HIV Care: Access

Lord Cashman Excerpts

Wednesday 11th September 2024 Lords Chamber

[Baroness Merron (Lab)]

There is what I call a three-pronged approach to interventions to reduce the number of people not being seen for care, which is so important, as I know the noble Lord is aware: identifying people who have not been seen for care; contacting them and re-engaging them; and addressing the barriers to engagement, which a number of noble Lords have referred to. This means sustaining engagement with care in the long term and supporting people with HIV.

We will review what lessons we are learning from the HIV action plan for England, which runs to 2025, and that means we will be able properly to inform the development of the new plan. I look forward to updating your Lordships’ House on this.

[Lord Cashman (Non-Afl)]

My Lords, we have come a long way since the dark days of the 1980s and 1990s, when many lives were lost. Progress has been made primarily through the work of activists, NGOs, the commitment of Governments and, indeed, the commitment and leadership shown by the noble Lord, Lord Fowler, to whom I pay tribute. But we are seeing greater numbers of people disengaging from HIV care for many reasons, including stigma, mental health issues, poverty, discrimination, and the terrifying fear of isolation within families and communities. Will the Government therefore look at the projects carried out across the country, including in Greater Manchester, and, indeed, as has been mentioned, the NHS South East London Integrated Care Board project, which focused primarily on these issues and groups and successfully reintegrated people back into HIV care? Arguably, this approach must be in any national HIV action plan.

[Baroness Merron (Lab)]

Yes, we will be looking at all the work currently going on and at the successes—and there are many. I believe that my noble friend is referring to Fast-Track Cities, an international initiative involving cities tackling HIV through a multidisciplinary, multi- sectoral approach. There are 13 signatory cities in the UK, and all are beacons of good practice that we must learn from, including in order to find out what is not working. I also want to emphasise peer support, which has been shown to reduce self-stigma, but also to improve engagement in care and the taking of treatment, and to having low levels of virus. This area will obviously very much feature in the new strategy.

NHS England: Ovarian Cancer

Lord Cashman Excerpts

Thursday 2nd May 2024 Lords Chamber

[Lord Markham (Con)]

Yes. Once again, I come at this from the perspective that health is the primary factor here. Clearly, a person’s biological sex is a key part of the information on their record that any clinician needs to know, so that absolutely needs to be primary.

[Lord Cashman (Lab)]

My Lords, I will make a simple point with which I hope the Minister agrees. Is it not to be welcomed that we come up with language that is inclusive and reaches as many people as possible, as the noble Baroness, Lady Burt, suggested, and as is indicated in the framing of the information we are discussing?

[Lord Markham (Con)]

Yes. To reiterate, I think that we should always use “man” or “woman” as the primary descriptor. For people with English as a second language, “woman” is very understandable. We can then be inclusive by saying a “person with ovaries”, so that we are absolutely clear. My remit here is health, so I want to make sure that most people, especially if English is their second language, understand who we are referring to when we say “woman”.

National Health Service: 75th Anniversary

Lord Cashman Excerpts

Thursday 30th November 2023 Lords Chamber

[Lord Cashman (Lab)]

My Lords, it is a real pleasure to follow the right reverend Prelate the Bishop of London, particularly given her experience in the NHS—and, may I say, her recent intervention in Synod on the issue of same-sex unions. It is also good to look around the House and see Members wearing the red AIDS ribbon, a powerful reminder that tomorrow is World AIDS Day and of what research, awareness-raising and the saving of lives can bring about when we work together. I particularly congratulate the Government on the Secretary of State’s announcement yesterday on increasing opt-out testing for HIV/AIDS and hepatitis C. That brings me to my first point, which is that it is vital that we do not forget the lessons learned from the recent Covid pandemic and the importance of simple but effective preventive public health measures in helping to protect the NHS against the financial and logistical burden of seasonal and other infectious diseases.

