Life Expectancy: Pensions, Health and Insurance

Baroness Wheatcroft Excerpts

Wednesday 26th April 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend, whom I thank for that question, has characterised this issue in exactly the right way. Life expectancy is still increasing, but not at the rate it was. That is why the major conditions strategy was launched. I can give one example: cancer is one of the six major killers, and we are seeing 20% more cancer patients this year than we were pre-pandemic. So there are improvements in this space, and that is what the major conditions strategy is all about; but clearly, the record investment we are putting in needs to show that sort of output.

[Baroness Wheatcroft (CB)]

My Lords, the Minister’s ambition to increase life expectancy is not being helped by the current wave of doctors strikes, with extended waiting lists certainly bringing down life expectancy rates in some quarters. Can he tell the House why he and other Ministers will not get round the table now, with no preconditions, to discuss how this might be brought to a speedy end?

[Lord Markham (Con)]

The noble Baroness is absolutely correct: any strike action is regrettable, and we have a part to play, as do the unions, in trying to make sure that we reach a sensible place. We feel we have done that for nurses and ambulance drivers with the Agenda for Change, and clearly, we want to do the same for doctors. I think all noble Lords can agree that we do not want the impact on patients and healthy outcomes that strikes cause.

Hospitals: Maintenance

Baroness Wheatcroft Excerpts

Thursday 9th February 2023 Lords Chamber

[Lord Markham (Con)]

I know that it is a lot more than that. The number of cohort 1 and cohort 2 hospitals being built at the moment is substantially more. This is a real programme; in fact, I invite all my colleagues here to a parliamentary open day, which I think will happen in the next month or so, when we plan to exhibit exactly what we are doing. We will have virtual reality glasses so that noble Lords can see the hospital of the future. Please come along and see for yourselves how real this programme is.

[Baroness Wheatcroft (CB)]

My Lords, the old joke about how many men it takes to change a light bulb tends not to go down well in PFI hospitals, where the answer can be “Several—and a lot of money”. In November, the Minister said to me that he was re-examining all these ruinous PFI contracts. Can he tell the House what progress he has made?

[Lord Markham (Con)]

We are actually making a lot of progress on them. A number of them, dare I say it, were introduced by Governments of a different colour and we are now working through and correcting those. At the same time, private capital can do a lot of good things. Many in the House will have heard me say just yesterday that if we put LED lightbulbs in every hospital, it would cost £400 million and save £100 million a year. That is the sort of thing private capital will fund every day of the week, probably at a 5% yield, giving us £95 million of savings a year. That is a good use of private capital, and the sort of thing I am looking at.

Care Homes: Severely Disabled People

Baroness Wheatcroft Excerpts

Wednesday 30th November 2022 Lords Chamber

[Lord Markham (Con)]

My noble friend identifies an ageing demographic, the challenges that brings to all of us and the pressure on adult social care and the centres. As I have said, this is a challenge, but there are high levels of satisfaction in the sector: 89% of people are satisfied and 64% are very satisfied. So, although we have not got this right in every case, we are broadly on the right track and getting good results.

[Baroness Wheatcroft (CB)]

My Lords, eight out of 10 of the largest providers of care for the disabled and children are at least in part private equity owned and, in many cases, wholly so. Their interest rates are already their major concern, and these are going up. Is the Minister concerned that these private equity-owned homes will be forced either to cut what they do and serve their customers less well, or close? If he is concerned, what is he doing about it?

[Lord Markham (Con)]

The financial health of this sector is an area of interest; we all of course recall some of the problems and failures about 10 years ago. I had a meeting on this subject just this week, identifying the health of the providers to see if that is of concern. The margins made in this space are fairly typical of other industries, so they are not indicative of an area under particular stress. But I have my mind on this issue and will keep an eye on it.

NHS: Waiting Lists and Increased Spending

Baroness Wheatcroft Excerpts

Tuesday 22nd November 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness. As I say, we have committed to that workforce plan, and it will be detailed. We will look at every place in every part of the country because we understand that that is needed, and it is part of the critical plan to get on top of the 7.1 million waiting list. As I think we have accepted, it is not a quick win; it will get higher before it gets lower again. Clearly, however, we need to get on top of it, and we are focused on it. It is very much about the plan and the new spending plans that we put in place to address it.

[Baroness Wheatcroft (CB)]

My Lords, last year NHS trusts paid an interest bill of almost £500 million on PFI hospital contracts. This year, that bill will rise again. Can the Minister tell us what proportion of the increase in NHS budgets will go just to pay interest charges on these dreadful contracts, and what plans he has to try to renegotiate them?

[Lord Markham (Con)]

I thank the noble Baroness; I will need to get back to her in writing on the detail of that. However, looking into the PFI contracts is very much part of my agenda; I had a meeting on that just last week, and we are reviewing it.

