Integration of Primary and Community Care (Committee Report)
Baroness Merron Excerpts(1 week, 2 days ago)
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Baroness Merron (Lab)
My Lords, I congratulate my noble friend Baroness Pitkeathley on her incisive introduction of what I consider to be a pragmatic and thoughtful report, although I am sure it did not make for pretty reading by the Minister. I thank all members of the committee for their thorough application to the task that was before them: to shine a light on integrating primary and community care to put patients at the centre, which is exactly how it should be. They have done it by offering solutions that are, to quote my noble friend Baroness Pitkeathley, “simple and virtually cost-free”. I am sure that your Lordships’ House would say to any incoming Government, “Watch and learn”.
I am delighted to commend the noble Lord, Lord Jamieson, on his excellent maiden speech, through which he surely honoured the memory of his late mother. As the noble Lord so clearly understands the links between health, housing, environment and other factors, I am sure that we can all look forward to his constructive future contributions.
Day in and day out, primary and community care services provide vital support to millions but, like much of the NHS, they are under considerable strain. Yet, as the noble Baroness, Lady Tyler, said, acute services receive more attention and priority from the Government.
The backdrop to this debate is that backlogs have now reached more than 1 million in community health services. The latest NHS data shows primary care delivering almost 30 million more appointments in March, which is an increase of 25% compared to the same period before the pandemic. Yet, as your Lordships’ House has noted on many occasions, the greatest economic returns from the NHS budget come from investing in primary and community care. This makes good sense.
Some £14 is added to the economy for every £1 invested, and, crucially, it lowers demand in the need for hospital and emergency care. This begs the question being probed in this debate, and which is the headline question to put to the Minister: if these points are accepted—and maybe they are not, in which case I am sure the Minister will say that—then why is there a concentration on acute services, at the expense of prevention and proper integration between primary and community care? There is also a lack of proper integration between the NHS and social care. Why has this situation been allowed not just to develop but to deepen in its severity?
The noble Lord, Lord Altrincham, highlighted that it was repeatedly put to the committee that poorly co-ordinated care undermines the quality of patients’ experiences and can have profound consequences for their long-term health. It should not be that somebody’s health and well-being gets worse because professionals do not contact each other; because patients are made to make inconvenient and unnecessary trips to multiple locations and practitioners; because staffing is inadequate; or because records are not being shared. It is telling that a broad range of witnesses repeatedly spoke of the problematic lack of integration between social care and the National Health Service, even though social care was not within the remit of the report.
For all this, I have heard noble Lords describe the Government’s response to this report as delayed, disappointing and failing to match words with the necessary focus and action. I welcome the principles behind the report’s key recommendations. I trust that the Minister will do likewise and tell your Lordships’ House what more the Government will be doing than is currently the case.
I am sure that many noble Lords will, like me, remember the ambitions articulated during the passage of what is now the Health and Care Act to formalise the integration of primary and community services. However, NHS leaders are telling us that this is not supported by the current commissioning and contracting arrangements. The policy continues, they say, to be developed in silos from the centre, both at NHS England and at the department. I will be interested to hear the Minister’s response to this observation.
For many of us, being treated at home, or as close to home as possible, is best for our health. It is how we want to be cared for. It is also the most efficient and cost-effective for the National Health Service. Nobody wants to be left waiting until hospital treatment is needed; that makes no sense at all. As envisaged in the Health and Care Act, integrated care systems still have the potential to create more joined-up health and care, with primary care being integrated into broader NHS services in the community, through schemes such as Pharmacy First and through the extension of access to services, such as by evening appointments to fit around the needs of local populations.
There is no appetite for further structural reform, but we need to know what is working and what is not. What assessment have the Government made of the effectiveness of ICSs? What are the obstacles to success and how will they be overcome? Is everything in place to ensure that ICSs can make the best possible use of their allocated funds to plan and innovate?
