Cancer Referral Targets

Baroness Merron Excerpts

Monday 5th June 2023 Lords Chamber

Asked by

[Baroness Merron]

To ask His Majesty’s Government what steps they are taking to ensure that NHS trusts in England meet their target for cancer patients to be treated within two months of an urgent GP referral.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

My Lords, NHS England continues to actively support those trusts requiring the greatest help to cut cancer waiting lists. This work is backed by funding of more than £8 billion from 2022-23 to 2024-25 to help drive up and protect elective activity, including for cancer. To increase capacity, we are investing in up to 160 community diagnostic centres—CDCs. Within CDCs, we are prioritising cancer pathways to help reduce the time from patient presentation to diagnosis and treatment.

[Baroness Merron (Lab)]

My Lords, nearly 90% of cancer patients in 2010 received their first treatment within two months of urgent referral, which exceeded the operational standard, something the Government have not achieved since 2014, while last year fewer than 65% of cancer patients were treated within this standard. With earlier intervention being key to saving lives, what is the Government’s estimate of how many lives are lost each year due to failure to meet this agreed standard? What is the impact on survival rates of continued delays to a workforce plan promised long before the pandemic and still being reported as not having been signed off by the Treasury?

[Lord Markham (Con)]

The noble Baroness is correct about early diagnosis. That is why we have invested in 160 CDCs, which will be primarily focused on cancer, and why there are 11,000 more staff than in 2010, a 50% increase, as well as 3,000 more consultants, a 63% increase. We are seeing more supply than ever but at the same time, given Covid and the pent-up demand caused by that, we are also seeing more than demand than ever. The major expansion of supply is focused on making sure that we quickly detect those people.

NHS GP Surgeries: Purchase by US Companies

Baroness Merron Excerpts

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

My understanding on this is that actually it is not a massively profitable area at the moment. The biggest provider in this area, Babylon Health, as we all know, did not manage to make it work. So, while I think we all understand my noble friend’s concerns, I do not believe that this is the case with the GP funding model.

[Baroness Merron (Lab)]

My Lords, research has shown that GP surgeries owned by some private limited companies have been offering a lower level of care, with unqualified staff seeing patients. So, in view of the Minister’s comments on quality, how much of a concern is this for the Government? On top of this, with some 4,700 GPs being cut over the last decade, cuts to training places and the many years that it takes to train a GP, what response will the Minister make to the latest GP patient survey, which reports that patients are now ever less likely to be able to see a GP?

[Lord Markham (Con)]

Clearly, we have our targets in terms of making sure that people can see a GP. I am glad to say that 70% of appointments are now face to face, and we are on target to hit our 50 million increase in appointments. So it is good to see that we are getting that done. Do we need to do more? Clearly, there is ever-increasing demand from the demographics of the situation, so we need to increase supply through additional training places, as I said.

NHS National Health Inequalities Improvement Programme

Baroness Merron Excerpts

Thursday 25th May 2023 Lords Chamber

[Lord Markham (Con)]

Absolutely. We work very closely together. The Healthy Start programme gives seven fruits a day to kids up to the age of seven to make sure that they get fruit and vegetables, and that is very much a joint initiative. Clearly, we need to be joined at the hip on some things, but as regards school meals, the DfE takes the lead.

[Baroness Merron (Lab)]

My Lords, the levelling up White Paper promised to design and test a new approach to ensure compliance with school food standards. Although pilot schemes were meant to start last September, a recent Written Answer from the Schools Minister stated that

“standards are being kept under review”,

with no sign of the pilot scheme. Have the Government given up on their promise and does the Minister consider the existing standards for school meals and the means of compliance sufficient to tackle nutritional inequalities across the country?

[Lord Markham (Con)]

As mentioned previously, the review did not happen because of Covid, and it is very much within the plans that it is time to look at school standards again. Clearly, that is key to making sure that there is a healthy diet in schools, and of course that goes across the board.

