Carers: National Strategy
Debate between Lord Evans of Rainow and Baroness Wheeler
Lord Evans of Rainow (Con)
My noble friend is absolutely right and raises an important point. The Department for Education’s new data on young carers, collected through the school census published last year, is an important step towards improving their visibility in the school system, allowing schools to better identify and support their young carers. That will also provide an annual data collection to establish long-term trends. We will consider the findings from the census to inform the next steps.
Baroness Wheeler (Lab)
My Lords, on International Women’s Day last week, Carers UK stressed that older women aged 75 to 79 are providing the most unpaid care—50 hours per week—and that there has been an alarming increase since 2011 in women aged over 85 providing unpaid care. These are not the women who come under the Government’s award of one week’s unpaid carer’s leave from work, and neither will they be first in line for the small amounts of respite care funding that GPs have been allocated. How are the Government addressing this situation, and what specific actions will be taken to help to alleviate the terrible burden of care these women face?
Lord Evans of Rainow (Con)
The noble Baroness raises a very important point and, as I have already mentioned, the Government have conducted a census looking at the data to identify those carers. Various groups of carers all have different needs. My noble friend just mentioned child carers, and the noble Baroness just mentioned carers of working age; employers have to be sympathetic and understand.
Lord Evans of Rainow (Con)
Also, it is challenging for those aged over 85. As I alluded to in my previous answer, GP practices have to be able to identify people in that age range so that they can work with social services and the local authority to make sure that they are supported.
Respiratory Syncytial Virus: Immunisation Programme
Debate between Lord Evans of Rainow and Baroness Wheeler
Lord Evans of Rainow (Con)
The noble Lord makes a very good point. He is an expert on this matter, and I can assure him and the whole House that NHS England has been proactive in this matter. He is ahead of the game: I have yet to have my vaccines done, but the local GP practices in my neck of the woods, I notice, are doing it digitally, online and via text. They are very good at that.
NHS England is preparing earlier than ever before for what is expected to be another challenging winter. More than 7.7 million people have already received their flu jabs since the start of the autumn campaign on 11 September, so we are making good progress. But that is not to say that some areas could not do better.
Baroness Wheeler (Lab)
My Lords, the JCVI endorses the RSV vaccination programme for 75 year-olds and ages above, but its 11 September statement underlines that the cost-effectiveness of vaccinating over 65s should also be kept under review, particularly as evidence of the protection offered to over 75s emerges. Does the Minister have any further information on how this review has been taken forward, and on timescales for possible conclusions and recommendations? Obviously, extending the vaccination to over 65s would be a major advance.
Health: Osteoporosis and Fractures
Debate between Lord Evans of Rainow and Baroness Wheeler(1 year, 3 months ago)
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Lord Evans of Rainow (Con)
My Lords, I thank my noble friend Lord Black of Brentwood for bringing forward this Question for Short Debate. As chair of the All-Party Parliamentary Group on Osteoporosis and Bone Health, he has long been a champion for those with osteoporosis. I thank him for sharing his experience of looking after his own mother over many years.
My noble friend is absolutely right that osteoporosis represents a growing challenge, particularly for older people. In the UK, it is estimated that over 3 million people have osteoporosis and over 500,000 fragility fractures occur every year. People of all ages want to enjoy good health for as long as possible, but remaining independent often depends on health and social care services being effective enough to support them wherever they live. Many people of working age also suffer preventable fractures, with an estimated 2.6 million sick days taken every year in the UK due to osteoporotic fractures. Studies show that over 22% of the population aged 50 to 64 will suffer from a fracture at some stage.
To that end, this year’s spring Budget announced a package of measures to support individuals at risk of, or experiencing, musculoskeletal conditions, including by making best use of digital health technologies to support people to manage symptoms better and to increase mobility, and by designing and scaling-up musculoskeletal community hubs, thereby expanding access to community-based services and delivering physical activity interventions. These will be effective as exercising regularly reduces the rate of bone loss, lowering the risk of fractures and falls. Given that good work improves health and well-being, the spring Budget also announced measures to support people with musculoskeletal conditions to remain in or return to work, including by integrating employment advisers into musculoskeletal pathways, building on the success of the NHS talking therapies programme, and piloting the WorkWell partnerships programme to support disabled people and people with health conditions who want to work.
