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.

Health: Pancreatic Cancer

Lord Kakkar Excerpts

Monday 21st November 2022 Lords Chamber

[Lord Markham (Con)]

I agree that screening programmes are, without doubt, the way forward. I mentioned earlier the 73 different pancreatic cancer research studies, of which screening is a very important element, so I totally agree that that should be our top priority.

[Lord Kakkar (CB)]

My Lords, I declare my interests in the register. Clinical research is fundamental to ensuring the evaluation and rapid adoption of new therapeutic interventions that could improve survival rates in diseases such as pancreatic cancer, but operational pressures in the NHS are having an impact on the ability to conduct that clinical research. Is the Minister content that there is sufficient emphasis and support to maintain the infrastructure for clinical research and the capacity to deliver translational, early-stage and later-stage trials in pancreatic cancer?

Long Covid

Lord Kakkar Excerpts

Thursday 17th November 2022 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I join other noble Lords in thanking the noble Baroness, Lady Thornton, for having secured this important debate and for the very thoughtful way in which she introduced it. I declare my own interests as chair of King’s Health Partners, chairman of UK Biobank and an active researcher in the field of thrombosis, a particular pathophysiology that has both impacted acutely on Covid and may have some role in long Covid symptoms.

We have heard that some 2.1 million people—some 3.3% of our population—have self-reported, as part of the ONS data collection programme, symptoms attributable to long Covid. It is striking that some 500,000 of those individuals reported having had Covid some two years previously. This represents a substantial, ongoing, chronic burden of disease. We should all be conscious of its potential impact on the way in which we are able to deliver healthcare through the National Health Service.

As we have heard, little is known about the etiology of long Covid. There is a suggestion that part of it may be attributable in some individuals to a failure to properly clear the virus from their bodies. It is also possible that there are genetic determinants that drive individual immune response and that this dysfunction is part of the explanation for long Covid symptoms. There is a now well-established phenomenon of dysfunction in the microvascular and endothelial cells that line blood vessels, which may be responsible for some of the long Covid symptoms. Indeed, a profound hypercoagulable state—a tendency to a risk of thrombosis and blood clots—manifests itself in an important number of long Covid patients.

We have heard of the importance of research in trying to understand more about the etiology of long Covid and to better understand its history. This is critically important if we are to be able not only to research and develop new therapies but to address the question of long Covid through the mechanisms underlying its development and sustained impact. This research is also critically important in understanding how we should properly develop services to manage patients. At the moment, His Majesty’s Government have committed some £194 million to the provision of clinics and services to manage Covid patients—some £90 million of which is to be spent in the financial year 2022-23. However, when one looks at the burden, this resource is only able to provide services for some 5,000 patients a month. The substantial demographic of long Covid is running into many hundreds of thousands, if not millions, of people. We clearly need to understand from prospective research not only what volume of services is needed but how those services should be constructed, based on our knowledge of the natural history of the disease, in order to adequately and properly manage the requirements of those patients beyond symptom control.

Is the Minister content that the approach to research is sufficient? As we have heard, some £50 million has been committed by the Chief Medical Officer to a variety of research programmes. Is he able to address the question, raised by the noble Baroness, Lady Thornton, of why a national cohort has not been established to allow us to marshal the current clinical burden of long Covid in our country and then to apply an appropriate methodology and protocols to the evaluation of these individuals? Research undertaken in this systematic fashion is not only highly efficient but provides the best opportunity for us rapidly to understand and start addressing the questions that need to be addressed if we are to be able to develop these new therapies and organise and deliver services in the most appropriate way for these patients.

Beyond the financial commitment to the development of a long Covid research cohort, there is also the need to ensure that the data collected through routine exposure of these patients to NHS services can be marshalled to inform the research effort. Those data should be able to link with other datasets whose huge value in addressing acute Covid and in the post-infection period has been established. I reiterate my interest as chairman of UK Biobank, which has been used in this regard. It is a unique resource, available to the country, where half a million of our fellow citizens have provided their biological material. The genome in those individuals has now been mapped and the opportunity exists to interrogate the dataset, using that biological material, to assess novel biomarkers and the prevalence of disease. The deep phenotyping and repeat imaging give the capacity to understand structural end organ dysfunction in Covid. All this requires an approach from His Majesty’s Government with regard to data sharing, within and across datasets, between researchers in different institutions and, as we have heard, with those outside the public sector wishing to support this research. Is the Minister able to provide some reassurance on this?

Menopause

Lord Kakkar Excerpts

Tuesday 18th October 2022 Lords Chamber

[Lord Markham (Con)]

With constraints on the public purse, I like many others believe that targeted support is probably the best form of support, and 60% of women receive it free. At the same time, as I am sure the noble Baroness is aware, to prevent it being a barrier to the others, next year we are introducing a fixed cap so that the costs should be a maximum of only £19 per year, which I believe will not act as a disincentive to the 40% who can afford to pay.

