NHS: Drug Shortages

Lord Bellingham Excerpts

Wednesday 17th January 2024 Lords Chamber

[Lord Markham (Con)]

There are 78 medicines for ADHD, 10 of which are particularly affected. We have put export restrictions in place on that, and we are working it through so that we can hopefully get it resolved by April. It is something we are working very closely on, because we know the importance.

[Lord Bellingham (Con)]

My Lords, I understand the Minister’s department has a cap on total allowed sales of branded medicines to the NHS. I think it will be a 4% cap over the next five years. Is this making the problem worse? Is it exacerbating the problem? Is it something he could look at with his ministerial colleagues?

[Lord Markham (Con)]

I think the cap my noble friend is referring to is actually in terms of the price negotiations on the VPAG and how the rebates kick in. It is not my understanding that is something that is at issue here. We are talking about where there are specific ranges. A study was produced by the Pharmaceutical Research and Manufacturers of America looking at supply issues across lots of countries over the 10 years from 2012 to 2021. The UK was consistently in the top three. Yes, there are some issues that we are working through, but by and large we are consistently in the top three of supply.

Recovering Access to Primary Care

Lord Bellingham Excerpts

Tuesday 9th May 2023 Lords Chamber

[Lord Markham (Con)]

The noble Lord makes a very good point. It is really making sure that the independents can play a very important role. It is, where necessary, making sure that whole-estate planning takes that into account. A lot of the work I have been doing with Minister O’Brien—he heads the GP space while I look after the capital space—is looking at how we can create the sorts of models where you can put pharmacies alongside GP surgeries, in many cases, and make sure that that capability is there. I freely admit that capital is at a premium within the system, so we have to be creative in the ways we use it, but the noble Lord is absolutely correct that this is a key way to make sure we have a network of independent pharmacies that can really serve their local community.

[Lord Bellingham (Con)]

My Lords, I thank the Minister for the Statement and put on record my gratitude to him and other junior Ministers who played a very important part in making sure that this initiative has been brought to fruition. I pay tribute to the local surgery in my own community in Norfolk, the Great Massingham and Docking surgery, where the receptionists are invariably incredibly patient and polite to everyone and the doctors are quite outstanding—they have a lot of very satisfied people in the community because of their attitude to local people who may have ailments. But, obviously, they are under pressure, and that is why I welcome the Government’s announcement on Pharmacy First and on recruiting new GPs. Can my noble friend tell the House whether the Government’s commitment to recruit an extra 6,000 GPs by the end of this Parliament is on course? Has the number of GPs in training increased? Can he just clarify those two points?

As the noble Lord, Lord Boateng, pointed out a moment ago, pharmacies are often at the centre of communities. Apart from anything else, pharmacists often have a really strong relationship with patients because they see them on a regular basis, understand their needs and see them consistently—which, unfortunately, is not always the case with doctors. That is why I support the Pharmacy First initiative, which could be a lifeline to a lot of pharmacies that are under pressure. They will be able to prescribe many more medicines, but can my noble friend tell the House whether they will be able to prescribe antibiotics for some of the conditions he mentioned? If that is the case, that would be a very positive extension to the services that they provide.

[Lord Markham (Con)]

I thank my noble friend. As evidence of the good work that receptionists do under trying circumstances, in a recent survey 91% of patients said that their needs were met. On the target of having 6,000 extra GPs by the end of this Parliament, currently we have increased the number by 2,000 but, in all honesty, I think the feeling is that we will struggle to meet the 6,000 target—I believe that is something that Sajid Javid, as Minister, said before. But there is a 50% increase in the number of graduate trainees since 2014, with more than 4,000 currently in training. So we have made steps in the right direction, albeit not as far as we would hope.

On the supply of antibiotics, the idea behind this is that there will be certain agreed treatments that the pharmacist will be able to give. Clearly, UTIs is an example where you often need antibiotics to clear those up, and in those circumstances there will be agreed treatments that pharmacists can give: provided that, in the pharmacist’s judgment, the symptoms warrant it, the pharmacist will be able to enable the supply of antibiotics. On all those, this is a very positive way forward.

GP Appointments

Lord Bellingham Excerpts

Thursday 23rd February 2023 Lords Chamber

[Lord Markham (Con)]

Are you going to dare me?

Sorry, I think a diplomatic response is probably wise at this stage. I note that, under the Barnett formula, per person funding for the NHS is Scotland is higher than it is in England. So there is significant funding in place. How well it is administered north of the border is probably a matter for the Scottish Government.