Ministers will recall that a targeted hygiene approach was applied to control transmission of Covid-19 and other infections in public areas, at COP 26 in Glasgow, and at the 2022 Commonwealth Games in Birmingham. The approach was extremely successful. If the Government were actively to promote targeted hygiene among the public and with owners and operators of public spaces, it could deliver a threefold benefit: building public confidence in using communal spaces and, by preventing illness, reducing pressure on the NHS and boosting productivity in the workforce.

This brings me to my second concern: the complications following aesthetic surgery procedures abroad, a service now widely advertised in the United Kingdom. Demand for cosmetic surgery is increasing year on year. Recently in the United Kingdom, the British Association of Aesthetic Plastic Surgeons, or BAAPS, in its 2022 national audit, reported a 102% increase in cosmetic procedures performed nationally, accompanied by a growing trend in patients seeking cosmetic surgery abroad, resulting in an increase in complications on their return. The BAAPS 2022 audit found a 44% increase in complications following cosmetic surgery abroad, including life-threatening concerns necessitating emergency surgical debridement and intensive care admission for sepsis.

This national concern is twofold: first, the increased burden placed on the NHS; and secondly, the physical and psychological burden placed on the patient. The true burden on a young working female demographic has seen increased incidence of lost workdays, significant side-effects of renal impairment, hearing loss from antibiotics, repeat theatre visits to valuable emergency theatres, and A&E visits. There is also a real concern about the true cost to the nation and the NHS arising from multi-resistant bacteria. This is in addition to cosmetic deformity and psychological issues from permanent scarring.

There are many factors influencing patients’ choosing cosmetic surgery abroad, but there is little public awareness of the incidence of complications following such surgery abroad and the additional financial burden incurred on seeking treatment and corrective procedures, both privately and in the NHS. Study proposals are being drawn up by the British Association of Plastic, Reconstructive and Aesthetic Surgeons. The aim of this service evaluation, as the Minister may know, is to obtain retrospective and prospective data from all plastic surgery units in the United Kingdom relating to recent NHS and private clinic admissions for complications following cosmetic surgery abroad, the management of surgical and non-surgical treatment, and the country in which the primary surgery was performed. Therefore, I urge the Minister and his department to engage with BAPRAS on that proposal, and I look forward to his response.

Finally, I end with a quote from a senior aesthetic consultant:

“Problems remain: bad days, loss of workdays, side effects of drugs to hearing, kidney and liver function, loss of life and scarring and psychological effects of cosmetic surgery that has gone wrong. The real worry will be the introduction of multi-resistant bacteria to many specialist parts of our NHS, A&E, infectious diseases, plastic surgery, ENT and general medical longer-term needs. Our NHS lacks direction and leadership, due to the political football that is the NHS and the transient nature of the managers who run it and who are responsible for the spend in it”.


That is as damning as it is concerning, and it is clearly time for urgent intervention—and I have not even touched on the deeply worrying proposal for physician assistants. Yes, let us celebrate this amazing 75th anniversary. I have much to thank the NHS for, not least the love and care of my late husband in his 50th year, at the end of his life. But while congratulating the NHS, let us also take the necessary action and decisions to assure its continuation.

HIV and AIDS

Lord Cashman Excerpts

Wednesday 1st December 2021 Lords Chamber

[Lord Kamall (Con)]

I am sure that all noble Lords would like to join the noble Lord, Lord Fowler, in celebrating the work of the NGOs. A lot of aid is government to government, which can sometimes be a barrier in reaching those it needs to help, especially in countries where the people who are suffering from HIV are discriminated against or stigmatised. Often, the best way to reach them is not via government but via those NGOs, so of course, I pay tribute to them, as I am sure all noble Lords do.

[Lord Cashman (Non-Afl)]

My Lords, the Global Fund to Fight AIDS, Tuberculosis and Malaria has saved 44 million lives since being founded 20 years ago. It is estimated that more than 3 million of those were thanks to UK aid. Therefore, will the Minister confirm that continued close partnership with the Global Fund will remain a central pillar of the UK Government’s planned international development and global health strategies?

