(1 week, 4 days ago)
Lords ChamberAs I mentioned earlier, while 24 months is a realistic transition, not everything will wait that long. It is the case, as the noble Baroness says, that there is still advice to women who could become pregnant to take folic acid supplements, and it is important that we keep that message going. However, 50% of pregnancies are not planned, so it is not possible to prepare by taking supplements. We are looking at all ways of effectively getting the message across.
My Lords, I congratulate the Government on publishing the regulation. I pay my own tribute to the noble Lord, Lord Rooker—although he may not welcome it—for his tenacity on this particular issue. One of my frustrations when I was a Minister on this was how long the processes and consultations took. For future reference, if other supplements are to be introduced into our food, I wonder whether the department has looked at ways in which it could possibly shorten the process without compromising patient safety.
Patient safety is at the forefront of this. I do not want to look backwards, but I gently suggest that there are all sorts of reasons for delays. Still, we are where we are now, and what is important is moving ahead. We are working closely with the Chief Medical Officers across the UK. We are very much in lockstep with the devolved Governments, and I think that will also assist.
(1 week, 4 days ago)
Lords ChamberWe have already made a number of commitments, but the noble Baroness is quite right to observe the excessive numbers on the waiting list. We are deeply aware of the distress and continuing difficulty that this causes for many. The noble Lord, Lord Darzi, in his independent investigation, confirmed that about 1 million people are waiting for mental health support as of April 2024. Moving to the 10-year plan will be an opportunity to put mental health services in a different place. In addition to the commitments that the noble Baroness has mentioned, we are providing access to a specialist mental health professional in every school and providing open-access Young Futures hubs.
My Lords, I am grateful to the noble Lord, Lord Alton, for organising a recent meeting with the Minister, the MHRA and some psychiatrists, who raised the issue of SSRIs and their side-effects. One concern was that patients need to be aware that one side-effect of SSRIs is to have suicidal thoughts. Therefore, I was surprised to see on the NHS website’s page on the side-effects of anti-depressants that you have to scroll down four or five pages before seeing the warning signs about suicidal thoughts. While we await the review from the MHRA which it discussed with us, will the Government and the NHS look at the advice on the website so that those who are prescribed SSRIs are clearer about the risk of suicidal thoughts?
I would be happy to look at that. However, there have been warnings on the leaflets accompanying medication for some 20 years. It is always a cause to review to ensure that it is most effective. There are at least two sides to this. One is the clinician doing their job to discuss side-effects, including on withdrawal from the medication, but it is important that patients understand it as well.
(1 week, 5 days ago)
Lords ChamberMy noble friend has campaigned tirelessly for the vaccine rollout in respect of RSV, for which I thank her, and I know that many others would wish to thank her for that too. With regard to the other vaccines about which my noble friend asked, we will continue to work with the JCVI and, as there are further developments, I will update your Lordships’ House.
If the spread of any of the four viruses listed by the noble Baroness, Lady Morgan, were to turn into a pandemic, hospital capacity would be an issue of concern. Hospital capacity is already an issue in most winters. With that in mind, figures released last week show that NHS hospitals are operating at 95% capacity. Therefore, what discussions are the Government and the NHS having with the independent healthcare sector to utilise its spare capacity to help to alleviate the pressures, both this coming winter and in the face of future pandemics?
The noble Lord will be aware that being prepared for winter is crucial. It has felt for too long as though winter crises have almost become normalised. Certainly, our move towards a 10-year plan will ensure that we have an NHS that can provide all year round. To give one statistic on Covid, in the week beginning 1 December there were 1,390 hospital beds occupied by confirmed Covid-19 patients per day, which was 41% lower than in the same week last winter. However, we are absolutely aware of this issue and we are not expecting a difficulty in respect of beds.
