Healthcare Sector: Clinicians
Baroness Nargund Excerpts(6 days, 1 hour ago)
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Baroness Nargund
To ask His Majesty’s Government what steps they are taking to support clinicians to become innovators and entrepreneurs in the healthcare sector.
Baroness Nargund (Lab)
I thank my noble friend the Minister for her reply and welcome the Government’s commitment to innovation, but the actual programme has supported only a small fraction of the NHS workforce so far. I have met so many doctors, nurses and other healthcare professionals in my career with innovative ideas that could improve patient care, reduce costs and improve productivity. Yet too often, these ideas get nowhere because there are no clear, accessible pathways to develop them, and we are losing out on so many innovators and innovations that would benefit not only our patients but the Treasury. Does my noble friend the Minister agree that we now need an NHS entrepreneurship workforce strategy that could truly make our NHS the Silicon Valley of health innovation? If so, what steps could the Government take to give every NHS staff member protected time, training, mentoring incentives and accessible, clear pathways to develop and scale their innovative ideas?
Baroness Merron (Lab)
I certainly agree with my noble friend that there is a rich seam of intellectual capital among the 1.5 million NHS staff in our country. I am glad to say that the clinical entrepreneur programme is already a world leader in healthcare entrepreneurship, as my noble friend looks for. It has supported over 1,800 NHS staff and 690 start-ups, and it has raised more than £1.2 billion. We have now doubled the baseline annual funding for the programme. Yes, I agree that a clear pathway to adoption is vital, so we are expanding the health innovation networks, because they will provide the necessary support.
Modern Service Framework for Dementia and Frailty
Baroness Nargund Excerpts(2 weeks, 5 days ago)
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Baroness Nargund (Lab)
My Lords, I am grateful to the noble Lord, Lord Weir of Ballyholme, for securing this important debate, and I welcome the Government’s commitment to delivering the modern service framework for dementia and frailty. Dementia is not gender neutral. We may not have a cure at the moment, but we can cure the inequity in access to research, clinical trials, early diagnosis and effective treatments.
In England, more than 500,000 people now have a recorded diagnosis of dementia, and nearly two-thirds of them are women. Dementia and Alzheimer’s disease have been the leading cause of death for women in England and Wales since 2011. Almost two-thirds of unpaid carers for people with dementia are also women. Women live longer, but longevity alone does not explain this disparity. The APOE4 gene increases women’s risk of Alzheimer’s disease more than men’s.
The emerging evidence suggests that the hormonal changes associated with menopause may increase vulnerability. The hormone oestrogen is vital for memory formation, as it is essential for effective communication between neurons in the part of the brain involved in memory. The link between dementia and menopause extends beyond misdiagnosis, yet until recently, the relationship between menopause and dementia received remarkably little scientific attention. We need more research about the risks of developing dementia in women who undergo early or premature menopause. As the noble Lord, Lord Weir, mentioned, we need to work on reducing risk and, where possible, identify who is at high risk of developing dementia. Part of that involves identifying the risk in women going through early or premature menopause.
This has a human cost. Karen Barber from Essex devoted more than a decade of her life to public service at HM Passport Office and HMRC. In her 50s, her memory and organisational skills began to deteriorate. Her symptoms were repeatedly attributed to menopause and stress. She was repeatedly told that her symptoms were “in her mind”. Without a diagnosis, she was dismissed from her job for poor performance. More than 10 years later, and only after paying privately for a specialist assessment, she was finally diagnosed with young-onset dementia. Karen’s story is not simply one of illness; it is a story of delayed diagnosis, lost employment, financial hardship for the family and a system that failed to recognise the disease at the time.
For too long, medicine has been built around a male standard. Women’s underrepresentation in research and the failure to analyse differences between the sexes have left important gaps in our understanding of dementia. As we have known for a long time, studies show that women are underrepresented in dementia clinical trials relative to the burden of disease they bear. One review found that, among 118 dementia trials, only eight reported outcomes separately for women and men. In several studies, treatment benefits appeared greater in men, reminding us that biological sex may influence how medicines work. If we do not measure these differences, we cannot deliver gender-based care and the truly personalised, precision medicine that everyone deserves. I therefore warmly welcome the framework’s commitment to expanding dementia clinical trials, which is absolutely necessary and urgent, and the confirmation that participation will increase to 2,000 people over the next five years.