[Lord Kamall (Con)]

I thank the noble Lord for his question and pay tribute to his work during our many years together in the European Parliament, where he was probably one of the strongest champions for LGBTQ+ issues, and AIDS and HIV awareness. My only regret is that I was not able to champion as strongly as I wanted to on ethnic diversity and the lack of it in the EU. Of course, we remain committed to the Global Fund and to other partners, including UNAIDS and the global financing facility. It is important that we all work together on this issue, not only in our own countries but particularly in countries where the situation is difficult and people have challenging health systems, and in countries where, unfortunately, gay people or those suffering from HIV are discriminated against or even stigmatised. One of the things that we can be proud of in the UK is that we stand up for those people.

HIV Action Plan

Lord Cashman Excerpts

Monday 18th October 2021 Lords Chamber

Asked by

[Lord Cashman]

To ask Her Majesty’s Government what funding they will provide to support the new HIV Action Plan to end new HIV transmissions in England; and whether this will be included in the upcoming Comprehensive Spending Review.

[Lord Cashman (Non-Afl)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. In doing so, I record that I am a member of the APPG on HIV/AIDS and a patron of the Terrence Higgins Trust.

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

The Government remain committed to reaching zero new HIV transmissions in England by 2030, and we continue to make good progress towards this target. In September, the Government committed £36 billion over the next three years for the NHS and social care, but decisions on future funding for non-NHS and social care budgets, including for the new HIV action plan, are being taken as part of the comprehensive spending review.

--- Later in debate ---

[Lord Cashman (Non-Afl)]

I thank the Minister for his Answer. He hits the nail right on the head. He will be aware of concerns by NGOs, the Elton John AIDS Foundation, the National AIDS Trust and the Terrence Higgins Trust that the Government will back down on their financial commitments on HIV/AIDS. We need greater commitment to ending transmissions now, not less. Will the Minister therefore ensure that the Government keep their commitments, made at the height of the Covid pandemic in December 2020, by the Chancellor, to end new HIV/AIDS transmissions by 2030? Will he further commit to implement opt-out HIV testing in high incidence areas in England?

[Lord Kamall (Con)]

I start by paying tribute to the noble Lord, Lord Cashman. We served in the European Parliament together for many years, where he was always a champion of LGBTQ+ issues and made sure that people were aware of the issue of tackling HIV. Funding for HIV treatment and care services is provided by NHS England and NHS Improvement through specialised commissioning. HIV testing and prevention is funded by local government through the ring-fenced public health grant. In March 2020, the Government announced that the HIV prevention drug PrEP would be routinely available across England. The public health grant in 2021-22 includes £23 million to cover local authority costs of routine commissioning, in addition to the £11 million made available in 2021. I give the noble Lord that statement.

Social Care in England

Lord Cashman Excerpts

Thursday 14th October 2021 Lords Chamber

[Lord Cashman (Non-Afl)]

My Lords, it is good to be back and to be engaged in this important debate, for which I thank the noble Baroness, Lady Pitkeathley, whom I also congratulate on her wonderful, excellent opening statement. I also welcome the Minister to his position. Of course, I know him well from our many years together in the European Parliament.

During the pandemic, I am sure that others have felt that there is a fear of growing old or of becoming frail or ill. I believe it is our duty as the fifth-largest economy and as a civilised society to remove those fears immediately. I refer to my interests as set out in the register, particularly as a trustee of the charity Neighbours in Poplar. Indeed, I have decided to focus on an April 2021 grass-roots report, of which I am one of the co-authors, which was commissioned by Neighbours in Poplar, which is led by Sister Christine Frost. The organisation serves needs across the London Borough of Tower Hamlets. The report includes input from medics, paid and unpaid carers, care recipients and volunteers. It is a report from the front line, observed, witnessed and reported. It is not a parochial approach. It is evidence-based and, I believe, a microcosm of what is happening across England and what is being experienced by many councils and agencies. Social care is broken and can be fixed only by a holistic approach, with adequate funding. It cannot be done on the cheap. That has been tried, and it has failed catastrophically.

