Hospices: Funding

Lord Balfe Excerpts

Thursday 24th October 2024 Lords Chamber

[Lord Balfe (Con)]

My Lords, I echo yet again the thanks to the noble Lord, Lord Farmer, for initiating the debate and for the very thoughtful speech with which he introduced it. I declare an interest as the joint chair of the All-Party Group on Together for Short Lives, which is a charity devoted particularly to babies that are born with what are seen as incurable diseases. If a baby is born in that situation, it is a great shock to the parents because they are not generally expecting it, and when the baby is born there is a huge traumatic effect. We are to have a debate on assisted dying, but we have noticed that for little babies there is already assisted dying, because the consultants can ask for medicines to be withdrawn. From time to time, there are very sad court cases where hospitals go to court to get permission to withdraw medicine against the wishes of the parents. I would like that to be looked at more thoroughly in terms of whether we have even yet got it right. We got some minor changes under the last Government together with my friend and colleague, the noble Baroness, Lady Finlay, but there is still a lot to be done in this area.

In so far as the funding of hospices goes, I would like the Government to look at the system outlined in Wales and see whether we can get some sort of agreement on a system and a way of going forward in this country. The fact of the matter is that the charitable raising of funds for hospices is a popular way of raising money—we have one in our area that is well subscribed to—because people like giving, but we must not let everything rest on charity. The points made by my noble friend Lord Farmer about dignity, including intrinsic dignity, and ethics were extremely important; I hope that they will be borne in mind.

Finally, I ask the Government to have a look at the way in which integrated care boards disburse their funding because the variety in disbursement is greater than should be acceptable, even in a partially devolved system.

NHS Continuing Healthcare

Lord Balfe Excerpts

Monday 2nd September 2024 Lords Chamber

[Baroness Merron (Lab)]

I do understand the concerns raised by the noble Lord and agree that we need to take a close look at all these areas. I have already raised that with officials and with Minister Kinnock, who is the responsible Minister in this area. On the second question, there is indeed a relatively low conversion rate, and I understand that the decision was originally made to ensure that everyone who might be eligible is actually assessed. The assessment acts as a gateway to other NHS-funded care but, having looked at it, this could perhaps be made somewhat clearer. On the first question, the noble Lord will understand that I cannot give a definitive answer, and he will be aware that legislation does not limit the number of hours or the cost of nursing care that a local authority may provide. However, the Care Act 2014 sets out that local authorities can provide nursing care only in very limited circumstances—for example, where it is a minor part of overall care, such as basic wound care.

[Lord Balfe (Con)]

What action are the Government taking to hold integrated care boards to account to ensure that the National Framework for Children and Young Persons’ Continuing Care is implemented equitably and consistently across all local areas? I declare my interest as the joint chair of the all-party group for children with short lives.

[Baroness Merron (Lab)]

It is crucial that we provide the right support to children and young people. NHS England’s regional teams are working with local systems to explore the delivery of continuing care to that younger group. It is important to say to your Lordships’ House that we do not currently collect data on, for example, children and young people, but we will be doing so from April next year. That will help us capture evidence, which will enable us to improve things in the way the noble Lord and his all-party group want to do. We continue to welcome views from stakeholders and partners in this regard.

Care of Critically Ill Children

Lord Balfe Excerpts

Monday 29th January 2024 Lords Chamber

Asked by

[Lord Balfe]

To ask His Majesty’s Government what steps they have taken, or propose to take, following the publication in September 2023 of the review they commissioned from the Nuffield Council on Bioethics, Disagreements in the care of critically ill children.

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

The department is working closely with other organisations to ensure that recommendations are taken forward and oversight is maintained. Together, we have taken steps on several recommendations aimed at improving the experience families and healthcare professionals have of navigating disagreements. NHS England has introduced regional conflict champions and launched resources and conflict management training on e-learning for health. The Ministry of Justice will hold a round table on how less adversarial court models could be used.

[Lord Balfe (Con)]

I thank the Minister for his reply. This review arose from an amendment to the Health and Care Act 2022, moved by my good friend, the noble Baroness, Lady Finlay, that I helped to draft. What steps have the department taken to establish a task force, as was recommended in the report? Secondly, there are a lot of recommendations in the report—far too many for an Oral Question. Will the Minister meet the noble Baroness, Lady Finlay, and me to review where we have got to with this most necessary look at administrative procedures?

[Lord Markham (Con)]

First, I thank my noble friend and the noble Baroness, Lady Finlay, for their work in this field. Of course I will very happily meet to talk about progress. Minister Caulfield has agreed to chair the task force itself, and we have agreed the constituent parties; we are including the Ministry of Justice, the Royal College of Paediatrics and Child Health, the Royal College of Nursing and health qualification providers, which will all take part in the task force.