The report highlights the need for a seamlessly integrated patient-centric healthcare sector where patients are given the type of care that they need, when, where and how they need it, whether that be through access to a GP, a pharmacist or a district or mental health nurse. I can tell the House from these Benches that if the next Government are a Labour one, we are committed to making change so that more people get care at home in their community—shifting services out of hospitals and into the community, so that the NHS becomes as much a neighbourhood health service as it is a National Health Service.
The report also says that the Government should focus more on preventive rather than reactive care to tackle the needs of an ageing population, many of whom are coping with complex health issues which require intricate and continuous care. We share that view and are committed to change: we will focus on prevention, shifting the focus to embedding long-term planning, tackling the social inequalities that influence health, ensuring children have the best start possible, empowering people to take responsibility for their health, improving screening programmes and boosting capacity in local public health teams.
I was struck by the observation articulated by the noble Baroness, Lady Finlay, that the committee heard more frustration expressed by witnesses on the inadequacy of digital connectivity than almost anything else. They identified technical issues, cultural attitudes and misunderstandings about GDPR. The noble Baroness, Lady Barker, put it well: that currently, the co-ordination of patients’ data is no one’s responsibility. How do the Government intend to address that point?
What is the Minister’s view as to whether legislation and guidance need to be reviewed to ensure that the tension, whether real or unjustified, between data privacy and effective healthcare planning and provision is overcome? As the noble Lord, Lord Allan, raised, does the Minister consider that appropriate training has been and is being given?
Turning to the workforce, dealing with the problems of its recruitment, retention, numbers, training, morale and well-being will support the integration of services, as spoken to by the noble Baroness, Lady Redfern. What plans are there to include integration in training, and how will NHS and local government staff be made aware of other services and how to work closely with them? Does the Minister consider that the social care workforce should be a component of the NHS long-term workforce plan?
Putting patients at the centre is, as my noble friend Lady Armstrong wisely observed, far from outlandish. Wrapping the NHS around the patient, instead of the patient having to wrap themselves around the NHS, is how it should be. I hope that this report will contribute to that outcome.
Immunisation: Children
Baroness Merron Excerpts(1 week, 3 days ago)
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Lord Markham (Con)
The noble Baroness is quite right. I had two young sons at around that time, and it was a concern. Of course, we did go ahead, but it was a consideration. It is an excellent question. I have not seen the study of those various cohort groups but I will go back, because it is something we need to bring out.
Baroness Merron (Lab)
My Lords, it is concerning that measles cases continue to rise, with a particular spike in London, where certain areas have low vaccination rates. With the advent of microarray patch technology, can the Minister confirm that this is being looked at? Does he agree that the chance to dispense with using needles and special storage, and the opportunity to use less of professionals’ time, could present an opportunity to drive up vaccination rates?
Lord Markham (Con)
It has to make sense to take more measures that are easy for people, including maybe less skilled people, to operate. Funnily enough, I was talking just today to the head of Moderna about how it is packing syringes, or has planned to for vaccinations going forward, rather than vials, to take that step out of the process. The easier we can make it, the better.
International Health Regulations: Amendments
Baroness Merron Excerpts(1 week, 4 days ago)
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Lord Markham (Con)
I do agree: I do not think that it would help to postpone it. I had this exact conversation with the American Health Secretary, who is very aware that we are getting nearer and nearer to an American election and, for all the countries to be able to co-operate fully, the timing is right to reach a solution now. However, we will not reach an agreement at any cost or anything which might impact our sovereignty.
Baroness Merron (Lab)
My Lords, the Brownstone Institute, to which the noble Lord’s Question refers, was set up to work against Covid restrictions and lists articles which argue that Covid-19 vaccines do not work, that children should not be vaccinated and that vaccine mandates compare with the crimes of the Soviet gulag. On this basis, perhaps the Minister would like to comment on what note he should be taking of the Brownstone Institute, if any. What assessment has been made of the impact of dangerous propaganda like this on the low take-up rates of vaccinations that we see among minority ethnic groups and where there are regional and social disparities?