[Lord Kakkar (CB)]

My Lords, I draw attention to my registered interests. The menopause is associated with an increased risk of heart attacks and strokes as a result of falling oestrogen levels. Despite this, women are consistently less well represented in cardiovascular clinical research than men. Is the Minister content that the ongoing publicly funded research effort in cardiovascular disease will be able adequately to address the challenge of postmenopausal heart disease?

[Lord Markham (Con)]

I will not pretend to be able to give a detailed answer at this point. I am aware that part of the funding through the health and wellbeing fund is to make sure that women’s reproductive health is included in some of those research programmes, but I will look specifically at the cardiovascular point and respond in writing.

Pharmaceutical Research and Development Spending

Lord Kakkar Excerpts

Thursday 13th October 2022 Grand Committee

[Lord Kakkar (CB)]

My Lords, I apologise for not having added my name to the list. I was responsible for chairing a meeting elsewhere and did not anticipate finishing on time. I am grateful for the indulgence of noble Lords in permitting me to intervene in the gap. In so doing, I declare my interests as chairman of King’s Health Partners and of the Office for Strategic Coordination of Health Research and as an active researcher with studies in the national research portfolio.

I, too, thank the noble Baroness, Lady Wheeler, for introducing this debate so thoughtfully, building, of course, on the immense contributions the noble Lord, Lord Hunt, has made over many years in debates on this question.

I shall confine my comments to the increasing problem that the deteriorating performance in clinical research in our country is having on the capacity to invite inward investment in research and development, as we have heard in this debate.

The National Institute for Health and Care Research is responsible for the application of public funds to ensure that there is infrastructure and capacity available within the clinical research network to deliver our national research portfolio. Is the Minister content that the public funding made available to NIHR to establish that infrastructure and create that capacity in the CRN is appropriately applied? Of course, the NIHR has recognised that there are currently important problems in the delivery of clinical research and is trying to take steps to ensure that the rather bloated national portfolio of approved studies is reduced in some way by the removal of studies that are identified to be underperforming or poorly performing. But this action itself has a profound impact on the perception of the standing of our country as a suitable location for inward investment of research funding to undertake clinical trials. Are His Majesty’s Government content that the approach being taken with regard to management of the portfolio and the problems associated with the size of the portfolio that predate Covid are the appropriate steps? Are appropriate measures being taken to ensure that there is no perceptional impact in terms of reducing the attractiveness of the United Kingdom for overseas funding for clinical research in such a way that it undermines the overall life sciences vision and strategy?

It is important to try to understand where the application of funding to drive the clinical research effort nationally is being directed. Again, can the Minister confirm that there is an appropriate mapping of the populations where the research effort and opportunity might be achieved against where the infrastructure funding to deliver that research is being applied, so that there is a targeted approach that ensures that maximum capacity is delivered, particularly in the medium term, to overcome these particular clinical research problems?

Primary and Community Care: Improving Patient Outcomes

Lord Kakkar Excerpts

Thursday 8th September 2022 Lords Chamber

[Lord Kakkar (CB)]

My Lords, I join other noble Lords in thanking my noble friend Lord Patel for the very thoughtful way in which he introduced this important debate. In so doing, I remind noble Lords of my own interests. In particular, I am chairman of the King’s Fund and King’s Health Partners.

In opening this debate, my noble friend described—and many other noble Lords added to his description—the substantial challenges that the NHS faces in general and in particular in primary and community care. So far in the debate, there has been a consensus and recognition that failure to address those challenges will ultimately lead to the NHS, in general, becoming totally unsustainable. We see the manifestations of this every day in the crisis to ensure that patients in an acute situation can be delivered to hospital through the ambulance service; in the substantial waits and, quite frankly, clinically unsafe environment that now represents many accident and emergency departments; in the tremendous pressures demonstrated in the acute management of patients in medical, surgical and other disciplines in our hospitals; and, most importantly, in the failure to discharge patients from hospital back into the community. The result of all that is an NHS that is considered, regrettably, now to be failing in many aspects. That failure is attended by an increasing loss of confidence among our fellow citizens.

I strongly support my noble friend Lord Patel’s proposal to establish an ad hoc Select Committee of your Lordships’ House to examine in more detail the challenges and opportunities for reform in primary and community care. In proceeding along that line and in having identified the many challenges faced, the issue is to understand how we might address them. To do that, first, we must deal with a major problem, which is the discordant perception and expectation among some important groups, with regard to what should be delivered by primary and community care services in the NHS. The expectations are those of politicians, of the public, and of health and care professionals. Those expectations are starting to differ widely when we look at the reality of what can be provided through a model of primary and community care established at the birth of the NHS.