Autism: Diagnosis Targets

Baroness Merron Excerpts

Tuesday 16th May 2023 Lords Chamber

[Lord Markham (Con)]

First, I totally agree with my noble friend’s sentiment about the power that AI, when done in the right way, can have in this space. Clearly, the stress is on the words “the right way”. I think it is fair to say that we are all on the nursery slopes as regards what it can do. I have seen how effective it can be in taking doctors’ notes, recording a meeting and drafting action points, which a doctor can then review. I am sure that we would all agree that that is very promising. There are future generations of AI being talked about that may be able to perform diagnosis. In the 10 to 15 years of looking ahead in the long-term workforce plan, these are some of the things that we will have to try to take into account. However, we are in the very early stages.

[Baroness Merron (Lab)]

My Lords, when it comes to autism services, we know that there are major disparities across the country which predate the pandemic but which were made much worse by it. The number of people waiting for an assessment has grown by 169% from pre-pandemic levels. How will the Minister ensure that the national framework and the standards for autism assessment within it are deliverable at a local level and in every part of the country?

[Lord Markham (Con)]

First, each ICB now has to have a lead for autism and learning difficulties. The noble Baroness is correct that there are some disparities— I am sure that she is aware of the two ICBs which have restricted their services quite significantly, although, thankfully, they are now rowing back on that. We need to make sure that we are on top of all of them. As the noble Baroness is aware, I and other Ministers are taking a personal interest in this. Clearly, there is a lot of work to be done.

NHS: Allocation of Financial Resources

Baroness Merron Excerpts

Thursday 11th May 2023 Lords Chamber

[Lord Markham (Con)]

Yes, and we are doing it. We have committed to an up to £7.5 billion increase in funding over the next two years. We announced last month a social care plan which is addressing this and reforming the sector, and we are starting to see the changes.

[Baroness Merron (Lab)]

My Lords, the Royal College of Emergency Medicine described as unambitious the Government’s plan to see 76% of A&E waits meeting the four-hour standard by 2024. As this target has not been achieved in the past two years, how does the Minister see it working to drive down waiting times? How will the Minister ensure that hospitals are not prioritising patients with minor conditions at the expense of those in greater need of admission simply to allow them to meet the target?

[Lord Markham (Con)]

Numbers out just this morning show that we are now at 75% of people being seen within four hours, so we are close to the 76% target. That is the best since September 2021. I am the first to admit that we want to go further, as the noble Baroness states. It is about making sure we have got the care in the right places. We are triaging to make sure that the most important cases are seen first and, as I mentioned in a previous answer, we have things such as fall services, which can avoid trips to A&E in the first place, and more primary care in place to avoid visits in the first place. That is what the primary care recovery plan is all about.

Life Expectancy: Pensions, Health and Insurance

Baroness Merron Excerpts

Wednesday 26th April 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend is correct: it is a key issue. There have been successes such as the sugar tax levy, which has reduced sugar consumption by about 40%. But clearly, you need only to look at the statistics to see that all western nations, including the UK, are facing this problem. It is a challenge that we have to attack. We can learn a lot in this space from Japan, where employers and the whole society are very much involved in the healthy lifestyles of their workers and people.

[Baroness Merron (Lab)]

My Lords, life expectancy for those with a learning disability is particularly shocking: only four in 10 live to see their 65th birthday, nearly half of their reported deaths are avoidable, and those living in the north-west and the Midlands are at greater risk. What action are the Government taking to address the specific barriers faced by people with learning disabilities in getting access to the timely, quality healthcare which could perhaps extend their life expectancy?

[Lord Markham (Con)]

As noble Lords are aware, we have been putting significant investment into mental health; from memory, there has been a £2 billion-plus increase over the last year. In recognition that learning disability is an issue we particularly need to tackle, as the noble Baroness is aware, we are putting investment into schools so they can identify it early on. Some 35% of schools now have the right educational leads in this space, and the figure will rise to 50% next year. It is a big improvement, but do we need to do more? Absolutely.

