NHS: Allocation of Financial Resources

Lord Markham Excerpts

Thursday 11th May 2023 Lords Chamber

[Lord Roberts of Llandudno]

To ask His Majesty’s Government what financial resources are being allocated for (1) additional beds, (2) extra ambulances, and (3) the recruitment and training of extra NHS staff.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The delivery plan for recovering urgent and emergency care services sets out how we will provide 5,000 additional permanent beds, backed by £1 billion of dedicated funding to support capacity. We are also providing ambulance services with £200 million of additional funding in 2023-24 to grow capacity and improve response times, alongside delivering 800 new ambulances. We are committed to publishing a long-term workforce plan for the NHS, which will be published shortly.

[Lord Roberts of Llandudno (LD)]

My Lords, over the years, we have had many promises for the NHS. I wonder how the 40 new hospitals are getting on. We were also promised £350 million a week if we came out of Europe. The present Prime Minister made promises earlier this year; are they any more sound? Are there 5,000 more hospital beds, 800 extra ambulances and thousands of staff? Given the conflict over nurses’ pay and other NHS pay and conditions, we are suspicious. I ask the Minister for a full, detailed Statement on the funding and progress of all these pledges.

[Lord Markham (Con)]

We have been giving a lot of Statements. Just this week, I was telling the House about the primary care plan; we announced the social care plan earlier in April; and we had the emergency recovery plan and the elective recovery plan. The plans are in place, and they are starting to show improvements, which will continue.

[The Lord Speaker (Lord McFall of Alcluith)]

The noble Lord, Lord Campbell-Savours, is taking part remotely.

[Lord Campbell-Savours (Lab) [V]]

My Lords, is it not possible that the great British public just might be prepared to see a far greater proportion of their taxes diverted from ill-thought-out and often totally unnecessary tax concessions to the better off, which invariably fail any incentive testing anyhow, in favour of a properly funded National Health Service that slashes waiting times, properly funds health professionals and meets the health requirements of the British people? That is what the public want. Just ask them and look at the polling data.

[Lord Markham (Con)]

We are putting in record investment. Right now, we are spending about 12% of our GDP on health services; a few years ago, the figure was more like 7% or 8%, so there is record investment. I think the whole House would agree that how we use that investment is the most important thing. We have seen that certain hospitals have a 13% lower cost per patient treatment than others because of effective use of technology. That is where I want to see investment take place.

[The Lord Bishop of St Albans]

My Lords, I welcome what His Majesty’s Government are doing to try to get on top of this very difficult problem. Will the Minister give us a little more information, particularly about ambulance services? In Hertfordshire, which is in my diocese, category 2 call-outs, for strokes and hearts attacks, should have an 18-minute response but the response is averaging two hours and six minutes at the moment. There is a great deal of anxiety among ordinary people when these things happen. When do we think that the money going to the ambulance service is going to bring response times down?

[Lord Markham (Con)]

I am pleased to say that the figures announced today show that response times are coming down. For category 1, the most serious, we achieved the 15-minute target for 90% of calls. We are moving in the right direction, albeit there is a lot more that needs to happen in this space. That is what the investment in 800 new ambulances is about, as well as the £200 million of funding. Most importantly, it is about making sure we have the right services in place. Some 50% of ambulance calls do not result in a trip to the hospital. There are fall services, which are often best placed to help, which will pick people up in their home.

[Baroness Blackwood of North Oxford (Con)]

My Lords, I declare my interest as chair of Genomics England. Some 3.5 million people live with rare diseases but only 5% of those conditions have a specific therapeutic. Condition management is essential, but patients struggle to find it because of poor awareness and a shortage of specialist clinicians and nurses. The England Rare Disease Action Plan 2023 commits to a workforce strategy but it does not commit to anything on capacity. What are the Minister’s plans to resource the rare disease workforce?

[Lord Markham (Con)]

This will be another element covered in the long-term workforce plan, making sure that we have got every route covered. My noble friend mentioned signposting people to those services. We are shortly launching a new app service—some 30 million people already have it—to make sure we are signposting to the place where people can get the right treatment for everything, including rare diseases.

[Lord Laming (CB)]

My Lords, does the Minister agree that one of the best ways to help the health service would be if the Government would allocate money dedicated to social care services? This would relieve the pressure on beds. Many beds would be relieved—thousands of beds—and it would prevent people having to go into hospital. Is that possible?

[Lord Markham (Con)]

Yes, and we are doing it. We have committed to an up to £7.5 billion increase in funding over the next two years. We announced last month a social care plan which is addressing this and reforming the sector, and we are starting to see the changes.

[Baroness Merron (Lab)]

My Lords, the Royal College of Emergency Medicine described as unambitious the Government’s plan to see 76% of A&E waits meeting the four-hour standard by 2024. As this target has not been achieved in the past two years, how does the Minister see it working to drive down waiting times? How will the Minister ensure that hospitals are not prioritising patients with minor conditions at the expense of those in greater need of admission simply to allow them to meet the target?

[Lord Markham (Con)]

Numbers out just this morning show that we are now at 75% of people being seen within four hours, so we are close to the 76% target. That is the best since September 2021. I am the first to admit that we want to go further, as the noble Baroness states. It is about making sure we have got the care in the right places. We are triaging to make sure that the most important cases are seen first and, as I mentioned in a previous answer, we have things such as fall services, which can avoid trips to A&E in the first place, and more primary care in place to avoid visits in the first place. That is what the primary care recovery plan is all about.

[Baroness Jolly (LD)]

My Lords, sometimes the NHS is a bit like a greedy child, always needing more. In his Question, my noble friend mentioned additional beds, extra ambulances, and recruitment and training. Will the Minister tell us what budget each of these items comes from? Will the Minister enlighten the House about this issue?