GPs: Anti-depressants and Alcohol

Baroness Wheatcroft Excerpts

Wednesday 16th November 2022 Lords Chamber

[Lord Markham (Con)]

I agree with the premise of the question. Clearly we want the most efficient use of our resources. As I am sure the noble Lord is aware, there is a national review of overprescribing, which is looking at precisely these sorts of guidelines to make sure that medicine is used only when it is needed.

[Baroness Wheatcroft (CB)]

My Lords, there is clear evidence that the prescribing of activities, particularly cultural activities, is very effective in treating depression in many cases. What steps are being taken to encourage the prescribing of culture and other activities, as opposed to expensive drugs?

[Lord Markham (Con)]

I agree that the first step should normally be cognitive talking-type therapies. As the House will be aware, we have been investing quite considerably in the mental health space. We have had a 25% increase in referrals to talking therapies, to 1.8 million in the past year alone. I very much agree that there should always be action to see whether we can help with those cognitive behavioural-type therapies first before resorting to prescribing drugs.

Eating Disorders

Baroness Wheatcroft Excerpts

Tuesday 1st March 2022 Lords Chamber

[Baroness Wheatcroft (CB)]

My Lords, the eating disorders charity Beat conducted a survey last autumn and found that 69% of those with eating disorders had found that their GPs did not know what to do with them. That result was, if anything, worse than the same survey conducted five years earlier. It is good the Government are acknowledging that medical students need to learn more about how to deal with eating disorders, but could the Minister give us a guarantee that those GPs already in practice who know nothing about eating disorders at the moment—and choose not to—can be helped to understand the issue better?

[Lord Kamall (Con)]

This is an opportunity to pay tribute to the work of Beat and to remind noble Lords that it is Eating Disorders Awareness Week, and we should be aware of these issues. One of those issues is understanding the different types of eating disorders. Eating disorders is a catch-all phrase and we have to understand that there is: anorexia nervosa, which is more common among people aged eight and over; bulimia nervosa, which tends to affect people at 12 or 13; binge eating disorders, which affect people in adolescence and also their later years—their 30s and 40s; and other atypical eating disorders. It is really important that we understand this and, when we look at training for the general workforce and specialist mental health workforce, that they are more aware of the issues of eating disorders.

Covid-19: Lateral Flow Tests

Baroness Wheatcroft Excerpts

Thursday 10th February 2022 Lords Chamber

[Lord Kamall (Con)]

It is interesting that an earlier question asked if we are looking at British-based manufacturers. We want to be very careful that there is no preference, it is all based on merit and we have tests that meet all standards. To answer the question about the wider procurement process, there was a Question last week when I gave some detailed answers about the write-down of some of the value. We bought some of that equipment at the height of the market when people were desperately trying to buy equipment all over the world. Ships were being redirected en route when people thought they were receiving goods. That is why we paid the market price at the time.

[Baroness Wheatcroft (CB)]

My Lords, there is still the occasionally ping heard. Can the Minister bring us up to date with how many people are still employed on Test and Trace and what the total cost has been so far?

[Lord Kamall (Con)]

That is a valid question and if the noble Baroness could write to me, I will respond.

Vaccination: Condition of Deployment

Baroness Wheatcroft Excerpts

Thursday 3rd February 2022 Lords Chamber

[Lord Kamall (Con)]

As ever, the noble Baroness is absolutely right. Once again, I thank her personally for her frequent advice and questions, based on her years of experience. This gives me the opportunity to be quite clear: just because we are intending to revoke VCOD does not mean that we should let up in the fight against this virus. We need to continue to be vigilant, to wash hands, to respect space, and we hope that many people will continue, as in this Chamber, to wear face masks in crowded places and to ventilate areas, particularly when you are with people that you do not know and do not normally associate with. We should not give up on those; in fact, some of those measures, especially handwashing and others, are good common sense anyway, whether we have a virus or not. We hope that one of the lessons from this whole Covid experience has been the need for better hygiene and for us to be more aware. We cannot yet let up. We may have revoked VCOD, but it is really important that we continue to battle against this virus.

On the first question, about understanding the very real concerns, as the noble Baroness said earlier, I do not think we should simply categorise people as anti-vaxxers or pro-vaccine and virtuous; I think we need to understand their reasons. I had conversations this week when I was chairing the round table with local community organisations and I made the point to them that we want to learn from them. It is all very well for me, as a Lords Minister, to say this, but they understand much better in the community. Sometimes, it is a lack of trust. Sometimes, there are historical trust reasons. Sometimes, it is people’s personal experience. Noble Lords will have heard the recent story about the police, for example: it does not exactly engender trust in figures of authority within certain communities. It just shows the spillover effect of all these issues—discrimination, racism, but also lack of trust—and we have to be quite clear that we understand individual communities. Sometimes, even though they are in the same ethnic community, they may live in different parts of the country and respond in quite different ways. It is very easy to group people and say, “Oh, all BME, all Asians or all disabled people feel this way.” These people are individuals, and we need to understand their concerns.

