NHS: Elective and Cancer Care Backlog

Baroness Finlay of Llandaff Excerpts

Tuesday 7th December 2021 Lords Chamber

[Lord Kamall (Con)]

The Government have announced the NHS long-term plan. We have had a budget increase. We are focusing on a number of different issues. One of the challenges over recent years has been the ageing population. That should be a positive thing and we want to make sure that we look at the new health challenges that we face for the future.

[Baroness Finlay of Llandaff (CB)]

My Lords, do the Government recognise that one-fifth of patients with cancer are diagnosed in emergency departments across the country? When patients are diagnosed late, the nature of cancer and its progressive metastasising behaviour means that, by the time they are diagnosed, the treatment burden is greater and the cost to the NHS goes up. Early diagnosis becomes the only way to tackle the overall problem.

[Lord Kamall (Con)]

The noble Baroness makes a very important point—as did the noble and gallant Lord—about how we reconfigure our healthcare system to make sure that we catch these diseases much earlier in the system rather than waiting for secondary referral. This is not only in primary care but lots more self-diagnosis with more technology now in the home and elsewhere.

Health and Social Care

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Monday 6th December 2021 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I should declare my interest in relation to medicine, the BMA and the Royal College of Emergency Medicine, and I would like to ask about emergency medicine. The winter flow data from the Royal College of Emergency Medicine has data from 40 sites across the UK. They are reporting that, in November, there were 275,596 attendances. Their long hospital stays had increased by 13% to more than 48,000 patients. Their 12-hour stays in emergency departments were twice as high as they had been in the previous year, and that was equivalent to 7.3% of all attendees. Their four-hour performance is incredibly low, at 62%. I know from one department that was built for 28 patients that, on a Monday in November, it had 108 patients in. This becomes unsustainable, and the overcrowding is a danger in terms of Covid and infection. It is also a danger to the welfare of staff because, in this particular department, even the staff toilets were not flushing, so the staff had to leave the department just to excuse themselves.

The estate takes time to rebuild and be repaired. What is being done with projects now to create additional space for emergency departments to manage this overcrowding? Is there targeted money going to make sure that the departments are in a good condition of maintenance for the staff? Separate, but related, to that, is the pension block, which has stopped doctors from returning from retirement and has pushed some doctors into early retirement, being addressed in the long term? It is important that doctors who have retired because their pension pot has reached its limit can be incentivised to come back to take pressure off in GP surgeries and in hospital departments, particularly out-patient departments, by seeing patients where their long-term experience and wisdom can contribute to the clinical services.

[Lord Kamall (Con)]

I thank the noble Baroness for the points she makes. We are doing what we can to support the dedicated NHS staff in healthcare services. This year alone, we have invested over £15 billion on top of the existing NHS annual budget, and that includes funding to help get patients out of hospital, freeing up beds and supporting hospitals to manage Covid-19. In addition, we are looking at how we can tackle capacity issues on NHS 111 and A&E. We are giving NHS 111 £98 million to boost capacity, help people avoid unnecessary ambulance trips to A&E and take pressure off hospitals. We realise that NHS 111 is often the first port of call to provide urgent medical advice quickly and book time slots for people at their local A&E or appointments at alternative services. We are also delivering the largest ever seasonal flu vaccination programme, so we hope to tackle it on that basis. A number of CCGs and others are having conversations about how we can tackle the pressures on A&E.

The noble Baroness makes the point about staff who, during Covid, went way beyond the call of duty, and we managed temporarily to address those concerns. We are very grateful to staff who had retired and returned, and we are looking at whether that can be a long-term solution. We need to make sure that no one who is willing to come back is disincentivised. I do not have the details at the moment but I commit to write to her.

NHS: Primary Care Surgeries

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Wednesday 24th November 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for that important question. International engagement remains crucial to tackling the pandemic and ensuring future resilience. In my first few weeks in the job, I have had a number of meetings, at bilateral, G7 and other levels, to make sure that we are fostering international health partnerships. “It is also really important that we understand the contribution the private sector can make towards making the NHS better for all of us.” Those are the words of Alan Milburn, also a former Labour politician.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare that I am a fellow of the Royal College of General Practitioners. Do the Government recognise that, with an increasing number of GPs working salaried and part-time, it is essential that they have security in their contracts? There is a tension when commercial providers need to provide profits to their shareholders, which can work in the opposite direction to the needs of the community, as the medical staff should be working as a co-operative to improve services locally.