Lord Markham (Con)
I thank the noble Baroness. All Members of the House, when we had a good Question on the take-up of Covid vaccines, agreed that information supporting the take-up is a vital health message to get across. To any detractors, I say very firmly that it is not the view of the Government, and I know that it is not the view of nearly all noble Lords.
Covid-19 Vaccination: Coronary Disease
Baroness Merron Excerpts(3 weeks, 4 days ago)
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Lord Markham (Con)
Absolutely. We are all very aware of the damage done by all the myths around the MMR vaccine 20 to 30 years ago and the impact that has had on people. The more we can get the message out, the better. As the noble Baroness, Lady Merron, asked me yesterday, we have learned that it is about making sure that we communicate to all groups so that we can make sure that ethnic minorities and other minority groups get that information.
Baroness Merron (Lab)
My Lords, after many years of stalled progress, the rate of premature deaths from cardiovascular disease continues to increase, for reasons that the British Heart Foundation describes as “multiple and complex”. The warning signs of this have been present for over a decade. As this phenomenon did not start with Covid, what assessment has been made of the contributory factors of government policy pre Covid and what steps are being taken to turn this around?
Lord Markham (Con)
Deaths from heart disease among those under 75 are down by about 20% compared with 2010, which is a clear trend. Notwithstanding that, we are very aware—Sir Chris Whitty is concerned about this—that Covid meant that a lot of people did not get basic heart and blood pressure checks. That is why we have introduced the Midlife MoT, which is designed to give people a 10-year risk analysis; have put blood pressure devices in pharmacies and all sorts of other places to get 2 million checks; and have a workplace heart disease strategy check. All this is designed to get that prevention in place so that people are aware of and understand the risks.
NHS: Long-term Sustainability
Baroness Merron Excerpts(1 month ago)
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Baroness Merron (Lab)
My Lords, I congratulate the noble Lord, Lord Patel, on securing this debate and for introducing it with his characteristic authority, insight and care, with which we are so familiar in your Lordships’ House.
I am delighted that my noble friend Baroness Ramsey of Wall Heath chose this debate in which to make her excellent maiden speech. How proud her mother and father would have been today, and what a difference she made to the life of her late sister, and, indeed, to the National Health Service; and what a difference I know she will make to your Lordships’ House.
To give some context to the need for long-term sustainability, over the last 14 years, as we have heard, the health service has acquired the undesirable distinction of having the longest waiting lists, the lowest patient satisfaction and the worst strikes in its history. The noble Lords, Lord Patel and Lord Kakkar, not only described the harsh realities and inequalities of the current systems but asked what all parties would do about correcting it. I am flattered to be invited to give some flavour of how an incoming Labour Government—if there is to be such a thing—would approach the challenges ahead.
On that point, I am glad that my noble friends Lord Hunt and Lord Reid and the noble Lord, Lord Crisp, recognised the positive impact on the health of the nation of the last Labour Government, in which I had the honour of serving as a Public Health Minister. That allows me to say to noble Lords, including the noble Lords, Lord Bethell and Lord St John, and the noble Baronesses, Lady Boycott and Lady Finlay, that, when it comes to prevention and a focus on the broader improvement of health, I am totally signed up.
My noble friends Lord Hacking and Lord Parekh have brought a welcome analysis to today’s debate. I agree with my noble friends Lord Hunt and Lord Turnberg and the noble Baroness, Lady Hollins, that bullying, burnout and pressure on the workforce is no way to retain or get the best out of people—we need only talk to people in other sectors to remind us of that.
This change will require a change in culture on so many levels. The noble Lord, Lord Crisp, spoke of the fundamental need for shared vision, hope and energy. It struck me that they are exactly what is missing at present in health and social care. As we have heard today and so many times before, social care is inextricably linked to the health service. I remind any incoming Government, including a Labour one, that there are a number of first-rate and considered Lords reports, including on social care, primary and community care, and long-term sustainability. Therefore, any Government would be extremely well advised to delve into them. Wes Streeting, shadow Secretary of State, has been very clear about the measures that need to be taken on social care, emphasising the need for long-term planning, thinking and funding.
