Adult Social Care: Staffing

Debate between Lord Forsyth of Drumlean and Lord Markham

Tuesday 12th December 2023 Lords Chamber

[Lord Markham (Con)]

The shorthand for the German system is the “double doughnut”, which tries to give wraparound care. We can learn many things from that system, which is why a part 2 reform needs to happen here. I accept that we are clearly not there yet.

[Lord Forsyth of Drumlean (Con)]

My Lords, is not the truth of the matter that the Government have just shuffled off responsibility on to local authorities? Can the Minister tell the House what percentage of expenditure by local councils is now being spent on social care to fill the gap, at the expense of vital local services?

[Lord Markham (Con)]

My noble friend is correct: on average, it is about 74% or 75% of a local authority budget. I think we would all agree that that is not a good situation, because obviously a local authority has a number of matters it needs to deal with. This is one of the issues around long-term reform that we will need to consider.

Adult Social Care

Debate between Lord Forsyth of Drumlean and Lord Markham

Wednesday 22nd November 2023 Lords Chamber

[Lord Markham (Con)]

I thank ADASS for its report. The outcomes we are seeing show a number of things: as well as the £8.1 billion investment we put in, we have brought down waiting lists for assessment by 13% since the peak level. We are seeing high levels of satisfaction with a lot of the work we are doing; 83% of people say that they are satisfied with the services they are receiving. Yes, there is a lot more to be done, but there is a lot of good progress as well.

[Lord Forsyth of Drumlean (Con)]

My Lords, in July 2019, the Government promised that they would fix the crisis in social care. When does my noble friend think that that will be redeemed?

[Lord Markham (Con)]

Always at this point, I find that the best tactic is to offer my noble friend a meeting. The People at the Heart of Care 10-year plan is exactly what we are trying to design here. I mentioned some of the progress that is being made: we have seen recruitment go up and an increase in staffing, and we have a put in place a qualification for staff, so that they feel there is a career structure for them. The number of people is going up year on year. Yes, there is a lot to do, but we are getting there.

Children’s Hospices: Funding

Debate between Lord Forsyth of Drumlean and Lord Markham

Tuesday 14th November 2023 Lords Chamber

[Lord Markham (Con)]

As I said, it is a responsibility for all of them, but I will happily give the noble Baroness a detailed reply so that it is very clear exactly what they are doing to make sure that happens.

[Lord Forsyth of Drumlean (Con)]

My Lords, a bazillion years ago when I was the Scottish Health Minister pre-devolution, we introduced a pound-for-pound match-funding system for hospices. That worked brilliantly because it meant that hospices could raise more cash and the Government provided support for organisations that depend on being voluntary. Would my noble friend consider doing that, not just for children’s hospices but for the movement as a whole, which does such fantastic work?

[Lord Markham (Con)]

My noble friend makes an excellent point. My understanding is exactly in this vein: £7 million was paid in match funding to children’s hospices in exactly the way he mentioned. As to whether we should be doing that more widely, it is a good idea, and I am happy to take it away and come back on it.

NHS: Staff Numbers

Debate between Lord Forsyth of Drumlean and Lord Markham

Tuesday 12th September 2023 Lords Chamber

[Lord Markham (Con)]

My first point on that is to ask what the real facts are. Five years on from qualification, around 95% of doctors are still registered with the General Medical Council and still practising in the UK. So the fact is that retention is very high. That notwithstanding, we want to do everything that we can to retain people, and professional development is what the long-term workforce plan is all about. Also, we all know that pensions were a big reason for a lot of the brain drain and doctors leaving the profession, and that was something we were quite radical in supporting and changing. We are going through this bit by bit, asking what key things we need to do to retain our staff and resolve this.

[Lord Forsyth of Drumlean (Con)]

My Lords, I have seen press reports that suggest, from future projections, that one in 11 people in the workforce will end up being employed by the NHS. Does the Minister really believe that this is sustainable? What plans does he have to avoid what would be a completely impossible situation for the economy?

[Lord Markham (Con)]

Yes, I am aware of this. Health spending equates to roughly 11% of the GDP of our country. Not surprisingly, the number of people in the workforce reflect that. It is absolutely mind-blowing; the amount of investment going into this space is bigger than the economy of Greece. Without a doubt, we have to make productivity improvements and look to technology, AI and all the things we can do to improve output and make sure that that total is not just ever-increasing.

