New Hospitals
Baroness Walmsley Excerpts(2 years, 9 months ago)
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Baroness Walmsley
To ask Her Majesty’s Government what progress they have made towards their commitment of building 40 new hospitals.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
The Government committed in October 2020 to build 40 new hospitals by 2030. We have confirmed an initial £3.7 billion to support these schemes for the first four years of the 10-year programme. This, together with eight previously announced schemes, will mean that we will have 48 new hospitals by the end of the decade. Six of the 48 new hospitals are currently in construction, including the first of the 40 new hospital schemes, and one scheme is now complete.
Baroness Walmsley (LD)
My Lords, as the Minister said, eight NHS capital schemes already under way when the promise was made were added to the Prime Minister’s pledge for 40 new hospitals by 2030, but now their cost overruns will have to be paid for out of the original pot of money. Can the Minister say how many of the originally promised 40 will now have to be postponed and how many are really new?
Lord Kamall (Con)
The Government have said that we will deliver 40 new hospitals by 2030 and in October 2020 we published the full list of the 40. This includes eight schemes that were announced by previous Governments but are to be delivered this decade and 32 new hospitals. We have also confirmed that we will identify further new hospital schemes, the process for which is ongoing, with a final decision to be made in spring 2022. This means that 48 hospitals in total are to be delivered over the decade.
Covid-19 Update
Baroness Walmsley Excerpts(2 years, 9 months ago)
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Lord Kamall (Con)
I thank the noble Lord for giving me notice of his question just before we came in. I tried to get an answer as quickly as possible, and I apologise that that answer has not arrived. I want to make sure it is absolutely right and that I am certain that I do not mislead the House unintentionally.
Baroness Walmsley (LD)
My Lords, as we move towards 1 April, I want to raise the issue not just of the concerns of staff, which the Minister has rightly mentioned, but the concerns of patients. Could patients in a ward, an NHS clinic, primary care or any other health setting be informed as to which members of staff have not been vaccinated? Would they then have the right to politely request that they are treated only by vaccinated staff?
Lord Kamall (Con)
The noble Baroness makes a very interesting point and an interesting suggestion. I am not quite sure of the details absolutely on those issues—as I said, further guidance will be published. But I promise to write to her, as she so gallantly intimates or hints.
Clinical Negligence Claims
Baroness Walmsley Excerpts(2 years, 9 months ago)
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Lord Kamall (Con)
The noble Lord raises an important point about how we resolve a number of these issues. As many noble Lords will be aware, when the NHS does a wonderful job, we all support it but, sadly, when it does not do such a good job, there is a culture of delay, defend and deny. Sometimes it is incredibly difficult, and I have heard of people who have had terrible experiences in trying to get someone to resolve their issue. I heard of a very sad case: a young official in the department told me that a friend of hers, a young Afro-Caribbean lady, 24 years old, lost a baby and, miraculously, the papers have disappeared. They are now trying to gaslight this poor patient. It is really important that we resolve this.
In terms of the cost, NHS Resolution negotiates large-scale contracts for defendant legal services, using its position as a bulk purchaser to obtain the best expertise. NHS Resolution is looking to resolve claims promptly and most claims are often settled without court proceedings or going to trial. It is a difficult balance because while we may be concerned about the fees of the injury lawyers, they are able to shine a spotlight on the NHS delay and denial, as it were, and go further when many patients themselves or their families are in distress.
Baroness Walmsley (LD)
My Lords, the element of compensation in clinical negligence cases which relates to the cost of further health treatment is based on the cost of care in the private sector. Why is this so when NHS treatment is as good or better? Should not private health costs be provided only where the patient cannot get treatment on the NHS?
Lord Kamall (Con)
Quite often patients choose to go on the NHS and when they are unable to do so because of various factors they will go private. I wonder whether we should be giving preference. We want to treat all patients equally.
Gametes and Embryos: Storage Limit
Baroness Walmsley Excerpts(2 years, 9 months ago)
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Lord Kamall (Con)
The Government are still considering the responses from the technical consultation in terms of extension of storage, but as I said previously, and I hope the noble Baroness will be assured by this, we hope to bring forward legislation to enact a new policy when parliamentary time allows. If an amendment is laid, we will give it due consideration.
Baroness Walmsley (LD)
My Lords, accurate information about the benefits, risks and success rates of egg freezing is essential to enable women to make their own decision. What progress is being made by the Competition and Markets Authority and the Advertising Standards Authority to investigate whether the provision of information is done accurately and ethically?
