NHS: Long-term Sustainability

Lord Kakkar Excerpts

Thursday 18th April 2024 Lords Chamber

[Lord Kakkar (CB)]

My Lords, it is a great pleasure to follow the noble Lord, Lord Bethell, and to congratulate my noble friend Lord Patel on the thoughtful way in which he introduced this important debate. I declare my interests in the register, in particular as chairman of the King’s Fund and as chairman of King’s Health Partners.

My noble friend alluded to the report of your Lordships’ ad hoc Committee on the Long-term Sustainability of the NHS, published in April 2017, to which the Government responded in February 2018. The debate to which he referred extensively covered the questions raised in that report and the Government’s response, but, regrettably, very little has changed since. It must be recognised that we have had the global pandemic, an acute health emergency, and many other challenges, but the reality is that we have not been able to address in any meaningful measure either acute or mid-term challenges in the sustained delivery of health and care in our country, and nor have we even initiated a meaningful approach to its long-term sustainability.

We have heard in this important debate that performance, regrettably, is not where it should be in clinical outcomes. It is well recognised and sought after by all parties in all constituencies that we improve clinical outcomes. They are not as good as modern medicine would predict and could deliver. Operational delivery is poor and its trajectory in the NHS does not appear to be improving. On workforce, we have found it impossible to inspire and motivate healthcare professionals, be they clinicians, nurses or other healthcare professionals, to remain committed to the NHS and be inspired not only to serve but to innovate, undertake research and ensure that the application of that research and innovation is quickly brought to bear for the benefit of patients. More broadly, the research and innovation agenda, which our country has led for so many decades, appears to be falling behind. If that agenda is not at the centre, sustainable healthcare in our country will not be achieved.

That is not to say that there have not been many important and very well-meaning initiatives over decades to address acute problems and longer-term sustainability issues, but they have not delivered. As a result, we must ask how we are going to reach a position where we can develop a national consensus that brings together diverse political, public and professional constituencies with a common understanding and vision for the future—a consensus that is appropriately motivated and understands that what is proposed is deliverable and remains a deep-seated national commitment across the political divide?

Part of the problem may be that questions, with regard to the medium-term or long-term sustainability of health and care in our country, are projected and considered through the lens of a clinical, a delivery or an innovation problem, rather than looking more holistically at all those issues. Some of them were addressed in the previous NHS long-term plan, but they need to be considered more broadly in the context of our country’s economy and other policies, such as immigration, which need to be co-ordinated with a wider understanding of healthcare delivery needs, if we are to have a sustainable long-term plan.

I follow the fine example of my noble friend Lord Patel and ask the Minister, as well as the noble Baroness, Lady Merron, and the Liberal Benches, what approach are they going to take, for the national interest, to achieve consensus on the needs for delivering our country’s health and care? How will this consensus be delivered? In the debate on the noble Lords’ report in 2018, the idea of a royal commission was dismissed as something that was not politically acceptable and would not deliver in a short enough timeframe. Six years have passed since that debate; maybe something like a commission would have delivered the answer in that period. It is now essential that we develop a clear consensus and have the courage to adopt a long-term plan that addresses the holistic needs beyond the question of clinical care alone.

Stroke Treatment

Lord Kakkar Excerpts

Wednesday 27th March 2024 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interests. The Minister mentioned the importance of prevention, which of course is not only primary but secondary prevention. In that regard, for both patients with atrial fibrillation at risk of a stroke and those who have had a stroke, it is vitally important that appropriate therapies, innovations in therapeutic intervention, and broader cardiovascular risk management are provided. Is the Minister content that we have a strategy that provides those opportunities, both for primary and secondary prevention of stroke?

[Lord Markham (Con)]

The noble Lord is quite right. Many noble Lords will have heard me echo Sir Chris Whitty’s words that his major concern about the whole Covid period was that people missed out on blood pressure and cardiovascular checks, which can be early-warning indicators. That is why we see prevention as a major leg of what we are trying to do, through having blood pressure checks and inviting everyone to have their health check every five years. What we are working on, and will be bringing out shortly, is greater use of digital for health checks, to do precisely what the noble Lord says.