Long Covid

Baroness Merron Excerpts

Tuesday 25th April 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness. My understanding is that the 90 specialist adult centres and 14 specialist children’s centres have care pathways which they are supposed to adhere to. Therefore, I hope that the instances which the noble Baroness brings up are the exception, but I am happy to investigate because I think we all agree that a consistent care pathway is vital in this space.

[Baroness Merron (Lab)]

My Lords, despite the provisions that the Minister has outlined, the reality is that just a fraction of the people who have long Covid are seen and supported. What steps are being taken to ensure that GPs recognise long Covid in those who do not self-label as having the condition, and how will the Minister respond to the data that shows inadequate access to specialised health services?

[Lord Markham (Con)]

As I say, the data that I have been working with indicate that 80% are seen within eight weeks, which I think most noble Lords would agree is a pretty good statistic. My understanding is that GPs are fully briefed on referrals and disability types. It is clearly important that people who are suffering in the long term make sure that they get treatment.

Diphtheria

Baroness Merron Excerpts

Tuesday 18th April 2023 Lords Chamber

[Lord Markham (Con)]

As I mentioned, we are doing the screening. We lead Europe on this; my understanding is that no other European country is taking the extensive measures that we are. I can also reassure the House—I was speaking to Susan Hopkins on this just yesterday—that UKHSA has deemed that there is a very low risk to the general population. The uptick in cases that we are talking about is in the migrant population, and the fact that we are vaccinating 88% of them against diphtheria shows that we are on top of the problem.

[Baroness Merron (Lab)]

My Lords, we know only too well from pandemics that diseases do not respect borders, and though, as the Minister says, we ought to be well protected against diphtheria in this country given the vaccination programme, recent increases in vaccine hesitancy have given cause for concern. On the steps that the Minister referred to that should be taken to maximise vaccination rates, can he indicate whether this will reflect regional variations, bearing in mind that the National Audit Office has reported a lower level of vaccine take-up in London?

[Lord Markham (Con)]

Absolutely. As the noble Baroness is aware, vaccination take-up is the responsibility of the ICBs in their areas. Like many other places, London has unique demographics. As I mentioned, our record is pretty good in this area, but it needs to be done nationally on a uniform scale.

Junior Doctors’ Strikes

Baroness Merron Excerpts

Monday 17th April 2023 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

“Mr Speaker, the honourable gentleman seems to ignore the fact that we have actually negotiated a deal with the NHS Staff Council, and it is a deal that it has recommended to its members. Indeed, the largest health union has voted in favour of the deal—indeed, it is his own health union—yet he seems to think we should tear it up, even though other trade unions are still voting in response to that offer and their leadership had recommended it.

Secondly, he says that we should sit down and negotiate. We have made an offer of 10.75% for last year, compared with the Labour Government in Wales, who have offered just 7.75%. So the offer, in cash terms, in England is actually higher than the offer that is being put on the table by the Welsh Government, which I presume he supports. He says he does not support the junior doctors in their ask for 35%, and nor does the leadership there. We need to see meaningful movement from the junior doctors, but I recognise that doctors have been under significant pay and workforce pressures, which is why we want to sit down with them.

The bottom line is that the deal on the table is reasonable and fair. It means that just over £5,000 across last year and this year will be paid for a nurse at the top of band 5. The RCN recommended this deal to its members, but it was rejected by just under a third of its overall membership. It is hugely disappointing that the RCN has chosen not to wait for the other trade unions to complete their ballots and not to wait for the NHS Staff Council, of which it is a member, to meet to give its view on the deal. It has chosen to pre-empt that, not only with the strikes that come before that decision of the NHS Staff Council but by removing the derogations—the exemptions—that apply to key care, including emergency care, which is a risk to patient safety.

Trade unions are continuing to vote on this deal. The deal on the table is both fair and reasonable, including just over £5,000 across last year and this year for nurses at the top of band 5. It has been accepted by the largest union in the NHS, including, as I have said, the shadow Health Secretary’s own trade union. It pays more in cash to AfC members than the deal on the table from the Labour Government in Wales. It is a deal that the majority of the NHS Staff Council, including the RCN’s own leadership, recommended to its members. We have always worked in good faith to end the disruption that these strikes have caused and we will continue to do so, but it is right to respect the agreement that we have reached with the NHS Staff Council and to await its decision, which is due in the coming weeks.”

