Northern Ireland Dentists: Amalgam Fillings

Lord Lexden Excerpts

Monday 22nd July 2024 Lords Chamber

[Baroness Merron (Lab)]

I am glad that my noble friend welcomes today’s announcement. I am sure the House will appreciate the particular set of circumstances surrounding amalgam, which are extremely complex. This has required considerable collaboration between several departments, as well as the devolved Administrations. I hope it will be regarded as something very positive, but I can assure my noble friend and your Lordships’ House that I will discuss with my ministerial colleagues the points being raised about the Windsor Framework and the relationships that that entails.

[Lord Lexden (Con)]

Do the Government accept that there is indeed a considerable amount of further work to be done to ensure that the Windsor Framework provides fully for the free movement of all goods within our precious single market?

[Baroness Merron (Lab)]

Certainly, the Windsor Framework, under which some EU rules apply in Northern Ireland, is intended to help the EU and the UK work together constructively and to ensure the smooth flow of trade within the UK internal market. I am sure that my colleagues in the Northern Ireland Office will continue to keep that under review. I know that the Northern Ireland Secretary has been very involved in the amalgam issue.

NHS: Fracture Liaison Services

Lord Lexden Excerpts

Monday 5th February 2024 Lords Chamber

[Lord Markham (Con)]

As I mentioned, I agree with the noble Baroness that the FLS has shown many cases of prevention. There is a good argument in terms of investment and the return on it all. That is something that we are working towards and, as the noble Baroness will know, it is part of the major conditions strategy for musculoskeletal. So it is something that we are looking to expand.

[Lord Lexden (Con)]

My Lords, do the Government regret dropping the commitment that they gave in a debate in this House in September to expand financial provision for fracture liaison services? Is the health department considering the introduction of a best-practice tariff to reward those trusts that establish and maintain these vital services?

[Lord Markham (Con)]

I think that the statement made previously has been corrected on this, but, as I mentioned, we accept that these services are very effective in what they do. That is why we have musculoskeletal as part of the major conditions strategy. It was something that we put £400 million behind last year, in terms of a workforce package. We are looking at the effectiveness of FLS and, in ICBs that are not doing it, whether there is a case to expand them further.

National Health Service: 75th Anniversary

Lord Lexden Excerpts

Thursday 30th November 2023 Lords Chamber

[Lord Lexden (Con)]

My Lords, following the splendid introductory speech by the noble Lord, Lord Hunt, which ended with a quotation from Nye Bevan, I will make a little historical contribution to this important debate, if I may. Other speakers will be dealing with the present and looking forward to the future; I hope a historian may be forgiven for looking back to the origins of the NHS, the 75th anniversary of which we are celebrating.

Cinemagoers in the 1940s learned much about public affairs from the widely admired Pathé News, which was shown before the main film. In March 1944, audiences who saw that month’s Pathé News heard the following words from the Minister of Health about the formation of a National Health Service:

“Whatever your income, if you want to use this service—nobody is going to try to make you unless you want to—there will be no charge for treatment. The National Health Service will include family doctors who you choose for yourselves and who will attend you in your own homes when this is necessary”.


The clipped, kindly, authoritative voice continued:

“It will cover any medicines you may need, specialist advice and, of course, hospital treatment, whatever the illness, special care for mothers and children and a lot of other things besides. In fact, every kind of advice and treatment you may need … We are out to improve the health of every family and the whole nation. If we cut out the money worries which illness brings, then there would be no reason to put off getting advice and treatment”.


That is how the nation heard that it could look forward to the provision of comprehensive health services, free at the point of use, from which it was to benefit so profoundly in the years that lay ahead.

The voice from which it heard about these radical reform plans was that of Sir Henry Willink, the Conservative Health Minister in Churchill’s wartime coalition. It fell to Willink to work out how to achieve this promised transformation of healthcare in Britain. He set about the task in a spirit of consensus, telling Pathé News viewers:

“It is not a cut and dried scheme. These proposals are for discussion in Parliament, and we want them talked about by everyone concerned, and you, everyone in this audience, are very much concerned”.


The nearer the scheme came to fruition, the more concerned the British Medical Association grew about the effect it would have on their members’ private practice. Willink made a number of concessions to the BMA, agreeing that doctors would not, as had originally been envisaged, be grouped as salaried employees into health centres under local authority control. This concession had far-reaching results, which the Labour Party had to accept when it found itself in charge of the legislation that created the NHS after 1945.

Today, Sir Henry Willink is almost entirely forgotten, his contribution to building our National Health Service unsung. Willink was a calm, modest, intellectual figure, later master of a Cambridge college, who had no taste for rough party politics, totally unlike the brilliant, flamboyant, combative Nye Bevan, who denounced the Tories as “lower than vermin” when the NHS was officially launched in July 1948. By the way, younger elements in the Conservative Party responded by forming Vermin Clubs, with little membership badges featuring ugly creatures. Miss Margaret Roberts, later Mrs Margaret Thatcher, had quite a collection of these badges.