[Baroness Wheatcroft (CB)]

My Lords, whatever the reasons people refuse to be vaccinated, the Statement says more than once that it is a professional duty of those working in the health service or in care homes to have the vaccination. Therefore, I rather agree with the noble Lord, Lord Cormack, that it is an unusual situation in which those who breach their professional duty will be allowed to continue in the role. Can the Minister tell us whether what appeared to be a decision taken through thorough research and as a matter of principle has now been changed, not because of principle but because of practicality—we need these people in the health service because of the terrible shortage of staff?

[Lord Kamall (Con)]

One of the things we have constantly done has been to listen—I had daily calls over the Christmas period, for example—and follow the evidence. Clearly, one of the issues may well have been staffing and warnings of potential shortages, and we had to balance all that up. As the noble Baroness, Lady Finlay, said, these things are nuanced; there are number of different factors we have to consider.

As for professional responsibility, on more than one call I have been on with senior NHS staff, clinicians and senior practitioners, they have told me that in their codes—for example, the GMC code and the nursing code—there is a professional duty to be vaccinated against transmissible diseases. Clearly, that is an issue. The NHS has had to speak to individual clinicians, those who have been reluctant, to try to press that issue, but clearly it came up against freedom of choice. It is difficult and I may not understand it, but we all think differently, which is why we have such great diverse thoughts and debates. It is really important that we understand individuals’ concerns and we can address them, but we are not going to be able to persuade everyone.

Personal Protective Equipment: Accounting

Baroness Wheatcroft Excerpts

Wednesday 2nd February 2022 Lords Chamber

[Lord Kamall (Con)]

If you consider how quickly the Government, and all of us, had to act during the early days of the pandemic, it was clearly an emergency. Lives were being lost. This is a stab in the dark, but maybe some noble Lords read a newspaper called the Guardian. One of its headlines from April 2020 read:

“Hospital leaders hit out at government as PPE shortage row escalates”.


Everyone knew that it was essential to get hold of as much PPE as you could in an incredibly challenging market.

[Baroness Wheatcroft (CB)]

My Lords, the Minister explained that the ultimate decision on what PPE contracts to issue came from the department, but I think the House would still be interested to know what proportion of the unusable PPE, or PPE that was unfit for purpose, came through the VIP trail.

[Lord Kamall (Con)]

That seems a reasonable question, but I hope the noble Baroness will understand that I do not have the answer at the moment. This is very much a dynamic situation. Some of the equipment we have may be deemed to be out of date but may be reclassified as usable after scientific analysis.

Health and Care Bill

Baroness Wheatcroft Excerpts

Lords Hansard - Part 3 & Committee stage
Wednesday 26th January 2022 Lords Chamber

In my view, this sort of conversation ought to be available to people in the circumstances that we have discussed. I say only that this is the wrong route, and it would be better if its provision were pursued through the charitable and pastoral sector rather than through being embedded in what will inevitably be an insensitive statute.

[Baroness Wheatcroft (CB)]

I support both these amendments. I have listened to the noble Lord, Lord Moylan. In answer to his points on Amendment 203, it is highly relevant that organisations such as Marie Curie want this legislation in the Bill. Marie Curie’s nurses work tirelessly to make the end of life as gentle and congenial as possible for so many patients, but if they believe that this would help them, I would certainly support the amendment.

I agree with the noble Baroness, Lady Brinton, that in this country people are too frightened to talk about dying, and that is what we are talking about tonight—and for some it will be painful. Nevertheless, dying is a subject that nurses and those in hospitals should be empowered to feel comfortable discussing with their patients, and Amendment 203 should help with that.

It is with some trepidation that I venture to support Amendment 297, having heard the noble and learned Lord—

[Noble Lords]

Lord Mackay.

[Baroness Wheatcroft (CB)]

Yes, Lord Mackay. Your Lordships can see how nervous it makes me feel! I think that, in this particular situation, private Members’ Bills have failed, and the Government show absolutely no intention of moving on something that is so crucial to so many people. Although you have to be wary of opinion polls, it seems perfectly clear that opinion in this country has moved and that a majority of people would like not to have assisted dying made mandatory but to have the choice at the end of life of how they say farewell.

Like others, my inbox has been inundated, and I have tried to reply to one or two of those who have been opposed to the proposal from the noble Lord, Lord Forsyth. One doctor, Dr Whitehouse, a palliative care doctor, wrote to tell me that nobody had come to him whom he could not help, and it was very important that everybody should treasure their short remaining time, and palliative care would do that and assisted dying should be resisted. I wrote back to him a week ago through email—he gave me his email address—and said that I wanted to know more. I am a firm believer in palliative care; it works wonders, and it has improved hugely over the years, but I do not believe that it works in every case. I asked him whether it worked, for instance, with motor neurone disease, or whether it could cope with the incontinence which makes the end of life such a discomfort and an indignity for so many people—or did the help that could be provided mean only understanding and care, which does not necessarily deal with the indignity at all? Noble Lords will not be surprised to learn that I have not heard back from Dr Whitehouse, and neither do I expect to.

