National Insurance Contributions: Healthcare

Baroness McIntosh of Pickering Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Merron (Lab)]

As the right reverend Prelate is very aware, most hospices are indeed charitable. They are independent organisations that receive some statutory funding for providing NHS services. As we discussed in a recent debate in your Lordships’ House, the amount of funding that charitable hospices receive varies by integrated care board area, and that will depend in part on population need and the breadth and range of palliative care and end-of-life care provision within the ICB footprint. With NHS funding being provided on a tariff basis, as is usual every year, there is NHS planning guidance, a local government finance settlement and consultations with independent providers. That will happen this year as it has every single year under every previous Government.

[Baroness McIntosh of Pickering (Con)]

My Lords, the Minister is aware of my interest with the Dispensing Doctors’ Association. The idea that allocations will be made in due course simply will not wash. GP practices, care homes and pharmacies will close their doors if the Government do not act urgently.

Pharmacies: Rural Areas

Baroness McIntosh of Pickering Excerpts

Tuesday 10th September 2024 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, I refer to my role with the Dispensing Doctors’ Association; I am grateful to the Minister for paying tribute to it. The right reverend Prelate identified the problem of having equal funding in urban and rural areas, where the dispensing doctors she identified fulfil such a crucial role. Can she give the House a commitment that sufficient funds will be made available in the negotiation of the GP contract so that all the services that are available in urban areas will also be available in rural areas?

[Baroness Merron (Lab)]

I know that the noble Baroness understands that there are some services which cannot be provided—for example, online services do an excellent job, as do dispensing doctors, but although I regard the online option as a very creative one that I would like to see expanded further, there are some things that require in-person attention and that will not be possible. We of course take account of situations across the country, in all the discussions, and that includes rural areas.

Inflammatory Bowel Disease

Baroness McIntosh of Pickering Excerpts

Monday 20th May 2024 Lords Chamber

[Lord Markham (Con)]

I think there are two things. One is the CDC programme; the 160 centres and 7 million tests that we have rolled out are now very much helping in that space. However, it is also about making sure that the right people get the tests. On the question of awareness as well, we now have these faecal tests—a bit like bowel cancer screening—which can tell with 90% sensitivity whether you have inflammatory bowel disease or irritable bowel syndrome. With one, you absolutely need to see a specialist for endoscopy, while with the other, you do not. Telling the difference is key.

[Baroness McIntosh of Pickering (Con)]

My Lords, does my noble friend share my concern that a number of people, increasingly women, are being wrongly diagnosed with IBS when in fact they have an underlying cancer condition? How does he imagine that we can rectify this situation?

[Lord Markham (Con)]

For the benefit of the House, I would say they are often confused. Irritable bowel syndrome is suffered by about 10% of the population while inflammatory bowel disease—we are talking about Crohn’s disease and colitis—is suffered by less than 1% of the population. The key thing is trying to understand the difference between the two; as I say, we have this poo test, for want of a better word, which can do that. With people who test positive, you absolutely need to get them into that screening programme and get it right the first time, so you can pick up those problems and things such as cancer.

Integration of Primary and Community Care (Committee Report)

Baroness McIntosh of Pickering Excerpts

Thursday 9th May 2024 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, I congratulate the noble Baroness, Lady Pitkeathley, and the committee on their report and on securing this debate. I also welcome my noble friend Lord Jamieson and congratulate him on his excellent contribution today.

I declare my interest as an adviser to the Dispensing Doctors’ Association, and the fact that my late father and brother were both dispensing doctors. Dispensing doctors are general practitioners who provide primary healthcare to around 9.9 million rural patients. Almost 3.5 million of those patients live remotely from a community pharmacy and, at a patient’s request, dispensing doctors are allowed to dispense the medicines they prescribe for them. Only certain patients are eligible to receive dispensing services from a dispensing doctor. In total, around 7% of all prescription items are dispensed by such doctors.

The unique benefit of a dispensing doctor service is that it provides access to medicines and general healthcare under one roof. They provide a total network of 1,107 dispensing practices, spread across England, Scotland and Wales, and are a wonderful example of integration between prescribing and dispensing services that are collocated.

Turning to the conclusions of the report and the Government’s response, I think it is important to note that in Scotland health and social care partnerships have existed for a few years, yet funding arguments continue and, despite integration, there is still inadequate funding for social care, with a lack of care placements, delays in discharge from the acute sector and difficulties admitting patients in A&E, so integration has not yet met the needs of patients in Scotland. I ask my noble friend directly: does he agree that neither GPs nor their contracts currently prevent shared facilities? There used to be physios, district nurses, health visitors and others all collocated at a surgery, but it was these very organisations that removed themselves from the premises, not GPs.

I have some points to put directly to my noble friend the Minister. Remote consultations are simply not the answer. Complex patients and multiple conditions need more face-to-face time with GPs. Social care is means-tested; healthcare is needs-led. The difference between them must be addressed before integration can proceed further. Does he not agree that coterminous health and social care areas do not necessarily work for health, where patients may be given a choice, and it could actually destabilise current general practice if that were to happen? I also ask him to consider that it is not about who owns GP practices, which is perhaps a red herring. The Government must address the rules about occupation, then ownership itself becomes irrelevant. Will my noble friend and his department be mindful of the poor history of contracting, particularly GPs contracting out for out-of-hours service?