Lord Kamall (Con)
I thank the noble Baroness for raising this very important issue, because not everyone is aware of the biological facts around fertility, particularly the decline of fertility with age. If a woman freezes her eggs in her 20s, she has a higher chance of success than if she does it in her 30s. In fact, while IVF treatment has improved over the years, the success rates of IVF are still only around 30%, so it is important that as many women and couples know as much as possible. On the detailed questions that she asked, I will write to the noble Baroness.
Covid-19 Vaccinations
Baroness Walmsley Excerpts(2 years, 9 months ago)
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Baroness Walmsley (LD)
My Lords, is the Minister aware of an article in the Health Service Journal today in which a highly respected chief executive of a highly rated acute trust said that his hospital was struggling on every front and that it was far worse than in January? He said that the emergency department was at record levels and elective referrals were increasing as exhausted staff turned down extra shifts needed to reduce the growing backlog. One in five of his beds is filled with medically fit people who cannot be discharged because they cannot find a care package. There have been more than 65,000 Covid admissions to English hospitals in the last three months; that is double the same period last year when, of course, there were no vaccines. Does the Minister agree with this chief executive when he said, “This time the vaccine hasn’t saved us”?
Lord Kamall (Con)
The most important thing is getting the third vaccine. The Government are monitoring and considering a wide range of factors, including cases and immunity, but also advice from the NHS as to whether it is feeling overwhelmed. That is the situation at the moment. We continue to monitor it; it is not a static situation. We are trying to get the booster out as much as possible and are really driving home the message that the booster is the most effective way to fight against Covid. We are making sure that we get as many people as possible vaccinated and taking up the opportunity of a booster.
NHS: Fracture Liaison Services
Baroness Walmsley Excerpts(2 years, 9 months ago)
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Lord Kamall (Con)
The department and the NHS continue to work with interested groups to expand the understanding of the wide-ranging needs of people across the country. One example is NHS England’s Covid-19 MSK—musculoskeletal—stakeholder group, which is advising on the impact that lockdowns have had on the physical and mental health of those with MSK conditions. Collaborating with NHS England were the British Orthopaedic Association, the British Society for Rheumatology, the Chartered Society of Physiotherapy, the Arthritis and Musculoskeletal Alliance, and Versus Arthritis. Self-managed resources for patients are being developed. I will write on the specific question that the noble Baroness asked.
Baroness Walmsley (LD)
My Lords, could the Minister say what research is being carried out to establish the extent to which universal provision of fracture liaison services could relieve the pressure on hard-pressed GPs, ambulance services and A&E departments?
Lord Kamall (Con)
NHS England and others are well aware of the need to reduce the pressure on GPs and other services that the noble Baroness mentioned. That is why they very much welcome the investment in 100 community diagnostic centres, not only on NHS premises but in places such as football stadiums, shopping centres, and so on, making sure that there is more access to these services and that patients can be seen quicker and more speedily.
Smoking Cessation: Prescription of E-cigarettes
Baroness Walmsley Excerpts(2 years, 9 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
I thank the noble Baroness for her questions. It is really important that we look at how we can reduce smoking in this country. The point about the e-cigarettes and the MHRA’s wish to licence products is that it wants to move smokers on to a pathway away from smoking cigarettes and on to e-cigarettes since they are seen as a safer option. It does not want to encourage people to smoke e-cigarettes, but to move them off cigarettes and on to e-cigarettes. At the moment, the MHRA does not feel comfortable licencing any of the existing products, and therefore wants to have conversations with manufacturers and others to see if there can be a product produced that it feels comfortable licencing so that it can be available for prescription. Moreover, by having that MHRA stamp of approval, it may well encourage others to buy it over the counter.
Baroness Walmsley (LD)
My Lords, it is three years since the change of rules that allowed medicinal cannabis to be available on NHS prescription, but there have been only three NHS prescriptions in that time. How confident is the Minister that smokers will be able to benefit from regulatory change when children with intractable epilepsy cannot? Do not both of these situations require further training for doctors to ensure their confidence to prescribe?
Lord Kamall (Con)
The hope is that we will be able to move current cigarette smokers to e-cigarettes, but I am afraid that I will have to write to the noble Baroness on her specific question.
Covid-19: Vaccinations Administered Abroad
Baroness Walmsley Excerpts(2 years, 10 months ago)
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The Lord Speaker (Lord McFall of Alcluith)
The noble Lord, Lord Flight, is not present, so I call the noble Baroness, Lady Walmsley.
