Health and Social Care: Malnutrition

Baroness Masham of Ilton Excerpts

Tuesday 5th November 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness is right to raise the important issue of malnutrition in the community. We have put together a malnutrition task force, which has published a series of guides of expert advice on prevention and early identification of malnutrition in later life. These guides draw together principles of good practice and offer a framework for making sure that the situation which the noble Baroness has identified does not arise. We have also published a guide for care homes on integrating good nutrition into daily practice. This includes screening, initiating nutritional care plans and considering fortifying food and using oral nutritional supplements when appropriate.

[Baroness Masham of Ilton (CB)]

My Lords, does the Minister realise that there is a huge problem of pressure ulcers due to bad nutrition? It costs the country millions, if not billions, of pounds. Could she do something about this? It is very difficult to encourage people who do not want to eat to do so.

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right to identify some of the very significant health consequences of malnutrition. This is one of the reasons why it has been taken on board as a top priority by not only NHS England but the care system from top to bottom. The start is to have the right screening and to gather the right data so that we can identify where this needs to be improved. She is right that it needs to be integrated into nursing practice so that we not only prevent malnutrition in the first place but, where it does occur, provide the right support to put it right and the right care where there are health consequences for individuals due to clinical, social or economic problems.

Sexually Transmitted Infections: England

Baroness Masham of Ilton Excerpts

Thursday 5th September 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

We will need to confirm the distribution of the grant in due course. I am sure that will be the subject of questions as we go forward. As for the guidance that comes from Public Health England, in developing its plans, local systems work in close partnership with directors of public health to respond to local health needs and deliver on the commitments for the long-term plan. Public Health England works very closely with those directors of public health.

[Baroness Masham of Ilton (CB)]

My Lords, do the Government agree that drug resistance to some of these STIs is very serious and a strategy would help to make people more aware of the problem?

[Baroness Blackwood of North Oxford]

The noble Baroness is expert in this area and often raises this issue. She is absolutely right that antimicrobial resistance among some STIs is a growing concern. Public Health England has a world-class surveillance system to enable early detection and management of antimicrobial resistance. It is particularly an issue when it comes to gonorrhoea, and it uses that intelligence to advise the national gonorrhoea treatment guidelines. We will continue to keep on high alert when it comes to these matters.

National Health Service: Bullying

Baroness Masham of Ilton Excerpts

Wednesday 3rd July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I certainly agree that charging those who come from other countries and use the National Health Service is perfectly sensible and appropriate, and by no means racist. I also believe that, as the call for action on bullying says, it should be perfectly straightforward to get out messages on safety from senior leaders and staff voices. It should be a positive message about how it is a natural extension of the social contract between the NHS and those who use it.

[Baroness Masham of Ilton (CB)]

My Lords, if a member of staff is being bullied by their senior, who should they go to for help?

[Baroness Blackwood of North Oxford]

The noble Baroness asks an important question. There are structures built into the NHS to enable those people to speak up. There is a “freedom to speak up” champion and a system of champions, so that it is perfectly clear to those experiencing bullying by senior managers who they can speak to.

Academic Health Science Centres

Baroness Masham of Ilton Excerpts

Tuesday 2nd July 2019 Grand Committee

[Baroness Masham of Ilton (CB)]

My Lords, I thank my noble friend Lord Butler of Brockwell for bringing up the matter of redesignating academic health science centres. As noble Lords know, the six NHS university health partnerships that have been designated by the department of health are Cambridge, Imperial College London, King’s Health Partners in London, Manchester, Oxford and University College London. I ask your Lordships and the Minister to look at a map, where you will see that Scotland and the north of England have been left out. There is a serious north-south divide. Both Newcastle University and Glasgow do some excellent work. Will the Government extend the list to include the north of England and Scotland, so that the work to research new treatments and to improve health education and patient care can also be promoted in these areas? That would help to alleviate the discrimination between north and south.

I declare an interest as president of the Spinal Injuries Association. There is a great need for research. Spinal injury causing paralysis is life-changing. Several bodies are raising money for this, on aspects such as bowels, bladders, pressure sores and sexual matters. Some of this research has links to some of the six partnerships on the list, but the ultimate aim is to find a way of joining the spinal cord. That needs global co-operation and the highest dedicated research, with hospitals and universities working together.