The Government are also undertaking two consultations to understand how best to increase employer use of occupational health services. Osteoporosis disproportionately affects women, who often face a one-size-fits-all health system that does not consider their specific health needs. The women’s health strategy for England set out plans to achieve the 10-year ambition for women to have improved outcomes with musculoskeletal conditions, including through increasing early identification and treatment of those at risk, which many noble Lords pointed to in the debate.
The noble Baroness, Lady Donaghy, asked what the Government are doing. We are proposing to announce, in the forthcoming Autumn Statement, a package of prioritised measures to expand the provision of fracture liaison services and improve their current quality. NHS England is also setting up a fracture liaison service expert steering group to explore the expansion and improvement in quality of services for people with osteoporosis and those potentially at risk of fractures. We also have the major conditions strategy. I assure noble Lords that we are committed to making sure that people get the best care, no matter what condition they have.
Last month, we set out our initial plans for the major conditions strategy, with the case for change and strategic framework. This report identifies actions to improve outcomes for individuals across six major conditions groups, including musculoskeletal conditions. It includes exploring how best to support musculoskeletal service improvement and leadership—for example, through improving collection of data. Joining up patient experiences across datasets will enable more effective commissioning of support for those with musculoskeletal conditions. It is also includes, together with NHS England, exploring further support in the provision of fracture liaison services, which many noble Lords mentioned here today. This could include identifying people at risk of further osteoporotic fragility fractures, and implementing strategies to reduce risk of future fracture, including falls, and mortality.
Fracture liaison services are key to prompt diagnosis of osteoporosis and are acknowledged as the world standard for secondary fracture prevention. According to the Royal Osteoporosis Society, for every £1 spent on fracture liaison services in the UK, the taxpayer can expect to save £3.28. By levelling up provision to cover everyone over the age of 50, we could prevent just under 5,700 fragility fractures every year, a point very well made by my noble friend Lord Black.
As noble Lords will be aware, fracture liaison services are commissioned by integrated care boards, and while we expect musculoskeletal fragility fracture and fall services to be fully incorporated into planning and decision-making, coverage is not universal, with only 50% of the country able to access services. The noble Lord, Lord Allan of Hallam, always gives very demanding targets, 100%, and he is absolutely right to demand that. It will take time, but it is the intention to be able to do that across the way. I have noted the 100% and I look forward to discussing that in future debates.
NHS England is already working with commissioners to support the mobilisation and implementation of fracture liaison services in each area and to establish a greater number of clinics. It has provided local health systems. My noble friend Lord Black talked about leadership, and I will certainly make sure that colleagues in the department are fully aware of what he is talking about: it will certainly be considered by Ministers.
NHS England’s “getting it right first time” programme has a specific workstream on musculoskeletal health and is exploring how best to support integrated care systems in the diagnosis and treatment of osteoporosis. As part of this work, NHS England is reviewing pathways for secondary prevention of fragility fractures. Systematic vertebral fragility fractures and non-ambulatory fractures feature, and we will publish guidance to support local health systems to implement these pathways. The programme has also produced a draft adult orthopaedic trauma national speciality report, which includes recommendations on adopting fraction liaison services.
I turn to some specific questions. My noble friends Baroness Chisholm and Lord Shinkwin asked about having a dedicated fracture tsar. As the noble Lords will be aware, the role of the NCD as speciality adviser is to provide specialist clinical advice, and leadership to drive transformation of services for patients and support the commissioning of services. I think it is an important point to have somebody focused day in, day out, whose waking worry is to take it from 57% to 100%. I certainly will feed that one back.
The noble Lord, Lord Bilimoria, talked about DEXA scanners. Unfortunately, I have not got precise detail on that so I will write to the noble Lord on the specific details of that particular question.
I pay tribute to the noble Baroness, Lady Finlay, and her colleagues for the work that she does on this. She reminded us that prevention is better than cure, and that physical exercise and diet throughout one’s life helps with this. I didn’t realise “gobbling up” was a technical, clinical term, but we know exactly what you mean; that is the importance of diet and exercise to keep that bone mass and muscle mass there. As the Minister always says, in one week in hospital for patients, you lose 10% of your body mass, which is a sobering thought.
I do not underestimate how painful and debilitating this silent disease is, but I am confident that real advances have been made and will continue to be made. I assure noble Lords that the Government is determined to support improving access to, and quality of, services for those with osteoporosis.
In answer to my noble friend Baroness Bloomfield, I am very happy to meet with the ROS at a time convenient, and I extend my thanks once again to noble Lords for securing this debate and for the thoughtful comments and questions.