Baroness Walmsley (LD)
My Lords, another group of people who are not having their jabs recognised are the public-spirited people who took part in the Novavax clinical trial. Novavax has said that it cannot guarantee that having a Pfizer booster is safe for those in their trial, because it has not trialled it. Yet, the Government are now saying that they can have the booster—or they can start all over again and have one of the other jabs. Why?
Lord Kamall (Con)
One of the difficult issues we face is pushing international partners to agree that the participants of well-regulated vaccine clinical trials should be treated as fully vaccinated. Only a couple of weeks ago I was on a call with G7 health and transport Ministers, trying to push them to ensure that they recognise those very brave people who came forward for vaccine trials. So far, sadly, we have not had much success. We continue to push them, but, in the meantime, we have found the solution of giving people another vaccine in order for them to be recognised. However, we would prefer international recognition.
Ageing: Science, Technology and Healthy Living (Science and Technology Committee Report)
Baroness Walmsley Excerpts(2 years, 10 months ago)
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Baroness Walmsley (LD)
My Lords, it is a pleasure to begin the winding speeches on behalf of the Liberal Democrat Benches, not least because we have just had 19 excellent speeches. Indeed, the level of agreement about the relevant issues indicates to me that the Science and Technology Committee had a lot of the right answers, and I make no apology for repeating some of them in a few minutes.
First, I thank the noble Lord, Lord Patel, the committee staff, our witnesses and, in particular, the medical experts on our committee who helped me to understand some of the more scientific elements of what we were hearing. As a member of the committee, I enjoyed it very much. I found it interesting but also important because in the introduction to the report on ageing we pointed out that by 2035 there will be some 5 million people over 80 and I will be one of them—in fact, I will be over 90 if I live that long, so I have a vested interest in the Government’s response to this report. In welcoming the noble Lord, Lord Kamall, to his new Front Bench role, I hope he is going to give me some comfort at the end of this debate.
As the noble Viscount, Lord Ridley, emphasised, we can thank medical science for the fact that we are living longer. The doctors and scientists are keeping us alive, but we have to ask ourselves: for what quality of life? That is why the Government issued their grand challenge of five more years of healthy life by 2035, while narrowing the gap between rich and poor. I welcome that, but is it achievable? That is what the committee set out to discover.
We heard that although average life expectancy in the UK has continued to increase year on year, although recently at a slower rate, healthy life expectancy has not kept pace. Indeed, there is a widening gap between the two, and between rich and poor. People are living longer—although women in the lowest 10% demographic group are not—but many of those extra years are spent in poor health, with multiple diseases that can mean a person spending half the week visiting several different departments in their local hospital.
The health and care system is not designed for people with multimorbidities, as the noble Baroness, Lady Manningham-Buller, just said, nor for early diagnosis in many cases, as mentioned by the noble Viscount, Lord Ridley. We therefore recommended that older people should have a designated medical professional to integrate their care and smooth out the bumps in the availability of treatment; the noble Lords, Lord Crisp and Lord Kakkar, recommended this too. The Government say that it is already happening, but not according to the evidence we heard. We think it could save money in the end, as well as providing a better service for older people.
However, there is something to be thankful for, although the noble Lord, Lord Kakkar, pointed out the problems with the clinical trials regulation. Our report outlines considerable progress in researchers’ understanding of the biology of ageing, and we reported on the work on new therapies and repurposed drugs to tackle age-related diseases. We urge the Government to continue to support this work, but believe that the “R” of R&D is often better supported than the “D”. More effort thus needs to go into developing the discoveries of our scientists here in the UK, to avoid the benefit going to companies and patients abroad.
Age-related diseases do not just happen as soon as you turn 60. We heard evidence of the lifelong lifestyle and environmental factors that correlate with health in old age. This is particularly relevant to the second part of the grand challenge mission: to narrow the gap between rich and poor, as many noble Lords have mentioned. We concluded that this knowledge should be used by public health authorities and national regulators to help individuals to understand and make use of it but, critically, to enable them to do so.