Cancer: Staffing

Lord Kakkar Excerpts

Thursday 14th March 2024 Lords Chamber

[Lord Markham (Con)]

First off, I completely agree about continuity of care—in any treatment, to be honest. I was just saying, in answer to a maternity question the other day, that continuity of care in the midwifery space is another vital example. On the question of learning lessons from what the noble Baroness mentioned, we have some meetings set up, so I look forward to discussing it further then.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interests. The Minister rightly identified an improvement in survival rates for those between their late 30s and 69 over the last 30 years. He also accepted the fact that those delivering cancer services are under a huge amount of pressure to ensure timely provision of that care. It is also essential to achieving long-term improvement in outcomes that we continue to innovate and that clinicians are provided the opportunity to participate in clinical research, which validates innovation and allows its adoption at scale and pace. Is the Minister content that we are doing enough to protect time for clinical research and participation by all healthcare professionals in those protocols to drive those advances in innovation?

[Lord Markham (Con)]

First, I completely agree on the need for and the vital importance of clinical research in all this. Providing clinicians with time does two things: it means that they get their incredibly valuable time, resources and brains on it; it also addresses the question asked earlier about retention. Of course, this is why a lot of clinicians want to be in this space, so they have time to do research as well. There are very good personal and medical reasons why they should be allowed to do that.

National Health Service: Key Targets

Lord Kakkar Excerpts

Tuesday 16th January 2024 Lords Chamber

[Lord Markham (Con)]

Staff retention, particularly of GPs, is vital. That is why we listened to the number one reason they were retiring, which was the feeling that their pensions were being adversely affected. We changed the rules in the last Budget to try to address that; it is early days, but I hear that that is starting to make progress. Primary care is the front line. That is why I am pleased that we have increased the number of appointments by more than 50 million, ahead of our manifesto target. But it absolutely needs to be a key focus.

[Lord Kakkar (CB)]

My Lords, I draw attention to my registered interests. The long-term—and, indeed, the short and medium-term—sustainability of the NHS is critically dependent upon active engagement in research and the adoption of innovation at scale and pace. Is the Minister content that His Majesty’s Government are doing enough to ensure that the NHS is resourced to support that research and innovation agenda?

[Lord Markham (Con)]

It is key, and I think we are all aware that a couple of years ago—this was a result of the report of the noble Lord, Lord O’Shaughnessy—we were not doing as well as we needed to be in the clinical trials area. I am glad to say that, since then, there has actually been a lot of progress towards it, so we are now hitting similar levels to comparative nations. Innovation is at the heart of everything we have done. We have some very good examples of that; I mentioned the stroke AI treatment earlier. We have just set a similar thing in terms of AI for looking at chest cancers, but it is absolutely something we need to make sure we continue to progress.

Stroke Care

Lord Kakkar Excerpts

Monday 24th July 2023 Lords Chamber

[Lord Markham (Con)]

There are a number of things. For want of a better phrase, we have a tier rating for the different trusts and hospitals and they can be put into the equivalent of special measures—that is not the right term, but the noble Lord knows what I am referring to. Ultimately, the NHS and Ministers also have the ability to hire and fire, as we know that leadership is vital in all these areas.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interests. It is clearly important that stroke networks are properly supported to deliver clinical care efficiently and effectively but, beyond the capacity to do that, there must also be ongoing capacity to participate in further research and development and to provide the opportunity for appropriate clinical evaluation of innovations that will yet further improve outcomes for those suffering ischemic stroke. Is the Minister content that there is sufficient support for that activity in stroke networks?

[Lord Markham (Con)]

A lot of good work is being done. AI is often used to analyse brain scans very quickly in a lot of these centres that the noble Lord mentions. One of the very good things about trusts is that they have a lot of independence to develop their own initiatives, but sometimes the challenge—which I have really taken up—is getting that innovation adopted widely. I and the Secretary of State are great believers in that but, candidly, we need to work harder on it.

Stroke Rehabilitation and Community Services

Lord Kakkar Excerpts

Wednesday 22nd March 2023 Lords Chamber

[Lord Markham (Con)]

As I say, I see social prescribing as taking in a whole range of arts, music and sport. Given that that is a particular interest of my noble friend, I am happy to follow up on both arts and music.

[Lord Kakkar (CB)]

My Lords, I draw attention to my declared interests. One of the most effective ways to reduce the burden of disease associated with stroke is to intervene earlier in trying to prevent stroke. What approach do His Majesty’s Government take to screening in the community and in populations for risk factors such as heart rhythm disorders, which, once identified, might be managed appropriately and reduce the ultimate burden of stroke?

[Lord Markham (Con)]

The noble Lord makes a very good point. The House has heard me mention before that Sir Chris Whitty’s major concern right now around excess deaths is the cohort aged 50 to 65, as they missed out on three years of blood pressure and cardiovascular tests during the pandemic. With that in mind, we are looking at how we can roll out those sorts of services to the community so that they are accessible. You might not necessarily need a GP appointment, but could be tested in shopping malls and places like that, so that those things are picked up.