Innovation reduces inequalities only if it is designed for everyone. This is not only a health challenge for women, it is also an economic one. Women already face a substantial gender pension gap, and many leave the workforce prematurely because of caring responsibilities or their own ill health. For women with young-onset dementia, like Karen Barber, years of lost earnings, delayed diagnosis and interrupted careers compound lifetime financial disadvantage. Preventing dementia becoming a pathway into poverty should be part of our national ambition. Women bear a double burden when it comes to dementia, as I said earlier—I repeat it. They constitute the majority of those living with dementia and the majority of those caring for people with dementia. Too often, they also constitute the majority of those overlooked by research, clinical trials and clinicians.
If this modern service framework is truly to be once in a generation, it must place women not at the margins but at its very heart when it comes to clinical trials and early diagnosis. As the noble Lord, Lord Weir, said, this is a huge opportunity to achieve that. Can my noble friend the Minister assure the Committee that sex and gender differences will be embedded throughout the modern service framework, from research funding and clinical trial design to the adoption of new diagnostics and treatments with proportionate representation of women? That includes ethnic minority women, because there are some differences in clinical trials and mandatory reporting of sex-disaggregated outcomes. If we are serious about precision medicine, which we should be, it must be precision medicine for all women.
Pharmacy Closures
Baroness Nargund Excerpts(3 weeks, 6 days ago)
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Baroness Merron (Lab)
As I have said, we keep this constantly under review, but it is the case that GPs can provide dispensing services in a number of situations. That particularly helps if people live further away from a community facility than is ideal.
Baroness Nargund (Lab)
My Lords, I thank my noble friend the Minister for her reassuring reply about the closure of local pharmacies. However, research published in 2025 shows that access to local pharmacies has declined almost four times faster in England’s poorest communities. What assessment have the Government made of the impact of this on health inequalities? What steps will they take to integrate pharmacy services within neighbourhood health centres?
Baroness Merron (Lab)
That comes into the category of underserved areas, particularly if there are fewer pharmacies. I disagree with my noble friend about the overall picture in terms of pharmacies; we are supporting them to do more work, and a bigger range of work strengthens their position. It is not necessary to live right near a pharmacy, because of provision by online pharmacies. Finally, I repeat that local authorities can also seek to open pharmacies where there are underserved areas.
IVF Treatment
Baroness Nargund Excerpts(3 weeks, 6 days ago)
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Baroness Nargund
To ask His Majesty’s Government what assessment they have made of The Lancet article Is IVF treatment heading in the right direction?, published on 23 June, indicating that many IVF add-ons do not work; and what consideration they have given to giving regulators the power to ban them.
Baroness Nargund (Lab)
My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and I declare my interests as the lead author of the Lancet insight paper on IVF add-ons and as a board member of the Human Fertilisation and Embryology Authority.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, we are aware of the issues raised in the Lancet article regarding the effectiveness of IVF treatment add-ons. The regulator, the HFEA, provides information to patients on the effectiveness of fertility treatment add-ons through its website. In most cases, there is insufficient evidence to demonstrate that they improve treatment outcomes. The Government are considering a range of proposed reforms to fertility regulation, including the scope of regulator powers to regulate add-ons effectively.
Baroness Nargund (Lab)
I thank my noble friend the Minister for her reply. The concern about IVF add-ons is not only that many are unproven and ineffective but also that some can pose serious health risks to patients and unnecessary emotional and financial harm. The HFEA’s current traffic light system is guidance only and the regulator has no enforcement powers, which means that some add-ons with a red rating continue to be offered in clinical practice. Will she consider granting the HFEA interim enforcement powers for the use of red-rated IVF add-ons to protect patients from harm while the wider reforms to the fertility regulatory framework are being developed and implemented?
Baroness Merron (Lab)
I recognise the situation that my noble friend describes and note that, while the relevant Act has provided a strong framework for over three decades, the fact is that treatment, science and societal expectations have all evolved very significantly since the last major reform in 2008. It is the case that the Act does not currently provide powers to ban add-ons. We are constantly looking at what we can do while we await and consider legislative change, but that really is the best way forward to tackle this.
Nottingham Maternity and Neonatal Services
Baroness Nargund Excerpts(4 weeks, 1 day ago)
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Baroness Merron (Lab)
I am so very sorry to hear of the noble Baroness’s experience; I am grateful to her for sharing it with your Lordships’ House. I am sure we all offer our condolences and understanding as far as we can to support her and her family, and I say how sorry I am for her loss.