The disruption that Brexit is having on the NHS is evident. I have several reasons for being concerned about the £30,000 threshold, and universities may also have concerns. What assessment have the Government made of the impact of the £30,000 threshold on delivering research and on specific groups such as early-career researchers, part-time staff, technicians and other specialists working in the UK?

Many people with disabilities of all sorts live in hope that universities will find cures for their condition. It would be helpful if NICE were able to speed up its assessment of technology, which is increasing as research moves on at a great pace.

NHS Long-term Plan

Baroness Masham of Ilton Excerpts

Monday 1st July 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

The noble Baroness has communicated an important message and it is one reason why we have prioritised perinatal mental healthcare. Specifically, services for young girls, who are particularly at risk of self-harm and suicide, recognise this risk. I would be interested to see the findings of the task force she mentions to ensure that those concerns are communicated.

[Baroness Masham of Ilton (CB)]

My Lords, the Statement puts importance on technology. Will the Government speed up NICE in its assessments of technology? I hear that it is taking too long.

[Baroness Blackwood of North Oxford]

The noble Baroness, Lady Masham, is right to raise the importance of this. If we want to get innovative technologies and treatments to patients as soon as possible, we must ensure that we are one of the fastest in the world at regulating and assessing those technologies. However, it is also a matter of uptake. We have dramatically improved that process but we can and must always strive to do better. This is part of my job and I will make sure that I keep working harder at it.

NHS: Bullying

Baroness Masham of Ilton Excerpts

Wednesday 5th June 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I am afraid I was not here 21 years ago to hear the noble Lord’s maiden speech, but I shall look it up with utmost urgency upon leaving the Chamber and I thank him for his proposal. As the work moves from the interim people plan to the people plan, in which the work on bullying and the violence reduction strategy will be developed, I am sure that his proposal will be considered as a very sensible plan.

[Baroness Masham of Ilton (CB)]

My Lords, how seriously does the CQC take bullying and what does it do about it?

[Baroness Blackwood of North Oxford]

The CQC takes this extremely seriously. One proposal in the people plan is for the CQC’s scorecard to include a proper measure of a sustainable workforce, so that the new staff engagement metrics for the NHS oversight framework can be taken into account in the CQC’s well-led assessments during inspections, and that includes questions about bullying.

Antimicrobial Resistance

Baroness Masham of Ilton Excerpts

Thursday 2nd May 2019 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, I thank the noble Lord, Lord Lansley, for this most necessary debate, which covers vital aspects of life and death. So much parliamentary energy and time has been spent on Brexit that a subject as important as antimicrobial resistance has not been as prominent as it should have been on the parliamentary agenda. However, I congratulate Professor Dame Sally Davies, the Chief Medical Officer, for what she has done to help the UK become one of the world leaders in the subject. Antimicrobial resistance is a world dilemma. Governments across the globe should work together and treat this as an emergency problem which must be solved.

The World Bank has predicted that globally, AMR will lead to increases in morbidity and mortality, increase the burden on healthcare systems, increase extreme poverty and could inflict heavy losses on the global economy. The European Medicines Agency’s leaving London for Amsterdam does not give a good message to the world about our status in leadership, new medicines and safety. We will not have voting rights. We will be second-class members if we leave the EU.

I must declare an interest. I had sepsis last June, and know only too well the difficulties of combating infections. Sepsis needs quick diagnosis and antibiotics, but there is a problem getting the correct antibiotic for the appropriate infection. One needs accurate, rapid tests. After nearly a year, I am still battling an infection which persists in going up and down—even though I have the help of three hospitals and the advice of a cousin in Australia, who is a professor of microbiology. I mention this to illustrate how challenging these infections are, especially if they are resistant to treatment. During the year, I have witnessed the stress and pressure some hospital departments are under. The shortage of experienced staff and the difficulties of communication are of concern. There is no doubt that Brexit is not helping. Many much-needed nurses and doctors come from Europe. Many of our doctors and nurses go abroad, where the grass seems to be greener. One never knows what infection will emerge.

I would be grateful if the Minister could tell your Lordships what the Government recommend about Candida auris. The Sunday Times has said that:

“Eight patients in hospitals in Britain have died after becoming infected with Candida auris, the deadly Japanese super-fungus”.