Since Bevan carried the legislation through Parliament, it would be absurd to question his central role. But neither he nor the Labour Party deserve to monopolise the credit for the building of the NHS. Bevan’s biographer, Dr John Campbell, refers to

“the long and cumulative process by which the Service came into existence in 1948 … There can be no doubt that some form of National Health Service would have come into being after 1945 whoever had won the General Election”.

The Tories, who made a firm commitment to finish Willink’s work in their 1945 manifesto, made a cardinal political error as Bevan’s great NHS Bill was going through the Commons: Willink moved a hostile amendment, opposing the nationalisation of all hospitals, voluntary and municipal. This enabled Labour, in the rough and tumble of party politics, to portray the Conservatives as opposed in principle to the NHS, which was of course totally untrue.

Perhaps on the 75th anniversary of the NHS this year, it might be appropriate to remember Henry Willink as well as Nye Bevan. Willink stood for consensus; Bevan for conflict. Could it be that, over the last 75 years, the NHS would have benefited from a little more of Willink’s consensus and a little less of Bevan’s party strife? Would progress have been easier to achieve if politicians of all parties had worked together, in full partnership with health professionals, in that spirit of national unity, embodied in Churchill’s wartime coalition, from which our NHS emanates?

I will make just one point about the provision of health services today. I do so with sadness, disappointment and a little anger. In the debate on the King’s Speech, alongside the noble Baroness, Lady Donaghy, I drew the attention of the House to the compelling case that the Royal Osteoporosis Society, supported by parliamentarians of all parties, had made for government funding of fracture liaison services. A commitment appeared to have been given in this House in a ministerial reply to a debate on these services in September. It contained the following words:

“We are proposing to announce, in the forthcoming Autumn Statement, a package of prioritised measures to expand the provision of fracture liaison services and improve their current quality”.—[Official Report, 14/9/23; col. GC 241.]


The Autumn Statement last week contained no such announcement. Commenting on the U-turn, my noble friend Lord Black of Brentwood, who introduced September’s debate but cannot be in his place today, deplored the Government’s unwillingness to make what is, in reality, a tiny investment of some £27 million per annum in fracture liaison services. This callous decision will blight the lives of tens of thousands of people with pain and disability and put many people at risk of premature death. This was a deplorable position indeed in the year of the 75th anniversary of our NHS.

King’s Speech

Lord Lexden Excerpts

Thursday 9th November 2023 Lords Chamber

[Lord Lexden (Con)]

My Lords, I follow a most moving speech. Despite being the son of a superb medical practitioner and the grandson of another, I rarely speak at any length about health issues. I think this restraint owes something to my failure to master the subjects that would have enabled me to follow the family tradition and serve the community in my turn as a doctor. However, as a close observer of the many grave issues confronting our health service today, I have recently been impressed by the determined efforts of the Royal Osteoporosis Society to direct public attention to the very patchy provision of fracture liaison services in our country. It is an urgent and pressing matter that calls for action by the Government in this new Session, as the noble Baroness, Lady Donaghy, made clear in her important speech. I agree with all that she said and I support from these Benches the case that she made.

The Royal Osteoporosis Society deserves much credit for the way it has heightened awareness of the situation through its Better Bones campaign, conducted over many weeks in partnership with the Sunday Express. Thanks to this campaign, we know that fracture liaison services, the world standard for diagnosing osteoporosis at an early stage, are not provided by more than half of NHS trusts. In areas where they are not available, those with fractures generally receive treatment in A&E departments, but they are often not told that osteoporosis was the cause. That means that they do not receive the treatment they need and disappear from the system, inevitably to suffer another fracture in due course.

The royal society’s estimate of the cost of filling the gaps where fracture liaison services are not currently provided would be a not-unthinkable £27 million a year. The potential savings are large, not just in reduced healthcare costs but in ensuring that people can continue to work until later in their lives. It is a common misconception that action to tackle osteoporosis mainly involves preventing hip fractures in people over the age of 70, like me. Osteoporosis and fractures can have a huge effect on younger people’s professional lives. One in every 12 women over 55 experiences a spinal fracture, rising to one in 10 for those over 60.

We should be deeply troubled by the extent to which osteoporosis goes undiagnosed. It is estimated that some 2.6 million women and men endure the effects of undiagnosed spinal fractures. They inevitably find themselves reducing their hours of work or being pushed into early retirement due to vague back pain that is often the result of undetected fractures. This is borne out in the statistics. Every year in England, there are around 67,000 fractures in the working-age population. As a result, some 2.6 million working days are lost every year, according to the International Osteoporosis Foundation. Drug therapies can reduce the rates of refracture by up to 90% for the most common fractures.