The noble Baroness is right to talk about cover-up. That did happen in this case and has also been identified through other reviews. Certainly, as Donna Ockenden conducts reviews into Leeds and Sussex, we will be able to find out what happened there. But we are not waiting, and I assure the noble Baroness of that.
It is worth speaking about the role of the regulators, because it has come up not by using the word itself but by how account is kept. The Secretary of State is meeting with the GMC—which we currently have a three-month consultation on reforming—because he wants to hear its personal account for failings in care. The Nursing and Midwifery Council has been undergoing a widespread programme of reorganisation and change under new leadership, which, again, is much needed. I assure the noble Baroness that, as part of the taskforce, we are looking at all parts of the health system where things go wrong, including how accountability is established, because we should be avoiding that harm where it is avoidable.
Baroness Nargund (Lab)
My Lords, I welcome the report and thank my noble friend the Minister for all the work she is doing with the Secretary of State to support and to implement recommendations. Our thoughts are with the families affected. The report has yet again shown the racial bias in care, which is harming mothers and babies. I request that my noble friend the Minister ensures that cultural competency training is integrated in medical school and in midwives’ training, so that they are qualified after receiving that training and it is not left for later.
Baroness Merron (Lab)
It is absolutely crucial, as my noble friend says, that the training should reflect the needs of the care that will be given. That is something that I know the taskforce will look at very closely. Donna Ockenden’s report offers insight and recommendations on workforce and training. The noble Baroness, Lady Amos, may also do so. I mentioned the anti-discrimination programme, but I should also say, on inequalities, that we have launched a maternal care bundle on what the best practice is for clinical conditions that are the leading causes of death for women from Black and Asian backgrounds. As I say, the numbers reflect a great inequality which cannot be allowed to continue.
Foetal Alcohol Spectrum Disorder
Baroness Nargund Excerpts(1 month ago)
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Baroness Merron (Lab)
I take the noble Baroness’s point, which is why I am glad that we committed in the 10-year health plan to making it a legal requirement—therefore strengthening it—that alcohol labels display health warnings and consistent nutritional information. That is something else that noble Lords have raised. As was referred to in the previous question, it is also important that we note that part of care for pregnant women is dealing with alcohol consumption.
Baroness Nargund (Lab)
My Lords, no amount of alcohol is considered to be safe in pregnancy. Foetal alcohol spectrum disorder—FASD—affects roughly one child in every classroom of 25 children, and it is a preventable neurodevelopmental disorder. A report published just two days ago by the National Organisation for FASD suggests that inaction in addressing this problem is costing the UK economy £9.2 billion annually. As most people in the UK drink alcohol, and as nearly half of pregnancies are unplanned and one-third of births are unplanned or associated with feelings of ambivalence, I ask my noble friend the Minister: do the Government have any plans to extend the public health campaign to pre-conception clinics and to advise women who are planning to get pregnant? That requires pre-conception advice, as so many pregnancies are unplanned. Will the Government also link that to school education, please?
Baroness Merron (Lab)
My noble friend is quite right about the potentially lasting effects of foetal alcohol spectrum disorder on children, which is why the main priority is preventing it. There are three approaches. First, the clear advice—the safest approach, if you are pregnant or could become pregnant—is not to drink alcohol, and that will remain consistent. I have just referred to the legal requirement for alcohol labels. We will of course continue to look at how prevention messaging can best reach people pre conception. The obvious point here is that so many pregnancies are not planned, so there is no neat solution to getting to the right people. We have to get our messaging right, which is why we are taking the approach we are.
Healthy Life Expectancy: England
Baroness Nargund Excerpts(2 months, 1 week ago)
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Baroness Nargund
To ask His Majesty’s Government what assessment they have made of the fall in healthy life expectancy over the last decade in England; and what plans they have to address this.
Baroness Nargund (Lab)
My Lords, I beg leave to ask the Question standing in my name on the Order Paper and I declare an interest as founder and trustee of the charity Health Equality Foundation.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, the fall in healthy life expectancy over the last decade is unacceptable and underlines the scale and complexity of the challenges we face. Through the 10-year health plan, we are taking action to tackle the drivers of ill health and inequality, including reviewing the Carr-Hill funding formula, to better match resources to need, and creating a smoke-free UK.