The report, which I will make available through the Library, along with the follow-up report, took this holistic approach across a range of topics such as nutrition, housing, quality of care, access to health services and communications. I will read from the report. Its summary dealt with meals on wheels post Covid. Sadly, the meals on wheels service in that borough had been cut just prior to Covid. Who decides whether our carers are adequate to the task? Are carers engaged or unengaged? How do people excluded from social media and without internet access find out what is going on? How do they engage? How are we meeting mental health and inappropriate housing needs? The report states:

“Please do not take this report lightly. We need to you to be aware that the majority of those to whom we have brought meals and contact with the rest of humanity during the past year were vulnerable, frail individuals of all ages, evidence of which is the 50-plus clients who have passed away since we started on 17 March 2020, two of whom were single, elderly, disabled men living alone and one on the top floor of a block of flats without a lift. He had been unable to get out and meet friends for the last four years. We sent questionnaires to each meal recipient asking two questions: Is there anything you are worried about and what do you need to help? Which services do you most need or want improvements on: health, social services, meal delivery, day centres, carers and others? We have 200 people on our delivery list and we received over 100 responses from the clients and the major need mentioned is hot meal delivery.


We also asked the volunteers to give us their impression, viewpoints, perspective on the seriousness of the recipients’ needs. Many volunteers have been consistent in their deliveries and have noticed the deterioration and increasing needs in the clients and as the majority of these clients are disabled, elderly or frail, their need is increasing rather than decreasing. We ask now: whose responsibility is it to deliver meals on wheels post-Covid?


Our second major concern for the future is the quality of care being delivered to those entirely dependent on the care, expertise, sensitivity and time of those who care for them, a service the client is paying for. We have come to the conclusion that it is not so much the agency which is the issue but rather the quality, standards and suitability of the individual carer. Therefore we ask that every paid carer be required to reach agreed national standards and that registration be required. Every paid carer should be registered as are foster carers. We ask also that the commissioning of care services be far more rigorous, ensuring that what is promised is actually delivered.”


I am coming to the end of my time, so I will chase quickly towards the conclusion. The report goes on:

“Communication has appeared as a major concern. How do people who are not on the internet find out what is available? It came to our attention that many are not in receipt of pension credit simply because they do not know how to go about accessing it. Many spend hours fruitlessly on the phone to council helplines. Mental health and communication are interlinked. Funding and time need to be put into joining people up and rebuilding communities.”


Finally, it is clear that we need to be proactive where we can and help prevent people needing social care. Now is not the time to cut services; long-term negative consequences will follow. Will the Government therefore commit to end the underfunding of local authorities and ensure properly funded services and a high standard of social care for those who need it?

HIV: Pre-exposure Prophylaxis

Lord Cashman Excerpts

Tuesday 1st December 2020 Lords Chamber

Asked by

[Lord Cashman]

To ask Her Majesty’s Government what assessment they have made of the impact pre-exposure prophylaxis is having on new HIV transmissions; and what steps they are taking to ensure that there is sufficient access to that treatment.

[Lord Cashman (Non-Afl) [V]]

My Lords, I beg leave to ask the Question standing in my name on the order paper. In so doing, I refer to my entry in the register of interests.

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

My Lords, the Government recognise the huge impact that HIV pre-exposure prophylaxis plays, as part of a combination of prevention interventions, in reducing HIV transmission. That is why we have provided £11 million to local authorities during this financial year for routine commissioning of PrEP. We are continuing to work closely with local authorities and other stakeholders to support the rollout, which will benefit tens of thousands of people.

[Lord Cashman (Non-Afl)]

[Inaudible]—study has shown that they are 100% effective when taken properly and there is no difference in reports of condom use. More importantly, contradicting the claim that access to PrEP would somehow encourage an increase in risky sexual behaviour, there are no other STIs. Therefore, given that one of the key barriers to increasing access to PrEP is it being delivered exclusively through sexual health clinics, what discussions have the Government had about expanding access to PrEP to other healthcare settings such as gender clinics, maternity units, GPs and pharmacies?