Ultra-processed Food

Debate between Lord Forsyth of Drumlean and Lord Markham

Tuesday 18th July 2023 Lords Chamber

[Lord Markham (Con)]

My understanding is that those guidelines are there; it is absolutely the right question. The Department for Education, working with the Department of Health, makes sure that a nutritionally balanced diet is there. There is also a joint DfE/DHSE programme in respect of nursery milk and fresh fruit and vegetables for young children, to give them a good start in life.

[Lord Forsyth of Drumlean (Con)]

My Lords, is it not the solution to this problem not to ban things but to improve education so that people understand what they are eating and make rational and clear choices? Is it not the case that many of these processed foods are bought by people because they are cheaper? If we could encourage people in schools to learn what used to be called domestic science—cooking skills and so on—so they can use fresh ingredients, then we would advance this case far more effectively than by banning things.

NHS GP Surgeries: Purchase by US Companies

Debate between Lord Forsyth of Drumlean and Lord Markham

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

My understanding is that it is a range of issues, clearly including workload, pay and conditions. We are trying to address those; I think the change in the pensions rule has been generally welcomed in terms of encouraging more doctors to stay on in place. But it is a range of those measures—again, all things we are hopefully addressing through the new training and skills programmes, and the long-term workforce plan.

[Lord Forsyth of Drumlean (Con)]

My Lords, could my noble friend take the Question from the noble Lord, Lord Warner, a little more seriously? If we look at what has happened to vets, for example, private equity has bought up veterinary practices and prices have gone through the roof in order to pay for the funding costs. If this were to happen with general practice, I think that would be a very retrograde step.

[Lord Markham (Con)]

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

Life Expectancy: Pensions, Health and Insurance

Debate between Lord Forsyth of Drumlean and Lord Markham

Wednesday 26th April 2023 Lords Chamber

[Lord Markham (Con)]

This goes very much to our strategy of improving healthy life expectancy by five years by 2035. “Healthy” is a key component of that, taking the major conditions strategy and looking at the six major causes of death—cancers, heart disease, respiratory issues, dementia, and mental health and musculoskeletal issues—and what we can do on each one to improve lifestyles.

[Lord Forsyth of Drumlean (Con)]

My Lords, considering inflationary pay demands in the health service, has my noble friend given enough emphasis to the benefits provided in the form of final salary index-linked pensions? Is there not a conflict between being concerned about inflation and knowing that you will be protected? How long is it possible to sustain such a system?

[Lord Markham (Con)]

I know that my health brief is broad but including pensions and insurance in it is quite a challenge. Like other noble Lords, I am very aware of the impact of inflation on the final salary scheme and on lifestyles, and of the fact that not many employers can afford the schemes any more—apart from, dare I say it, government. That has an impact. However, I am happy to meet my noble friend to go through this in further detail.

Adult Social Care: Challenge Procedures

Debate between Lord Forsyth of Drumlean and Lord Markham

Wednesday 19th April 2023 Lords Chamber

[Lord Markham (Con)]

I will answer quickly to allow a final question, but yes, our anti-obesity strategy is very much about that.

[Lord Forsyth of Drumlean (Con)]

I am most grateful to my noble friend, who is a glutton for punishment. I wanted to follow up on the point made by the noble Lord, Lord Blunkett. It is all very well saying that the money is coming from local government, but the problem is that the tax base in local authority areas does not reflect the demand in those areas. Therefore, there is unmet need where the need is often greatest, is there not?

[Lord Markham (Con)]

I knew that was coming. As a former local authority deputy chair of finance, I very much understand the problem my noble friend describes. My Treasury colleague has gone, but we all agree that local authorities have a very important part to play in this. The mix between local and central funding is clearly something we need to work on.

Adult Social Care

Debate between Lord Forsyth of Drumlean and Lord Markham

Monday 20th February 2023 Lords Chamber

[Lord Forsyth of Drumlean (Con)]

Answer.

[Lord Markham (Con)]

It is lovely to have noble friends.

Given the conversations I am sure we will come to shortly about improving hospital flow and the 13% of beds that are blocked, we felt that the focus needed to be very much on providing beds for short-term care. That is where we wanted to put the £7.5 billion of extra funding. We thought that was the immediate priority because we knew the flow issues were impacting A&E, ambulance wait times and everything else. That is not to say that we do not intend to implement all the Dilnot reforms, but the priorities were very much around improving flow and discharge.