(2 weeks, 6 days ago)
Lords ChamberI am very grateful to all those, including pharmacists, who have used all their networks and contacts to spread the word. That is why we have had over 60,000 responses and more than 1 million visits in what is the largest ever consultation in the history of the NHS. I call on all groups to continue their efforts to ensure that voices across all communities are heard loud and clear.
During the vaccine programmes for Covid, the NHS and the last Government put a lot of effort into looking at ways to reach people who are vaccine hesitant—often from some black and Asian communities and other excluded communities. What lessons have been learned by the Government and the NHS to ensure that the consultation on the 10-year plan reaches as many people as possible from these communities, so that their voices are heard?
The lessons that have been learned are that there has to be a whole range of ways of consulting: in person around the country; online, where people can access the website; and through toolkits such as the “workshop in a box”. As I mentioned in an earlier answer, the consultation also needs to be tailored to the needs of those who need to speak up. We are asking the public, staff and organisations what is important, and we want, as the Prime Minister said, their fingerprints all over the 10-year plan.
(3 weeks, 5 days ago)
Lords ChamberThe noble Baroness will have heard me say before that we had to take some tough decisions at the Budget to fix the foundations in the public finances, and that enabled a settlement for the Department of Health and Social Care of some £22.6 billion. As she knows, the employer national insurance rise will be implemented in April 2025, and in due course the department will set out further details of the allocation of the funding I referred to for next year.
My Lords, I know this Government take drug-related deaths seriously, as did the previous Conservative Government when we awarded 12 projects a share of a £5 million fund to reduce rates of fatal drug overdoses, adopting a similar approach to that of the Vaccine Taskforce to tackle health challenges. Has there been any evaluation of how successful those projects were? What plans are there to continue or expand them?
Our continuing work in this area is part of the Office for Life Sciences programme. This Government continue to fund research into wearable technology, virtual reality and artificial intelligence, all in a bid to support people with drug addictions. Since coming into office, we have awarded £12 million to projects across the UK that are showing innovation in respect of technology, because we want to support people with addictions.
(3 weeks, 6 days ago)
Lords ChamberMy Lords, the Minister said that it was not only about rocking up to the General Dental Council, as the noble Lord, Lord Harris, said, but about having conversations. Can the Minister confirm what specific conversations the Government have had with the NHS, with the General Dental Council and with other dental bodies to encourage the opening of schools of dentistry in so-called dental deserts, especially in areas such as Norfolk, which my noble friend Lord Fuller described as the Sahara of dental deserts?
As the noble Lord will know, we are very keen to see that the areas that are most underserved—as I know from my own experience in Lincolnshire—are targeted. One of the reasons is the problem of recruiting and retaining dentists, as there is not a dental school to call upon. That point is well understood. We are keen to target the areas that need the most, as well as providing additional urgent dental appointments. Early conversations have also taken place with the Minister for Care, Stephen Kinnock, about reforming the dental contract, which is absolutely key, and that work will continue at pace.
(1 month ago)
Lords ChamberI and my ministerial colleagues are extremely aware of the anxiety the overpayments have created, and they are being independently reviewed to establish exactly why they happened. While I cannot commit to the amnesty the noble Baroness asks for, I can assure her and your Lordships’ House that we and the DWP are working to be as sympathetic to people as possible. I urge anyone in receipt of carer’s allowance to inform DWP of a change in their circumstances, so that overpayments can be avoided in future.
My Lords, we on these Benches also add to the tribute to the noble Lord, Lord Prescott, who has passed away.
My noble friend Lady Verma referred to the stress unpaid carers are under. We know that unpaid carers who look after family members may themselves have mental health issues, or may be looking after people with such issues. What support do the Government currently provide for the mental health of unpaid carers and those they care for, and what extra measures do they plan to introduce?
One of the key things in all this is the identification of carers. As has been discussed in your Lordships’ House on a number of occasions, a lot of people do not identify as carers. Therefore, we are encouraging GPs and, in the case of young carers, schools, to identify carers, so that they can get the support they deserve. The noble Lord, Lord Darzi, identified that making sure that unpaid carers receive recognition and support is key, and it will be in the 10-year plan as we go forward.
