Junior Doctors Contract

Baroness Masham of Ilton Excerpts

Monday 30th November 2015 Lords Chamber

[Lord Prior of Brampton]

I am delighted to do that, having been the chairman of an NHS trust for 12 years myself and knowing that my noble friend was chairman of the Imperial NHS trust and that the noble Lord, Lord Hunt, who is opposite, was chairman of the Heart of England NHS Foundation Trust. Given the pressure and stresses on management and the complexity of its day-to-day role, I think that no other organisation is as challenging as a large acute hospital. Managers have to do their work in the full glare of publicity as well and it is extremely difficult, so I certainly join my noble friend in paying tribute to the extraordinary work that many of them do in the NHS.

[Baroness Masham of Ilton (CB)]

My Lords, the Statement says that the Government’s ambition is,

“to make NHS care the safest and highest quality in the world”.

How is this to be achieved without enough high-quality doctors? Do the Government agree that, regarding the teams—the therapists and nurses, as well as the doctors—we need hard-working but contented staff?

[Lord Prior of Brampton]

The noble Baroness is absolutely right that the biggest asset in the NHS is the people who work in it. That is not just doctors and nurses but therapists, allied health professionals and all those people such as porters, caterers and the like. We have an extraordinary workforce, which, sadly, we often take for granted. I am always struck by the results of the NHS staff survey, which are nothing like as good as one would expect to see in many other businesses, so I agree entirely with the noble Baroness.

Health

Baroness Masham of Ilton Excerpts

Thursday 26th November 2015 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, I thank my noble friend Lord Crisp for securing this debate, which comes at a time when the NHS is under serious stress. The demands on it are immense, but, as my noble friend suggests, if everybody pulled together a healthy and resilient population may be achieved.

It is of great concern that the funds for public health are being cut back, because grants to voluntary organisations can help people who need support in so many different ways. It will be at our peril if sexually transmitted diseases and their clinics are neglected. In West Yorkshire some strains of gonorrhoea have become resistant to their treatment drugs. In London there are some excellent HIV/AIDS treatment units, but HIV infection is still increasing. Drug-resistant strains of tuberculosis are also increasing. It would be very unwise to become complacent.

Public Health England should educate the public about the dangers of a wide variety of infections. Hepatitis C can now be cured, but few patients are getting the drugs they need. The problems of alcohol abuse, alcoholism and drug abuse must be addressed. Treatment centres should not be put at risk. I ask the Minister: how will cuts to public health budgets affect drug and alcohol clinics? If Public Health England cannot afford to tackle these problems with NHS England and NGOs, perhaps the drinks industry and the private sector can help. Working together must be the answer.

Simon Stevens, head of NHS England, said that hospitals should be health-promoting environments. Hospital food is integral to the health and resilience of patients, hospital visitors and NHS staff. I experienced hospital food that was tasteless and unpalatable. Much of it was wasted. It came from Wales and was reheated. People in spinal units, who have serious injuries and have to be in for long periods, sometimes being treated for pressure sores, need good diet and nutrition, which is key to building health resilience in patients. Also, hospitals are where people are at their most vulnerable. Many of them may be elderly and have eating problems. They need good nutrition to heal, gain a healthy weight and recover from their illness. Good food builds good morale. Indeed, patients getting depressed can look forward to meals and going home early.

There is currently a TV programme called “Doctor in the House” on BBC1. Last week a doctor visited a family in their home, and there was a diabetic man who was eating all the wrong food. The family was shown what a good, healthy diet and plenty of exercise could do to bring high sugar levels down. The woman was shown how to beat anxiety and the daughter how to prevent infections by washing her hands. Many people need to be helped to live healthy lives and to feel good. I am sure that these sorts of programmes will help.

The paraplegic sports movement was started by an inspired Jewish doctor at Stoke Mandeville Hospital rehabilitating wounded military personnel from the Second World War. It was found that if you could compete in sport you could compete in normal life and work, however disabled. These sports became the Paralympics. Many disabled people worldwide live healthy and resilient lives, having been stimulated through sport. I salute His Royal Highness Prince Harry for the Invictus Games, which show the amazing feats accomplished by modern injured military personnel, who achieve so much.