[Lord Markham (Con)]

The budgets are in the allocations for each ICB and each hospital, and within them there are specific allocations to make sure that these fundings are rooted in the place where they have the most effect. As for making sure that really does happen, it is the responsibility of each ICB to make sure it is doing that. Ministers hold them to account by each having seven ICBs to take care of and make sure that they are hitting those targets.

[Baroness Manzoor (Con)]

My Lords—

--- Later in debate ---

[Baroness Manzoor (Con)]

My Lords, I very much welcome the significant sums of money that have been put into the NHS to date by the Government. It is not just increases in beds that we need in hospitals. We live in an age where we have made significant inroads and innovation in technology, diagnostics and so forth, including artificial intelligence. Will my noble friend the Minister say how new technologies are being used to ensure that patients are not needing the extra beds in hospitals and creating the old mistakes we know of?

[Lord Markham (Con)]

I shall answer quickly. As I said, there is already a 13% lower cost in a hospital which is digitally mature. We have virtual wards going in to make sure that we can treat as many as 50,000 patients every month to improve the flow and improve services.

[Lord Stirrup (CB)]

The Minister has mentioned the long-awaited workforce plan. While we have been waiting we have seen a number of interesting initiatives, such as the greater use of pharmacies and the proposal to put SAS doctors into GP surgeries. Will the workforce plan look holistically at the totality of healthcare professions and qualifications, so that in future the workforce can be used in the most efficient way possible?

[Lord Markham (Con)]

Absolutely. The plan is looking at the use of Pharmacy First, as the noble and gallant Lord mentioned, and at the use of technology and the productivity improvements that will make. It is looking at the use of apprenticeships and at how we can bring people back into the nurse and doctor workforce. It is obviously looking at things such as pensions, which we are improving so we can retain more of our doctors. It is a holistic and very detailed study. I know it is taking a while to come out, but it will be worth the wait.

Recovering Access to Primary Care

Lord Markham Excerpts

Tuesday 9th May 2023 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

My Lords, I shall now repeat a Statement made in another place:

“Madam Deputy Speaker, with permission, I would like to make a Statement on the primary care recovery plan. For most of us, general practice is our front-door to the NHS. In the last six months, over half the UK population has used GP services, and GPs in England carry out around 1 million appointments every single day. They are doing more than ever. General practice is delivering 10% more appointments a month than before the pandemic; the equivalent of the average GP surgery sees an additional 20 patients every working day. There are more staff than ever, with numbers up by a quarter since 2019, and we are on track to deliver our manifesto target, with an additional 25,000 staff already recruited into primary care. We are investing more than ever, too, with the most recent figures showing that funding was around a fifth higher than five years before, even once inflation is taken into account.

But we know that there is a great deal still to do. Covid-19 presented many challenges across the health service, leaving us with large numbers of people on NHS waiting lists, which need to be tackled. In general practice, patient contacts with GPs have increased between 20% and 40% since the pandemic. As well as recovering from the pandemic, we face longer-term challenges, too. Since 2010, the number of people aged 70 and above has increased by a third, and this group attends five times more GP appointments than young people. Not only that, but advances in technology and treatments mean that people understandably expect more from primary care systems.

Today I can announce our primary care recovery plan, and I pay tribute to my honourable friend the Member for Harborough for this plan. I have deposited copies of the plan in the Libraries of both Houses. Our plan will enable us to better recover from the pandemic, to cut NHS waiting lists and to make the most of the opportunities ahead by focusing on three key areas: first, tackling the 8 am rush by giving GPs new digital tools; secondly, freeing up GP appointments by funding pharmacists to do more, with a Pharmacy First approach; and, thirdly, providing more GPs’ staff and more appointments. NHS England and my department have committed to make over £1.2 billion of funding available to support the plan, in addition to the significant real-terms increases in spending on general practice in recent years. Taken together, our plan will make it easier for people to get the help they need.

The plan builds on lots of other important work. Last year, we launched the elective recovery plan, which is making big strides to reduce the backlog brought by Covid-19. We eliminated nearly all wait lists over two years by last July, and 18-month waits have now decreased by over 90% since their peak in September 2021. By contrast, in the NHS in Labour-run Wales, people are twice as likely to be waiting for treatment than in England. They still have over 41,000 people waiting over two years and nearly 80,000 waiting over 18 months.

In addition, this January, I came before the House to launch our urgent and emergency care plan, which is focused on how to better manage pressures in emergency departments, with funding to support discharge to improve patient flow in hospitals. Today’s plan is the next important piece of work.

Turning to the detail of the plan, our first aim is to tackle the 8 am rush. We will do this by providing GPs with new and better technology, moving us from an analogue approach to ways of working in the digital age. An average-sized GP practice will get 100 calls in the first hour of a Monday morning, but no team of receptionists, no matter how hard-working, can handle such demand. About half of GPs are still on old analogue phones, meaning that when things get busy, people get engaged tones. We are changing this by investing in modern phone systems for all GPs, including features such as call-back options, and by improving the digital front-door for even more patients. In the GP practices that have already adopted those systems, there has been a 30% improvement in patient feedback on their ability to access the appointments they need. This also reflects the fact that online requests can help find the right person within the practice, such as being directed to a pharmacist for a medicine prescription review or to a physio for back pain.

In doing so, we will make the most of the 25,000 more staff we now have in primary care. Today’s plans fund practices without this technology to adopt it, while also providing them with staff cover to help them manage a smooth transition into this technology. Indeed, many small GP practices find it hardest to fund new technology, or to manage the disruption that comes with transitioning to new ways of working, so we are funding locum cover alongside the tech itself. Notwithstanding that, people will always be able to walk in or ring if they prefer; if someone wants to ring up and see someone face to face, these investments will make that easier, too.