[Lord Bellingham (Con)]

My Lords, is it not the case that many European countries charge patients who fail to turn up for appointments without due cause? Is this something we are going to look at in this country?

[Lord Markham (Con)]

I am clearly aware of that. At the same time, I am very aware that we want to make sure that people are able to see a doctor when they need to and are not deterred from that. So we would have to tread very carefully and it is definitely not in our plans at the moment.

Urgent and Emergency Care Recovery Plan

Lord Bellingham Excerpts

Thursday 2nd February 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness. Taking those questions in reverse order, yes, it is understood that virtual wards do not work for everyone. At the same time, I am constantly surprised by the data: for instance, the average age of an NHS app user is in the mid-60s—so it is not a particularly young demographic who use this. Obviously, the examples I have seen, particularly on COPD at Watford, show that an older population is using that. However, we absolutely need to make sure that there is not a digital divide from that.

On the noble Baroness’s points on the workforce, she is quite right. We live in a competitive market, and one of the benefits of full employment is that, again, most people who want to work have a job, but one of the downsides is that there is competition for jobs. We have to face up to those realities and be realistic in terms of workforce, in that if you are going to attract and retain the good people, which you need to have as the bedrock of your services, you need to make sure you have an attractive and rewarding place to work. Clearly, that has to be a feature.

[Lord Bellingham (Con)]

My Lords, the Minister mentioned new hospitals. Is he aware that the biggest obstacle to major health improvements in west Norfolk is the chronic state of King’s Lynn’s Queen Elizabeth Hospital, which I gather is the most internally propped-up hospital in the UK? He will be aware of an all-party campaign to secure the building of a new hospital. Can he tell the House where are we with that process?

[Lord Markham (Con)]

I am very familiar with the problems with the so-called RACC—reinforced, autoclaved aerated concrete—hospitals. King’s Lynn is one of those, and there are a handful of others. There is a recognition that everything we do in the new hospital programme has to ensure that those hospitals are rebuilt in time, because they have a useful life that is fast reaching its end. Our priority number one is making sure that they are replaced.

Care Homes: Staffing

Lord Bellingham Excerpts

Wednesday 11th January 2023 Lords Chamber

[Lord Markham (Con)]

Before we went ahead with this, we spoke to many care providers to make sure that there was capacity within the system to do it. It was understood that the capacity is there. In fact, there is potential underused capacity of as much as 40,000. We are confident that the staffing is in place and that the care packages are there to really make a difference.

[Lord Bellingham (Con)]

My Lords, is the Minister aware that a lot of homes across Norfolk are complaining that they cannot sponsor more overseas members of staff? At a time when there are not enough locally trained and motivated staff, surely there should be more flexibility for those quality homes that want to sponsor more overseas members of staff.

[Lord Markham (Con)]

Yes, this is absolutely something that we talk to our Home Office colleagues about all the time. I believe that 15,000 people have already come through on this route in the last nine months or so; we are seeing a rate of about 1,500 a month. It is very important and something on which we are focused.

Childhood Obesity

Lord Bellingham Excerpts

Thursday 17th November 2022 Lords Chamber

[Lord Markham (Con)]

I am afraid the noble Lord is testing my memory as to what that was. If he will excuse me, I will find out what it was and write to him.

[Lord Bellingham (Con)]

My Lords, obviously the situation in the UK is extremely concerning, but we should consider what is going on elsewhere in the OECD: some countries have a better record than us, and others have brought in extremely innovative initiatives. What can we learn from other countries?

[Lord Markham (Con)]

I thank my noble friend for his question. Absolutely, we always need to ensure that we are trying to learn from best examples, either in this country or from around the world. The OECD talks about four major strands: information and education; increasing healthy choices; modifying costs, such as a sugar tax; and restrictions on the placement of food and promotions. Noble Lords can see that we are taking much action in all those areas. Most of all, I am pleased to see that, influenced by a trailblazing initiative started in Amsterdam, we are now funding five local authorities to follow that across Birmingham, Bradford, Nottingham and Lewisham to see what we can learn from those initiatives.

NHS: Access to Treatments

Lord Bellingham Excerpts

Wednesday 7th September 2022 Lords Chamber

[Lord Kamall (Con)]

I am afraid I shall have to disagree. I ask noble Lords to think about what we have been doing with the Health and Care Act: for the first time, we are talking about properly integrating health and care together. They will be completely connected from the beginning of life and all the way through life. We also had the paper on integration and we are taking a number of different steps to make sure that social care is no longer the Cinderella service, but properly joined up all the way through people’s lives.