The right reverend Prelate, the noble Baroness, Lady Cavendish, and my noble friends Lord Turnberg, Lady Pitkeathley and Lady Warwick were absolutely right to speak about the invisibility of unpaid carers and the poor treatment of employed care staff. That is not sustainable—and neither are the record levels of sickness and long-term conditions that affect the workforce, which my noble friend Lord Davies and the noble Lord, Lord Londesborough, spoke about so clearly.
I do not consider myself a technological expert, but rather a technological convert, which I am sure the noble Lord, Lord Allan, will be very pleased to hear. So I have looked to countries such as Israel, which I believe to be at the cutting edge, which is where the UK needs to be. At the emergency department of the Sourasky Medical Center, people register digitally, identify themselves through facial recognition and measure their own blood pressure, temperature and heart rate in self-triage booths. Patients are given a barcode and a number is sent to their phone, which they can track on a screen. The most serious cases are seen within minutes, and virtually no one waits more than an hour. Last month, this Tel Aviv hospital became the first in the world to integrate an AI chatbot into its triage process.
What is the driving force behind that? This Israeli hospital is designing healthcare around the needs of the patient, which my noble friend Lord Carter and many other noble Lords called for. Sadly, that is very much in contrast with Britain, where our NHS reels from crisis to crisis, while the political debate circles around funding, staffing and pay. The way that we bank, shop, travel and work has been digitised in the past decade, yet the NHS remains largely outdated. There are multiple IT systems in the NHS and no requirement for them to be interoperable.
That means that systems cannot talk to each other, sometimes even within the same hospital, let alone between institutions or between primary and secondary care. There are at least 21 different types of electronic patient records in hospitals and 34 apps to book an appointment. No company would be able to survive with productivity like this, as the noble Baroness, Lady Tyler, said. Let me ask the Minister: how has the Government allowed the NHS to develop like this?
NHS England’s digital lead, Joe Harrison, estimates that every pound spent on technology generates between £3.50 and £4 in savings. Such an approach makes sound financial sense, as well as good health sense. While the case for reform is overwhelming, too often the innovators are thwarted by a fragmented system or vested interests. What is being done to overcome this?
We know that an estimated 13.5 million hours of doctors’ time is wasted every year due to inefficient IT. Fixing that would be the equivalent of 8,000 new doctors joining the NHS. That is the difference between the huge staff shortages that we see and filling almost every vacancy for a doctor. With our country’s population ageing, the health of the public worsening and chronic disease rising, the sustainability of the NHS is crying out for change.
I recently went to the National Theatre’s production of “Nye”, as I know many other noble Lords have done. When he created the NHS in the 1940s, Nye Bevan had absolutely no idea of the scientific revolution ahead. Regrettably, if we dropped Nye Bevan into the NHS today, he would see the modern-day pressures of an NHS that is overly hospital-based and gets to patients too late, at greater cost and with worse outcomes.
If Labour does get into government, we will arm the NHS with the modern technology it needs, doubling the number of scanners, and putting AI into every NHS hospital, so that patients are diagnosed earlier. We will get rid of the unnecessary bureaucracy whereby innovators have to tout their technology to each individual NHS trust; we would stop the need to sign separate agreements with each of them. We will streamline the route in for innovators and put the entire NHS in partnership with the technology and life sciences sector.
Following the pandemic, more than 32 million of us carry the NHS app in our pockets. That provides the potential to transform how the NHS interacts with patients, promotes good health and increases people’s control over their own healthcare. We would make the NHS app not just something to assist the NHS in healthcare but a key component in delivering care—both preventive and curative—and empowering patients.