I ask my noble friend this directly, because this is something where NHS England, particularly in parts of Suffolk, has got the wrong end of the stick: why has EPS for dispensing doctors, and indeed hospitals, not been commissioned and the infrastructure put in place? The question of who is to pay for that infrastructure remains a vexed issue. I put to my noble friend the words of Dr West, who chairs the Dispensing Doctors’ Association; they strike a chord with those of many others, such as the noble Baroness, Lady Barker, and my noble friends who talked about data sharing, as well as the noble Baroness, Lady Pitkeathley. He asks why there is not one prescribing record per patient. Currently, there are different records for GPs and each hospital where that patient may be treated.

Will my noble friend urgently address the issue of GP training? The government response says:

“We will ensure that all foundation doctors can have at least one 4-month placement in general practice by 2030 to 2031”.


I am staggered, as I am sure others are, that this is not already the case. How can it be that, among doctors who are reaching the end of their training and are looking to have a placement, there are still about 100, as of this week, who do not yet have a placement to go to? That is unacceptable when they have reached the end of what is already a very long period of study and training.

To conclude, if integration is to proceed, which I would welcome, it has to be costed and well thought through. There is no one size fits all. What may well work in an urban area such as Pimlico, which was the example that was chosen, may not work in North Yorkshire or other very rural, sparsely populated areas. It has to be acceptable for the doctors and healthcare workers as well as the patients. Again, I note that integration in Scotland has not yet brought benefits to patients. I urge my noble friend the Minister to put GPs at the centre of patient care and ensure they have access to all patient needs, to ensure better care and fewer emergency admissions to hospital and a joined-up healthcare and social care service.

Cancer: Staffing

Baroness McIntosh of Pickering Excerpts

Thursday 14th March 2024 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, I remind the House of my interest with the Dispensing Doctors’ Association. Does my noble friend share my concern about the number of GPs, particularly those under 55, who are considering retirement in the next five years? How do the Government plan to fill the vacancies that will be created, to ensure that, particularly in rural areas, a fast track will exist for patients who are suffering from cancer for the earliest possible referral to hospital? I refer to the letter I wrote to our noble friend Lord Evans on this.

[Lord Markham (Con)]

I thank my noble friend and totally agree that GPs are the front line of our medical services. We are trying to do everything we can to make sure that they feel valued and are retained. The recent change to the pension law was all about addressing that very point, answering GPs’ number 1 concern in order to keep them. Their hard work has seen a 25% increase in the cancer referral rate: we treated 3 million people, up 600,000, over the last year, thanks to their work and the expansion in the diagnostic centres we have set up.

NHS App: Medical Records

Baroness McIntosh of Pickering Excerpts

Tuesday 19th December 2023 Lords Chamber

[Lord Markham (Con)]

The fundamental principle underlying all this is that none of the data leaves the control. The data controllers today—be it GPs, the NHS or the hospital—stay as they are, and any use of that data has to be approved outside of that. The noble Baroness is absolutely correct. We want to make sure that it is not used for any purposes that are not going to improve health outcomes, such as the ones we have talked about.

[Baroness McIntosh of Pickering (Con)]

My Lords, could my noble friend update the House on where we are with sharing data—in particular, the outcomes of clinical trials—with our European partners?

[Lord Markham (Con)]

Clinical trials are among the key areas that are vital to the life sciences industry. We are all aware that, post-Covid, we were falling a bit behind. I am glad to say that now we have improved, so that 80% of the time we are doing the clinical responses in time. We can still do better; that should be 100% but 80% is good. Most importantly, our data is the envy of the world. Just to give noble Lords an example, about 90% of our hospital records are digitised. In Germany, it is less than 1%.

Healthcare (International Arrangements) (EU Exit) Regulations 2023

Baroness McIntosh of Pickering Excerpts

Wednesday 5th July 2023 Grand Committee

[Baroness McIntosh of Pickering (Con)]

My Lords, I congratulate my noble friend on bringing forward what I view as very welcome regulations for us this afternoon. I have to declare an interest, as I currently have an EHIC, which I assume will expire at the end of this year, and visit a very small number of the countries on this list. Given that the list on page 5 in the Schedule seems very full, I take this opportunity for my noble friend to put my mind at rest, because originally—it was a year ago, 2022—it was pointed out that the GHIC, which my noble friend explained will replace the EHIC in the regulations, originally did not cover countries such as Norway, Iceland or Liechtenstein, but they appear on the list. Is that because the original primary legislation did not cover them, or were we just waiting for the regulations before us this afternoon? Can he confirm that the EHIC covers those three countries and that the GHIC will also cover them?

