Health: Pancreatic Cancer

Baroness McIntosh of Hudnall Excerpts

Monday 21st November 2022 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend. Key to this is the Help Us to Help You campaign, which reaches out to lots of different communities, including a number of minority communities. At the same time, we have rolled out the early cancer diagnosis service to GPs, where they are looking out for some of those warning signs, even when people are there for a regular appointment. Clearly, as has been said by other speakers today, a lot more needs to be done; it is a journey, but awareness is the vital first part of that journey. On that point, I thank the Pancreatic Cancer UK charity, which has been excellent in this field.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister has just referred to awareness, to which he has referred many times in the course of this Question. Would he accept that, for some people, it is difficult to understand what you need to be aware of—particularly with a disease which is, as far as I am hearing today, largely asymptomatic for a good part of its early progression? Can he tell the House where people, who perhaps need to be aware, should look for the things that they need to be aware of?

[Lord Markham (Con)]

The noble Baroness is correct: the problem about the so-called invisible diseases—of which cervical cancer is another example—is that you do not know quite what you should be looking for. That is why I mentioned earlier the non-specific symptoms pathways, which are exactly designed for those sorts of things, whereby general checks are included in the area so that, although people do not even go along with a specific symptom, they are starting to be screened. That needs to be rolled out further. As I mentioned before, this would cover 75% of the population by March 2023; clearly, we need to be at 100%, with the target of March 2024 for that.

Abuse and Deaths in Secure Mental Health Units

Baroness McIntosh of Hudnall Excerpts

Wednesday 9th November 2022 Lords Chamber

[Lord Markham (Con)]

We are investing, and I understand and agree with the point that training is key to this. We have committed to spend £2.3 billion more in 2023-24 in the mental health arena, exactly around this space. It is something that we are working on, and we understand that we need to ensure that the mental health of all our citizens, whatever their race or colour, is well served and looked after.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, as a member of the committee that the noble Baroness, Lady Buscombe, chairs, may I ask the Minister to especially note what she said about the importance of acting quickly on whatever recommendations come forward? Will he also acknowledge that mental health services, not just in secure institutions but across the country, are under very severe strain and that it is when people get into crisis that they are then put into secure units, often because they have not had the help they need before that crisis arrives? Will he please accept that there is a very serious shortage of mental health provision across the country? It would be interesting to know what real impact the numbers he has been able to tell us about today will have on that.

[Lord Markham (Con)]

As previously mentioned, we are investing to increase the provision—I believe it is £2.3 billion in 2023-24, which is a significant sum. We have increased the workforce by 7,000 in this last year alone, and there are plans to increase it further. Clearly, we need to keep that under review. I agree with the premise that prevention is always better than cure in these instances, and we need to make sure that mental health services, training and support are given at the point of need.

Mental Health: Advertising and Body Image

Baroness McIntosh of Hudnall Excerpts

Thursday 30th June 2022 Lords Chamber

[Lord Kamall (Con)]

My noble friend has asked me a very concise question, which will require a less concise answer. Clearly, there is a link between obesity and type 2 diabetes, for example, but one of the difficult things in this area, as with much in healthcare, is getting the right balance. The more emphasis we put on tackling obesity, the more unintended consequences there will be for people with eating disorders. There is now calorie labelling in restaurants and other out-of-home places, but some charities working with people with eating disorders are concerned that this may have a negative impact on them. It is always a difficult balance, but we must try to achieve it.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister and other noble Lords have raised the issue of social media. What assessment has he made—or is he aware of—of the influence of social influencers, particularly in cases where they are supported by commercial deals that pay them in part to promote certain kinds of advertising?

[Lord Kamall (Con)]

The noble Baroness makes a really important point about a contributing factor to people having poor body image. We know that there are influencers who promote certain products, and that they often alter their own image so that it is almost an idealistic image—whatever that means. Young people then feel inadequate when looking at those images. We also must recognise that this issue affects not just young people but a range of people—even older people. For them, it might be as a gentle a thing as a comb-over, but if that makes them feel better, great. We must look at this issue in its entirety, and it has been looked at as part of the online advertising programme.

Draft Mental Health Bill

Baroness McIntosh of Hudnall Excerpts

Tuesday 28th June 2022 Lords Chamber

[Lord Kamall (Con)]

I am sure the noble Lord is aware that one of the things we found when looking at the shortage of doctors—even though we have more doctors than ever before—was that some people are likely to stay close to where they were trained. That is why, for example, we have opened the new medical schools, and we are bringing more doctors into the system. Clearly, that will not happen overnight, since training to be a doctor takes a very long time.