--- Later in debate ---

[Lord Markham (Con)]

Again, we welcome the report and many aspects of it. What I and my ministerial colleagues care most about is having the results and the impact. I think—and hope that noble Lords will agree when they see the work that she is doing in this space—that Minister Whately is gripping it and providing results. Let us see how that progresses first, because I think that that will have the impact that we need.

[Lord Forsyth of Drumlean (Con)]

My Lords, given that the Government promised that they would fix social care, and given that in the Answer to this Question the Minister said that there were 10 million people affected, is it wise to go into a general election without having done so?

[Lord Markham (Con)]

As ever, I thank my noble friend for his friendly questions. No; we know that this is an area that needs to be addressed, and I think that it is an area that we are addressing. I have been up here for about five months now, and in the time that I have been here, we have announced a £7.5 billion increase in spending over two years, a £700 million discharge fund over this year, and the recruitment of thousands of people every month from overseas. Yes, there is a lot more to be done, but there have been some very solid results in the meantime.

Urgent and Emergency Care Recovery Plan

Debate between Lord Forsyth of Drumlean and Lord Markham

Thursday 2nd February 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness for her question and her recognition of the 12 hours. In all these spaces, data is always the way that you give a backdrop to better services, and 12 hours is part of that. As regards capacity, I totally agree that we need more of it. I was surprised by what she said—I will find out some more about it. However, the absolute direction is a recognition that, with Covid and flu, what might have been the right number of beds a couple of years ago is not today. That is why we are committed to the 5,000 extra beds and, just as importantly—potentially more so—the 50,000 in virtual wards, because that is using technology to look at how we can expand supply, and absolutely critical to that is having the workforce.

[Lord Forsyth of Drumlean (Con)]

My Lords, my noble friend quite rightly pointed out that there are more doctors than ever in the NHS, but many of them are in training. As my noble friend Lady McIntosh pointed out, we are losing very senior and experienced doctors because of the rules that apply on pensions. My noble friend said that this was being addressed. I remember raising this several years ago—it is a continuing problem. What is worse is that doctors leave the NHS because of the tax implications for their pensions and then come back and cost it even more money. My noble friend says that this is being addressed, but in the autumn I heard the Chancellor say that he was going to freeze the level of the maximum amount that counts towards the pension before you pay tax for the next three years—so how is that addressing the problem? Is it not an urgent problem? We may be putting more people into the service who are in training, but we are losing people out the bottom at a greater rate.

[Lord Markham (Con)]

I thank my noble friend. As I mentioned just now, retaining doctors is critical, and pensions are a key issue. We had an excellent debate on this a couple of weeks ago. Again, we are working on all of that with the Treasury. However, as I said then, the simplest thing is that, while I understand the Treasury’s concern about making special rules for special groups and the potential knock-on from that, we can very quickly make sure that, if people are hitting that pension ceiling, they can get the equivalent pay in their pay package very quickly. As a health department we have the ability to do that, to make sure that no one is financially losing out from that. If it does not make sense for them to get it through their pension, they can get it through their salary instead. I am not saying that that is perfect, and more work needs to be done across the Treasury, but we can do that quickly.

PPE Expenditure

Debate between Lord Forsyth of Drumlean and Lord Markham

Wednesday 25th January 2023 Lords Chamber

[Lord Markham (Con)]

In the circumstances at the time, I think we were all worried that we were going to run out of PPE. If the noble Lord remembers, it was the Wild West out there in terms of trying to purchase it, with planes gazumped literally on the runway and flying to other countries. That is why we stepped in. We bought to a worst-case projection, because we knew we could not afford for PPE to run out in our social care homes or our hospitals. We ended up buying 20% too much as a result, and that is what we are dealing with now. However, only 3% of everything that we bought ended up being faulty, which I think people will agree was a pretty good result.

[Lord Forsyth of Drumlean (Con)]

My Lords, will the Minister indicate how much we are paying for storage of PPE? Are the press reports that we paying for the storage of PPE on a substantial scale in China correct?

[Lord Markham (Con)]

Right now, less than 1% of stock is held in China—to answer that question directly. In terms of cost, we are currently paying about £700,000 per day, which is why we are writing off the stock and effectively disposing of it. We have tried to donate as much of it as possible to people who want it, but we have to bite the bullet on the rest and say, “You know what? It’s no longer required so we are disposing of it as rapidly as possible.” We are bringing down those costs; we will be saving £200 million a year through that rapid disposal.