I note, on this particular date and others, the fact that noble Lords have actually cared for, and looked after, family relatives, which gives you first-hand experience of the challenges for family and friends of people living with this difficult disease. As a noble Lord mentioned—I do not know who—the good news is we are all living longer, but the bad news is that, at some stage, we may all suffer from this terrible disease.
Baroness Wheeler (Lab)
Can I ask if the noble Lord is going to follow up with a letter on the questions he did not cover please? Thank you.
Lord Evans of Rainow (Con)
Do forgive me, apologies. I have not got that information in my notes, I am afraid, so I will write to you and the noble Lords on that specific question.
Dementia Diagnosis
Debate between Lord Evans of Rainow and Baroness Wheeler
Lord Evans of Rainow (Con)
That issue varies around the country. In some areas, there certainly are shortages; we all know of examples where there is a shortage of beds for dementia services. Some areas are better than others and more can certainly be done, but the noble Lord highlights a very good point. Most families will agree that it is very important to keep dementia sufferers in their own home. That brings us on to the point about carers and communities working with families to keep those dementia sufferers in their own home for as long as possible.
Baroness Wheeler (Lab)
The Minister has recognised that dementia diagnosis rates vary significantly across the country, but we are less sure about exactly why. Does the Minister agree that, without this key information, it is impossible to address the current diagnosis postcode lottery? What steps are the Government taking to bring the diagnosis pathway up to the required standards everywhere, and what consideration have they given to the introduction of culturally relevant assessment tools to support this?
Lord Evans of Rainow (Con)
NHS England is taking several actions to improve diagnosis rates. In the financial year 2021-22 the Government allocated £17 million to the NHS to address dementia waiting lists and increase the number of diagnoses. NHS England is sharing learning on good practice with dementia clinical networks. There is a substantial variation of ICBs throughout the country, as I said previously, and the Government have recognised that. That is why they have commissioned the dementia intelligence network to investigate this and report back.
Health: Cardiac Arrest
Debate between Lord Evans of Rainow and Baroness Wheeler
Lord Evans of Rainow (Con)
The noble Lord is exactly right: surviving a heart attack is one thing, but recovery, both of the victim and their family, is another. I will take that point back to the department.
Baroness Wheeler (Lab)
My Lords, it is estimated that 999 call handlers and ambulance services do not have access to data on the whereabouts of tens of thousands of defibrillators, meaning that emergency services cannot direct bystanders to them in the event of a cardiac arrest while they wait for ambulance support. We know that a victim’s chance of survival falls by about 10% with every minute that defibrillation is delayed. What steps are the Government taking to address this, particularly targeting areas of poor health and high OHCA incidence so that the chances of survival in these communities can be significantly increased?
Lord Evans of Rainow (Con)
On the noble Baroness’s latter point, NHS England has partnered with St John Ambulance to co-ordinate skills development to significantly increase the use of AEDs by individuals in community settings such as those she has just outlined. The ambulance service has access to the location of defibrillators, but, as I said to the noble Lord earlier, it is important that, if you have a defibrillator, you register it so it ends up on the system.
Primary Care: Inequality
Debate between Lord Evans of Rainow and Baroness Wheeler
Lord Evans of Rainow (Con)
The noble Baroness makes a very good point and she is absolutely right: GP practices are diversifying in the number of people and the types of services that they offer, including those she mentioned.
Baroness Wheeler (Lab)
My Lords, does the Minister agree, from the achievements of the scheme in Brazil and the impact coming through from the London pilot, that CHWs could prove particularly valuable in the management of people with multi-morbidities in their own homes? The CHW role of being the eyes and ears of the GP in the community and visiting people in their home the day after hospital discharge to make sure they are okay could be a tool for addressing the revolving-door hospital discharge problem and helping prevent unnecessary visits to A&E. Will the promised primary care emergency care funding be used to support this and the development of other important public health work?
Lord Evans of Rainow (Con)
The noble Baroness is exactly right, and that funding will be made available. There are currently four community health and well-being workers covering 500 households in the example I gave. My understanding is that they will not only help with healthcare provision with GPs and local hospitals but work with Jobcentre Plus so they can help people get work and access benefits, to help with mental health conditions and others.
Respiratory Syncytial Virus Immunisation
Debate between Lord Evans of Rainow and Baroness Wheeler
Baroness Wheeler (Lab)
My Lords, maximising new vaccinations for RSV for babies and older people in the next winter season is vital, given that it will be just one of the many similar respiratory and related illnesses facing patients and the health service during this winter and the next. Can the Minister reassure the House that the Government are making full use of the public information budget to raise awareness of RSV, Covid, flu and strep A, in particular the differences between them and the steps that people do and do not need to take in each case?