[Lord Bellingham (Con)]

My Lords, the Minister will be aware that access for NHS patients depends on hospitals that are fit for purpose and structurally sound. Is he aware a number of hospitals around the country, built in the 1970s, have leaking roofs and ceilings that are being propped up, including the Queen Elizabeth Hospital in King’s Lynn in my old constituency? Can he tell the House about plans to announce the new phase of rebuilt and new hospitals?

[Lord Kamall (Con)]

This is something that the previous Secretary of State, who had a very short term in office, considered. When he was looking at the priorities, one of the issues for him was the hospital programme—how we make it more streamlined and modular, and how we simplify the whole process of building new hospitals. Sometimes, these will be hospitals based on old models; at other times, this will mean things such as surgical hubs, which, whatever is happening elsewhere, will focus specifically on the conditions that need to be treated.

Covid-19 Update

Lord Bellingham Excerpts

Tuesday 6th July 2021 Lords Chamber

[Lord Bellingham (Con)]

My Lords, as a strong supporter of the Government’s policy on the coronavirus, I was nevertheless critical of them being very slow to enunciate a clear policy on masks over a year ago—so I have a lot of sympathy with those noble Lords who have expressed concern about the imminent lifting of compulsion regarding masks. Surely one possible compromise might be to keep masks where you have passengers on public transport sitting or standing next to each other?

[Lord Bethell (Con)]

My Lords, I hear my noble friend’s words loud and clear. The Government have indicated that we will leave it to those who run the transport systems themselves and to local politicians. There is a good case for a degree of devolvement and subsidiarity in this matter. He is right that masks do perform an important role, but they are not a catch-all, and it is therefore reasonable to leave those who run the transport systems to make decisions for themselves.

E-cigarettes

Lord Bellingham Excerpts

Thursday 31st October 2019 Westminster Hall

[Jane Dodds (Brecon and Radnorshire) (LD)]

I have not put my name forward to speak, but I would like to say a few words.

[Sir Henry Bellingham (in the Chair)]

Yes, indeed. I call Jane Dodds.

[Jane Dodds]

Thank you, Sir Henry. I wanted to draw attention to the correlation between people who have mental health difficulties and the propensity to smoke. I pay tribute to my right hon. Friend the Member for North Norfolk (Norman Lamb), who has championed the cause of mental health throughout his time in Parliament. I hope that Committee members will not mind my thanking him for everything he has done.

This debate relates specifically to England, and I am a Welsh MP, but I draw attention to the issue of cross-border healthcare. Many people in Wales who need to attend a residential mental health unit have to travel to England, and of course there is complete disparity between the practice in Wales and that in residential units in England. I realise that this is not totally within the Committee’s brief, but I would like it to consider how the policy for mental health units in England, which have particular rules and regulations around access to e-cigarettes, could be married up with the policy in Wales. There are significant differences between them. We talked earlier about learning from international bodies and countries around the world, but there is also a need to look at the whole UK, and consider how we can get parity between the nations. Thank you, Sir Henry, for allowing me to speak. Diolch.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Henry. I apologise if I sound a bit croaky; I have a cold that is going round. Hopefully I will get rid of it soon, given what is to come over the next few weeks.

I thank the right hon. Member for North Norfolk (Norman Lamb) for introducing this debate, and for his characteristically well-informed speech. It is sad to think that it could very well be his last speech in what has been an illustrious career as an MP. I am sure that it will not be his last speech as a campaigner or activist. I also congratulate him on his work chairing the Science and Technology Committee, and on the excellent report that we are considering.

I thank all the other right hon. and hon. Members who have spoken, including the hon. Member for Ayr, Carrick and Cumnock (Bill Grant), and my right hon. Friend the Member for Rother Valley (Sir Kevin Barron), who I have enjoyed working with for many years. He has also had an illustrious career, and was an excellent Chair of the Health Committee for a number of years; he will be sorely missed in this place. There were also speeches by the hon. Member for Dartford (Gareth Johnson) and by the hon. Lady who has just spoken; I did not catch the name of her constituency.

[Sir Henry Bellingham (in the Chair)]

Brecon and Radnorshire—by-election win.

[Mrs Hodgson]

Excellent. Thank you.

