Healthy Life Expectancy: England
Baroness Nargund Excerpts(3 weeks, 5 days 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(3 weeks, 5 days 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(1 month, 3 weeks 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(1 month, 3 weeks 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.