I congratulate the three maiden speakers, and I am pleased they have chosen health as their subject for debate.

Gender-based Violence: Women with HIV

Baroness Masham of Ilton Excerpts

Wednesday 25th November 2015 Lords Chamber

[Lord Prior of Brampton]

I think I am right that there are some 16 million women worldwide who suffer from HIV/AIDS so it is a huge problem, particularly in sub-Saharan Africa. I am not familiar with the innovation fund to which the noble Baroness referred, but I will investigate that and write to her.

[Baroness Masham of Ilton (CB)]

My Lords, is the Minister aware that there are many African men living in the UK who deny that they may be HIV positive, refuse to have a test and therefore put women at risk? What will the Government do about that?

[Lord Prior of Brampton]

I believe that some 103,000 people are HIV positive in England, of whom two-thirds are men. The majority of people who are HIV positive come from sub-Saharan Africa. The noble Baroness made the point that some who know they are HIV positive are not taking appropriate action and asked what we can do about them. It is also worth pointing out that some 18% of people who are HIV positive are ignorant of the fact. We have a very big communication programme ongoing to try and educate and inform these men, and we will continue putting the necessary resources into those programmes.

Atrial Fibrillation

Baroness Masham of Ilton Excerpts

Wednesday 4th November 2015 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, I thank the noble Lord, Lord Black of Brentwood, for this debate and for his ongoing questions to the Government on atrial fibrillation. Both my late husband and one of my best friends had irregular heartbeats. I used to check their pulses and told them that they must get checked out for atrial fibrillation, but their doctors did not take these abnormalities seriously. This is why I strongly support this debate on improving the diagnosis and management of AF.

I declare an interest as the vice-chair of the All-Party Parliamentary Group on Atrial Fibrillation. I am pleased to tell your Lordships that there is to be a meeting tomorrow in Portcullis House on transformation of AF services following NICE clinical guideline 180 and what it will mean for patients. It is good to have these specialising all-party groups to help to make Parliament aware of the many needs.

My husband had a stroke while watching a cricket match on TV and I knew exactly what was happening. Neglect in the local hospital, bleeds, clots and diabetes followed. It was a nightmare. If strokes can be avoided, that must be a priority. Prevention is much better than cure because so often there is not one. We need to prioritise prevention. Sadly, many people with AF are not diagnosed and many who have been diagnosed do not receive the anticoagulation treatment that they need. It has been estimated that as many as 700,000 people in the UK may be undiagnosed. Improving access to the full range of anticoagulation therapies would bring benefits to patients and the NHS.

For many years, I have felt that basic first aid should be taught in all schools to pupils above a certain age. Taking the pulse manually should be commonplace. I have been amazed that so many people cannot take their pulse. With so much talk about self-management and self-care, surely it is time to show everyone the way with basic training. Does the Minister think that all GPs have read the NICE guidelines on AF? If they have, why are they still prescribing aspirin?

I congratulate the Stroke Association on all that it is doing to help with AF. If all the estimated 1.4 million people with AF in England were detected and adequately treated, an estimated 16,000 strokes could be prevented every year. In addition to reducing mortality and severe disability, additional health and social care costs could be avoided. The NHS alone could save £130 million with appropriate detection and treatment of AF. I hope that the Minister will give us some encouragement. It is a very important issue.

Lyme Disease

Baroness Masham of Ilton Excerpts

Thursday 22nd October 2015 Grand Committee

[Baroness Masham of Ilton (CB)]

My Lords, I thank the noble Lord, Lord Greaves, for this short debate alerting your Lordships to a topical issue. Last Thursday, the Evening Standard had a double page headed, “The Ticking Lyme Bomb”, and yesterday the Daily Mail had a large article entitled, “So what IS the truth about the Lyme disease ‘epidemic’?”. I come from North Yorkshire, which is one of the areas listed as having a particularly high population of ticks. Lyme disease is transmitted by the bite of a tick affected with Borrelia burgdorferi bacteria. Ticks do not jump or fly but climb on clothes or skin. The bite does not itch or hurt, so the tick can remain on the skin for longer than 24 hours, which is dangerous.

