC also says that doctors must contribute to adverse event recognition.

Again, as has been pointed out, these things have happened before: we had the Robert Francis report into Mid Staffs and the Bristol inquiry into heart surgery. Those people who have been whistleblowers have been traumatised, but nobody has been as completely destroyed as the parents when they know that their child has been killed. Child bereavement is overwhelmingly terrible, but when you know that it was from the action of another person it is even more impossible to come to terms with it.

I hope the Government really will look at whether some urgent intermediate action can be taken, and whether they can have discussions with the GMC so that doctors who are reported to the GMC as being difficult because they are raising concerns are not treated with some of the problems that have arisen, where we have seen doctor suicides and so on when they have been inappropriately referred. I hope the Government will seriously consider whether there needs to be a senior doctor on every board, both in hospital and a provision in the community. Even the appraisal systems that are in place do not seem to be working adequately to protect whistleblowers.

[Lord Markham (Con)]

I thank the noble Baroness for bringing her knowledge and skills to this. Bringing senior doctors very much goes along with the sentiment that we were all trying to express about equipping boards in the right way to be the first line of defence in bringing such things up. I know that many boards have doctors on them, but the noble Baroness raised a very good point; it is something that we should take back. From my point of view, I absolutely see the sense in making sure we do that.

Community Health Services: Waiting Lists

Baroness Finlay of Llandaff Excerpts

Wednesday 12th July 2023 Lords Chamber

[Lord Markham (Con)]

As noble Lords probably know, we published this data for the first time in March, so it is only now we are getting the data that we can truly work on it. It sets out 35 different areas where we understand those waiting lists for the first time, so we know which ones to prioritise—home oxygen being clearly one of those.

[Baroness Finlay of Llandaff (CB)]

My Lords, with a staff absence rate of 5.6% overall for NHS community staff, which is equivalent to 75,000 staff, what are the Government doing to address this high level of sickness, including mental health sickness? Without the staff, the services cannot be provided. Can the Minister also explain what is being done to target those who have particular training in looking after children, given that in some areas the waiting lists for children are incredibly high, particularly for mental health services for children in the community?

[Lord Markham (Con)]

The noble Baroness is correct: absenteeism is often an example, in the same way as poor retention is, of problems in the wider workplace and the pressures that people have to face now. That is why the long-term workforce plan, which I think was welcomed by all noble Lords, looks to tackle every aspect: recruiting more staff so the pressures on individuals are reduced; making sure we have training and retention plans in place; and the necessary skills training in each area, including that of young people.

Dementia Palliative Care Teams

Baroness Finlay of Llandaff Excerpts

Thursday 15th June 2023 Lords Chamber

[Lord Markham (Con)]

We have developed the dementia palliative care toolkit, which we are spreading around all the ICBs. Health Education England has developed an end-of-life care training programme, which is being taken up. Derbyshire has been a key part of the efforts as well, with its own programmes. It is very much our responsibility to make sure that the ICBs, which by law have to provide these services, are providing them to a high standard.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my interest in palliative care and as vice-president of Marie Curie. When are the Government going to produce a strategy for these ICBs to commission against, and against which the provision of palliative care can be measured across the country? The evidence at present is that it is extremely variable. While toolkits have been rolled out in some areas, that has not happened everywhere, and some ICBs seem to have remarkably little commissioning on the table working with the voluntary sector, in particular, and local authorities. I was appalled to see the draft major conditions strategy, in which palliative care for people with dementia is only one short phrase rather than a distinct paragraph.

[Lord Markham (Con)]

Dementia is an important part of the major conditions strategy and obviously there will be more coming out of that going forward. As I said, the Health and Care Act made the ICBs firmly responsible. Some are excellent examples, such as Derbyshire; for the others that are not, it is very much our responsibility in the centre, and I include Ministers in that. I have mentioned before that each of us has six ICBs that we look after, and part of our job is making sure that they are commissioning to the standards they need to.

Mental Health Services: Huntington’s Disease

Baroness Finlay of Llandaff Excerpts

Monday 12th June 2023 Lords Chamber

[Lord Markham (Con)]

Yes, I think is probably the best answer I can give in the circumstances. I will absolutely do that and will write to my noble friend.

[Baroness Finlay of Llandaff (CB)]

My Lords, the draft major conditions strategy refers to mental health conditions and dementias so that should include diseases such as Huntington’s. The problem is—and I declare my interest in palliative care—that as these patients become terminally ill, they have complex physical and mental health needs, yet we know there are serious inequities in provision. Despite the Government’s own amendment to the Health and Care Act 2022, the draft strategy does not have a distinct section on palliative and end-of-life care. Why have the Government not made this a core, integrated part of the strategy for these major conditions when patients, such as the ones with Huntington’s, have really complex needs—and their families have complex needs too—particularly around the time of their death?

[Lord Markham (Con)]

The noble Baroness is correct that they have complex needs and I know from personal experience, with both my mother and my father, the importance of end-of-life palliative care. I thank the noble Baroness for the warning of the question and have been assured that the integrated whole person care approach that the major conditions strategy sets out will include palliative care measures.

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.

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.