Finally, what do the health and care leaders want? They know that investing in primary and community care results in a lower demand in hospital emergency care. For every pound invested in the NHS, £4 comes back to the economy. The greatest economic returns come from investing in primary and community care, where we see a £14 economic return for every pound invested. If Labour is to be in government, this is the step change that we will make.
Cass Review
Baroness Merron Excerpts(1 month ago)
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Baroness Merron (Lab)
My Lords, Dr Cass and her team are to be thanked for their rigour and their care with this report, in which they have navigated many complex and sensitive issues. This review into the NHS’s gender identity services concludes that children and young people have been let down by inadequate research and evidence on medical interventions, and they have been failed by inadequate services amidst a debate which has, sadly, been marked by extreme toxicity.
At the same time, at the heart of the complexity around gender identity services are two aspects that are simultaneously true. There are trans adults who have followed a medical pathway and say that, for all the pain and difficulty involved, it was not just life-affirming; it was life-saving. There are also people who followed a medical pathway and say that it has ruined their lives irreversibly and ask how anyone could let that happen. For those children, young people, and now adults, but particularly those who are being referred into gender identity services today, there is a duty to get this right.
The Cass review refers to many scandals, which exposes both the inordinate amount of time that children and young people are waiting for care while their wellbeing deteriorates, and medical interventions that have been made on what could be called shaky evidence. Can the Minister say how it came to be that NHS providers refused to co-operate with this review? How was it allowed that adult gender services would not share data on the long-term experience of patients? What accountability does the Minister feel that there should now be?
The Minister will know that the discussion around the substance of the review has been highly toxic. People have felt silenced, and it has required investigative journalism to prompt this review to take place. Tribute should be paid to journalists, including Hannah Barnes, and to the whistleblowers, who together helped shine a light on the Tavistock clinic. It is concerning to note that Dr Cass said that the
“toxic, ideological and polarised public debate has made the work of the review significantly harder”,
and that will
“hamper the research that is essential to finding”
a way forward. This particularly vulnerable group of children and young people is at the wrong end of the statistics when it comes to mental ill health, suicide and self-harm. They have been badly let down, so we owe it to them to approach this discussion with the sensitivity it demands.
Parts of this report today will sound very familiar: services unable to cope with demand; significant staff shortages; a lack of workforce planning; and unacceptably long waits for the mental health support and assessments that children and young people need, such that in some cases children become adults before they even get a first appointment with the gender identity services. To this point, the Cass review recommends a follow-through of services up to the age of 25, to ensure continuity of care. Will the Minister indicate how long it will take to establish these services, and could the Minister set out what plans there are to cut waiting times for assessments for mental health and neuro- developmental conditions?
Last month’s decision by NHS England to stop the routine prescription of puberty blockers to under-18s is welcome. However, the loophole that exists for private providers risks illegal trading. In the other place, the Secretary of State said that she expected private clinics to follow the report’s recommendations to follow the evidence. I underline our support for these expectations on compliance. Does the Minister consider that further regulation might be needed to enforce the recommendations? Could he say something more about the timescales involved in making progress, both for the CQC to incorporate the recommendations into its safe care and treatment standards and for NHS England’s urgent review on clinical policy for cross-sex hormones?
Children’s healthcare should always be led by the evidence and be in the best interests of their welfare. Dr Cass’s report has provided the basis on which to go forward. This report must also provide a watershed moment for the way in which society and politics discuss this issue. There are children, young people and adults, including trans children, young people and adults, who are desperately worried and frightened by the toxicity of the debate. There are healthcare professionals who are scared to do their job and make their views known. I hope that we can now put children’s health and well-being above all else.
Baroness Burt of Solihull (LD)
My Lords, I believe that the Cass review is an extremely thorough summary of where we are now and of the pathways available to young people that we need to explore. Most importantly, this report gives a way forward for young people and their clinicians who feel anxious and frightened because they find themselves at the centre of a political maelstrom.