From a practical point of view, I have never yet had to make a claim. I once, rather unfortunately, contracted salmonella poisoning as a Conservative candidate at a hotel which will remain nameless in north London, which rather sorrowfully served chicken drumsticks but did not have the foresight to defrost them. Unwittingly, I was so hungry I ate the chicken drumsticks, and within 36 hours I was in a very sorry way, but not as bad as some of my older colleagues at the time, who had to be hospitalised because of salmonella poisoning. I was then fortunate enough to be injected, not in my arm but in another part of my anatomy by a French doctor and had to have a course of whatever tablets they were.

Are we under these arrangements required to pay similar costs to those in that scenario up front, keep receipts and claim them back when we are back in the UK? Is that how it works? I think most of us are covered, and I know the department and the Foreign Office encourage all of us who travel outside the UK to have the fullest possible medical insurance that we can. Is it reciprocal? Does, say, a Norwegian, a Dane, a Liechtensteiner or someone from whatever third country pay here and is then reimbursed by their medical authorities—just to be absolutely clear on the reciprocity of the situation?

I give the regulations before us this afternoon a very warm welcome.

[Lord Naseby (Con)]

As I understood it, the Schedule on page 5 covers overseas territories and dependent territories. I note that the Cayman Islands is not listed. I have not had time to check whether anywhere else is off the list, but I wondered whether my noble friend could find out and let me know. I ought to declare an interest: one member of my family is working in the Cayman Islands, and there may be others. I recently attended a conference of all the overseas territories and dependent territories, and there seemed to be rather more than appear here, but that may be me and my memory bank. I leave that question with my noble friend.

General Practitioners: Recruitment and Retention

Baroness McIntosh of Pickering Excerpts

Monday 12th June 2023 Lords Chamber

Asked by

[Baroness McIntosh of Pickering]

To ask His Majesty’s Government what assessment they have made of the current state of recruitment and retention of general practitioners.

[Baroness McIntosh of Pickering (Con)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and declare my interest with Dispensing Doctors.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

We acknowledge that there are challenges in growing GP numbers. We are working with NHS England and the profession to explore measures to boost recruitment, address the reasons why doctors leave the profession and encourage them to return to practice. As of March 2023, there were 1,903 more full-time equivalent doctors working in general practice compared with March 2019, and we have a record 4,000 doctors in GP training.

[Baroness McIntosh of Pickering (Con)]

I have slightly different figures, although I thank my noble friend for his Answer. Since 2015, there has been an 18% increase in the number of patients per GP but a 7% reduction in GPs, with potentially 39% of the GP workforce considering leaving the profession in the next five years. Does my noble friend share my concern about the recruitment and retention of GPs? What urgent action is he going to take to address the workforce strategy for GPs to double the number of medical training places and to ensure that general practice once again becomes an attractive place for doctors to work?

Maternity Services

Baroness McIntosh of Pickering Excerpts

Thursday 9th February 2023 Lords Chamber

[Lord Markham (Con)]

That question probably deserves a more detailed reply then I can give here in 30 seconds. In terms of the direction of travel, continuity of care, not just in the maternity service but in understanding that person and their needs, has to be the right thing to do to make sure that we have cradle-to-grave treatment with people who know your case. So I agree with that direction of travel and I will follow up with a more detailed response.

[Baroness McIntosh of Pickering (Con)]

My Lords, will my noble friend update the House on the number of midwives available? I understand that there is concern among expectant mothers about the availability of midwives.

[Lord Markham (Con)]

The figure for the number of midwives has been roughly constant over the last few years at about 23,000. We want to increase that, which is why we have made a commitment to increase the number of graduate places to more than 1,000 each year. This year, as I say, we have 1,200 places, so we are making good progress.

Urgent and Emergency Care Recovery Plan

Baroness McIntosh of Pickering Excerpts

Thursday 2nd February 2023 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, my noble friend will be aware that this problem is not unique to this country. I am ashamed to say that Denmark, my mother’s original country, is building new hospitals all over the place but people cannot be treated because there are not enough doctors to treat them. Is my noble friend aware of the report from the Health and Social Care Committee in the other place, which noted that there are almost 500 fewer full-time equivalent GPs in a three-year period and that the committee realised that that accounts for the fact that there is an increased challenge in accessing GPs and also a lack of continuing healthcare? Will my noble friend take this opportunity to explain to the House what proposals the Government have to retain GPs so that recently qualified GPs are not working as locums in preference to being salaried or partners in a practice? I declare my interest as an adviser to the Dispensing Doctors’ Association.

[Lord Markham (Con)]

I thank my noble friend and agree that the GP service is the backbone. As per the earlier comments, a lot of the issues and challenges we have with A&E are because people are not getting their appointments in the GP space, and fundamental to that is having enough doctors. I did not quite recognise the figures. I am aware of an increase of over 2,000 GPs since 2019. That is not to say that that is enough, and so, again, the workforce plan will be key to making sure that we are building for that long-term future. However, we are also looking to retain them. We had a very good debate in the House about pensions and what we need to do in that space, and we will make sure that everything we do—including, I hope, the primary care plan—will show that primary care is key to the solution.