[Lord Bethell (Con)]

My Lords, the noble Lord makes a completely fair point. There is absolutely no question of there being a social stigma associated with taking PrEP or any kind of moral cloud over those wishing to take this important therapy. That is not in any way our purpose. He makes a valid point that there are good arguments for the supply of PrEP to be not just through GUM units but also through GPs and perhaps pharmacists. These are arguments that we hear and that we are looking at very closely. I hope that, at some point, I will be able to update the noble Lord on our progress on this matter.

Sexually Transmitted Infections: England

Lord Cashman Excerpts

Thursday 5th September 2019 Lords Chamber

[Lord Cashman (Non-Afl)]

My Lords, I remind your Lordships that I intervene as a non-aligned Member of this House and declare my interest as a patron of the Terrence Higgins Trust. I thank the Minister for her response to the Question. What progress has been made towards PrEP being routinely commissioned for all who need it before the end of the trial in 2020? Does she agree that PrEP needs to be made available as part of routine sexual health services from April 2020 and that no gay or bisexual man should be discouraged from being placed on the PrEP impact trial?

[Baroness Blackwood of North Oxford]

The noble Lord will agree that this Government have shown significant commitment to the roll-out of PrEP since the start of the PrEP impact trial in October 2017. Over half of the 26,000 places have been filled, which is welcome progress. The trial is scheduled to continue until autumn 2020 and work is now starting to consider future commissioning for PrEP after the trial has ended.

Sexual Health Services

Lord Cashman Excerpts

Thursday 29th November 2018 Lords Chamber

Asked by

[Lord Cashman]

To ask Her Majesty’s Government what assessment they have made of the impact on public health outcomes of people being turned away from sexual health services, as reported by the British Association for Sexual Health and HIV.

[Lord Cashman (Lab)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper. I refer your Lordships to my registered interests; in particular, I am patron of the Terrence Higgins Trust.

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

My Lords, local authorities in England commission comprehensive open-access sexual health services based on the needs of their communities. Services have responded to meet increased demand, with attendances at sexual health services increasing by 13% between 2013 and 2017, from 2.9 million to 3.3 million.

[Lord Cashman]

I thank the Minister for that response. Much has indeed been achieved but there are worrying trends. As we know, sexual health services are funded by local authorities, which have endured reduced funding year on year and, to maintain other essential services, councils have disproportionately cut funding to sexual health services. Clinics have closed, staffing levels have reduced and capacity has reduced further because walk-in sessions have been replaced by appointment-only sessions that cap demand. The overall effect has been to reduce access to screening and treatment, with subsequent increases in sexually transmitted infections and considerable public health impacts, notably infertility, teenage pregnancy and HIV transmission. I therefore ask the Minister, in the context of these worrying developments, how the Government will ensure that councils maintain an adequate level of comprehensive sexual health service provision.

[Lord O’Shaughnessy]

I am grateful to the noble Lord for raising this important issue. First, it is worth saying that the public health grant to local authorities is ring-fenced, and that is meant to provide for sexual health services among others. He mentions STI rates and says attendances have increased. I know that service configurations are happening and there are changes in different parts of the country. It is important that attendances have increased. I think there is a mixed picture on ST infections; some are increasing but there is good news. The noble Lord mentioned teen pregnancy—not that that is a sexually transmitted disease, of course—the rates of which are down. HIV diagnoses are down and we see a positive picture in the new data today, so there is cause for optimism. As we look to the future in the spending review, we will be making the case for improved services at sexual health clinics through the public health spend.

Mental Capacity (Amendment) Bill [HL]

Lord Cashman Excerpts

Committee: 2nd sitting (Hansard): House of Lords
Monday 15th October 2018 Lords Chamber

[Baroness Finlay of Llandaff]

I would like to intervene for a moment as I think this has been a valuable debate, even though short. I shall pick up on the point made by the noble Baroness, Lady Barker, on conditions, which are incredibly important. She cited one example, and I return to the musician to whom I referred earlier. Most professional musicians will feel that their instrument is an integral part of their own personality. If they lose speech, they will communicate through their instrument, especially their mood—their feelings, responses and so on—so it is a terrible deprivation of liberty to separate a musician from their instrument.