Interestingly, the most balanced response I have seen to the report came from Stonewall, which was consulted by Cass, and I have used some of its points here. Cass says that these youngsters have been sorely neglected by the NHS, which sidelined them away from mainstream care to services that have fallen short. She points to how we can start the process of making it up to them, by giving them the holistic care that they need and deserve.
Despite the way in which the report was received by certain gender-critical individuals, it does not question trans identities or recommend rolling back healthcare access. It does not say that puberty blockers are unsafe or dangerous. It does say that there is insufficient and inconsistent evidence about some of the effects of puberty suppression. In addition, it notes that cross-sex hormones are well established and have transformed the lives of trans people, and supports their use from the age of 16. Importantly, it does not, at any stage, suggest a ban on social transition for any age of child or young person, but recommends that this be done with the support of parents and clinicians.
Cass says that gender incongruence is a result of a complex play between many biological, psychological and social factors, of which sexual orientation can be one. There are many factors, and no simple answer. For example, saying that such young people are simply confused gay people, unhappy teenagers, or that it is all the fault of social media, is all too simplistic. Regrettably, this has not stopped the Government spinning their own version of who is to blame.
For example, this week’s Statement by Secretary of State Victoria Atkins said that Tavistock clinicians “almost always” put children on an irreversible path of blocking puberty, then prescribed cross-sex hormones and on to surgery as an adult. This is not my understanding of the situation. In 2019-20, only 161 under-19s were referred by gender identity development services for puberty blockers. It was estimated that only around one in six GIDS patients ended up being prescribed puberty blockers. Is not the picture bad enough, without painting something even worse?
There are currently more than 5,000 children on the waiting list for treatment. The NHS has confirmed that everyone currently on puberty blockers via the NHS—fewer than 100 children—will be able to continue on them. These children, and any new recommendations for puberty blockers, will not be prescribed unless they agree to take part in a clinical trial to test the effectiveness of puberty blockers properly. How long does the Minister estimate that it will take for this clinical trial to be set up? Speaking of waiting lists, I understand that it currently takes three years for a child on the list even to be seen. How will the trial ever be set up, except for the few now on puberty blockers, while the rest languish for years on waiting years while their puberty seeps away? Does the Minister not agree that it is time to make up this shocking treatment which has, or rather has not, been given to children by the NHS and put them immediately on a par in priority with other NHS services?
These are our children. They, and the clinicians who want to treat them, have been intimidated by the toxic environment that we have all helped to create. I have heard the Cass report described as a rock that we can now all cling to. We will never all agree about some quite fundamental issues regarding trans and the nature of trans, but we must never make our children suffer for it; we must never make them pawns in a zero-sum game. We must rise above it and argue well, with more light than heat, to protect our children, who, after all, must be at the centre of all we seek to do.
Immunisation: RSV
Baroness Merron Excerpts(1 month ago)
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Lord Markham (Con)
I too add my thanks; the noble Baroness is very good at holding our feet to the fire, and it is very important and appreciated. Regarding the age group, we are being guided by the scientific advice on what is most cost-effective.
Baroness Merron (Lab)
My Lords, earlier this year we discussed the busy pipeline of new vaccines, including those for RSV, which, coupled with the concerning decline in the uptake of immunisation, does point to the need for a fresh look at delivery mechanisms. What steps are being taken to move beyond traditional arrangements, and when can we hope to see an improvement plan in place, in readiness for the RSV immunisation programme?
Lord Markham (Con)
Of course, the communication needed for each one is different, and that is a vital consideration. As I said, we found that, often, it is easier to put RSV in the infant rather than the pregnant mother. It is a question of considering which is the most effective way to get the best outcome and the highest take-up rate. That is one of the key criteria we are looking at. Regarding general communication, the noble Baroness will be aware that, on MMR, we have challenges in both London and the West Midlands. That has shown that you need other communication routes to get to some ethnic minority groups, using technology such as the app. There is no one silver bullet —you need a series of measures in place.