GP Appointments

Lord Kakkar Excerpts

Thursday 23rd February 2023 Lords Chamber

[Lord Markham (Con)]

First, my understanding is that the vast majority of homes in Cornwall have broadband, to which your mobile phone will of course connect. That is where people will be making appointments from. They can use digital to do that. Secondly, we are rapidly increasing the number of doctors’ appointments. We made a pledge to increase the number of appointments by 50 million. To date, we have increased them by 36 million—11% up since 2019. So we are making more appointments available. Do we want to do more? Absolutely. Are we going to publish a primary care plan shortly to show how we will address those additional needs? Yes.

[Lord Kakkar (CB)]

My Lords, I draw attention to my registered interests. Deprived communities often have the most acute shortages of general practitioners, yet it is among those populations that there is the greatest burden of chronic comorbidity that requires integrated care, with a particular focus on communities where outcomes are the poorest and the healthy life years are the shortest. What do His Majesty’s Government propose to do about addressing the specific issue of GP shortages in deprived communities?

[Lord Markham (Con)]

As mentioned, we are increasing the number of doctors. We have 2,000 more versus 2019. The House will be pleased to know that that is a key part of the workforce plan for recruiting and retaining more doctors. As to comorbidities and deprived areas, clearly that is the role of the integrated care boards. They are set up very much to understand the needs of their areas and to make sure that they are looked after properly. In a lot of cases that means investing in primary care. We all know that a lot of the reason why we have a lot of people in A&E is that they cannot get GP-type services, so getting upstream of that issue and investing in primary care is the direction in which we need to go.

Social Care: Integrated Care Systems

Lord Kakkar Excerpts

Wednesday 11th January 2023 Lords Chamber

[Lord Markham (Con)]

Each ICB has a slightly different approach to ensuring that it is there and ensuring the kind of co-production with these front-runners that I talked about earlier. It is about trying to see whether there are new and better ways of doing it. Maybe at another time I can talk to the House in more detail about what those six different pilots are doing. It is about taking the comments that I have heard here over the last few weeks about what works and trying to scale them up.

[Lord Kakkar (CB)]

My Lords, I draw attention to my registered interests. Is the Minister content that the current approach to institutional and professional regulation will foster effective integrated care across institutional boundaries, secondary care, primary care and the broader community?

[Lord Markham (Con)]

Clearly, it is early days. These were set up last summer and we must ensure that they bed in properly and learn. I am confident that that is the right approach, but, as the noble Lord mentioned, we must make sure that regulators in this space ensure that that is the case. It is probably a question for a few months’ time, when we can be sure.

NHS Winter Pressures

Lord Kakkar Excerpts

Tuesday 10th January 2023 Lords Chamber

[Lord Markham (Con)]

Obviously, prior to this, we were in touch with the adult social care sector to make sure that there was that capacity within the system for it. We have been assured that the capacity exists, but we wholeheartedly agree that we need to recruit the staff to fill those vacancies, which is why we have taken measures to recruit internationally as well as in the domestic recruitment programme. Those are all key components of the longer-term plan to solve this issue.

[Lord Kakkar (CB)]

My Lords, I remind noble Lords of my declared interest as chairman of the King’s Fund. The Statement made yesterday in the other place refers to a primary care recovery plan. It is well recognised that the hospital system is not sustainable if primary care cannot discharge its important gatekeeper function. Is the Minister able to confirm that, as part of that plan, there will be a radical review of options that might be adopted to ensure that primary care can deliver its important function?

[Lord Markham (Con)]

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

NHS Waiting Times

Lord Kakkar Excerpts

Tuesday 22nd November 2022 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend for that. While I am not familiar with that exact case, I saw a very good, probably quite similar, example in Chase Farm Hospital, which has four operating theatres in a sort of barn. It has a complete production line for elective hip replacements and so on to get that capacity and efficiency.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interests. The Minister will be aware that innovation, be it therapeutic or in models of care, is essential to improve efficiency and efficacy in the delivery of NHS services. Is he content that there is sufficient protection in the NHS budget to drive that adoption of innovation and ensure that staff are properly trained for its application?

[Lord Markham (Con)]

I thank the noble Lord. As I have said previously, innovation, and being able to back that up with investment, is key. The House will see that we have protected a lot of the research funds so that we can do exactly that. That is the direction of travel. The new hospital programme, which I look after, is very much about looking at best practice and innovation around the world and making sure that we employ the best in our new hospitals and across all our trusts.