We are also looking at what else needs to be done at that level. There are other pathways, such as nurses becoming doctors after a certain amount of time. Clearly, international recruitment plays an important role there. Our aim is to have an additional 27,000 mental health professionals in the NHS workforce by 2023-24. We are investing money to achieve that, but again, it is a question of how long it takes for the money to get through. At the same time, we must ensure that by having this additional workforce in the NHS, we are not squeezing out the voluntary sector but ensuring that we are working in partnership with it.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, I am sure the Minister will agree that if we get to point of having to apply the Mental Health Act to a particular individual, the system has failed because that person is, by definition, in crisis. I entirely accept that this Bill is necessary because the current legislation is no longer fit for purpose—Simon Wessely’s review is a very salutary read in that respect—but it is none the less the case that what we really need is to better equip our preventive services to deal with incipient mental health problems as they emerge, trying to prevent them becoming critical. That has been alluded to, in various ways, during this discussion.

Can the Minister tell the House where the £900 million —I think that is what he said—that is being committed immediately to the improvement of mental health services is to be spent? The real crisis is in the availability of human resource to deliver the service. There simply is not enough of it, as many people in this House, and certainly beyond, know from personal experience.

[Lord Kamall (Con)]

As noble Lords discussed during the Health and Care Bill, prevention is crucial. One thing I became aware of when I became a Minister was, when talking to the NHS and others, how they want to move away from purely curing to prevention. In response to the noble Baroness’s specific question, I commit to write to her on the exact allocation of that, but there is one area that plays an incredibly important role. We know, for example, looking back on the crisis, that when we did not know how long it would last, that created a lot of uncertainty. Uncertainty is very unbalancing for people, and it is a huge factor in them having mental health issues. Clearly, one of the issues that came up during the Bill was the use of civil society organisations, social prescribing, music and art therapy, but also conversations—people being able to talk to someone about the issue they are facing and feeling they are not alone. Clearly, that is something we have looked at, in terms of prevention, but in response to the specific question I commit to write to the noble Baroness.

Long Covid

Baroness McIntosh of Hudnall Excerpts

Monday 23rd May 2022 Lords Chamber

[Lord Kamall (Con)]

My noble friend is absolutely right that we must take this seriously. This is why, first, we have tried to map it to the three medical conditions I mentioned earlier: acute Covid-19, ongoing symptomatic Covid-19 and post-Covid-19 syndrome. We are also looking at the WHO definition, which defines post-Covid-19 condition as the condition that

“occurs in people who have a history of probable or confirmed SARS-CoV-2 infection; usually within three months from the onset of COVID-19, with symptoms … that last for at least two months”

and which

“cannot be explained by an alternative diagnosis.”

In my meetings with other Health Ministers from across the world, they want to learn from us what we are doing on long Covid and how we can co-operate better.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister has stressed the fact that the diagnosis of long Covid is quite tricky and variable, according to the period of time over which people have suffered from it. Can he tell the House what support the NHS is able to provide for GPs to understand how to look at people who are presenting with an unspecified collection of symptoms which might be long Covid? Can he also say what is being done to help employers to understand this?

[Lord Kamall (Con)]

The noble Baroness makes an important point because there have been some reports that patients feel that GPs have not taken their concerns seriously. In response, NHS England has worked with the Royal College of General Practitioners to provide advice for GPs on the identification and management of long Covid. They have also worked with Health Education England to produce e-learning modules on Covid-19 recovery and rehabilitation. Rather than take up too much time, I commit to writing to the noble Baroness on her second question.

Health and Care Bill

Baroness McIntosh of Hudnall Excerpts

Lords Hansard - Part 2 & Report stage
Thursday 3rd March 2022 Lords Chamber

[Lord Lansley (Con)]

My Lords, I will not go on at great length because noble Lords have heard more than sufficient from me today, but this group brings us to what is known in the trade as the provider selection regime: that is, how the NHS goes about the process of commissioning services from a range of providers and the relationship between that and the choice that is available to patients. I am going to refer to my amendments, Amendments 98 and 99, and, without going on about it, I commend Amendment 80 in the name of the noble Lord, Lord Warner. Finding out whether people have actually experienced choice and whether that is helpful to them is a useful thing to do, and I am not sure whether it features in the current electronic referral system. It would be useful to add it in.