We also want to make sure that patients know how their request is going to be handled on the same day that they make contact. Clinically urgent issues will be assessed on the same day, or the next day if raised in the afternoon. If the issue is not urgent, an appointment will be scheduled within two weeks, but, crucially, people will not be asked to call back tomorrow. Instead, they will get their appointments booked on the same day or be signposted to other services.

The second area of this plan is Pharmacy First. As well as giving GPs new technology, I know that we need to take pressure off GPs where possible by making better use of the skills of all clinicians working in primary care. We saw the incredible role that pharmacists played during the pandemic—their capacity to innovate and deliver for the communities that they served, freeing up GP appointments in doing so—so the second part of our plan is to introduce a new NHS service, Pharmacy First, on which we are already consulting with the Pharmaceutical Services Negotiating Committee.

Some 80% of people live within a 20-minute walk of a pharmacy, so making it easier for pharmacists to take referrals can have a huge impact. Referrals might be from GPs, NHS 111 or, from next week, urgent and emergency care settings. Community pharmacists already take referrals for a range of minor conditions, such as diarrhoea, vomiting and conjunctivitis, but with our Pharmacy First approach we can go further still. We will invest up to £645 million over the next two years so that pharmacists can supply prescription-only medicines for common conditions, such as ear pain, UTIs and sore throats, without requiring a prescription from a GP.

One of the most significant shifts we are making is in oral contraception. Pharmacists can already manage the supply of contraception prescribed elsewhere; from later this year, they will also be able to start women on courses of oral contraception. This is another way in which we aim to reduce the barriers to women accessing contraception, in light of our women’s health strategy. Pharmacists will also be able to do more blood pressure checks, which is one of the most important risk factors for cardiovascular disease. Not only will those kinds of steps make it easier for people to get the care they need; we expect that they will release up to 10 million appointments a year by 2024-25.

The third part of our plan is about providing more staff and more appointments. We are making huge investments in our primary care workforce, and are on track to meet the manifesto commitment of 26,000 more primary care staff by next March, meaning that we have more pharmacists, physios and paramedics delivering appointments in primary care than ever before. In 2021, we hit our target of 4,000 people accepting GP training places, and our upcoming NHS workforce plan will set out how we will further expand GP training. We are also helping to retain senior GPs by reforming pension rules, lifting 9,000 GPs out of annual tax changes. These are the pension reforms that the British Medical Association welcomed, describing them as ‘significant’ and ‘decisive’ changes and citing them as ‘transformative for the NHS’.

As well as freeing up more staff time, our plan cuts bureaucracy, too, so that GPs spend less time on paperwork and more time caring for patients. We will remove unnecessary targets, improve communication between GPs and hospitals, and reduce the amount of non-GP work that GPs are being asked to do. For example, patients are often discharged from hospital without fit notes, meaning that they then have to go to their GP to get one. By the end of this year, NHS secondary care services, which understand those patient conditions better, will be able to issue fit notes, and we have streamlined the number of targets on primary care networks from 36 down to just five. Taken together, this work will free up around £37,000 per practice.

Today’s primary care recovery plan funds and empowers our GPs and pharmacists to do more, so that we can prevent ill health, keep cutting NHS waiting lists and improve that vital front door to the NHS for many millions of people. I commend this Statement to the House.”

--- Later in debate ---

[Lord Shipley (LD)]

My Lords, I support the comments made by the noble Baroness, Lady Wheeler, on the Statement. We on these Benches welcome the aspirational nature of what the Government are proposing. During the Covid pandemic, we all learned that community pharmacists play an absolutely key role in supporting the health system. In my personal experience of securing additional injections, I was very impressed by how well the whole NHS system worked in delivering the inoculation service through community pharmacies. One of the good things about it is that you can book a slot, in the same way you book a slot with a GP. However, for this to succeed—and to free up 30,000 GP slots, as the Government intend—booking an appointment with a pharmacist needs to be just as easy. We then need to be very clear about what pharmacists will do, and what GPs will no longer have a contractual obligation to do.

On the workforce shortages that have been referred to, it would help if the Minister could explain whether the manifesto commitment to deliver 26,000 more primary care staff by next March is deliverable. It is difficult to see how the Government will do that unless more money is made available, so I seek the Minister’s confirmation that more resource will be delivered on the back of this initiative to ensure that it happens.

I will ask the Minister three further questions. First, were patients of different backgrounds, genders and geographies involved in drawing up the plan, and can he outline the patient involvement? Secondly, is there sufficient qualified staff of all professions to deliver the multidisciplinary plan? Finally, as the noble Baroness, Lady Wheeler, asked, when does the Minister does expect the new plan to be up and running?

[Lord Markham (Con)]

I thank noble Lords for their comments and appreciate the general welcome for the tenets of the plan from all sides. I want to say that, rather than “too little, too late”, this is actually a plan that bolsters a service that is already on target for an increase of 50 million appointments from 2019—a service in which we are seeing a 10% increase per month versus pre-pandemic levels. I think that, on anyone’s reckoning, that is a pretty impressive achievement. The Pharmacy First plan that we talk about will free up another 10 million appointments a year in addition to that. Also, the use of digital technology will make it easier to get appointments and ensure that those who need them most can get them. It will ease the 8 am frustrations that we are all too aware of.

Addressing the comments on the pharmacy closures that have happened, this can only help pharmacists by increasing the income-generating services available to them and increasing the footfall into those pharmacies. This can only improve their income and so their overall viability. So I hope we will see, from all of this, an increase in the number of community pharmacies. To answer the point, we will be setting up booking systems so that you can digitally book your pharmacy appointment. Equally vital will be the use of the NHS app and other technologies, such as 111, to navigate through services, so you know when you should be booking an appointment with a doctor and when you should be booking it with a pharmacy. The use of technology will be a vital element in all that.