Both business leaders and trade unions are firmly behind this year’s hugely informative Better Bones campaign in its call for universal fracture liaison services. How can that be achieved? The Government are being urged by the experts in this field to establish a transformation fund to fill the stubborn gaps in existing provision. Such a fund would enable us to keep up with the rest of the world in diagnosing osteoporosis early, before the disease has the chance to inflict grave damage on individuals and society. This is a proposal to which the Government should give the most serious consideration in this new Session, as the noble Baroness, Lady Donaghy, and I, and no doubt other noble Lords across the House, will agree.

As other noble Lords have noted, there is a most welcome reference in the gracious Speech to the need to

“strengthen education for the long term”.

Those words will attract wide cross-party support in both Houses, along with a strong desire to know more about the Government’s thinking and intentions. A succession of authoritative reports from highly respected bodies have in the last few years made major proposals for the reform of the existing education system, and a large degree of consensus has emerged about what should be done. It will be reinforced shortly by a report from a Select Committee of your Lordships’ House on Education for 11-16 Year Olds. I am a member of this committee but an infinitely less distinguished one than the noble Lord, Lord Aberdare, and indeed the noble Baroness, Lady Blower. Reform should proceed, as far as possible, on a cross-party basis to ensure that it provides the stability and confidence that schools, teachers and families need for the long term.

There is, sadly, one highly contentious matter on the education agenda: the Labour Party’s proposal to slap VAT on independent school fees. In the 1990s, the party buried this idea, which it had kept putting in its election manifestos; now it has dug it up again. It is a total myth that the independent sector of education is stacked with wealthy, well-endowed schools, educating the children of wealthy parents who can easily afford a sudden 20% fee increase. I declare my interest as president of the Independent Schools Association. Its 650 member schools are virtually unknown outside their own local communities, which they serve faithfully alongside colleagues in the state sector. The hard-working families without financial reserves who send children to these mainly small, unpretentious, but highly successful schools do not deserve to be hit by a brutal tax increase. Some will be forced to move their children to schools in the state sector. Why should they be uprooted in this way?

Reinforced Autoclaved Aerated Concrete: Hospitals

Lord Lexden Excerpts

Wednesday 13th September 2023 Lords Chamber

[Lord Markham (Con)]

Three of those have already had the RAAC eliminated from them. The remaining ones are part of the programme and the commitment to have their RAAC eradicated by 2035, but in the meantime the remedial measures are there and that is what the £698 million is all about. I visited them first hand to see the work, and all credit to the team—they have become real experts on the subject. At every hospital I visited, you could see that the team were right on their game and understood very well what work they needed to do there, always using expert advice from the Institution of Structural Engineers and others.

[Lord Lexden (Con)]

My Lords, do the details that my noble friend gave in answer to the noble Lord, Lord Hunt, represent the current position in implementing the clear commitments given by Mr Johnson in the 2019 manifesto, which I do not think have advanced quite as swiftly as had been hoped?

[Lord Markham (Con)]

The commitment to 40 hospitals is absolutely there, but, as noble Lords have mentioned, we have prioritised the seven RAAC ones—in fact five of those were new, while two were already in the programme—which clearly have to be done by 2030. So, just as we moved those in, we moved the others into the cycle of 2030-35, but we will still be delivering 40 hospitals by 2030, albeit, because of the RAAC hospitals, of a slightly different complexion.

NHS Staff: Food Banks

Lord Lexden Excerpts

Tuesday 7th February 2023 Lords Chamber

[Lord Markham (Con)]

Clearly, food banks should be a last resort for people; that is definitely my hope. I am glad to say that there are some good examples of where hospitals have thought that this is the appropriate thing to do and have set them up to help people in that circumstance. However, the biggest increase has been in energy bills, which we have sought to protect people from. I am glad to see that prices are forecast to reduce in future. Actually, gas futures prices are down 71% for next year, so things are starting to get better. Is it challenging right now? Yes.

[Lord Lexden (Con)]

My Lords, are the means of improving the conditions and welfare of all aspects of our much-valued NHS workforce forming a central part of the discussions that are continuing in an effort to reach an agreement in this current tragic dispute?

[Lord Markham (Con)]

They are a central part of the discussions, but at the same time, we have to work out how we can best spend the budget. There are difficult choices here. Clearly, we want to make sure that we are protecting elective recovery and front-line services in A&E, so there are a lot of competing demands in this space. We are seeking to balance those in the best way possible, with the help of the independent pay review bodies, to make sure that we protect and pay what is appropriate in the circumstances.