The words of Amendment 98 are in fact already in the regulations that the NHS currently lives by because, born of the previous experience when there were discriminatory payment arrangements for private sector providers relative to public sector providers—ie, more advantageous payment arrangements for the private sector than the public sector—in the 2012 legislation we legislated to prevent that happening in the future. The current Bill removes said prohibition on discrimination on the basis of the ownership, public or private ownership, of a provider.

Noble Lords might think, “Ah, this is trying to avoid us discriminating against the private sector.” This was actually included in order to prevent the Government or the NHS discriminating in favour of the private sector. There may be arguments for it in certain circumstances because NHS bodies often have, as it were, fully depreciated assets and to create additional capacity the private sector very often has to invest capital and has to meet the costs of capital as well as the revenue costs of providing services. None the less, we addressed all that and took the view that we did not want any discrimination: we wanted no competition on price, but we wanted competition on quality. That is why, to be perfectly frank, I am testing the Government’s intentions in omitting something that was a central plank of policy for the 2012 legislation.

On Amendment 99, if I recall there is language in the original White Paper from last year, which set the provisions for the Bill, which referred to “any qualified provider” and made it clear that it was the Government’s intention to maintain the existing choice arrangements and access to any qualified provider. Indeed, I think it said that it would “bolster” the system, although I am not sure whether that is happening anywhere. The amendment is really intended to test a particular issue that arose. I am a very sad person, and I was looking at the service conditions for the NHS standard contract; the noble Lord, Lord Stevens of Birmingham, will know them intimately. There is a point at which commissioners who are presented with people who wish to access other providers, who have a contract with another commissioner, are not required to extend that service to them. The way in which it was written in the standard contract was to talk about circumstances where the originating contract does not refer to the address—I think it said the postal address—included in the originating contract. My point to the Government is that this is absurd. There can be geographic limitations, but we should aim not to make them as limiting as the reference to a postal address in the originating contract would have made them.

The wider point is that, if one looks at the new provider selection regime, one sees that there is a process by which commissioners—the decision-making bodies commissioning services—go through a process of saying, “What are the circumstances of commissioning providers?” They ask whether it is circumstance 1, extending the existing arrangement; circumstance 2, going to a different provider; or circumstance 3, going to competition. The language of circumstance 2 is:

“where the decision-making body wants to use a different provider and the decision-making body considers it can identify a suitable provider without running a competitive procurement process”.

This is something that it will be readily able to do in many cases. A commissioner can say, “This is the circumstance. We want to go to a different provider and we know who we want to go to—that’s fine, we’ll give them the contract.”

Circumstance 3 is

“where the decision-making body cannot identify a single provider or group of providers that is most suitable without running a competitive process; or to test the market”.

The body could choose to test the market, but of course more than subtly. Whereas, in the past, the NHS tended to think that it needed to test the market in circumstances in which the legislation did not actually require it to, there is no such thing as compulsory competitive tendering in the 2012 legislation, or the regulations made under it. But now it has shifted completely the other way, and NHS bodies will be able broadly speaking to choose not to use competition at all. The question is whether that will really be sustainable. In the short run, access to the private sector may well be quite widespread, and there may well be a significant element of choice available to patients through the electronic referral service, but that may be closed down in years ahead, if these provisions are implemented in the way in which they are set out.

I issue a further warning to my noble friends. If you are a provider of services to the NHS and you believe that a decision has been made unfairly or inappropriately by the NHS, there is a standstill on the contract, you have 30 days, and you can send in a complaint, in effect, to the decision-making body, which then decides whether it has done the right thing. There is no independent process whatever, so it seems that the chances of providers resorting to law to challenge what they regard as unfair decisions on the part of decision-making bodies in the NHS rise dramatically with the implementation of these processes.

All that said, I hope what I can hear from my noble friends on the Front Bench is that what they said in the White Paper a year ago in February 2021 remains true: that they are going to sustain patient choice, that they will use the resources of NHS providers and beyond to enable us to fulfil our very demanding recovery programme, that they will think hard about whether the precise language in some of the respects that I have outlined is fair to providers, and that commissioners in the NHS will use their procurement capabilities to deliver best value for patients. I beg to move Amendment 98.

[The Deputy Speaker (Baroness McIntosh of Hudnall) (Lab)]

The noble Baroness, Lady Brinton, is contributing remotely.

[Baroness Brinton (LD) [V]]

My Lords, I start by commending Amendment 100 tabled by the noble Lord, Lord Warner, and I look forward to hearing him speak on it. It is an excellent idea to ask people how much choice they have actually had when offered treatment. I also thank the noble Lord, Lord Lansley, for explaining his two amendments, and I would like to say to him that he is not sad for carrying out his role in your Lordships’ House with interest and care. His expertise in matters that may leave others cold should be celebrated. The amendments of the noble Lord, Lord Hendy, ask that trade unions should be part of consultations on private providers, and that seems sensible.