[Lord Kamall (Con)]

I am sure that we all want to pay tribute to the work of GPs, who are at the front line and, quite often, are the gateway to many services across the NHS and the wider healthcare system. It is important that we recognise some of the pressures they are under, but also work out how to help them and, indeed, patients. As I have said in the past, I will be a champion of patients and it is important that patients have access to their GPs, as a gateway to further services.

Covid-19

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Monday 15th November 2021 Lords Chamber

[Lord Kamall (Con)]

I apologise if I have misled the House: I have booked my booster jab but I have not had it yet. I was able to book it in advance but I cannot have it until—perhaps I should not make this public, but they have given it to me one day before the six months is up. This will be all over the front pages tomorrow, it will be a huge scandal and noble Lords will be calling for my head. I understand that.

On the serious point, I share the frustration of all noble Lords who have brought this issue up. I was hoping to be able to announce a date today, but it was scratched at the last minute. I think there was some technical reason, but we hope to have good news soon. I know that will be as frustrating to many noble Lords as it is to me. Believe me, I would rather have good news than to be seen to be avoiding answering the question.

[Baroness Finlay of Llandaff (CB)]

I shall follow up on the question asked by the noble Baroness, Lady Tyler, in relation to pregnant women in particular. There were maternal deaths early on. It would be most helpful if we could have the data on the number of such women, the pattern of vaccination and the pattern of maternal deaths from Covid and severe infection. Women are still worried and hesitant because there was a failure to vaccinate early on, because the data on safety was not there. Having data on the drop in the number of deaths will help to persuade women of childbearing age to pursue being vaccinated, whether they are already pregnant or not.

[Lord Kamall (Con)]

The noble Baroness raises a very important point and I apologise for not spotting it and answering it earlier. Many noble Lords will be aware of the very sad story of a young lady who died because she felt that the vaccine was not safe; her mother is encouraging other pregnant women to have the vaccine. For that reason, we want clearly to communicate that the vaccine is safe and will not affect fertility, so getting the vaccine is the best way to protect yourself. Pregnant women are more likely to get seriously ill from Covid-19, and we know that vaccines are safe for them and make a huge difference. In fact, no pregnant woman who has had two jabs has needed hospitalisation with Covid-19. We need to make that clearer, and I will take this back to the department and the Government to make sure that we communicate more clearly. We all share the same will to share that message more widely.

Alcohol Duties

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Tuesday 2nd November 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Lord makes an important point in looking at the various factors that have to be balanced up. Clearly, we want to encourage consumers or drinkers to move towards low-alcohol and no-alcohol products, while balancing that against the wider economic climate and the hard two years that the hospitality sector has faced, which is why we announced the freeze to some alcohol duties. On encouraging people to go out and drink alcohol, I am afraid I am the wrong person, because I am teetotal.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my interest, having chaired the Commission on Alcohol Harm. Our report published last year cited the data, then 10 years old, which showed that the cost from alcohol to the NHS was £3.5 billion a year, while the Home Office’s own estimates were that the cost to society was £21 billion a year. In the decade since then, the number of alcohol-related hospital admissions has risen by 19%, and there has been a rise, too, in alcohol-related hospital admissions and deaths, which increased by 20% last year alone. Given the rising cost to the NHS, what contingency plans have the Government made should this drop in duty fail to decrease alcohol harms, and what other methods do the Government plan to use to decrease alcohol consumption?

Smoking Cessation: Prescription of E-cigarettes

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Tuesday 2nd November 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for pointing that out, and I will investigate. Not being a user of e-cigarettes or cigarettes, or of any sort of narcotics or alcohol, I am afraid that I am not really an expert myself. I will look into that and write to my noble friend.