(1 month ago)
Lords ChamberThe noble Lord is right to make reference to the UK rare diseases framework. The intention of that is to improve the lives of those with rare diseases—for example, by helping to get a faster diagnosis, increasing awareness of rare diseases, better co-ordination and care, and improving access to care, treatment and drugs for those in this country. I will add his suggestion to the list of matters to raise with the department.
My Lords, we can all be proud that the UK is home to some of the world’s best medical experts on rare conditions. As the noble Lord, Lord Hogan-Howe, said, there are patients in other countries—often poorer countries—who seek the help of a UK expert. The Minister knows that in the UK the NHS charges, understandably, and that is welcome, but there are other challenges if that expert goes abroad. She spoke about some international agreements in an earlier answer, so can she say a bit more about how NHS England works with other systems in other countries, especially with reference to some of those agreements?
The agreements that the UK has in place which contain referral arrangements whereby the funding is discussed and agreed as part of the process of the referral are with the member states of the EU, Switzerland, the EFTA-EEA bloc of countries, the British Crown dependencies and some overseas territories. As the noble Lord rightly acknowledges, it is only fair that those using the NHS are those contributing to it, and we therefore have to ensure that we stick to those agreements. If trusts seek to undertake work outside of that area, that will be a matter for individual trusts, which will have to make decisions about their funding and their requirements to serve the NHS.
(1 month ago)
Lords ChamberMy Lords, unintended consequences have plagued policymakers and Governments for many years. I am interested in whether the impact on primary care providers, hospices and care homes was a deliberate or unintended consequence of the recent rise in employers’ national insurance. Did the Government conduct an impact analysis of the cost to primary care providers, hospices and care homes before the Budget? If not, have they conducted one since or do they intend to do so? Can the Minister assure non-state providers of primary care, hospices and care homes that this was not a deliberate measure to squeeze them out of the health and care space and that the Government will consider appropriate measures to ensure that they can continue to be financially viable and invest in facilities, staff and front-line services?
I assure the noble Lord that there is no intent to squeeze out any providers, which are much valued and appreciated. We will continue to listen to their concerns and consult them as we make allocations, which is, as he knows, the usual practice for every Government. On the Budget settlement for the Department for Health and Social Care for 2025-26, I assure him that the Chancellor considered the impact of all the changes in the Budget.
(1 month ago)
Lords ChamberI hear what the noble Baroness says and I am glad to report that I met the Northern Ireland Health Minister recently, along with colleague Peers, to discuss a range of matters including differences across the nations. I will consider the point that she makes.
My Lords, while the original Question was about type 2 diabetes—as the noble Lord, Lord Patel, said, type 2 diabetes can be due to lifestyle and can sometimes be reversed—I want to ask the Minister about type 1 diabetes. Its exact cause is unknown and people can get it at any time of their life, yet there is no cure, so in some ways the need for CGM is more critical. The charity Breakthrough T1D, which represents type 1 diabetics, finds that black, Asian and minority ethnic groups in England and Wales and lower socioeconomic communities are much less likely to get access to or use these technologies. Closing that gap was one of the issues that we grappled with in government, so can the Minister tell the House what plans there are to ensure that as many type 1 diabetes patients as possible across England receive access to continuous glucose monitoring?
It is probably important to say at the outset that type 1 diabetes, as the noble Lord knows, is not related to lifestyle issues, and at this point cannot be prevented, so it is a case of management. The technology that is available now is quite remarkable— not just the CGMs that the noble Lord, Lord Rennard, inquired about, but also hybrid closed loop systems, where the CGM is paired with an insulin pump, so it is administered automatically without the person having to calculate. I think that is incredibly helpful. It is only available to those eligible, with type 1 diabetes, but the rollout began in April 2024. The noble Lord makes a good point, as did the noble Lord, Lord Rennard, about access and inequality in access. That is something we continue to work on, ensuring that everybody can fairly access these wonderful technology advancements.