However, no matter how healthily a person lives through life, inevitably they will become frail in old age, even if relatively fit, because of the cellular and molecular changes referred to by the noble Lord, Lord Patel. Most people would rather live safely—significantly, he also used the word “independently”—in their own home when they get old. They would of course be happier in their own community and, as the noble Lord, Lord Crisp, said, in control. This would also be cheaper for the health and care services and it is where home care comes in. Sadly, we know about the pressures on that, as well as on residential care, but the recent government announcement of an increase in national insurance contributions will do little for social care. Staff shortages and poor pay and working conditions mean that many old people, who would be better off at home, are kept too long in a hospital bed which could better be used to clear the backlog of procedures resulting from the pandemic. This illustrates the spider’s web of linked policy areas.
We heard encouraging accounts of where technology can help older people look after themselves, to ensure that they are safe and well, but many older people do not have the digital skills needed to operate these aids. They also cost money, which again is a challenge to achieving the second part of the mission: narrowing the gap between rich and poor. The availability of technological solutions should not further add to health inequality by being available only to the better off and digitally savvy. Do the Government have a plan to avoid that happening?
As the noble Baroness, Lady Watkins, said, loneliness can be a negative factor in well-being, as we have seen during the pandemic, when many people living alone have suffered mental health challenges. The internet can provide some communication but only if you have a connection, so this depends on the availability of decent broadband and a costly device, as well as the skill to use it. I join the noble Lord, Lord Mair, in asking: what are the Government doing to make sure older people are not left out of the digital age?
We heard from civil servants and Ministers that there is enthusiasm for achieving the grand challenge, but we came to the conclusion that this is unlikely. Why? It is partly because the progress towards achieving the challenge is not being monitored, while there is no road map to ensure the actions needed happen in a timely way. Achieving such a goal would have required a two-pronged approach: action to pick the low-hanging fruit—better support and joined-up health services for older people—alongside a prompt start on the long-term actions which can prevent many age-related diseases through lifelong strategies.
I repeat my noble friend Lady Sheehan’s question: has the grand challenge mission been ditched, diluted or incorporated into something else? Prevention of age-related illness is not just a matter of information and education about how to live a healthy life. Many people know exactly what they should be doing yet lack the resources to do it, such as enough income to buy healthy food and keep their home warm. But it also requires government to look at the lived environment and pressures under which people live. Examples of these are tackling our polluted air, which causes 40,000 extra deaths every year, enough income to keep the home warm and dry and the availability of nutritious food near to where people live, rather than high streets full of cheap fast-food takeaways.
The Institute of Health Equity recently reviewed the Marmot report 10 years on, and it emphasises that health and life expectancy follow the social gradient. It is abundantly clear that the challenges are worst in certain groups, so interventions to prevent the diseases of old age should be prioritised in the poorest groups if levelling up is to mean anything at all across all constituencies, not just the former red wall.
When all is said and done, what became obvious to me was that we should not start action on healthy old age when we are old; we should start when we are children. That would help us all and protect the NHS. The noble Baroness, Lady Young of Old Scone, commented on that, and I very much agree. The widening gap between rich and poor among older people living with multimorbidities says it all. Clearly, although we can mitigate the ill effects of an unhealthy old age with all the technical solutions we have recommended, such as research into the diseases of old age, repurposed drugs, technological aids, co-ordinated medical treatment and oversight—I recommend the sort of electric hob that turns itself off when you remove the pan, which is much safer for old people—in the end and over the longer timescale, it is the socio-economic factors that will have the greatest effect in giving us all more years of health at the end of life. I look forward to the Minister’s reply.
Drugs: Black Review
Baroness Walmsley Excerpts(2 years, 10 months ago)
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Lord Kamall (Con)
The Government have committed to answering in full the recommendations of Dame Carol Black’s review. In terms of joined-up thinking across government, the Government established the new Joint Combating Drugs Unit—the JCDU—in July 2021 to co-ordinate, and drive a genuinely cross-government approach to, drugs policy. The JCDU brings together different government departments, including those that the noble Baroness mentioned—the Department for Health and Social Care, the Home Office, the Department for Levelling Up, Housing and Communities, the Department for Work and Pensions, the Department for Education and the Ministry of Justice—to help tackle drugs misuse across society by adopting a cross-government approach.
Baroness Walmsley (LD)
My Lords, the drug treatment and recovery workforce has deteriorated in quantity, quality and morale in recent years, with excessive case loads, decreased training and lack of clinical supervision. How do the Government plan to increase the number of professionally qualified drug treatment staff and improve occupational standards and training requirements?
Lord Kamall (Con)
The Government will answer all the recommendations in Dame Carol Black’s review by the end of the year. In response to the noble Baroness’s specific question, I shall write to her.