[Baroness Finlay of Llandaff (CB)]

Can the Minister confirm that the nicotine levels will be looked at, given that the nicotine level in some e-cigarette products is very high and that nicotine is the addictive substance both in cigarettes and in the continued use of e-cigarettes? The commercial incentive for tobacco producers to produce flavoured, palatable and highly addictive products should not be pandered to.

[Lord Kamall (Con)]

The noble Baroness raises an important point about nicotine itself being a very addictive substance. I am sure that the MHRA will be looking at the guidance, but if the noble Baroness would like to write to me, I can confirm that.

Social Care in England

Baroness Finlay of Llandaff Excerpts

Thursday 14th October 2021 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I congratulate the noble Baroness, Lady Pitkeathley, on obtaining this debate, her important opening speech and her constructive suggestions. I welcome the Minister to his crucial role in the future well-being of the nation. I must declare that I chair the National Mental Capacity Forum and am vice-president of Marie Curie, which provides a great deal of care to people in the community as they are approaching the end of life.

Looking forward, we must fix social care properly. I have worked for decades with social carers in an integrated way through the hospice movement, where it is evident that those providing social care are an essential support to people with severe and life-limiting illness, and to their families. Without input from social care, families would break. Where there is a young parent who is ill, their children need to know the person who is coming to provide support to their parent—a person to whom they often look for emotional support also. Where a child or young person has learning difficulties compounded by physical problems, their social care is literally a lifeline for all in the family. Let us not forget the underage carers in so many families.

No one should think that social care is simply about washing, dressing and eating. It plays a vital role to enable the carers of people at home to cope with their own lives, go to work, go to school and study, and manage all aspects of the home. For the person, social care can make all the difference between feeling a burden, worried that one’s family is being worn down, and being able to function still in one’s role within the family and society. Where good social care is in place, people with profound disabilities are often still able to work with the support of different aids and adaptations, and I have been struck over the years by the number who have run businesses, written papers and even books. It is their carers who they praise as the person enabling them to do this.

Sadly, Marie Curie found that, during the pandemic, 61% of carers said that the person who had died had not had all the help that they needed with personal care before dying at home. More than three-quarters of carers said they did not receive all the care and support that they needed. It is the carers who spot when somebody is less well and when things are deteriorating, and is often the person who triggers the call to the GP or district nurse to come in and diagnose what has changed, alter medication and review the way in which an illness is managed. No one should think that these carers are unskilled or low skilled; they are not. They are very skilled and often have a wealth of experience.

When I was medical director of the hospice in Cardiff, I often looked to the care assistants just as much as the trained staff for important information on patients and families. They spotted whether families were behaving oddly. They would alert me to changes in a person’s condition because, when they took them to the bathroom or helped them with the meal, they spotted changes early. Patients talk to carers because they are not part of the power differential between professionals and patients. Patients often tell doctors and nurses what they think they want to hear, but will be much more open and frank with carers about worries and concerns that they may feel are too trivial to trouble trained staff with but are crucial.

Social care is essential to free up places in hospital. Carers should be there when somebody comes home; that transition from hospital to home is a vulnerable time both physically and psychologically, particularly for those who live alone. If hospital discharges do not happen, the backlog right through the system to the ambulance at the front door of A&E only worsens. It has been estimated that NHS bed days lost to delayed hospital discharges rose by 50% between 2015 and 2017—before the pandemic—when the number of beds available was decreasing in the hospital sector. This, of course, produced greater pressure.

Social care work is hard work. There is a workforce turnover of more than 30% and we must be able to retain skilled and experienced care workers by making sure that this is an important, high-status job, and that the travelling time between clients’ homes is recognised. For those who are unpaid family carers, we should consider carers’ leave, particularly when they are caring for someone who is dying at home.

As we move forwards, the reforms set out in the Health and Care Bill should ensure that every part of England is covered in an integrated care system, with close collaboration between the NHS, local government and other partners. However, it is deeply concerning for people living with terminal illness that there is no requirement on integrated care systems to ensure that they commission palliative care services. I therefore give notice that I will be bringing forward an amendment to the relevant Bill and I hope that the Minister will be able to assure me that the Government will consider carefully amending the Health and Care Bill to include a requirement for every integrated care system to arrange for the provision of specialist palliative care services to meet the needs of the population. Everything must be integrated for the benefit of all.