Gamekeepers who walk in heather and bracken are always well protected as they are dressed in thick tweed plus-fours and jackets, thick stockings and boots, but nowadays I see more and more people running in shorts, sometimes with no socks, or having picnics in parks in hot weather wearing little clothing. Could this be a reason for the increase in tick bites? I know of a woman from the Czech Republic who got a tick bite picking mushrooms in a forest. She got a rash and went straight to her doctor. She was given the appropriate antibiotics and did not develop the problems which can be associated with Lyme disease. Can the Minister tell us whether enough people know what to do when bitten?

I am told there are three vaccines for dogs but none for humans. How much research is taking place? Are we sharing research with other European countries, Canada and the USA that have the problem? The Health Protection Agency is very important. Can the Minister tell the Committee what research is being undertaken into complications resulting in long-term damage to the nervous system, joints and heart issue? Could there be any danger of Lyme disease being passed on by body fluids, such as infected sexual fluid which is lingering on and being found in people with Ebola?

Now the problems have been highlighted, results should be made public and help should be made available for those who need it. I hope this debate will help to make more people aware of what infected ticks can do.

Health: Children

Baroness Masham of Ilton Excerpts

Thursday 10th September 2015 Lords Chamber

[Lord Prior of Brampton]

My Lords, the causes of childhood poverty are profound. They are to do with employment, family relationships and education. The work that the DWP is doing with its troubled families programme and the work that the Department for Education is doing in improving educational standards will have a much greater impact on childhood poverty than, for example, focusing solely on things such as tax credits.

[Baroness Masham of Ilton (CB)]

My Lords, are there enough paediatricians across the UK to look after the under-fives, and is prevention of cerebral palsy a priority?

Health: Lymphoedema

Baroness Masham of Ilton Excerpts

Wednesday 9th September 2015 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, I thank the noble Lord, Lord Hunt of Kings Heath, for enabling your Lordships to discuss this very important and sometimes neglected subject. First, I ask the Minister: why are there national strategies in Northern Ireland, Scotland and Wales for lymphoedema, but not in England? Being Scottish, having been born and lived in that country, but having married an Englishman and living in England, I cannot understand why England is neglecting this very complex condition. England is without doubt more complicated, with so many more diverse sections of the community and with far greater numbers than the other three countries put together.

Lymphoedema is a long-term condition defined as tissue swelling due to a failure of lymphatic drainage. The condition can be inherited, though it is frequently caused by cancer treatments and by parasitic infections, as the noble Lord, Lord McColl, said. Though lymphoedema is incurable and progressive, a number of treatments can ameliorate symptoms. Tissue with lymphoedema is at risk of infection.

For many years, my husband had several complicated long-term conditions after a stroke and after developing type 2 diabetes. He developed cellulitis in both legs, which were hard and swollen, and he got agonising cramp at night. Sometimes he had to go into the local hospital when there was infection. As he was a rather tall, large man, the bed was often not long enough, so often when I visited him his legs were not elevated as they should have been. Whoever I had with me, and I, would elevate his legs on pillows. He hated his depression stockings. I think that there are better devices which might have been better for him. It was an uphill struggle and frustrating. I feel so strongly that with these long-term conditions there should be clear guidelines for hospitals, the community staff and the people at home. Correct management and care are so important and help to alleviate the discomfort of the patient.

To this day, I do not know whether my husband’s condition had developed into lymphoedema. One of the members of the Spinal Injuries Association, a paraplegic whom I knew well, was a remarkable person and a great campaigner for better facilities for disabled people. Patricia got breast cancer and, after her treatment, developed lymphoedema in her left arm. When she showed it to me, the arm was huge and swollen. There needs to be good aftercare for these patients. It seems to be patchy. Patricia died recently but a short time beforehand she took part in the programme “Countdown” and was unbeaten, having won every time.

I hope that one day a way will be found to beat lymphoedema. I ask the Minister: how much training do doctors, nurses and therapists have in treating lymphoedema? How much research is being undertaken worldwide into this most distressing and confusing affliction? I hope that the Minister will give us the satisfactory answer tonight that England will join the rest of the UK in having a strategy for lymphoedema.