(1 month ago)
Lords ChamberMy noble friend, who is a very impressive campaigner on the rights of carers, is right to talk about recognition. Of course, if one does not understand that one is a carer, it is hard to access support. I certainly agree on that point. There is guidance, for example, to support GPs in recording which of their patients are unpaid carers, to ensure that they get access to the support they need. Importantly—this has been raised a number of times in this House—in respect of young carers, there is guidance for GPs and it has recently been added to the school census, so young carers can be identified in order that there can be an assessment of needs. So it is true that we need to identify in order to support. Part of that is people recognising themselves as carers.
My Lords, I also pay tribute to the work of the noble Baroness, Lady Pitkeathley. I learned much from her when I was the Minister. The Minister may recall that, in April 2023, the previous Government set out the better care fund framework. This included £100 million to accelerate digitisation in the social care sector. This would enable the Government and NHS England to collect valuable data about the state of social care and identify gaps if the Government decide to deliver a national strategy. What plans do the Government have to continue and expand this vital process of digitisation across the care sector, hopefully in delivering a national strategy?
It is indeed the case that using technology and digital advance is key in all the areas where we are working, and the noble Lord will know that in the 10-year plan one of the three pillars will be, for example, going from analogue to digital. On that point, plans for going forward in dealing with social care, which is much needed in this country, will be set out in due course. I assure your Lordships’ House that it will be done through a cross-party approach, involving those with lived experience and the many voices and organisations that are part of the social care sector. We are keen that it is something that we can all get behind.
(1 month ago)
Lords ChamberI am sure the powers that be heard what the noble Lord said about a debate. On the point he raised, I absolutely agree that diagnosing cancer earlier, at stages 1 or 2, improves outcomes and survival. I refer again to the report by the noble Lord, Lord Darzi: we need to do more to diagnose people at an early stage. Work is already being undertaken to improve cancer screening uptake. We will continue to roll out targeted interventions such as the lung cancer screening programme, which has a particular effect and impact on the most disadvantaged areas. Members of your Lordships’ House will know that the Budget also committed to £1.5 billion of capital funding for new surgical hubs and diagnostic scanners, which will increase capacity.
My Lords, I will carry on the thread of questioning that the noble Lord, Lord Patel, started about early diagnosis. As the Minister said, it is very important that we look at early diagnosis. Noble Lords who are interested in diagnosis were looking forward to a follow-up report to the 2020 community diagnostic centre review by Sir Mike Richards. That was due to be published before the Budget, yet the Health Service Journal has reported that it has been shelved. Is this true? If so, can she explain why?
It is important that we concentrate on the biggest ever NHS consultation, because that will lead us to the 10-year plan, and all that we are doing will sit within that. As the noble Lord will know, we are committed to getting the NHS to diagnose cancer earlier, treat it faster and improve waiting times. One of the announcements in the recent Budget, which also shifts the dial, is that we will deliver an extra 40,000 scan appointments and operations every week. The 10-year health plan will set out our approach for shifting healthcare from sickness to prevention, including reducing the incidence of cancer.
(2 months, 1 week ago)
Lords ChamberI thank the noble Baroness for that point. It is one of a number of things that is discussed with industry. It is important to draw on the fact that the location restrictions—in other words, where things are located—that came into force in October 2022 have actually turned out to be extremely impactful. There is a whole range of measures that we need to look at, and we will continue to work with industry. As I said in response to my noble friend, we will look at the balance between what is mandatory and what is voluntary, because that will be our best way forward.