On the workforce, I absolutely acknowledge, as I think we all do, the importance of making sure we have the right workforce in place. That is why I think we are all pleased with and all supportive of the pension changes that will increase and retain the numbers of people. I am afraid I cannot give any more news on the date of the workforce announcement, but I can say that, as mentioned before, substantial work is going on in this place. Yes, we are committed to the increase of 26,000 staff, and this whole package has £1.2 billion of funding behind it, of which £645 million goes into the community Pharmacy First plan, because a vital part of all this, as noble Lords have said, is making sure that we have we have the qualified staff in place to do it.

So, I think we have a good plan here and it is probably best to hear what the industry has said. We have seen a welcome from across the board.

“This is the most significant investment in community pharmacy in well over a decade”


came from the Pharmaceutical Services Negotiating Committee. The Boots CEO said:

“We are really pleased … Our Boots pharmacy teams sit at the heart of communities, offering easy to access care and expert advice; it is great news that they’ll be able use their clinical expertise more widely to help patients”.


I really see this as a transformational step forward, united with the digital technology which will make huge differences. With that, I commend a plan that will make a real difference to patients and the services they receive from GPs in the community.

[Baroness Bottomley of Nettlestone (Con)]

My Lords, I commend this plan most warmly. It has long been said that family doctors are the jewel in the NHS crown, but of course there has been a total transformation in the primary care team: it is not simply family doctors but a much more complex team, and the frustration so many of them feel is that they work to the minimum of their ability rather than the maximum. As I understand this, it will enable people to work to the maximum of their skills and use their training to extremely good effect.

The other great difficulty is that patients want to be treated like partners—they want information, they want contact—so opening up the opportunity to use pharmacies far more is going to be extraordinarily important. Will my noble friend say a little more about the contribution of the NHS app? Obviously, it will take time for people to be really comfortable with it, but it seems to me that this could be a transformational component in releasing family services and making them more available.

[Lord Markham (Con)]

I thank my noble friend for her comments and completely agree that this plan is all about making sure that we are using our most skilled practitioners in the most effective way. We want to make sure that those people who really need to see a doctor get to see one when they need to, but that patients in need of other treatments that can be delivered by a community pharmacist, a nurse or some other medic, such as a physio, are seen by the right people. Fundamental to the navigation of all that is the use of technology and the NHS app, as my noble friend mentioned.

What I see is the app really helping inform people—giving them their patient records so they can do their own research and understand and take ownership of their own health. We all know that, just as we have seen in the space of banking and other areas, giving people ownership, so they can take control of their health, is fundamental. Once they are armed with that information, they can be helped to navigate to the point of most use. That is where I see fundamental change: it is an area where we will see such change in the way we all address our NHS services and look after our own health. I truly believe that it will be one of the most fundamental changes we will ever see in this space.

[Lord Boateng (Lab)]

My Lords, there is much in the Statement that is welcome, but I know from my own time, many years ago, as a very junior Minister in the Department of Health, but also more recently, as Chancellor of the University of Greenwich, with the role we play in the training of pharmacists, that small, independent community pharmacists have a real challenge in finding the space and capacity to provide advice and assistance to clients in conditions of sufficient privacy. What proposals will the Government come forward with, and with what funding, to assist the small independents—we are not talking about Boots and the big guys and gals but about the small independent pharmacists? What capital assistance is going to be provided to the small community pharmacists on our high streets who can potentially play such an important role, to enable them to structure their premises in a way that enables them to give the information that the Government are suggesting they should give in preference to GPs?

[Lord Markham (Con)]

The noble Lord makes a very good point. It is really making sure that the independents can play a very important role. It is, where necessary, making sure that whole-estate planning takes that into account. A lot of the work I have been doing with Minister O’Brien—he heads the GP space while I look after the capital space—is looking at how we can create the sorts of models where you can put pharmacies alongside GP surgeries, in many cases, and make sure that that capability is there. I freely admit that capital is at a premium within the system, so we have to be creative in the ways we use it, but the noble Lord is absolutely correct that this is a key way to make sure we have a network of independent pharmacies that can really serve their local community.

[Lord Bellingham (Con)]

My Lords, I thank the Minister for the Statement and put on record my gratitude to him and other junior Ministers who played a very important part in making sure that this initiative has been brought to fruition. I pay tribute to the local surgery in my own community in Norfolk, the Great Massingham and Docking surgery, where the receptionists are invariably incredibly patient and polite to everyone and the doctors are quite outstanding—they have a lot of very satisfied people in the community because of their attitude to local people who may have ailments. But, obviously, they are under pressure, and that is why I welcome the Government’s announcement on Pharmacy First and on recruiting new GPs. Can my noble friend tell the House whether the Government’s commitment to recruit an extra 6,000 GPs by the end of this Parliament is on course? Has the number of GPs in training increased? Can he just clarify those two points?

As the noble Lord, Lord Boateng, pointed out a moment ago, pharmacies are often at the centre of communities. Apart from anything else, pharmacists often have a really strong relationship with patients because they see them on a regular basis, understand their needs and see them consistently—which, unfortunately, is not always the case with doctors. That is why I support the Pharmacy First initiative, which could be a lifeline to a lot of pharmacies that are under pressure. They will be able to prescribe many more medicines, but can my noble friend tell the House whether they will be able to prescribe antibiotics for some of the conditions he mentioned? If that is the case, that would be a very positive extension to the services that they provide.