This matter polarises people, but the amendment is asking merely that Parliament should have the chance to debate a matter that is crucial to parliamentary Members and, more importantly, the constituents who vote for them. I support both amendments.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare all my interests in palliative care and as a director of Living Well Dying Well and vice-president of Marie Curie and of Hospice UK. I have two amendments in this group. I do not intend to lay out all the arguments against the amendment proposed by the noble Lord, Lord Forsyth. Indeed, the noble Lord was right that we had only three-minute speeches when we debated the Bill proposed by the noble Baroness, Lady Meacher. However, I remind the Committee that the Bill put forward in the other place by Rob Marris MP actually failed—it was voted out—and it was one that came high in the ballot, so if it had been voted in it would have progressed quite well.

Personally, I do not think this is the place for us to debate assisted dying, which would need a change in the criminal law. The procedural issues have been clearly explained by the noble and learned Lord, Lord Mackay of Clashfern. The noble Lord, Lord Forsyth, spoke about the right to die. I remind him that everybody is going to die—it is an inalienable right. What he is talking about is licensing some people to provide lethal drugs to others, against a set of criteria. I remind him that three-quarters of people in my branch of the profession—specialist palliative medicine—who look after these patients all the time, not only do not want the law to change but do not want anything to do with it in the event it changes.

The claim has been made that palliative care is not a panacea. Assisted dying is not a universal panacea either. There is a 6.9% complication rate in Oregon, which is experimenting with the fourth drug cocktail in seven years. I remind the Committee, because I have made a plea for specialist palliative care, that it is estimated that 118,000 patients each year in the UK cannot access specialist palliative care. That is why I have an amendment tabled to the Bill, which I hope the Government will look favourably on. Areas where assisted dying has happened rank low on end-of-life care compared to the UK. Areas with assisted dying have dropped in the rankings for palliative care since 2015 compared to areas which did not change the law.

Amendment 203 is well intentioned and builds on all the moves for advanced care planning that are spearheaded by specialist palliative care. I know it was drafted originally with Marie Curie’s help, because it initially discussed with me whether I would table it, but I did not and did not sign it for two reasons. First, it is imperative that such conversations begin early, are part of ongoing care and do not become a tick-box exercise which says, “Conversation offered—tick”. That risks all the dangers of what happened with the Liverpool care pathway. Sadly, I have seen all too often a patient being told, “But that’s what you said you wanted”, when their needs have changed. Much research on advanced care planning has been done by my colleagues in my team in Wales. This has now informed some of the moves that are happening. Having open conversations is something that patients want, and the clinicians trained in communication skills want to provide those openings and do.

The second reason that I was concerned about this is that excellent draft guidance on advanced care planning has been developed by NHS England and NHS Improvement, and is near to being published; I had the privilege of being consulted on the final draft. It sets out core principles that such planning must always be a voluntary process and that every effort must be made to help someone express their views and preferences. The person is central to developing and agreeing their advanced care plan with agreed outcomes that are shared in partnership with relevant professionals. They have a record of the shareable plan and are encouraged to review and revise it so that they can change their mind at any time. In addition, anyone involved can speak up if they feel that the principles are not being followed.

The very sensitive approach set out in the guidance recognises that people have different levels of preparedness for such conversations; that their perception of their illness evolves over time; and that, in the crisis of being given a diagnosis or told of disease recurrence, the views that a person expresses may subsequently change as they reframe their experience. The first step is to start with an exploration of how much the person wants to be involved, what matters to them, and the pace and language that matches the person, as well as that they are listened to and understood.

The amendment asks for a “relevant authority” to

“have regard to the needs and preferences recorded … in making decisions about the procurement of services.”

I hope that the Government can see that, by providing specialist palliative care as a core service, the type of bureaucratic delays that would be involved in procuring services would be completely replaced by a rapidly responsive specialist service that can address the person’s needs in all domains. The amendment also uses the term “relevant person”. If it were used as in the Mental Capacity (Amendment) Act, that person could turn out to be the care home manager, who may actually have competing interests and therefore is inappropriate.

A comprehensive survey of over 2,000 people by Cardiff University’s Marie Curie research department reported that people listed their top priorities towards the end of life as timely access to care at 84%, and being surrounded by loved ones at 62%. Being home was a priority for only 24%.

This is a well-intentioned amendment but it has now been replaced by the extensive consideration of the consultation and production of comprehensive guidance.