Baroness Nargund (Lab)
I thank my noble friend the Minister for that response. The Health Foundation’s report, Healthy Life Expectancy Trends in the UK: A Watershed Moment, published in April this year, makes it clear that healthy life expectancy is a key measure of our population’s health. The gap between the most deprived and the most affluent areas has grown, with those in the wealthiest areas now living up to 20 years longer. Social determinants of health affect healthy life expectancy—
Baroness Nargund (Lab)
I am coming to that. What plans do the Government have to address the social determinants of health across all government departments, because a single department cannot handle this? How can we close this gap?
Baroness Merron (Lab)
My noble friend’s assessment of the situation is right. That is why we are working across government on the wider determinants of health, including matters such as the Warm Homes Plan and the homelessness strategy. Alongside that, the 10-year health plan focuses on prevention and narrowing inequalities. The aim is to improve all conditions that will support longer, healthier lives across the whole country.
Miscarriage Care
Baroness Nargund Excerpts(2 months, 1 week ago)
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Baroness Merron (Lab)
The most reverend Primate makes a very sensitive point, which is of course correct. That is why NHS England has published a new policy to support NHS employees who are affected by baby loss, including paid leave. Our development through the Employment Rights Act will apply to NHS workers, including giving leave from work. We are currently consulting on the detail of this. It is about acknowledging the extreme effect on individuals of losing a baby, no matter at what stage.
Baroness Nargund (Lab)
My Lords, I welcome the Government’s commitment to review the graded models of care so that women can be helped, regardless of the number of miscarriages. How will the Government make sure that the needed services, particularly for support as well as investigations, are equitable throughout the country and not subject to a postcode lottery?
Baroness Merron (Lab)
The 10-year women’s health strategy is absolutely focused on ensuring that services and support are available equally, no matter where people live. They are variable, and that is not where we want them to be. I have just spoken about the bereavement services, for example. As of January this year, all ICB areas are expected to provide a seven-day-a-week bereavement service across maternity settings. That was not in place earlier, and it gives a sense of the trajectory.
Women’s Health Strategy
Baroness Nargund Excerpts(3 months ago)
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Baroness Merron (Lab)
That is an interesting invitation to consider. It would probably be helpful if I reiterate or explain better the points about the patient power payments. As I said in response to the Front Benches, its strength—by the way, I emphasise that it is a pilot—is that women’s voices are the voices that are least heard, and we know that creates the biggest problem in women’s healthcare. We know that just asking women what they think—we will be doing that, and we will be transparent in publishing the results, which will drive improvement—will not be enough. The reason for the financial point is that if the provider—it could be a private or a public provider—is not providing the right service then why can women not be heard on that? What will happen is not a cut in funding but the direction of an amount to go into the improvement of the service. In other words, at present there are no consequences for giving poor service. I do not see why women should have to put up with that.
Baroness Nargund (Lab)
My Lords, having served as a front-line doctor in women’s health for more than 40 years, 30 of them as a consultant gynaecologist in the NHS, I warmly welcome the new women’s health strategy and congratulate my noble friend the Minister on her efforts in making it happen. I also applaud the Government for the commitment to address the gender health gap and to tackle health inequalities in our country. Will the community hubs function as genuine one-stop clinics, with ultrasound and other facilities, to give women the diagnosis that they need without any delay, and will they take into account the needs of the local population so that women from lower socioeconomic backgrounds and ethnic minorities are not left behind?
Baroness Merron (Lab)
I am glad that my noble friend, with her professional experience, welcomes the women’s health strategy. I assure her that community diagnostic centres are absolutely key, as I mentioned earlier, to the ambition and intent to shift care closer to home and improve women’s experience. By their very design, they are streamlined and more convenient; they offer a wide range of tests, often in a single visit and, increasingly, same-day testing and consultation, where that is clinically appropriate. There are about 170 CDCs operating across the country; many have extended hours to fit around people’s lives—and, on the point about inequalities, we are working with local systems to make sure that they are located and developed according to the needs of the population.
Cancer Outcomes in the UK
Baroness Nargund Excerpts(3 months, 1 week ago)
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Baroness Nargund (Lab)
My Lords, I thank the noble Lord, Lord Patel, for securing this important debate and for his excellent introduction. I declare my interest as the founder and a trustee of Health Equality Foundation, a UK national charity.