Children’s Hospices: Funding

Lord Balfe Excerpts

Tuesday 14th November 2023 Lords Chamber

[Lord Balfe (Con)]

My Lords, I declare an interest as the joint chair of the all-party group whose secretariat is Together for Short Lives. The thing that is of great difficulty in this sector is uncertainty. In the interests of permanence and certainty, will the Minister include a dedicated long-term strategy in the Government’s mandate to NHS England that addresses the palliative care needed for children and young people so that the sector can have an assured future?

[Lord Markham (Con)]

My noble friend is correct; it is a long-term part of the statutory requirements of all ICBs to provide palliative care, so it is written into that NHSE mandate. It has to review all 42 ICB arrangements, and we make sure that in each setting they have the 24/7 care set-up required of them.

Folic Acid Fortification

Lord Balfe Excerpts

Tuesday 25th July 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness for that question; as I am rapidly learning, this is a complicated area. For the benefit of noble Lords who were not present yesterday, the tobacco arrangements are part of the Windsor agreement, so we passed primary legislation to allow us to make those changes. On the items before us, which involve secondary legislation, my understanding—if I am wrong, I will make a correction in writing—is that the co-operation of each of the devolved authorities is needed. That is why we are not able to proceed in Northern Ireland without its involvement. The plan is that we will go forward with GB-only measures if we have to. For obvious reasons, we would prefer not to do that; we want Northern Ireland to benefit from these changes as well but, as I have learned, it is a complex area.

[Lord Balfe (Con)]

My Lords, when I became president of the British Dietetic Association—the dieticians’ trade union—this was one of its priorities. When I stood down five years later it was still a priority. My noble friend Lord Rooker has pursued this relentlessly, but what we are overlooking, I am afraid, is that every year more and more babies are born with this defect. Some 80 countries have managed it; what has impeded us for such a long time? I echo my noble friend Lord Cormack’s question: will “early” next year really be early?

[Lord Markham (Con)]

As I have said, there are complications. The MHRA, for instance, has raised concerns about the side-effects of certain folic acid levels in respect of anti-epilepsy drugs. We are going through various medical areas and checking that we do not have unintended consequences, and these are some of the issues that have been taking time to deal with. I am not trying to give excuses, but to allow noble Lords to understand some of the complexities involved. As I have mentioned, the plan is very much to lay legislation in early 2024. We then have to give notice periods to the EU and the World Trade Organization, so, in order to achieve complete transparency for noble Lords, I am afraid there will be a two-year implementation timeframe from then. But rest assured that I will be pushing hard on this.

NHS Winter Pressures

Lord Balfe Excerpts

Tuesday 10th January 2023 Lords Chamber

[Lord Markham (Con)]

Yes, this is very much the focus of my colleague Minister O’Brien. I think it is understood that as many as half of the people who turn to up to A&E could have been looked after by the primary care system, so a lot of the pressures caused are as a result of that. It is absolutely a whole-system problem; many of the issues at the front end are about the GPs and at the back end they are about adult social care, which is why we need to address the whole system.

[Lord Balfe (Con)]

My Lords, last month, I had the dubious privilege of staying at one of the Minister’s hospitals. I was struck by the sclerotic way in which decisions were taken. It seems that the whole premium is on safety rather than looking after the patient. I would ask that the department looks into the way in which decisions are made, because I found far too often that a decision was made on the basis of what was safest. The multidisciplinary team, as it was called, was basically there to deflect anyone who wanted to do anything very adventurous. Will the Minister start looking, maybe in selected hospitals, at ways in which the decision-making and care process can be speeded up and made less sclerotic?

[Lord Markham (Con)]

I have seen very good examples of where that works. You have clinicians in the room with the data—the management and bed information. They make decisions according to the flow and number of people who they see are going to need a bed from the ambulances and the A&E situation, and the number who are ready to release. You have clinicians united with the information to make good decisions. Those are the best. The idea with the longer-term plan is to make sure those “best” have the tools in terms of the flight control system and have management processes in place so that they can adopt and follow best practice. It is key to what we are looking to make sure we have in place in time for next year, as the noble Baroness, Lady Merron, mentioned.

NHS Industrial Action: Government Preparations

Lord Balfe Excerpts

Tuesday 13th December 2022 Lords Chamber

[Lord Markham (Con)]

First, I will take the opportunity to thank the Armed Forces and anyone else who will be helping at this difficult time. I appreciate that that might cut into some of their plans for Christmas and I appreciate what they are doing in the circumstances. I cannot speak beyond that in terms of any financial support that they might be given, but they will definitely have our undoubted thanks.