[Lord Markham (Con)]

I thank my noble friend. As evidence of the good work that receptionists do under trying circumstances, in a recent survey 91% of patients said that their needs were met. On the target of having 6,000 extra GPs by the end of this Parliament, currently we have increased the number by 2,000 but, in all honesty, I think the feeling is that we will struggle to meet the 6,000 target—I believe that is something that Sajid Javid, as Minister, said before. But there is a 50% increase in the number of graduate trainees since 2014, with more than 4,000 currently in training. So we have made steps in the right direction, albeit not as far as we would hope.

On the supply of antibiotics, the idea behind this is that there will be certain agreed treatments that the pharmacist will be able to give. Clearly, UTIs is an example where you often need antibiotics to clear those up, and in those circumstances there will be agreed treatments that pharmacists can give: provided that, in the pharmacist’s judgment, the symptoms warrant it, the pharmacist will be able to enable the supply of antibiotics. On all those, this is a very positive way forward.

[Lord Mann (Non-Afl)]

The Government’s housing policy is to build, or to have built, 300,000 new houses a year. Has that been factored into this announcement? Is it the Government’s view that these new houses are a problem for primary care provision, or can the Minister assure me that the funding formulas are sufficiently robust that new housing is seen as an opportunity for primary care?

[Lord Markham (Con)]

The noble Lord is quite correct to point out that, where you have a number of new houses in a local community, you need to make sure that there are primary care services to serve them as well. Funnily enough, just today I was having a conversation with Housing Minister Maclean on this very subject, about changing the way that we look at Section 106 payments—or CIL payments, as they are called these days—to make sure that the provision of the primary care estate is one of the key elements that can be funded through that. I know that DLUHC colleagues are very much on board with that, because absolutely fundamental to the point that the noble Lord makes is that we need to make sure that, alongside the new housing, which we all agree is very important, there are sufficient primary care services as well.

[Baroness Young of Old Scone (Lab)]

My Lords, I thank the Minister for the Statement but regret that it concentrates on more GP and other ancillary services to meet rising demand rather than focusing on the causes of that rising demand. A major source of pressure on GPs is due to the complications of diabetes, yet inadequate action is being taken on obesity, often in the face of pressures from the food lobby. Similarly, the Minister talked about the rising number of over-70s—I should declare an interest—yet much of that pressure is due to elderly people failing to get adequate social care and falling back on general practice because they have nowhere else to go. Yet, over the last 13 years, the Conservative Government have absolutely run away from any sort of reform agenda for social care. Will the Minister comment on whether new phones are going to plug even the short-term pressure, and will he tell us what sustained long-term solutions to managing down the demand for GP and other ancillary services his Government are thinking of?

[Lord Markham (Con)]

First, I completely agree with the noble Baroness’s point that prevention is better than cure—I think we would all subscribe to that—and that is what the Government’s manifesto pledge of five years’ more healthy life is all about. On how the app comes into that, it all comes down to people taking more control of their own health, such as by being able to receive reminders that it is time for their cervical smear or heart MoT, so that they can start to take ownership of their own health. Towards that, the community pharmacists have already provided 1 million blood pressure checks, through which 300,000 people were found to have high blood pressure. That is a prime example of where this expanded network really can get on to the prevention agenda, which we all agree is absolutely key to helping solve the health situation going forward.

Childbirth: Black Women

Lord Markham Excerpts

Wednesday 3rd May 2023 Lords Chamber

[Baroness Thornton (Lab)]

My Lords, in begging leave to ask the Question standing in my name on the Order Paper, I draw the House’s attention to my interests in the register.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

While births in England are among the safest globally, we must do more to tackle maternal disparities. Local maternity and neonatal systems have begun to publish action plans to tackle disparities in outcomes and experiences in maternity care at a local level. The Maternity Disparities Taskforce, which held a meeting on 18 April, brings together experts from across the health system, government departments and the voluntary sector to explore and consider evidence-based interventions to tackle maternal disparities.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer. On 17 April I asked the Government about discrimination in the UK experienced by people of African descent—the Minister for Equalities pooh-poohed this report and strongly rejected most of the findings of discrimination. The following day the House of Commons Women and Equalities Committee published a report which said that black women are four times more likely to die in childbirth than white women in the UK. Does the Minister now accept that there was a point to my Question, and that research conducted on behalf of the Government since 2000 has shown that black women as a group have consistently remained at the highest maternity risk?

I would also like to ask the Minister about continuity of carer, which means having the same midwife throughout your pregnancy. It is a cornerstone of the Government’s and the NHS’s commitment to deliver safer maternity services, and indeed the report itself says that it is one of the ways to overcome barriers and improve communication and understanding throughout a pregnancy. When will the Government invest in the recruitment of midwives, bringing up their strength by 2,500, which the Royal College of Midwives says is essential to deliver this personalised care?

[Lord Markham (Con)]

I thank the noble Baroness; there were a number of questions there. I accept that there is a disparity, which is why the Maternity Disparities Taskforce was set up. I was speaking to Minister Caulfield just this morning, and I assure noble Lords that this is very high on her agenda. That is why, in providing continuity of maternity care, the focus is on making sure that people from ethnic minorities, particularly black women, get priority.

[Baroness Manzoor (Con)]

My Lords, this is not a new issue. I am pleased to hear that the disparities task force has been set up, but can it look not just at the issues of workforce planning—there is a shortage of midwives—but at the additional antenatal care that black and ethnic-minority women need because of underlying causes, and at the care they receive during labour?

[Lord Markham (Con)]

My noble friend is right. I was speaking to Minister Caulfield about this very subject this morning. She pointed out that a lot of the reasons for the differences are underlying health conditions and factors such as smoking, weight and alcohol consumption, as well as diabetes. Education is a key part of this, as is continuity of care, and making sure that there is prenatal and postnatal care is absolutely a focus.