Times Health Commission

Debate between Lord Forsyth of Drumlean and Lord Markham

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

No, we are working very intensively. We have some very good minds involved in this. I know from my work with my colleagues that we work hard on developing our own plans, some of which were announced just last week. We are facing a challenge, as we all know, from the setbacks around Covid but we are tackling it. What I am saying is that there is an absolute openness to new ideas, which is why I welcome any ideas that come to the table—but, believe me, we are working on a lot of our own ideas.

[Lord Forsyth of Drumlean (Con)]

My Lords, if the Government or the editor of the Times want to find out what we need to do about social care or look at what has been agreed on an all-party basis, all they have to do is to read the report from the noble Baroness, Lady Andrews, and the Select Committee that was set up by this House, which sets it out clearly—or even the report that was done by the Economic Affairs Committee three years ago, which predicted the mess that we are now in. We do not need journalists doing reports; we need the Government to respond to what Parliament has demanded.

[Lord Markham (Con)]

I think we have responded and are responding. That is very evident in the plans and funding that we have recently put in place and from the work that we are doing, which the House will see far more about as we announce it over the coming weeks and months.

Care Homes: Severely Disabled People

Debate between Lord Forsyth of Drumlean and Lord Markham

Wednesday 30th November 2022 Lords Chamber

[Lord Markham (Con)]

My Lords, the 200,000 extra care places that this funding provides is a solid example of an expansion of supply, and I hope all noble Lords agree that that is a substantial number. I hope they also agree with the work we are doing to recruit from overseas to increase the workforce in this sector, which is indeed increasing. Areas such as these show that we are committed to expanding the supply, and we are seeing that rewarded in the increase in the last few months.

[Lord Forsyth of Drumlean (Con)]

My Lords, has my noble friend yet had an opportunity to read the Economic Affairs Committee report on social care, a “national scandal”, which points out that in care homes in both the private and the charity sectors, people who pay their own costs subsidise others to the tune of 40%? The local authority rates are simply unsustainable, and this issue is therefore urgent and needs to be addressed. Simply talking about inputs all of the time is no good; we need to see what is happening to the outputs, which is a tragedy.

[Lord Markham (Con)]

Funnily enough, the meeting on the sector’s financial health that I mentioned was precisely in response to the Question last week, so that I can make sure that proper work is being done in this space. I will not pretend to have the answers to that yet because, as my noble friend mentioned, a long-term review needs to be done. But rest assured that I am working on this.

Adult Social Care

Debate between Lord Forsyth of Drumlean and Lord Markham

Thursday 24th November 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness. As mentioned, 200,000 care packages is a significant number and will make a significant impact on everything we are talking about here, and that is in conjunction with all the other measures we have put in place, including the £500 million discharge fund this year. In terms of the precise percentages of those allocations, I will quite happily commit to write on that, but I can say to your Lordships that the £4.7 billion represents a 22% increase in 2024-25. By any standards, I think that people would agree that a 22% increase is a significant amount.

[Lord Forsyth of Drumlean (Con)]

My Lords, has my noble friend read the report of this House’s Economic Affairs Committee entitled Social Care Funding: Time to End a National Scandal published some years ago? In particular, the point is made in the report that to try to fund social care by allowing for an increase in council tax is highly regressive and inequitable because the tax base of the local authorities is least where the demand is greatest.

[Lord Markham (Con)]

I have not read the report, which was published a few years ago—I will always stand up and say when I have read something and when I have not, and will not pretend to have read something that I have not. But I am aware of the issue. I was a local councillor many moons ago and am aware of the issue of the narrow tax base on which we are sometimes asking to draw, so it is a much wider question. That is why I am glad that a lot of this funding has come from central government as a down payment towards that. As I have mentioned many times, I accept that we need to find some long-term solutions in this space.

Health: Pancreatic Cancer

Debate between Lord Forsyth of Drumlean and Lord Markham

Monday 21st November 2022 Lords Chamber

[Lord Forsyth of Drumlean (Con)]

My Lords, the Government’s current campaign to encourage people to go and see their GP if they have symptoms is commendable, but how can this help when people are waiting months to get scans and then weeks to get the results of their scan? What can be done about this?

[Lord Markham (Con)]

This is where we see the diagnostic centres being a key area in this. We have set up 91 community diagnostic centres. In addition, in 2020 we had only 12 non-specific symptoms pathways; we are now rolling those out to 96, so that 75% of the population will be covered by March 2023, with a target of 100% by March 2024.