I welcome the Government’s National Cancer Plan for England and pay tribute to the Secretary of State, Wes Streeting, for his moving forward. I and many others are grateful for his openness about his own cancer experience and his dedication to improving cancer outcomes. The scale of the challenge is clear: cancer is the biggest killer in our country. The UK ranked 26th out of 36 developed countries in cancer mortality rates in 2021. The latest NHS digital data shows lower survival rates in the most deprived areas. As such, I applaud the Secretary of State’s unapologetically bold plan. Such determination is needed.
The last Labour Government’s introduction of the two-week referral pathway in 1999 was a landmark moment. It is encouraging to see the Government building on that legacy, with a goal of saving 320,000 more lives by 2035. I speak with over 40 years’ experience in the health service and 30 years’ experience as a consultant gynaecologist at St George’s Hospital. I served as a junior doctor on medical oncology wards, and I have close friends and family who have faced cancer.
I shall focus specifically on gynaecological cancers and the inequalities that run from incidence to outcomes. Gynaecological cancers affect more than 22,000 women each year in the UK. Around 60 women get a diagnosis every single day. Ovarian cancer alone causes more deaths than the other four gynaecological cancers combined, yet only about one-third of cases are diagnosed early, according to Ovarian Cancer Action. The inequalities are glaring. Research from Target Ovarian Cancer found that Black, Asian, minority and ethnic women wait, on average, six days longer than white women to begin treatment after their referral for ovarian cancer.
Uterine cancer, the fourth most common cancer in the UK for women, shows higher incidence rates among Black women. Data from Cancer Research UK shows the impact of socioeconomic deprivation on cancer rates: mortality from cervical and uterine cancers is 61% higher in the most deprived communities, while vaginal cancer has one of the steepest deprivation gradients, with 88% higher incidence in the most deprived areas of our country.
To improve outcomes and tackle deep-rooted inequalities, I shall raise areas where ambition must be matched by delivery. On screening and innovation, the ambition to eliminate cervical cancer by 2040 is world leading, and I welcome the rollout of HPV self-sampling. However, for other gynaecological cancers, our early-detection tools remain inadequate. The UK Collaborative Trial of Ovarian Cancer Screening with the protein biomarker CA125 and ultrasound scans demonstrated that detecting more early-stage disease did not translate into fewer deaths. On the other hand, cell-free DNA screening for ovarian cancer is emerging as the most promising screening tool for the general population. Investment in this area, and in biomarker research, early detection algorithms and clinical trials should be encouraged. As the renewed women’s health strategy highlights, femtech has a role to play, but it must be clinically evaluated with peer-reviewed research and linked to NHS pathways to reach all women, not just those with the means to seek it out.
On HPV vaccination, when misinformation reduced uptake in Ireland, disadvantaged schools were hit hardest and recovered slowest, according to a report in Vaccine. Having led a British Red Cross vaccine campaign for ethnic minorities in our country, I know that communities place their trust in friends, families and local organisations. Will the Minister ensure that the Department of Health and Social Care works closely with the voluntary sector and local government to counter misinformation in underserved communities?
On clinical research, a Target Ovarian Cancer survey found that only 23% of women with gynaecological cancer were asked about joining a clinical trial, despite 60% wanting to. I applaud the plan’s commitment to accessible trials, but access must not be determined by postcode. As the King’s Fund has highlighted, this requires the expansion of trial workforce capacity across the country. Will the Minister confirm how the Government intend to ensure that capacity keeps pace, particularly in deprived areas?
Finally, on community diagnostic centres, I welcome the £2.3 billion investment in diagnostics in the community and the commitment to post-menopausal bleeding clinics. We need genuine one-stop diagnostic facilities in community centres. By repurposing the existing resources from secondary care to communities and using the single purchasing power of the NHS to procure ultrasound machines and other testing facilities, this could be achieved in the community. Will the Minister confirm that community diagnostic clinics will be implemented as genuine one-stop shops for gynaecological cancer diagnosis, with particular attention to deprived communities in our country?
The Government’s ambition that three in four people survive cancer by 2035 is one that I support whole- heartedly, but it must reach every woman in our country—those in deprived communities, those from ethnic minority backgrounds and those with the gynaecological cancers that have been underfunded for far too long.
This plan can be the turning point to bridging the gender health gap and addressing inequalities in access and outcomes for the biggest killer in healthcare. I fully endorse the national cancer plan and look forward to its implementation.