Children’s Cancer Services
Baroness Merron Excerpts(1 month, 4 weeks ago)
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Lord Markham (Con)
I want to be fair to the NHS here. It has done an extensive study, with a lot of professionals rating extensive criteria, and they really did believe that in certain areas, the Evelina scored higher than St. George’s and the Marsden. It is a balanced decision; all I can do is absolutely promise noble Lords that we will take all those factors into account.
Baroness Merron (Lab)
My Lords, I appreciate that the Minister is looking at all of this, but given the difficulties of achieving the number of clinical trials in the UK, what effect is anticipated on research because of the proposed relocation of paediatric cancer services? Is there an intention to factor into the final decision the need to expand research capacity for childhood and adult cancers?
Lord Markham (Con)
Among the criteria the NHS has taken into account are clinical services, the patient care experience and research, and it scored the Evelina higher on research. I want to understand that, because many noble Lords will be surprised by that finding. I assure the noble Baroness that research and the ability to do clinical trials, which is a vital component of our life sciences industry, is an important factor in this decision.
Sexual and Reproductive Healthcare
Baroness Merron Excerpts(2 months ago)
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Baroness Merron (Lab)
My Lords, I start by congratulating the noble Baroness, Lady Barker, on securing this important debate, and on her thorough assessment of what is a very worrying state of affairs. As I am sure the Minister has heard, that assessment has been received with some unanimity of concern across the Chamber.
The Health Foundation estimates that sexual health services will have seen spend lowered by some 39% between 2015-16 and 2024-25, which is far in excess of the already problematic 27% cuts to the public health grant. However, the situation gets even worse as the reductions in the public health grant tend to be largest in the more deprived areas. In Blackpool, for example, ranked as the most deprived upper-tier local authority in England, the per-person cut to the grant has been one of the largest. Perhaps the Minister could address how this disparity in the provision of funding for sexual health services will be put right for people in the most disadvantaged areas. It would also be helpful to hear how we have got to this situation.
My noble friend Lord Hunt raised some key questions about the Office for Health Improvement and Disparities, which I certainly want to echo. I look forward to the Minister’s reply on that, as well as to an explanation about how these cuts, which are more extreme in disadvantaged areas, square with the Government’s levelling-up agenda.
I anticipate that the Minister will give your Lordships’ House a number of statistics to refute the negative impact of the reduced funding that I have referred to on sexual health services. However, a recent Written Question tabled in the other place by Rachael Maskell MP asked what recent assessment had been made of the quality and adequacy of the availability of sexual health services. Minister Leadsom replied:
“No formal assessment has been made of the quality and availability of sexual health services to meet demand nationally or locally”.
As this is the case, how can the Government assure themselves that they are satisfied with the impact of the funding that they provide? How can they address, therefore, the very real questions that have been put in the debate this evening?
I turn to the current state of demand. The Local Government Association, using data from the Office for Health Improvement and Disparities, reports on a number of areas. For example, almost all council areas have seen an increase in the diagnosis rate of gonorrhoea, with 10 local authorities seeing rates triple, while nearly three-quarters of areas have seen an increase in cases of syphilis and more than one-third of local authority areas have seen increases in detections of chlamydia. It is interesting to note that councils, as well as other groups, have called on the Government to publish a new 10-year sexual and reproductive health strategy to address infections in the long term. Perhaps the Minister could advise the House what consideration the Government have given to that proposal.
An analysis by the Guardian just last month found that spending by English councils on sexual health services had reduced by one-third since 2013 despite a rise in the necessity for consultations for sexually transmitted infections. Advice, prevention and promotion services have had the largest cuts to funding, with net spending down some 44% since councils were made responsible for public health in 2013. Meanwhile, STI testing and treatment fell by one-third and contraceptive spending by nearly one-third. Yet we know it is costly for people to end up in hospital who could otherwise have been treated through sexual health and reproductive services. So could the Minister comment on how cuts such as these make sense in terms of value for money, when research shows that each additional year of good health achieved in the population by public health interventions costs £3,800, around three times lower than the costs resulting from the NHS interventions that become necessary in the absence of those preventative measures?