Lord Evans of Rainow (Con)
The noble Baroness raises a very good point. She is absolutely right that the Government and the NHS have to use all media channels to make sure that people are aware of what is available. We have some new products coming through, one example of which is nirsevimab, which provides longer-term protection than its recently used predecessor of five months compared to one month. We try to communicate these, so that people do not have to go so regularly for immunisation. We hope that that one immunisation can cope with the winter season.
Community Pharmacies
Debate between Lord Evans of Rainow and Baroness Wheeler
Lord Evans of Rainow (Con)
Health Education England’s 2021 community pharmacy workforce survey identified an increase in the number of pharmacists from 23,284 in 2017 to 27,406. From 2026, all newly graduated pharmacists will have a prescription qualification, and we will upskill the existing workforce. This will provide further opportunity for the community pharmacy sector to better support the delivery of primary care.
Baroness Wheeler (Lab)
Of the 720 permanent pharmacy closures since 2015, 41% are in 20% of the most deprived areas. I cannot see how this squares with the Government’s vision of using pharmacies to relieve pressures on GPs and primary care. Both large and small pharmacies are affected, including those in supermarkets such as Sainsbury’s, Asda and Tesco. Boots is reducing essential pharmacy services, such as the provision of blister medicine packs for the safe taking and administering of daily medicines by patients, domiciliary care workers and carers who look after elderly and disabled patients. How will the Minister address this issue, which stands to affect thousands of patients?
Lord Evans of Rainow (Con)
My Lords, 80% of the population live within 20 minutes’ walking distance of a pharmacy. There are twice as many pharmacies in more deprived areas. Despite a reduction in the network in recent years, there are still about the same number of pharmacies today as there were 10 years ago.
Immunisation: Winter 2023-24
Debate between Lord Evans of Rainow and Baroness Wheeler(1 year, 10 months ago)
Lords ChamberRead Full debate Read Hansard Text
Lord Evans of Rainow (Con)
I thank the noble Baroness for that question. The JCVI often gives interim advice on that specific subject. I do not have a specific answer, but I can certainly get back to her on that very good question, which raises an important point.
Baroness Wheeler (Lab)
My Lords, the potential for new immunisation for RSV being introduced later this year for both babies and older people in time for the next winter season is very welcome. However, the seasonal and contagious nature of RSV raises growing concerns that the UK faces a future with co-circulating RSV, Covid-19, Strep A and other respiratory viruses, and this at a time when healthcare capacity is already overstretched. What is the Government’s latest assessment of the impact of these co-circulating viruses on primary and secondary care and workforce capacity?
Lord Evans of Rainow (Con)
RSV has been a challenge for the science community for decades. Up until very recently, we have had only one, very expensive preventive measure. The noble Baroness talks about the workforce. It is very important that we have the talented NHS staff to deal with these issues. We have made significant scientific advances recently, and I will report back to the noble Baroness when I have some data on that.
Cancer Therapies Access
Debate between Lord Evans of Rainow and Baroness Wheeler
Lord Evans of Rainow (Con)
My noble friend raises a very good point. One in two of us will develop cancer in the future, so we need to explore all therapies or vaccines wherever possible.
Baroness Wheeler (Lab)
My Lords, Cancer Research UK has shown that the annual rate of cancer diagnosis will increase by one-third over the next two decades, rising to nearly half a million. It takes 15 years to train an oncologist, pathologist or surgeon. In the light of previous questions, will the Minister assure the House that the long-awaited NHS workforce plan, when it is finally published, will address these particular shortages? How will the workforce plan dovetail with the also promised major conditions strategy, which the Government have announced that they are now putting in place of the 10-year cancer strategy, as we previously heard, which itself was long overdue?
Lord Evans of Rainow (Con)
My Lords, I can assure the noble Baroness that the new major conditions strategy will set out a strong and coherent policy agenda that sets out a shift to integrate whole-person care. Interventions set out in the strategy will aim to alleviate pressure on the health system as well as support the Government’s objective of increasing healthy-life expectancy and reducing ill-health-related labour market inactivity. We will cover the patient pathway from prevention to treatment and set out the standards patients should expect in the short term and over a five-year lifetime. Many stakeholders have already responded to the Government’s call for evidence on cancer.