Health: Chronic Fatigue Syndrome

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Tuesday 12th October 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend—my predecessor—for his warm words and his offer of advice to me, as I find my feet and find myself swimming at the deep end, if you like, in this job. Usually, when I get a question like this, I say, “I will ask my predecessor” but clearly, he has a question for me.

My noble friend is absolutely right that we have to be concerned about how we help those who are suffering from ME and chronic fatigue syndrome, but he will recognise that there is a range of views on this issue. If we want these guidelines to be widely accepted and respected, it is important that we get as many stakeholders around the table as possible. NICE has agreed to this round table; hopefully, we can then move forward.

[Baroness Finlay of Llandaff (CB)]

My Lords, I too welcome the Minister to his post. I declare that I have been vice chair of the NICE committee that produced the revised guidelines on ME/CFS over the past three years, through consensus agreement in the committee. This was fully compliant with NICE’s rigorous processes. Will the Government work with commissioners to ensure that appropriate specialist services for patients with ME are developed and continue, and that services monitor accounts of harms as well as benefits?

[Lord Kamall (Con)]

I thank the noble Baroness for her warm welcome. I am new to this and, as you can imagine, I am still learning the ropes and learning about NICE and its processes. However, I agree with the noble Baroness: it is really important that we address the issues she raises and if she writes to me, I will ask for some advice and respond to her.

Covid-19 Update

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Thursday 9th September 2021 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I have some supplementary questions. I am most grateful to the Minister for the update and for yet again appearing before the House. I will pose short questions about three areas.

First, on the public health messaging over asymptomatic carriers, we seem to have had a complete drop-off of mask wearing and of being distance aware. Neither of those impedes the economic viability of any business at all; they are simply social behaviours. People seem to have gone back to the most inappropriate social hugging, which is unnecessary. Yet I do not see any public health messages coming out just to maintain the control measures we had in place before. Could the Minister tell me what the plans are for that?

Secondly, does the noble Lord plan to widen the list of eligible children to ensure that those who have a family member, whether a sibling or parent, who is particularly vulnerable are offered vaccination—this would not be forced but would be an offer to them—rather than being excluded, as they are at the moment, because they themselves are not ill? They may carry quite a large emotional burden, knowing that someone at home could become very ill, despite being double vaccinated.

Thirdly, on preparing for the winter, does the Minister recognise this week’s notice from the Royal College of Emergency Medicine showing that 80% of respondents are not confident in their ability to cope safely in their departments as we go into winter, and that half of the emergency departments are reporting delays of transfer from ambulances into their departments? That compares with a quarter of such departments reporting these delays in October 2020, which would suggest that the whole backlog and silting up has got worse. Can the Minister explain what provision there is to expand bed provision, so that people who arrive in emergency departments and need admission can be moved rapidly into beds to be looked after, rather than having this backlog, which also stops ambulances going to other emergencies while they are stuck outside an emergency department?

[Lord Bethell (Con)]

I thank the noble Baroness for three extremely thoughtful questions. I will dwell on them, if I may, because they are a good opportunity to answer some of the concerns that I know many noble Lords have.

On public health messaging and behaviours, there is a question of perception. If we look closely at the analysis done by our behaviours team, we see that the public remain extremely conservative and restrained. While the noble Baroness’s perception may be that mask wearing and distancing have been given up and that hugging is not where she would like it to be, from the data it appears that the public remain extremely concerned about public transport, going to the shops and attending major events. Therefore, we are in a moment of transition, but roughly speaking we are where we would want to be.

Let us be clear: we are keen to get back to the life we once had, and vaccines are going to be the way that we do that. We want to return to intimacy and to the way in which our community likes to live. Testing, social distancing and the panoply of virus control play a role in that—but we are seeking to step back from those days and, so long as the vaccines work in the way they are working at the moment, we are keen not to disrupt people’s lives as much as we can.