That model, having at its heart family doctors well versed with the needs of their patients in broadly small communities in small practice settings, was fine some 70 years ago, but the demographic changes in our country, and the nature of chronic diseases that now attend so many citizens, which have a profound impact on their quality of life and their need to avail themselves of health services, are quite different from 70 years ago.

In addition to that, advances in medical and clinical practice provide important opportunities to impact on many of these conditions, but those advances require changes in the way we deliver care, pathways of care and an important emerging recognition that the hospital cannot be the place where the majority of patients with chronic conditions are managed. They must be managed in the community. Indeed, many must be managed in their home. That requires a different approach to understanding how professionals in primary care and community care settings need to be trained and the skill sets required. It also requires a confidence in understanding that what clinicians might have done previously should be done by other professionals.

Therefore, a professional workforce must be developed, with a recognition that skill sets will have to be developed differentially and that those who might previously not have been involved in delivering direct care—more specialist nurses, community nurses and practitioners—will now need to be encouraged and developed to do so. It also requires the adoption of innovation and technology to ensure that this care can be delivered safely in the community. Patients and their relatives need to be confident that they can understand and have confidence in the digital and technological solutions provided in their own homes and in community hubs and community settings.

Regrettably, none of this seems to be being addressed cohesively, so we rightly welcomed the opportunity provided in the most recent Health and Care Bill for the development of more broadly integrated community care settings and integrated care partnerships and boards to supervise the delivery of that care and bring different elements of the healthcare system together. But we need to go far beyond that. The Minister will be aware that in the debates on that Bill, which he so ably took through your Lordships’ House, there were suggestions, which we have heard from other noble Lords, regarding ensuring that workforce planning, a better understanding of the methodology used in planning, and the parameters considered in terms of demographic change, emerging technologies, advances in our understanding of pathophysiology and the capacity to deliver care should be included in very sophisticated workforce planning that will help us understand not only the number of healthcare professionals required but their potential disposition by way of discipline and specialty, and the capacity, with emerging understanding, knowledge and technology, to train different groups of healthcare professionals so that, as we have heard, they can work more cohesively together as a team, delivering so much more of the care in the community and at home so that patients never need to come to the hospital.

Indeed, other European countries have been able to achieve these ambitions. They have much lower levels of bed occupancy in their acute hospitals. Therefore, they see no particular anxiety about times such as winter, when acute admissions will inevitably increase. We have failed to achieve that. This failure is now taking us to a place where the system will, as I said, become entirely unsustainable.

In closing, I urge Her Majesty’s Government to have the courage to start addressing the problems we face and to start establishing a narrative and communication to bring together professionals, politicians, the public and patients to help understand and develop a consensus around the very important, serious and far-reaching decisions that now need to be taken to ensure that we strengthen primary and community care with new models; to ensure that those models are properly co-ordinated with the changes that need to occur in secondary and tertiary care; and, attending all that, to ensure that we have appropriate workforce planning across those different environments and care settings, attended by a proper review of the regulatory framework in which those professionals will deliver care and a better understanding of how we will ensure proper adoption of innovation through funding innovation streams beyond the recurrent funding for day-to-day delivery of care.

St George’s Hospital: Patient Deaths

Lord Kakkar Excerpts

Wednesday 18th May 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness raises a very important question, and it was one of the questions I asked when I was being briefed on this. Unfortunately, when HSIB was established, it did not investigate to historical cases. The future HSSIB will also not be able to investigate such cases; it will undertake only cases that are brought to it in the future.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interests. The Minister rightly identifies that the NHS, and indeed all healthcare systems, must be committed to ensuring the best clinical outcomes and securing patient safety. Clinical failings are subjected currently to a number of different potential investigations, such as local employer investigation, professional regulatory investigation, systems regulator investigation, civil litigation and potential criminal prosecution and interrogation. How do Her Majesty’s Government ensure that these multiple routes for investigating a clinical failing are properly co-ordinated to ensure that immediate learnings from such failings are applied to drive system improvement?

NHS Mental Health Patients in Private Hospitals

Lord Kakkar Excerpts

Thursday 28th April 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Lord clearly discusses an important point: we have to have the appropriate workforce. The Government have begun a register of social care to work out who is in the workforce, what qualifications they have and what improvements we have to make to social care. We should also remember that social care providers are a mixture of private homes and state provision. At the same time, we have to make sure that we have the right people, locally trained. For example, the visa system encourages people to come and work in our social care system as well.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my declared interests. In view of recent press reports about a young patient who absconded from a private sector mental health unit and subsequently died, and the subsequent coroner’s inquest findings, is the Minister able to confirm that the Department of Health and Social Care will be able to provide guidance on the safety and security arrangements that should attend outside areas at mental health units and subsequently might be used as the basis for CQC inspection?