[Lord Balfe (Con)]

My Lords, does the Minister accept that many working families are much worse off because of inflation? The image given by the Government is that they have no coherent strategy. We seem to be in a sort of playground situation of shouting at each other, whereas what we need is understanding from the Government as to how they are going to tackle the inevitable fall in the standard of living caused by the excesses that happened during Covid. Will the Government try to get their act together, because the sympathy of the general public is not with the Government? It is not against the strikers. At best it is neutral and at worst it is moving the other way as we get nearer to Christmas.

[Lord Markham (Con)]

We appreciate of course that these are difficult times. Unprecedented circumstances have caused the current inflationary environment, which we appreciate provides challenges to many people. We are trying our best to help them navigate through that. Obviously, the energy support package was a good example of where we are trying to make sure that probably the biggest component of inflation—the increased energy bills—is covered. We will seek to act and do what we can in all circumstances to help people through the crisis.

NHS: Waiting Lists and Increased Spending

Lord Balfe Excerpts

Tuesday 22nd November 2022 Lords Chamber

Asked by

[Lord Balfe]

To ask His Majesty’s Government what assessment they have made of the statement by the Institute for Fiscal Studies on 15 November that NHS waiting lists have risen in 2022 alongside increased spending on NHS England.

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

The Government continually assess data and reports on waiting lists from a wide range of sources, including the Institute for Fiscal Studies. The IFS statement confirms that the Government are right to support and challenge NHS England to continue to identify and address factors that constrain further activity, and to reduce waiting lists. The Autumn Statement announced a further £3.3 billion for 2023-24 and 2024-25 to enable rapid action to improve emergency, elective and primary care performance.

[Lord Balfe (Con)]

My Lords, I thank the Minister for his reply. Last week, the Institute for Fiscal Studies said that

“NHS spending in England is, in real terms, 12% above its 2019 level. Yet it is getting fewer people off waiting lists and into hospital treatment than it was … in 2019.”

We used to have a slogan: “Labour isn’t working”. The NHS is no longer working. The Royal College of Obstetricians and Gynaecologists has asked me whether we could ring-fence its money. I do not think we can. Can some of the hundreds of civil servants on six-figure salaries in his department get down to sorting out what is clearly a dysfunctional department?

[Lord Markham (Con)]

My noble friend is correct. Efficiency is very important, as pointed out in a previous Question. I have done some work in this space, and there are some trusts that are absolutely on the path to the 130% increase in elective treatments compared with 2019, for which the funding is in place. There are other trusts that are not. Clearly, my job and the job of all the department’s civil servants is to understand why that is and to challenge those trusts that are not; to support them where they need that support; and to ensure they are introducing best practice and innovation in order to make sure they all get back towards that level. There are some very good performers and others that are not so good.

British Heart Foundation: Tipping Point Report

Lord Balfe Excerpts

Tuesday 8th November 2022 Lords Chamber

[Lord Balfe (Con)]

My Lords, will the Minister look at any connection between vaccinations and worsening heart disease—in other words, the extent to which the vaccination itself might contribute to worsening a heart condition?

[Lord Markham (Con)]

My understanding is that that is something for in-depth research, which I do not have at my fingertips. I will inquire and write back to the noble Lord.

NHS: Winter Challenges

Lord Balfe Excerpts

Monday 10th October 2022 Lords Chamber

[Lord Markham (Con)]

I had the pleasure of visiting Watford General just a week ago, and I saw the virtual wards first hand, so I agree on the excellence we saw there. To give the House a sense of that, the wards have reduced 90-day readmission rates from around 45% to 7%. When I talk about performance improvements, those are precisely the sorts of areas in which I wish to see investment made, so that we can roll that out across the NHS. It is in those areas that we can make a real difference.

[Lord Balfe (Con)]

My Lords, we are now on our 10th Secretary of State in 20 years and we have had slightly more Lords Ministers. In that time, spending on the NHS has more than doubled, yet the answer always seems to be to look for more money. Does the Minister consider that we need to take a more fundamental look at the National Health Service to see whether priorities can be moved so that the money we are presently spending will be spent more wisely and we will not, every single year, have the same headlines, the same problems and the same inability to solve them?

[Lord Markham (Con)]

My noble friend is correct that we have to make sure that the record investment is put to good use. We have 200,000 more people working in the health service than in 2010. It is correct that we have more resources invested in this area than ever before and also that we have to make sure that those are used to best effect. Noble Lords can rest assured that that is very much in my remit.