[Baroness Merron (Lab)]

My Lords, last week was the most disruptive in the history of the National Health Service, with some 350,000 patients seeing their operations and appointments cancelled due to industrial action. Does the Minister accept that the public remain supportive of doctors and nurses and also that the public want to see the Government reaching fair, negotiated settlements to bring disruption to an end? If Ministers remain unable to get agreements over the line, what other options are being pursued, including the involvement of ACAS?

[Lord Markham (Con)]

I think we all want fair outcomes and negotiated settlements, and I think we felt that the agreement reached with the Agenda for Change parties was fair and was something, as mentioned in the Statement, that the union leadership recommended to the union members. Of course, we need to wait to see the outcome of the staff council of all the Agenda for Change unions from 2 May to see where we end up on that. Our hope is that, across the majority of those, we will see support. As noted, this is a generous offer; it is higher than the offer made in Wales, for example, and we hope it will be a way forward after 2 May. If that is not the case, we need to sit down and think about next steps.

Junior Doctors’ Strikes

Baroness Merron Excerpts

Thursday 30th March 2023 Lords Chamber

[Baroness Merron (Lab)]

My Lords, junior doctors are being asked to do the work of many. The NHS is short of more than 150,000 staff, yet the long-promised NHS work plan remains just that—long promised. We are still waiting for the general practice plan, the review of integrated care services and the social care update. Do the Government intend to get those plans out over the Recess when Parliament is unable to scrutinise them? With a quarter of a million appointments and operations potentially facing postponement because of the forthcoming strikes, when will the Health Secretary get back around the table with the BMA, this time to take talks seriously to stop the damage to patient care?

[Lord Markham (Con)]

We have taken the talks incredibly seriously. We have proven in other areas with the Agenda for Change unions that, with good will on all sides, we have managed to reach an agreement. I think most people would agree it is not a reasonable position to go in saying that, unless they get a 35% pay increase, they are not willing to have any further talks. That is not something that I believe many of us could support. We are always open to reasonable negotiation, as we have proved in the other cases, and we remain open to having that reasonable negotiation now.

--- Later in debate ---

[Lord Markham (Con)]

As I have mentioned many a time and am happy to mention again, the workforce plan will be announced shortly—soon. I wish I could give an exact date, but it is there. However, I am sorry to say that I do not believe that can be used as an excuse for the strike action that we are talking about now, which puts patients at risk. I know that, in other areas, the Agenda for Change unions have worked constructively with NHS trusts on derogations to protect patients, but I regret to inform the House that that is not the case now. There is lots that we need to do in the workforce space, and there is lots that we want to do around recruitment, motivation and making it a good place to work, but I would like to think that none of that means that the delay of a report is a reason to take this sort of action and put patients’ lives in danger. I do not think any of us would agree that that is a suitable reason.

[Baroness Merron (Lab)]

My Lords, perhaps I could invite the Minister to respond to my first question, building on the points made by the right reverend Prelate. In addition to the NHS workforce plan, which we await, I remind the Minister that we are also waiting for the general practice plan, the review of integrated care services and the social care update. Could the Minister take this repeated opportunity to say whether the Government will be publishing these over the Recess? If this is so, it is obviously of concern that Parliament will not have the chance to scrutinise the plans.

[Lord Markham (Con)]

Like all noble Lords, I absolutely agree that Parliament has to have every opportunity to fully assess, discuss, debate and scrutinise the plans. As noble Lords know, I cannot say when the report will be released, so I cannot say with all honesty whether it will be over the Recess or afterwards. I can only repeat the words “soon” and “shortly”, and say that there is not a definite plan to announce it over the Recess. What we fundamentally agree on is that these plans are being produced with stakeholders and a lot of consultation, and they will absolutely be subject to a lot of scrutiny, as we would expect. I expect to answer on the plans in this House, as I expect my ministerial colleagues in the other place to have to do as well.