My Lords, I pay tribute to the noble Lord, Lord Brooke, for his persistence on this issue. As a Minister, I received many similar Questions. The noble Lord asked about natural sweeteners, but can I ask the Minister about artificial sweeteners? The world-renowned Mayo Clinic suggests that artificial sweeteners, while reducing sugar intake, might also have negative side-effects, and that food labelled as having no sugar or being low in sugar may give the impression of being healthy but actually contain high levels of saturated fat, trans-fat, sodium and other cholesterol-raising ingredients. Can the Minister tell the House, first, whether the Government are aware of any negative side-effects of natural sweeteners and, secondly, what the current thinking is on informing consumers on how reformulating food with less sugar does not necessarily make it healthy?
The noble Lord makes some very good points. I can give the assurance that all sweeteners have undergone a rigorous safety assessment before being authorised for use. It is also worth drawing the attention of your Lordships’ House to the fact that the Scientific Advisory Committee on Nutrition is currently considering the recent World Health Organization guideline, Use of Non-sugar Sweeteners, which has particularly suggested that achieving weight control may not necessarily be about replacing sugar with sweeteners. It is about acknowledging that sweeteners are more difficult—to use a non-technical term—to use in the reformulation of food than they are in drinks. There has been success in drinks, which has not been exactly mirrored in food, but there are technical and practical reasons for that.
(3 months, 1 week ago)
Lords ChamberYes, and I thank the noble Baroness for making those points, which I certainly agree with. The challenge for us now is to reduce the number of people who live with undiagnosed HIV, but also to reduce the number not seeking care and treatment. For the first time, the latter has exceeded the former, which suggests that we have a challenge we must focus on in the new plan, and we will do so.
My Lords, I pay tribute to my noble friend Lord Black for his consistent campaigning on this issue, and especially for helping those with HIV. What has been learned from previous initiatives? We know that in recent years, the NHS and the previous Government looked at ways to address issues such as vaccine hesitancy, and the reluctance of some to seek tests and treatment at any time. What lessons have been learned from these previous initiatives for the HIV action plan—for example, by working with local communities and the charities that a number of noble Lords have mentioned to encourage more patients with HIV to seek treatment, especially in communities such as black and Asian communities, where there may also be a stigma, as the noble Lord, Lord Fowler, mentioned, around admitting that they have HIV?
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.
(3 months, 1 week ago)
Lords ChamberThe noble Lord raises an extremely good point. Before we speak about the groups to which the noble Lord referred, I want to point out that fortification will not be enough in any case. We need to continue our encouragement for women to take daily folic acid supplements before conception and in the first 12 weeks of pregnancy, because doing so can prevent up to seven out of 10 cases of neural tube defects—I want to emphasise that. I will take on board the noble Lord’s very important point and ensure that it is part of our considerations.
My Lords, I start by paying tribute to the noble Lord, Lord Rooker, for his persistence in this matter. When I was a Minister, I found it rather frustrating to be told that the consultation process could not be speeded up, so I pay tribute to the Minister for the progress she has made. However, I want to ask about a possible unintended consequence. The NHS website says that folic acid is not suitable for some people: those who are allergic to folic acid, obviously; those who have low vitamin B12 levels; those who have cancer, unless they have folate deficiency anaemia; and to those who are having a course of haemodialysis or who have a stent in their heart. Given these warnings on the NHS website, can the Minister assure the House that she is confident that those who suffer from those conditions will not be harmed unintentionally by increasing the volume of folic acid in our bread and flour?
I thank the noble Lord for his support in this area; I know that he also worked hard to make progress in it. I can give the assurance he asked for, and I would say to people that if they are concerned, they should seek expert advice about their own personal circumstances. All of the expert advice and relevant committees are content that this is the right way forward.
(3 months, 1 week ago)
Lords ChamberOn the point that the noble Lord correctly raises, it is worth reflecting that there has already been a reduction in the number of pharmacies since 2017. There are now some 1,200 fewer pharmacies than we had in 2017 and 600 fewer than there were two years ago. This is a trajectory that we would rather was not the case. Support is available—for example, through the Pharmacy Access Scheme, which provides financial support to pharmacies in areas where there are fewer pharmacies. I can say that we are monitoring access to pharmacies. While it is the case that four in five people live within a 20-minute walk from a community pharmacy, we absolutely recognise that the experiences of patients differ. If we are to see pharmacies as key to future plans for the health services, we will have to address that.