As we have heard, there is still some uncertainty about the use of e-cigarettes. They entered the UK market only 12 years ago, and because this technology is still so young, we do not know for certain what its long-term impacts on health will be. What we do know is that e-cigarettes are around 95% less harmful than conventional cigarettes, and because of that, an estimated 2.9 million people in the UK are using them to stop smoking. Each year, tens of thousands of people successfully use e-cigarettes to quit. A randomised controlled trial, published in the New England Journal of Medicine earlier this year, found e-cigarettes used in a stop smoking service to be nearly twice as effective as licensed nicotine replacement therapies, such as patches and gum.

The importance of e-cigarettes as a smoking cessation tool should therefore not be dismissed. However, that must come with the caveat—I think everyone has made this point—that using an e-cigarette is not completely risk-free. There has been a recent outbreak of serious lung injury in the US linked to vaping, although that has not been replicated in the UK. Currently, 3.6 million people vape in the UK, yet the number of cases of severe respiratory pathology associated with vaping is low and diverse, with reports over a long period.

I agree with ASH’s recommendation that e-cigarette users should buy vaping products, including e-liquid, only from mainstream suppliers that sell regulated products, because using black market products may carry lethal risks. They should report any adverse effects from e-cigarettes to the Medicines and Healthcare Products Regulatory Agency using the yellow card scheme. If they experience serious adverse effects that they think are due to vaping, they should immediately stop vaping and get advice from their doctor.

Has the Minister considered launching an e-cigarette safety education programme that will ensure that e-cigarette users know the risks, and what to do if anything goes wrong and they manifest any such symptoms? That may lessen the possibility of manifesting the same patterns that we have seen in the US of lung injuries linked to e-cigarettes.

The Committee’s recommendation 4 says that NHS England should issue e-cigarette guidance to all NHS mental health trusts, and the default should be to allow e-cigarette use by patients. As we have heard, people with mental health issues smoke significantly more than the rest of the population, and could therefore benefit significantly from using e-cigarettes to stop smoking. Encouraging and allowing patients in mental health units who are smokers to switch to e-cigarettes as a means of smoking cessation would allow them to engage with their treatment sessions in the facilities without the interruption of smoking breaks.

A third of the 50 NHS trusts that responded to the Committee’s survey ban the use of e-cigarettes. The Government have agreed to issue guidance to NHS trusts about e-cigarettes. Will the Minister please tell us when she anticipates that it will be published? I know that she might have to rush it out in the next couple of days, but she might have a magic wand and be able to do that. Doing so could allow patients in mental health units to engage more fully with their treatment, which could improve outcomes.

As the Committee has found, e-cigarettes have a role to play in our society and in the Government’s commitment to achieving a smoke-free generation. However, we must ensure that advice on the safety of e-cigarettes, both short and long term, is updated regularly and publicly, so that users have the most relevant and up-to-date information available to them. The Government must also consider the role that e-cigarettes play in mental health services and improving patient outcomes across the NHS.

Every contact counts, especially when it comes to smoking cessation, and none should be missed. However, due to the Government’s public health budget cuts since 2013, which I know the Minister is not personally responsible for, smoking cessation services have suffered, leaving the most vulnerable smokers behind, without any support to quit smoking. That must change. Again, I ask the Government to reverse those public health budget cuts, so that local authorities can provide the smoking cessation services that their local communities need and deserve. I look forward to the Minister’s response.

Health and Social Care Committee

Lord Bellingham Excerpts

Thursday 1st November 2018 Westminster Hall

[Dr Wollaston]

I thank the hon. Lady for making that point. We did not look at devolved issues, because the remit of the Health and Social Care Committee is England only, but the hon. Lady makes a very important point. As the Justice Committee has an ongoing interest in this issue, there might be an opportunity for that Committee to take the matter up more quickly than we would be able to, but I would be very interested if the hon. Lady wanted to write to me about it.

I again thank all those who contributed to the inquiry, and I look forward to hearing the ongoing thoughts of the Justice Committee.

[Sir Henry Bellingham (in the Chair)]

Would the Minister like to say anything?

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

Thank you, Sir Henry. I really welcome the report. My hon. Friend the Member for Totnes (Dr Wollaston) alluded to the fact that this issue lies within the bailiwicks of both the Department of Health and Social Care and the Ministry of Justice; I am glad that the Under-Secretary of State for Justice, my hon. Friend the Member for Charnwood (Edward Argar), is here beside me. We are seized of the importance of this issue and recognise that silo culture is often the enemy of good policy making. Rest assured that we will take away the report and reflect on it. We are very grateful for the interest that the Health and Social Care Committee has shown in this very important subject, because we do need to do a whole lot better.

[Sir Henry Bellingham (in the Chair)]

I am very grateful to the Minister for those words.