On eligible children, that ball is with the CMO at the moment. I completely hear the noble Baroness; she is entirely right about the emotional burden. I also emphasise the importance of making sure that children get the education they need, while at the same time empathising with their concerns for their loved ones and those with whom they live. It is an awful position for those children and families to be in. That is why the CMO is looking at vaccination for 12 to 16 year-olds and possibly beyond.

On winter preparations, I hear the noble Baroness’s comments about the Royal College of Emergency Medicine. The statistics she gave are a matter of concern, but the medical director of the NHS monitors these questions extremely carefully. We think we are in the position we need to be in to get through this winter. We are on the balls of our feet in case there is either an uptick in the current delta variant or a new variant. A huge amount of investment has gone into the redeployment of NHS beds. The NHS has never had a bigger capacity in terms of its workforce and the number of beds available. The use of ICUs and the management of Covid patients have become much more efficient and productive than they used to be, and we believe that we are in good shape.

Calorie Labelling (Out of Home Sector) (England) Regulations 2021

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Thursday 22nd July 2021 Lords Chamber

[Baroness Finlay of Llandaff (CB) [V]]

My Lords, I declare that I chair the Commission on Alcohol Harm. We cannot ignore the obesity epidemic, and we must grasp the nettle of the crisis of eating disorders of all types. However, alcoholic drinks are a major contributor to national ill health and obesity.

In 2020, our commission took evidence on alcohol harms, and I want to focus on the evidence we heard about the obesogenic effect of alcoholic drinks. As the Institute of Public Health in Ireland told us, alcohol

“can make a significant contribution to levels of overweight and obesity in the adult population”.

Adults who drink get nearly 10% of their daily calorie intake on average from alcohol, but people are ignorant of the calories. Over 80% of people do not know, or underestimate, the number of calories in a glass of wine and, similarly, over 80% of people do not know, or underestimate, the calorific content of a pint of lager.

A 175ml glass of 12% alcohol-by-volume wine has about 158 calories. That is equivalent to more than three Jaffa cakes, and it is more than a 330ml can of Coca-Cola, which contains 139 calories. This means that, per ml, wine contains more than double the calories of Coca-Cola. The Government have recognised the obesogenic effect of fizzy drinks through their high calorie content but turned a blind eye to one of the most damaging substances to our economy. Yet 308,000 children currently live with at least one adult who drinks at a high-risk level in England. We worry about obesity and do nothing about the most harmful of obesogenic substances.

Alcohol is exempt from the labelling requirements for food and non-alcoholic drinks. Alcoholic drinks are only required to display the volume and strength, and some wines are required to include allergens. I suggest that the alcohol industry is happy to describe alcohol by volume content, because it knows perfectly well that the public do not understand what this means, either in daily consumption terms or in calories. Information on nutritional values, including calories, ingredients, health warnings and so on are largely absent from labels. In commenting on this, the professor of public health nutrition Annie Anderson, told us she is

“shocked how far alcohol is always kept out of nutrition policy”.

Today’s debate is an example of that.

I would like to quote Adrian Chiles, who explored labelling for “Panorama”. He said:

“It is absurd in a pub that you buy a pint, it doesn’t have to tell you how many calories are in it, but you buy a bag of crisps to go with the pint, by law, it has to give you the number of calories … on an alcoholic product you don’t have to provide nutritional information including calories … if you’ve got a Becks blue, which is the alcohol free one, it’s got all the nutritional information and how many calories on it, ordinary Becks, they don’t have to put it on there”.


If we are labelling food with calories, it is blatantly absurd and deeply irresponsible to ignore alcoholic drinks, both in the bottle and when served by the glass in all out-of-home venues. There is evidence, as we have heard from the noble Baroness, Lady Jenkin, that when calories are displayed on drinks, people drink less, thereby also decreasing their liver damage, their risk of injury, of a road accident or of fuelling their addiction, quite apart from reducing their calorie intake and the obesogenic effect. I could go on. I strongly support the noble Lord, Lord Brooke of Alverthorpe.