I wish to focus, albeit briefly, on Amendment 106A, which proposes that Clause 70 be left out, and which will be spoken to later by the noble Baroness, Lady Thornton; I apologise to her that under the remote rules I have to speak first. I will confine my remarks to the views of the Delegated Powers and Regulatory Reform Committee’s 15th report, in which paragraphs 17 and 18 make plain its views about these proposed procurement arrangements and regulations. The first point that it notes is that the memorandum, at paragraph 481, says that

“full analysis has not been completed and there has not been time to produce a more developed proposal.”

Why on earth do the Government wish to bring into force legislation that they admit they have not had time to analyse, let alone produce a more developed proposal for? We from our Benches, along with other noble Lords, have repeatedly said that the Cabinet Office procurement Bill is likely to overtake the needs for NHS-specific procurement regulations.

Paragraph 17 of the DPRRC Report gets straight to the heart of the issue and provides a response to the amendments that the noble Lord, Lord Kamall, has tabled, starting with Amendment 101 in this group. It says:

“We do not accept that the inclusion of regulation-making powers should be a cover for inadequately developed policy.”


It is therefore more than a little surprising to see a slew of government amendments on this issue that, in the group under discussion, strengthen the powers under regulation.

Paragraph 18 of the Delegated Powers Committee report states that:

“Ministers would not ordinarily propose clauses in one Bill possibly requiring imminent amendment in a subsequent Bill without expecting to face questions. The House may wish to seek further and better particulars from the Minister concerning the possible effect of any Cabinet Office procurement Bill on the Health and Care Bill, and … to press the Minister on why it was necessary to include provision, based on inadequately developed policy, in the Health and Care Bill when the Government intend to introduce a procurement Bill.”


Not only have we tried this at an earlier stage, but there have been meetings between Committee and Report, and it appears that the Government are determined to press on. I know that the noble Baroness, Lady Thornton, has concerns about the Government’s intentions on the clause and its amendment; if she chooses to call a Division on stand part, we from these Benches will support her.

Eating Disorders

Baroness McIntosh of Hudnall Excerpts

Tuesday 1st March 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Lord is absolutely right; it is not just about understanding the issue but resolving it. Before the pandemic, we were meeting the targets of ensuring that people with disorders were seeing a specialist. Sadly, as a result of the pandemic, we have fallen behind. One of the reasons we are investing extra money in community health for adults and children now is to ensure that we catch up and make sure that people who are suffering with eating disorders are seen by clinicians who understand the issues and the differences between types of eating disorders, so that they are not misdiagnosed or given inappropriate information.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister will know that, although we routinely associate eating disorders with adolescents in particular, they may have roots in adolescence but sometimes emerge very powerfully in later years. They are consequently a lot more difficult to diagnose and manage. The noble Baroness, Lady Parminter, used the word “manage” in talking about how these illnesses should be treated. It is a matter of concern that GPs in particular and hospital services are extremely overstretched. The long-term management of remitting and recurring eating disorders is very hard to sustain. Can the Minister tell us what the Government are doing about that?

Eating Disorders

Baroness McIntosh of Hudnall Excerpts

Monday 17th January 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness raises a very important point about how we identify children and young people who are suffering from these disorders or may be a few steps away from it. We know that there are programmes from the Department for Education and our department to tackle mental health issues in schools, identifying pupils and encouraging them to come forward, to talk to a counsellor in the school, and making sure that there is signposting in the right place to ensure that we can tackle their issues.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister mentioned that eating disorders do not always present in the same way. He will be aware that some fluctuate, moving from chronic to acute over a period and back again. When people seek treatment for eating disorders, at the moment those who can afford it are not even able to access treatment in the private sector. If they were able to, however, would they then be able to access NHS treatments at a later date, for example, should they not be able to afford to continue with private treatment?

[Lord Kamall (Con)]

The noble Baroness raises a really important point. It is an issue that was raised over the weekend, in an individual case. I know that we are always advised as Ministers not to get involved in individual clinical decisions, but in this this case a child had not yet got a bed and the parents wanted to take them out for private treatment until a bed became available. They were told that if they went to use the private sector they would be put at the back of the list. I am trying to get more details on this but it seems a lack of common sense. I want to understand why it is happening, but I have not had an answer yet.