My Lords, we recognise that the current access to healthcare is based on an outdated model, where far too many patients are unable to book GP appointments online or by telephone in advance. They have to join the 8 am lottery to try to get an appointment by phone, only to be referred later to a pharmacist or hospital. The Pharmacy First reforms introduced by the last Government attempt to unblock the GP surgery bottleneck by allowing patients to access treatment for common health conditions without the need for a GP appointment. To ensure that patients in rural communities equally benefit from the Pharmacy First initiative, is the Minister able to give the House a firm commitment that the Government will continue the Pharmacy First approach and look at how this could be accessed by more patients in rural areas?
I am pleased to say that, as I am sure the noble Lord is aware, prescribing pilots are going on in NHS England. These will look at what more pharmacies could do in this regard, in particular asking whether more minor illnesses could be dealt with, and whether the long-term management of conditions could be better managed through pharmacies. We will be very interested in what those pilots come up with. They are across the entire country, so will of course include rural areas. This is something that we will want to ensure is available in rural and urban environments.
(4 months, 3 weeks ago)
Lords ChamberI assure the noble Lord that it is indeed a temporary problem. However, it is likely the alert will go on for a little while yet, not least because, as I mentioned, we can benefit from keeping it in place. I absolutely associate myself with the assessment that it is so much better to be self-sufficient within the United Kingdom, and that will be of great benefit. It is important to realise that this is a situation that we must live with but not be at the mercy of. I also assure the noble Lord and the House that this is because of external factors and not internal factors to do with the service, as was the case in 2022.
I thank the noble Lord, Lord Rooker, for raising this important issue and for his supplementary question. I also thank the Minister for her answers so far. Can she tell your Lordships whether the department has found an obvious reason why these stocks were low, and whether it was a confluence of factors or an unusual occurrence? I was speaking to a noble Lord who is an existing blood donor; he told me that when he read about the shortage he had not yet been contacted. What have the Government and the NHS learned from this experience about what does and does not work, both in the UK and in other countries, when it comes to encouraging the public to come forward to donate blood to avoid future shortages?
(4 months, 3 weeks ago)
Lords ChamberI will indeed be very pleased to report back to your Lordships’ House on this matter. It is something that greatly concerns me, because it cannot be acceptable that women go into childbirth, which should be a happy and safe occasion, and perhaps come away with trauma, and in some cases families experience death as well. We cannot have a situation like that. I have been very moved by the stories I have heard and will commit to working to put improvements in place, and to sharing that with noble Lords.
My Lords, I welcome the Minister to her place. I look forward to working constructively with her as we did when our roles were reversed. Has she read the report by Sands, the baby loss charity? It gave examples of Asian parents being dismissed as either being too anxious or exaggerating their claims, while black parents were stereotyped as feisty or dramatic by some NHS staff. When I was a Minister, a young female civil servant told me about her friend, a young Afro-Caribbean lady whose baby died during birth. When she tried to get the records for what happened that evening, she was told that they had somehow magically disappeared. She was being gaslighted. We know that the majority of NHS staff are highly dedicated but, when we hear stories such as this, what does the Minister believe should be done to tackle the culture of cover-up and gaslighting by that small minority of NHS staff?
I thank the noble Lord for his kind remarks; I am very pleased to see him again across the Dispatch Box. The duty of candour is extremely important in all this. Racism in this area is not just towards mothers and families; as the noble Lord said, it is also towards staff. Clearly, we need to tackle this for both patients and staff. The patient’s voice is key. Even at this early stage, it is quite clear to me that women, and people of black, Asian and minority-ethnic heritage, are not being listened to. We will bring forward plans to put this right. As part of the report to which I referred earlier, I will be glad to update the House in this regard.