[Baroness Walmsley (LD)]

My Lords, the NHS published equity and equality guidance in September 2021 aimed at improving maternal health for mothers and babies from black and other ethnic groups and those from the most deprived areas. However, no implementation plan or scrutiny mechanism has been developed, so how will implementation and adherence to these strategies and guidelines be assured? Who will report on progress, or the lack of it?

[Lord Markham (Con)]

First, through its local maternity and neonatal systems, every ICB is responsible for publishing an equity and equality plan. It will then be the job of both the CQC and the maternity surveillance system to measure them against that plan and make sure it is being kept up. Every area is different, but each needs a plan to address this issue.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister mentioned the Maternity Disparities Taskforce meeting on 18 April. Can he explain why the Select Committee was able to report that the task force had not met for nine months preceding the writing of its report? It does not look like the task force is putting much energy into this. Can he also say whether the work that is now being undertaken will take into account the fact that black women are regularly underrepresented in research and data, which leads to them being neglected in policy-making?

--- Later in debate ---

[Lord Markham (Con)]

The noble Lord is correct that data is an issue. A lot of the frustration that Minister Caulfield expressed is about the fact that we are having to look in the rear-view mirror, because the data is about two years old. One of the fundamental things is to get that live data so that we can see what action works and where more needs to be done.

[Baroness Berridge (Con)]

My Lords, it is also sad to note that the rate of black babies being stillborn is 6.9 per 1,000 births, as opposed to 3.6 per 1,000 for white babies. Can my noble friend the Minister please confirm that each trust is under an obligation to collect that kind of data and do specific research as to why a modern country has that really sad rate of higher mortality?

[Lord Markham (Con)]

That is what the equity and equality plans are all about: understanding the local needs of an area. As I mentioned before, a lot of this is often due to the underlying health conditions of that ethnic-minority group. Also, many of us take for granted the fact that we are very clear on how to access medical services, but a lot of people from these ethnic minorities do not have the experience—for want of a better word —of accessing them. A key part of the plan also needs to be about how we can make this care accessible for all these groups.

[Lord Walney (CB)]

Is the Minister aware of the findings of the 2015 Kirkup report into neonatal deaths in Morecambe Bay? Among its findings, it concluded that ethnic-minority women were on a number of occasions not given respect and agency by white British midwives, which may have contributed to neonatal deaths. Has that been looked at by the department, and what has been done since?

[Lord Markham (Con)]

I am familiar with that report, and the more recent Kirkup report on east Kent mentions some of the same issues. That is why part of the investment has been in a training programme to make sure that the suitable cultural awareness is there, because the noble Lord is correct that this is an issue.

[Lord Sikka (Lab)]

My Lords, institutionalised racism is a major factor in the higher death rate of black women during childbirth. Numerous surveys have shown that black women are paid far less for their work than their white counterparts, which reduces their access to good food, housing and healthcare. Ethnicity pay gap reporting is a necessary tool for developing policies to tackle institutionalised discrimination. Why are the Government opposed to introducing ethnicity pay gap reporting?

[Lord Markham (Con)]

I do not think I would categorise this in any way in terms of institutionalised racism, and I do not believe that noble Lords would think that of the NHS. Clearly, work needs to be done on helping all ethnic minorities to access health services and on education, because there are many underlying conditions. That is what we are doing now. A few years ago, the numbers were quite a lot worse; black women were five times more likely to die in childbirth, but that figure is now 3.7. A lot more work needs to be done, but we are improving.

[Lord Hamilton of Epsom (Con)]

Does my noble friend accept that the term “institutionalised” is, in the words of the Metropolitan Police Commissioner, “ambiguous”, in that it means different things to different people? Can he define “institutionalised”?

[Lord Markham (Con)]

The point I was trying to make is that I think all noble Lords would agree that the NHS does a fantastic job in addressing and reaching people of all ethnic minorities. That is something we can all support.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister omitted to answer the first question put to him by my noble friend Lord Hunt of Kings Heath about the frequency with which the task force met and the gap between its last meeting and the moment at which its report was put forward, if I understood the question correctly. Can he answer that now?

[Lord Markham (Con)]

My understanding is that since the task force was set up, which was little more than a year ago, it has had as many as four or five meetings. If that is incorrect, I will correct it. The latest meeting was on 18 April. Again, if noble Lords look at the actions that have come out of it, they will all agree that it is actions that count the most. The task force has been very thorough, and Minister Caulfield is very committed.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the Minister has referred a number of times to socio- economic disparities—indeed, the noble Lord, Lord Sikka, referred to the issues of poverty. The MBRRACE report and others have shown the disparity in death rates that sees black women dying in childbirth four times more often than white women. Will the Minister acknowledge for the record that there is a tragic difference here—a higher number of deaths—that cannot be fully accounted for by pre-existing health conditions and socioeconomic disadvantage?

[Lord Markham (Con)]

As I have said, this is a complex area. I do not think we understand all the underlying reasons. Underlying health is a reason, and access is another. What the statistics show is that there is a difference, which is why we are so focused on addressing it and making sure that everyone has excellent standards of maternal care.

Life Expectancy: Pensions, Health and Insurance

Lord Markham Excerpts

Wednesday 26th April 2023 Lords Chamber

[Lord Rooker]

To ask His Majesty’s Government how changes in life expectancy as measured by the Office for National Statistics have affected planning for pensions, health and insurance.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The Government consider a range of metrics when determining our approach to pensions, health and insurance, including life expectancy where relevant. We are committed to improving health life expectancy by five years by 2035 and to reducing the gap between areas where it is highest and lowest by 2030. Our major conditions strategy will focus on health conditions that contribute most to morbidity and mortality.