PPE Expenditure

Lord Lexden Excerpts

Wednesday 25th January 2023 Lords Chamber

[Lord Markham (Con)]

I think we all agree that, at the time, some mechanism was needed to sift the thousands upon thousands of offers of goodwill to help with PPE. A decision was made to take recommendations —the so-called VIP lane—and I think we all accept now that was not the right decision. Going forward, a different sifting mechanism would be set up in place of that. Now, of course, we have supply chains set up to do this, so we hope that occasion will not arise in future.

[Lord Lexden (Con)]

My Lords, my noble friend was right, was he not, to remind us of the context in which those decisions were taken three years ago? There was an overwhelming sense of crisis, to which the Government had to respond with extreme rapidity.

[Lord Markham (Con)]

Absolutely. I remember well, as I am sure do others, watching the news about planes being diverted to other countries and it being asked how come they were not coming to the UK and what the department was doing to get on top of it. I am sure there was criticism from this House—it was before my time—asking what we were doing as a Government to get a grip of it. Well, we did get a grip of it; we did buy the PPE and it did not run out. Yes, we ended up buying too much of it because, thankfully, the pandemic did not turn out to be as bad as we thought it would. I think we did a sensible thing at the time, and now we are going after all those people who did not keep to their supply agreements, and we are recovering the funds. By and large, with the benefit of hindsight, I think we did a fairly decent job—not perfect but pretty good.

Osteoporosis: Early Detection

Lord Lexden Excerpts

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

One of the many things for which I am responsible is NHS performance, as I think the House is aware, and these are exactly the sorts of issues that I am interested in, so I am happy to undertake to give an update on that. We all know that effective spend, which we need to make sure is always put to best use, involves identifying where these problems are, and 3 million people are affected every year. As I said earlier, a fractured femur is the second biggest reason for intake into hospitals, in terms of beds. That is something that I am happy to be measured by and report back on.

[Lord Lexden (Con)]

My Lords, following on from the question from the noble Lord, Lord Rennard, is it not the case that, while the Government accept that everyone over 50 should have equal access to fracture liaison services, insufficient progress is being made towards that crucial goal? Is there not a case for the appointment of a strong and determined national specialist adviser on osteoporosis to speed things up?

[Lord Markham (Con)]

As I mentioned earlier, this is the responsibility of all the ICBs. Part of my job is making sure that we as Ministers now regularly communicate with all the ICBs. There are a number of boards that I regularly speak to, check in with and visit on a frequent basis, and one of our checkpoints is making sure that they are on top of services such as these. I am delighted to say that every ICB has now set up a community base fall service, to make sure that if someone should fall in a case such as these, rather than an ambulance and two paramedics, we can have someone specially set up to right these people, put them on their feet and avoid an A&E visit.

Bereavement Support

Lord Lexden Excerpts

Wednesday 9th November 2022 Lords Chamber

[Lord Markham (Con)]

I agree; we have to address every group. Part of the research into this is about ensuring that every group has access to support. I cannot speak in detail on the group mentioned, but I will make sure that the new team we have set up addresses this, because mental health and the causes of suicide are often the tip of the iceberg, and we need to make sure that every single group is addressed.

[Lord Lexden (Con)]

My Lords, for centuries, people at times of bereavement have turned to their priests, pastors and other spiritual leaders. Should not the Churches, and the Church of England in particular, react to this report by renewing and indeed enlarging their spiritual mission to comfort and succour the bereaved? Or could it be that in the diocese of London there is a feeling that some are no longer equal to this task, it having caused a bereavement in 2020 by driving to suicide a priest who was the friend of my heart in Cambridge years ago, accusing him, falsely, of sex abuse, refusing to disclose the allegations to him and then later asking a commoner to cover up for it?

[Lord Markham (Con)]

I am afraid that I do not have any knowledge of the case in point. As I said before, I welcome the role of the right reverend Prelate the Bishop of London in producing this report, which I know all the bishops and all the Church, of whatever faith, will take directly to heart. Again, I can only repeat the title of the report: Bereavement is Everyone’s Business. The Church has a key role to play in that, as it fully understands.

NHS: Backlogs

Lord Lexden Excerpts

Wednesday 9th November 2022 Lords Chamber

[Lord Markham (Con)]

I agree that it is an area of key priority; that is why the spend in this year as reported by NHS trusts has gone up by 57%—an increase to £1.4 billion. So we recognise that this needs to be worked on, but I put it in the context of an overall £10 billion capital programme, including a new hospital build. We very much recognise that making sure we have excellent facilities is key to success in the NHS.

[Lord Lexden (Con)]

My Lords, what has become of the great hospital building programme that Mr Boris Johnson promised in the 2019 Conservative election manifesto?

[Lord Markham (Con)]

I am very pleased to say that the hospital programme is very much a feature. We are already working on five hospitals, which are in the process of being delivered. The programme for the 40 hospitals is very much in progress, and we see it as a real opportunity for the UK to take a lead, as we are looking at using a whole new series of modern methods of construction, which we believe will be world leading in this space.