The National Health Service should aim for the best quality of care for all long-term conditions throughout the UK. At the moment, it is patchy across the country.

Health: Skin Cancer

Baroness Masham of Ilton Excerpts

Wednesday 22nd July 2015 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, are there enough dermatologists in England?

[Lord Prior of Brampton]

The noble Baroness makes a very interesting point. It is recognised that there are not enough trained dermatologists in England—I think the figure I have seen is 177. To put it in context, there are 650 consultant dermatologists in England, so the answer is that there are not enough. The growth in the problem, if I can put it that way, seems to be running at about 3.5% a year. We are behind on this and need to catch up.

National Health Service: Sustainability

Baroness Masham of Ilton Excerpts

Thursday 9th July 2015 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, I thank my noble friend and congratulate him on instigating this debate, which is necessary but of great concern. I must declare an interest, as I use the NHS and it saved my life after a traumatic injury. Sustaining the NHS is vital but it has many challenges. There are so many demands on the service, which is struggling to keep its head above the water.

What can be done about the PFI hospitals? They are getting into serious debt, and is it not a fact that they may have to pay out more? This would be a disaster. Some of these hospitals are cutting services relating to patient care and closing wards to try to save money.

There are many more demands on the service as the population grows older. Money needs to be saved so that it goes to patient care. If one looks at the lists of well-paid managers, many of those posts could be merged, saving money. Something must be done to make locum doctors and nurses’ posts cost less. It has got out of control. It is vital to have good, well-trained front-line staff, but if too many are from agencies it means that there is not continuity of care, which is so important. Perhaps hospitals could have their own staff banks. I agree that patients must take responsibility for their hospital or GP appointments but they must be able to contact the hospital or surgery. This can be difficult. Communication throughout the NHS should be improved.

I feel that it is such an expense to the NHS when things go wrong. Patient safety should be top of the agenda. I hope that the duty of candour will help. There has been a culture of cover-ups for too long, which I hope will be changed to one of openness and honesty. An apology and correcting the mistake is often what is needed and that would help to lessen the need for litigation, which costs the NHS far too much. However, compensation should be paid when there is disability which is very expensive to live with.

On Monday, I attended a meeting on orphan drugs and rare and ultra-rare conditions. We discussed the extreme stress that parents and loved ones have when their family member is denied a drug which can save their life or improve its quality. There should be co-operation with charities, the NHS and industry working together to find ways of funding these vital drugs. I wish that the Prime Minister would help over this matter. He is a person who understands these very heartbreaking situations of life and death. There should not be discrimination for the people who need the NHS more than anyone.

Multidrug-resistant bacteria result in extra healthcare costs and productivity losses of at least €1.5 billion per annum. Each year, about 25,000 patients die in the EU from an infection caused by multidrug-resistant bacteria. London has been named the capital for TB in Europe. It is a serious public health and economic threat, demanding a concerted response.

As president of the Spinal Injuries Association, I end by saying that delay in admittance to a spinal cord injury centre when there is a spinal injury with paralysis can lead to an increased risk of acquiring avoidable complications such as pressure ulcers, contractures and infections. These secondary complications not only are an additional health hazard to the patient but have been shown to result in longer lengths of stay and present a real risk to the functional outcome for the patient and an extra cost to the NHS. NHS England should be doing more to help and should communicate better with the specialist units, which do a difficult job and need a boost to their morale.

Health Funding

Baroness Masham of Ilton Excerpts

Thursday 9th July 2015 Lords Chamber

[Lord Prior of Brampton]

I repeat my earlier response that prevention is extremely important. We are looking at a relatively small reduction of £200 million out of a total public health budget of more than £5 billion.

[Baroness Masham of Ilton (CB)]

My Lords, does this mean that campaigns on alcohol and drug abuse will be cut? Is the Minister aware that there is a great increase in liver disease and hepatitis C?

[Lord Prior of Brampton]

The decisions about which services to reduce must lie with local authorities.