If the musician plays a trumpet or another loud instrument and they are in a care home, it will be important to find somewhere they can go to play their instrument without disturbing everybody else. It sounds humorous but it is incredibly important to people. I was struck when I visited a care home some time ago and saw a man playing a piano. I thought he was a volunteer brought in to play—beautifully—to people. When he finished playing, I started to engage in conversation with him and it became clear that, while his recall for the symphony he had been playing from memory was superb, he could recall or discuss remarkably little else from which I could gain a modicum of sense. As a result, we had a bizarre conversation, other than about the symphony.

Conditions are absolutely essential. My hope would be that, in the code of practice, we require conditions to be put into the care plan that must be enacted on a daily basis. This should not be just a set of recommendations that could be ignored. My concern is that we link care planning to the delivery of care; that is extremely important.

I was grateful also for the support—albeit somewhat tentative—from the noble Baroness, Lady Tyler. I draw a distinction between the care manager and the care home manager. The care manager should be the person overseeing the direction of care planning; they could be the district nurse for somebody at home, or whoever runs the supported living environment on a day-to-day basis and looks at alterations in the care plan.

In a large care home, the care home manager often manages the building and the staff. They make sure that regulations are maintained and that the lifts work, dealing with all the things that happen on a day-to-day basis, but can have remarkably little contact with individuals. I do not want to sound disrespectful to care home managers when I say that I would envisage their co-ordinating role as much more like that of an administrative secretary, rather than as somebody who gets information directly from the person or the family. However, I would want them to make sure that the family had been consulted, that all the people who cared about the person had been spoken to and that that information was properly documented, with a package being put together for the local authority to inspect. I believe that the local authority will know which care homes on their patch are working well and which need an eye to be kept on them. I think I have half given my response to the Minister’s response.

[Lord Cashman (Lab)]

My Lords, before the Minister gets to his feet, I want to thank the noble Baroness, Lady Finlay, for that clarification. Precisely those concerns about the role of the care manager and the care home were put to us when we met 30 or so representatives from the different services. They also dealt with the potential conflict of interest. As was said earlier by the noble Baroness, Lady Murphy, there are always conflicts of interest in professional fields. Here, we are dealing with a conflict of interest around someone’s deprivation of their liberty, and we need to get it absolutely right. With that clarification, I say that the amendments make us think again about precisely how we can deal with the backlog and how we can be effective but give the individual the rights and protections they deserve.

Finally, I also thank the Minister for his early intervention and assurances around the inclusion of 16 and 17 year-olds and on the phrase “unsound mind”, which I raised during our first day in Committee. I hope that I have not detained him from his notes.

[Lord O'Shaughnessy]

I am grateful to Members of the Committee for their sympathy and for giving me breathing space. I was flustered by flipping forward and almost missing out this group of amendments.

As the noble Baroness, Lady Finlay, said, the issue of concern is the distinction between the person who is responsible for somebody’s care and the person who manages a care home—they are of course different. What we are trying to get right here—I understand that this is what the amendments are exploring—are the relevant responsibilities of those people, bearing in mind that we want to integrate liberty protection safeguards into the process of care planning.

The noble Baroness, Lady Barker, knows huge amounts about this topic and I very much respect her opinion. She pointed out that DoLS assessments are different from assessments under the Care Act. There are some overlaps. As she will know, there are similar questions or parts in both assessments concerning consent, for example, but she is right that they are different types of assessments. I want to explore whether her or indeed the Committee’s concern is that those assessments should not be carried out by care home managers or whether—a more positive view—they should be carried out by certain types of professional. Those are subtly different points. Perhaps I may give her the opportunity to respond in a moment, as I am really keen to explore this matter.

Clearly, we are trying to make sure that those who have the professional expertise to carry out certain types of assessments do so. Equally, we are trying to make sure that a co-ordinating body has responsibility for ensuring that these assessments are carried out in a proportionate way and are included with care assessments in an overall care plan, with people being answerable to the relevant regulatory bodies. If the noble Baroness would not mind, I would be grateful if she, along with other noble Lords, gave her perspective on that. I want to make sure that we determine the appropriate role of the care home manager.