The revelation by Public Health England illustrates the scale of the threat from the super-fungus, which emerged just 10 years ago in Japan, equipped with the fearsome biological armoury that lets it flourish in hospitals and resist most drugs and disinfectants. To date, the microbe has been found in at least 25 British hospitals. What seems to make Candida auris unique is that it spreads so easily from person to person. Once in the bloodstream, it circulates and multiplies, causing sepsis. I congratulate the UK Sepsis Trust for trying to make Parliament, hospitals, GPs, schools and the general public at large aware of sepsis.

With antimicrobial resistance, it is vital that we get new antibiotics. However, a disaster is unfolding in the antibiotics market. In the global struggle against superbugs, Achaogen is a biotech at the front line. Its failure is the latest symptom of an ailing antibiotic market. Its antibiotic, plazomicin, was, in 2018, approved by the UK food and drugs administration for treating complex urinary tract infections caused by drug-resistant bacteria. It is a vitally needed drug, and just one of many new antibiotics we need to replace drugs that are rapidly losing their effectiveness against superbugs. Its loss, for lack of funding, is a tragedy. This was mentioned by the noble Lord, Lord Lansley, and I think it is worth mentioning again.

On a more hopeful note, Carb-X, a global partnership dedicated to accelerating research to tackle the global rising threat of drug-resistant bacteria, with up to £550 million to invest, is said to fund the best science around the world. Its portfolio is the world’s largest development pipeline of new antibiotics, vaccines, rapid diagnosis and other projects to prevent and treat life-threatening bacterial infections. It is encouraging that the UK, the USA and Germany, and several trusts and foundations, are working together. The headquarters are at Boston University. I hope they have great success in helping to protect humanity from the most serious bacterial threat before us. We need better preventive measures as well as alternative treatments, including innovative ways to use the body’s own immune system and healthy bacteria.

I am trying a new treatment for wounds—Acapsil. It is micropore particle technology, a white powder applied to the wound surface. It consists of small particles composed of a network of very fine pores. It removes the toxins, and enzymes are excreted by the wound surface. It does not kill the micro-organisms. It is hoped that it is effective on antimicrobial-resistant infections. Another exciting discovery is that golden kelp, the common seaweed from the rocky shores of Mindelo in northern Portugal, has been found to contain microbes that could bolster the war on superbugs.

I would like to ask three questions. First, what are the Government doing to speed up detection of AMR throughout the NHS? Secondly, do the Government recognise the value of accurate antimicrobial susceptibility testing in safeguarding the remaining effective antibiotics, while accurately monitoring the newly emerging AMR and screening potential new antibiotics? Thirdly, are they aware that the Central Public Health Laboratory in Colindale is involved in an international consortium that has developed a rapid antimicrobial susceptibility test, but that in over two years it has received no direct funding to establish that test capability here?

I have a farm and pony stud. I support vets by saying that they should have the right to prescribe and dispense veterinary medicines, including antimicrobials, according to their responsible clinical judgments. The welfare of animals, as well as humans, must be paramount.

NHS Mandate

Baroness Masham of Ilton Excerpts

Thursday 25th April 2019 Lords Chamber

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his question. I can tell him that, while the accountability framework has not yet been published, it has been decided that it will be a high-level framework that will set two objectives: to ensure the effective delivery of the NHS long-term plan, and to support the Government in managing the effects of EU exit on health and care. Of course, the long-term plan includes improvements to a number of services and this will be followed by the national implementation programme for the long-term plan, which will have milestones for delivery of that plan up to 2023-24. I hope he will be reassured that eye health is included in that. If he would like to follow up specific points with me regarding the concerns his group has raised, I would be very happy to meet him later.

[Baroness Masham of Ilton (CB)]

My Lords, can the Minister give an assurance that people who want to do so can come to work in the UK and be paid less than £30,000? Otherwise, this will stop many people coming: care homes and people who are disabled and living in their own homes cannot afford £30,000.

Safety of Medicines and Medical Devices

Baroness Masham of Ilton Excerpts

Thursday 28th February 2019 Lords Chamber

[Baroness Masham of Ilton (CB)]

My Lords, when the noble Lord, Lord O’Shaughnessy, gave up his position at the Department of Health, many people were dismayed, as he was doing an excellent job. I am so pleased that he is still involved with the health service, and today is an example, as he has brought up the vital matter of safety in the NHS, particularly at this difficult time. I thank him for that. I also congratulate the Minister on taking on the mammoth task of looking after the interests of the NHS and social care.