[Lord Rooker (Lab)]

I thank the Minister, but is he aware that Office for National Statistics figures show that life expectancy, which is a key indicator of national health, has stalled in the UK since 2010 for the first time in 120 years? Is he aware that one consequence of this is that over half of families in England cannot get a funeral in less than three weeks, and 17% cannot get one for over a month? Funeral directors are running out of storage space because of what is happening. There are far too many early deaths under this Government, as shown in the report from the Government Actuary’s Department, placed in the Library last week, which states that before the pandemic the UK had the lowest life expectancy of any major European country.

[Lord Markham (Con)]

I am aware that there has been a similar phenomenon across all the G7 western nations. Life expectancy has been plateauing for the last few years, and the only country to buck that trend is Japan. A lot of this is to do with obesity, which I know noble Lords regard as a very important issue. While we are improving issues such as alcohol intake, the impact of obesity on healthy lifestyles is an important factor that we will need to tackle.

[Lord Allan of Hallam (LD)]

My Lords, as well as falls in overall life expectancy, there have been significant falls in disability-free life expectancy, as shown in the recent ONS figures. Can the Minister describe the steps his department is taking to understand why more people are acquiring long-term conditions earlier in their lives, and to ensure that health and social care services are geared up to meet that extra demand?

--- Later in debate ---

[Lord Markham (Con)]

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

[Lord Forsyth of Drumlean (Con)]

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

[Lord Markham (Con)]

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

[Lord Winston (Lab)]

My Lords, the Government have made a pledge that they know perfectly well they cannot keep. There is no way that this massive morbidity will be reduced: obesity is not the answer. If he looks carefully, he will see what the Science and Technology Committee—chaired by the noble Lord, Lord Patel, who may want to comment—showed: that it is clearly due to deprivation in poorer parts of the country, which leads to a much shorter life. The Government need to deal with this holistically; it is not the problem of the Department of Health and Social Care but a much wider issue.

[Lord Markham (Con)]

As ever, there are multiple factors at play. That is what the Office for Health Improvement and Disparities is all about: making sure that we are tackling this in exactly the holistic way the noble Lord mentioned, going back to all the major conditions that are causes of death and tackling each one by one. The 10 million cancer screenings save 10,000 lives a year, and our breast cancer screenings save 1,300 lives. There is a lot to do but a lot that we are doing already.

[Lord Patel (CB)]

My Lords, in his introductory remarks, the Minister quoted the Government’s ambition to extend healthy life expectancy by five years by 2035. Can he put some numbers to it? What age are we talking about?

[Lord Markham (Con)]

My understanding is that people are predicted to live a healthy life until around age 63. It is about looking at that aspect as well; it is not just about the length of life but how well we live it.

[Lord Robathan (Con)]

My Lords, last week, the Institute for Government issued a paper that said that every obesity strategy since the first one, in 1992, had failed. It also pointed out that taxes would have to rise to deal with the epidemic in obesity and type 2 diabetes. Can the Government bring together a decent strategy to help all the people who are overweight, so that they live longer and we have a healthier society?

[Lord Markham (Con)]

My noble friend is correct: it is a key issue. There have been successes such as the sugar tax levy, which has reduced sugar consumption by about 40%. But clearly, you need only to look at the statistics to see that all western nations, including the UK, are facing this problem. It is a challenge that we have to attack. We can learn a lot in this space from Japan, where employers and the whole society are very much involved in the healthy lifestyles of their workers and people.

[Baroness Merron (Lab)]

My Lords, life expectancy for those with a learning disability is particularly shocking: only four in 10 live to see their 65th birthday, nearly half of their reported deaths are avoidable, and those living in the north-west and the Midlands are at greater risk. What action are the Government taking to address the specific barriers faced by people with learning disabilities in getting access to the timely, quality healthcare which could perhaps extend their life expectancy?

[Lord Markham (Con)]

As noble Lords are aware, we have been putting significant investment into mental health; from memory, there has been a £2 billion-plus increase over the last year. In recognition that learning disability is an issue we particularly need to tackle, as the noble Baroness is aware, we are putting investment into schools so they can identify it early on. Some 35% of schools now have the right educational leads in this space, and the figure will rise to 50% next year. It is a big improvement, but do we need to do more? Absolutely.

[Baroness Cumberlege (Con)]

My Lords, my noble friend will be aware that for many years, the UK has enjoyed increases in life expectancy but now we are getting reports that the rate of increase is declining. What plans—I have given my noble friend notice of this question—do the Government have to reverse this trend?

[Lord Markham (Con)]

My noble friend, whom I thank for that question, has characterised this issue in exactly the right way. Life expectancy is still increasing, but not at the rate it was. That is why the major conditions strategy was launched. I can give one example: cancer is one of the six major killers, and we are seeing 20% more cancer patients this year than we were pre-pandemic. So there are improvements in this space, and that is what the major conditions strategy is all about; but clearly, the record investment we are putting in needs to show that sort of output.

[Baroness Wheatcroft (CB)]

My Lords, the Minister’s ambition to increase life expectancy is not being helped by the current wave of doctors strikes, with extended waiting lists certainly bringing down life expectancy rates in some quarters. Can he tell the House why he and other Ministers will not get round the table now, with no preconditions, to discuss how this might be brought to a speedy end?

[Lord Markham (Con)]

The noble Baroness is absolutely correct: any strike action is regrettable, and we have a part to play, as do the unions, in trying to make sure that we reach a sensible place. We feel we have done that for nurses and ambulance drivers with the Agenda for Change, and clearly, we want to do the same for doctors. I think all noble Lords can agree that we do not want the impact on patients and healthy outcomes that strikes cause.