The noble Baroness, Lady Barker, was right to draw attention to the workforce that is necessary to provide these services. There have been many warnings that a large number of skilled medical staff have left the NHS and, even in the unlikely event of a major injection of resources, it would just not be possible to replace that loss of workforce overnight.
I think we in this Chamber all agree that long-term workforce planning is essential to ensure the sustainability of crucial sexual health services. There is currently a retirement cliff edge for all members of multidisciplinary teams. That has been exacerbated by difficulties in recruiting new staff into the specialty, as well as the experience of the pandemic, which saw more healthcare professionals leaving the sector. As we have heard today, there is an urgent need to recruit new trainees by addressing the low number of training posts in GUM and HIV and lower awareness of the specialty. A survey of RCN members reported that sexual and reproductive health is not regarded as attractive to new staff, while concerns were also raised about the diminishing options for education and training. That is borne out by the limited exposure to the specialty that we see in undergraduate training and in the core general training following medical school—something highlighted by the noble Baroness, Lady Barker.
In all this, the failure to plan and invest in a sexual and reproductive workforce only exacerbates pressures elsewhere in the healthcare system. People are being pushed into hospital now due to untreated STIs, with admissions to hospital for syphilis and chlamydia doubling between 2013-14 and 2022-23 while gonorrhoea admissions have tripled.
As the noble Lord, Lord Allan, said, the workforce plan refers to what I would describe as a hope—a hope that there will be benefits from improved joint working between ICBs and local authorities on workforce planning, development and training for public health areas, including sexual and reproductive health services. In answer to a Written Question that I tabled last month, the Minister confirmed that NHS England conducted an annual performance assessment of the ICBs for the 2022-23 financial year. Can the Minister indicate what assessment has been made of those promised improvements through joint working in respect of sexual and reproductive health services; in other words, is the joint working delivering in the way that the workforce plan hoped for?
Importantly, how will the Government address the very real issues that have been highlighted in this debate? They are real, they have been with us for years and they need resolution.
Cancer: Staffing
Baroness Merron Excerpts(2 months ago)
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Baroness Merron
To ask His Majesty’s Government, in the light of warnings by the Parliamentary and Health Service Ombudsman, what assessment they have made of the risk to cancer patients in England presented by the staffing levels, workloads and working conditions of healthcare professionals.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
I express my regret about the cases referenced by the ombudsman. The department is taking steps to reduce cancer diagnosis and treatment waiting times across England and to improve survival rates across all cancer types. Through announcing the first ever NHS long-term workforce plan, we are taking meaningful steps to build the NHS workforce for the future. The Government are backing the plan, with over £2.4 billion of funding for additional education and training places.
Baroness Merron (Lab)
My Lords, the Minister will know that numerous complaints relating to patients with cancer that were investigated by the Parliamentary and Health Service Ombudsman included misdiagnosis, treatment delays, the mismanagement of conditions, poor communication and unsuitable end-of-life care. As the NHS is grappling with over 110,000 staff shortages, how is patient safety being compromised by the Government’s long delay in bringing forward the workforce plan? What immediate action will the Government take to deal with the continuing risk to cancer patients posed by a workforce that the ombudsman describes as “understaffed, under pressure and exhausted”?
Lord Markham (Con)
As the noble Baroness says, we see increasing the workforce as a core component here. I was speaking to the president of the Royal College of Radiologists about this the other day, and we obviously need to make sure that the workforce can be as effective as possible at what it does. We are doing a lot of new diagnosis, and 80% of all the medical AI technologies are in the radiography space, which is making a huge difference to diagnosis and productivity. It is clearly fundamental that we get the treatment to these people as quickly as possible.