In the past year, I have taken part in several All-Party Parliamentary Health Group evidence sessions on cancer and other disabling conditions. I found the overriding similarities between them to be late diagnosis of the condition and the problems arising from not having the correct medicines and treatment at the right time. At a recent seminar on safety, one of the main dangers highlighted was fatigue of doctors and nurses, risking them giving patients the wrong dosage or the wrong medicines. I understand how that can happen on a busy ward with a shortage of experienced nurses or during a 12-hour shift.

It is sad that the European Medicines Agency has already left London and gone to Amsterdam. Medicine regulation in the UK will be affected by our departure from the EU. With the EMA having left London, it has already begun. The Royal College of Surgeons is pleased to hear that the Government are considering the establishment of a national medical devices registry. Can the Minister give your Lordships a progress report on that matter?

I am so pleased to hear that NHS Improvement is delivering a new patient safety strategy. So many bodies work for the NHS that it is sometimes difficult to know which is doing what. Will that strategy look at the dangers of counterfeit medicines, many of which are available on the internet? Addiction to medicines is a growing problem.

It is estimated that 52,000 people in the UK die every year from sepsis, a serious complication of an infection. I declare an interest as I had it in the summer; I have been on antibiotics for more than six months. A new rapid test for the early diagnosis of sepsis is being developed by researchers from the University of Strathclyde. The device, which has been tested in a laboratory, may be capable of producing results in two and a half minutes.

In a recent report, NHS Improvement stated:

“Treating pressure damage costs the NHS more than £3.8 million every day”.


It also noted:

“Despite extensive prevention programmes, evidence suggests about … 2,000 patients a month develop pressure ulcers”.


Bruin Biometrics has produced an SEM scanner, which is used to address the problem of pressure ulcers. It is a wireless, hand-held device designed to be an adjunct to clinical assessments; it can alert clinicians to incipient pressure damage not visible at the skin’s surface. It is encouraging that these useful devices are being developed so that prevention can avoid many medical problems.

In August 2018, NHS Improvement issued a patient safety alert after 35 people died from cardiac arrest due to hyperkalaemia, or elevated potassium levels. What support is the Department of Health and Social Care giving providers to ensure that they can comply with requirements to test for and treat that condition? Should not guidelines go out to trusts and GPs? High potassium is a danger to kidney patients because their medication can cause high serum potassium, which is dangerous for the heart and can cause cardiac arrest. On the other hand, low potassium levels can be a danger for people with spinal injuries, so more attention should be paid to potassium levels.

Sodium valproate has been discussed by two noble Lords. It is a drug which has put pregnant women with epilepsy in danger of having children who are autistic. This unfortunate case illustrates the need for clear and honest information along with accurate data. Good communication should be set up between hospitals and GPs, patients and carers, voluntary organisations and public health, and prison health and regulators. All stakeholders should communicate where necessary and should work in harmony, not in isolated silos. What is difficult for patients is when they are given conflicting advice and views. This has been a big issue on the Patients Association helpline. There is much to do, and I look forward to hearing the maiden speech and the Minister’s reply.

NHS: Specialist Services in Remote Areas

Baroness Masham of Ilton Excerpts

Tuesday 11th December 2018 Lords Chamber

[Lord O'Shaughnessy]

The noble Lord makes an excellent point with great insight, as ever. We all want to move to an integrated care system which allows us to worry less about levels of care and think instead about patients and the care around them. We believe a lot can be done within the current regulatory framework but, when the Prime Minister asked the NHS to produce its long-term plan in return for the significant funding increase we are giving, she asked what legislation might be needed to complete that framework.

[Baroness Masham of Ilton (CB)]

My Lords, as president of the Spinal Injuries Association, I ask the Minister if he is aware of the terrible state of spinal injury specialised hospitals, which do not have enough beds. Is he aware that the association and our fundraisers have privately employed two specialised nurses to help the hospitals which do not have expert help available?

[Lord O’Shaughnessy]

I am of course concerned by the point the noble Baroness makes. She has raised it with me privately. I absolutely applaud the work that the association has done but I will come back to her about our specific plans on how to make improvements.