Health and Care Bill

Baroness McIntosh of Hudnall Excerpts

Lords Hansard - Part 1 & Committee stage
Thursday 13th January 2022 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, this debate has shown clearly that attacking health inequalities must go beyond the bounds of the NHS as the impact of external factors is massive. I remind the Government that in 2015 poor housing alone was estimated to cost over £10 billion. That was in part because of the poor housing but it was compounded by inactivity and, as a result, obesity.

We should look at the antecedents of complex problems. Marie Curie’s report Dying in the Cold revealed failures in healthcare, bereavement and grief and the challenges of providing care for those with complex needs. Learning difficulties and autism, for which we often do not know the underlying causes, are disproportionately prevalent among people who are socially excluded and at high risk of homelessness, yet for them managing homelessness alone is particularly difficult because of their overall vulnerability. It has been estimated that autism alone has a twelvefold prevalence in those who are homeless compared to the general population.

The antecedents of many of the problems go back to childhood. They carry a life sentence of their trauma, which feeds into worsening health inequalities, aggravating factors such as alcohol and drugs consumption and other behaviours. Unless we strengthen the wording in the Bill to monitor and do something about the data that comes forward, the proposal of my noble friend Lord Kakkar—it is essential that we address this as a core problem to be tackled—will not be realised. I hope that when the Minister replies he will provide some assurance that the Government will consider strengthening the wording in the Bill in the light of this debate.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, I wonder if I might be allowed to speak at this point for the simple reason that I am shortly due to take over from the noble Baroness, Lady Fookes, in the Chair and if I do not contribute now, I will not be able to at all. I have no special expertise to bring to the scrutiny of the Bill, therefore this is the first time I have spoken on it and it may be the last. I want to speak in support of the contribution of my noble friend Lord Howarth of Newport, right at the beginning of what has been a very long and extremely interesting debate but which, until recently, when my noble friend Lady Pitkeathley mentioned it, did not refer back to the points he raised.

In making my brief remarks, I draw attention to my own interests, which are mostly to do with the arts. I am thinking about what my noble friend Lord Howarth said about the arts sector and what it can contribute. I ask the Minister, when he comes to reply, if he would look to one side of his department—particularly towards the Department for Education and to the Department for Digital, Culture, Media and Sport—for further evidence, in addition to the very strong evidence my noble friend Lord Howarth put forward, of the impact of engagement with the arts, particularly on people suffering from often multiple disadvantages.

It is very clear that the data emerging in relation to education points to a strong impact on the health, particularly the mental health and well-being, of young people in education settings when they are able to engage creatively with the arts and arts practitioners. It would be very easy, in thinking about the huge diversity of issues that have been raised here which bear on health inequality, to see engagement with the arts as a “nice to have” extra—something that, if we get everything else right, we can perhaps add in. But it is more important than that, as the evidence is now strongly beginning to show. I therefore ask the Minister not to forget what my noble friend Lord Howarth said at the beginning of the debate in his reply, and to consider very seriously how health inequalities can be properly and creatively addressed by further engagement with the arts sector.

I will say one last thing, which perhaps seems not quite at the heart of it, but it is important. My noble friend Lord Howarth, in giving his examples, spoke about arts organisations, many of which are trying to contribute to this area. To be able to do that, they need people with skills who can deliver the work. Nearly all the people who can deliver the work and have those skills are freelancers. As we all know, they have suffered hugely in the last two years as a result of the crisis that we have all been through. Freelance workers in all sectors, but particularly the cultural sector, have had a very bad time and quite a lot of them have left. I add that as an additional thing to remember when we look at the expectations we can reasonably—and should—have of the arts sector. It needs to be able to properly support the people it has to engage to deliver the work that it can do.

Breast Screening

Baroness McIntosh of Hudnall Excerpts

Tuesday 14th December 2021 Lords Chamber

[Lord Kamall (Con)]

I have previously announced government investment in retention programmes and looking at getting back those who have retired and increasing training places in medical schools and elsewhere.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, going back to the question from the noble Baroness, Lady Fookes, could the Minister remind the House exactly what is the rationale for not including women over 70 in the screening programme, given that, as he has conceded, vulnerability to breast cancer increases with age?

[Lord Kamall (Con)]

The Marmot review found that screening women outside the ages of 50 to 70 could lead to overdiagnosis and to referring women for unnecessary tests and overtreatment. But women in other categories with a very high risk of breast cancer—those with a family history, for example—are often screened earlier and more frequently. Women are not automatically invited for breast cancer screening if over 71, but they can request screening themselves.