Long Covid

Lord Markham Excerpts

Tuesday 25th April 2023 Lords Chamber

[The Earl of Clancarty]

To ask His Majesty’s Government what steps they will take to support those suffering from long Covid.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

We are committed to supporting people experiencing long-term effects of Covid-19. We have invested £314 million in long Covid care, establishing 90 specialised services for adults and 14 services for children and young people across England. These direct people with long Covid conditions into care pathways that provide appropriate support, treatment and rehabilitation. Furthermore, we have invested £50 million in research to better understand long Covid and how to treat it.

[The Earl of Clancarty (CB)]

My Lords, with ONS data now showing more than 2 million people affected by long Covid, is it not high time that this condition was properly addressed in the workplace, as asked for by Long Covid Support and the TUC? Will the Government specify long Covid as a disability under the Equality Act 2010, as other conditions have been? Will they recognise long Covid as an occupational disease for all front-line workers? This is surely the least we can do for those who risked their lives to protect ours and those who continue to work in an unsafe environment.

--- Later in debate ---

[Lord Markham (Con)]

I thank the noble Earl for his question and for raising this subject generally; it is of key importance to all of us. In the area of long Covid, we are still learning. The reality is that there are a lot of situations where, thankfully, long Covid might end after 12, 14 or 16 weeks. For those reasons, it is not appropriate to define it as a long-term disability in legislative terms at this stage. At the same time, clearly, if people are suffering from conditions that mean they are unable to work for a length of time, they are absolutely able to get personal independence payments and the other payments that are due to them.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister will be aware that there is real concern about the rising number of inactive people of working age, due mainly to long-term sickness. I accept what he said about the time limits, but to what extent is he concerned that our failure to tackle long Covid appropriately will add to that labour market inactivity?

[Lord Markham (Con)]

I take issue with the statement of failure to deal with it. We pioneered this space. We set up 90 specialist adult centres and 14 specialist centres for kids. We have invested £314 million and 80% of people are seen within eight weeks of being referred. That shows that we are taking this seriously. The noble Lord is absolutely right that we want to ensure that we get as many people into work as possible. In the case of long Covid, we are definitely doing that.

[Baroness Bull (CB)]

My Lords, the Minister will know that evidence shows that the risk of long Covid increases with each subsequent reinfection, and that most adults were last vaccinated in the autumn, which means that their immunity is waning and that they are vulnerable to new infection. For many, this will be their second or even third case of Covid. Given that the living with Covid strategy is to manage Covid like other respiratory illnesses, what consideration have the Government given to adopting a similar vaccination strategy as they do for flu, in that those not eligible for free vaccinations could be offered the option to buy a vaccination? Have the Government made any assessment of the impact that such a strategy would have on the number of reinfections and therefore the rates of people suffering with long Covid?

[Lord Markham (Con)]

I thank the noble Baroness. I think we all accept that this is a complex area where, naturally, we are being guided by the science. Our vaccination strategy has been focused on the highest-risk groups. On allowing other people to pay over and above, as with flu, I think it is best that I come back in correspondence.

[Lord Borwick (Con)]

My Lords, in the statistics for long Covid, are any particular professions overrepresented among sufferers?

[Lord Markham (Con)]

I thank my noble friend. We do not capture statistics in that way—I had a chance to ask the department quickly a few minutes ago—but I will inquire to see whether we can find out more on that. Obviously, some occupations, such as working in the health service, lend themselves more to it, because you are more likely to catch Covid, which is why how we look after our own staff is of paramount importance. On the wider point, I will come back to my noble friend.

[The Senior Deputy Speaker (Lord Gardiner of Kimble)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely.

[Baroness Brinton (LD) [V]]

My Lords, 2 million people currently reporting symptoms of long Covid is a shocking 3.1% of the population, with over a million people having had it for at least one year. There are some very successful models for assessment and treatment, but some clinics still assume that long Covid is like ME/chronic fatigue and do not investigate for microclots and heart and lung problems. Why is there not a gold standard for assessments and treatment of long Covid in England as there is in a number of other countries, including Scotland?

[Lord Markham (Con)]

I thank the noble Baroness. My understanding is that the 90 specialist adult centres and 14 specialist children’s centres have care pathways which they are supposed to adhere to. Therefore, I hope that the instances which the noble Baroness brings up are the exception, but I am happy to investigate because I think we all agree that a consistent care pathway is vital in this space.

[Baroness Merron (Lab)]

My Lords, despite the provisions that the Minister has outlined, the reality is that just a fraction of the people who have long Covid are seen and supported. What steps are being taken to ensure that GPs recognise long Covid in those who do not self-label as having the condition, and how will the Minister respond to the data that shows inadequate access to specialised health services?

[Lord Markham (Con)]

As I say, the data that I have been working with indicate that 80% are seen within eight weeks, which I think most noble Lords would agree is a pretty good statistic. My understanding is that GPs are fully briefed on referrals and disability types. It is clearly important that people who are suffering in the long term make sure that they get treatment.

[The Lord Bishop of London]

My Lords, the advice of the DWP and DHSC is that, if those impacted by long Covid are unable to work, they will be able to access financial assistance through schemes such as PIP. However, in practice, as the noble Baroness said, there is a lack of recognition of long Covid among GPs and PIP assessors. What steps are the Government taking to make sure that more long Covid sufferers are identified and able to access financial support?

[Lord Markham (Con)]

They are absolutely part of the prescribed path. I know from my DWP colleagues that it is part of the training that those people should be supported with personal independence payments. As of January, more than 4,000 people were being treated and receiving payments in this way. It is fundamental that they get access to those payments going forward.

[Lord Patel (CB)]

My Lords, two things are important in the long-term management of patients with long Covid. The first is epidemiological studies, and I am glad that the Government are backing with £50 million the NIHR to do such studies. The second is finding cures. Interestingly, the molecular studies carried out by Oxford show that there might be mitochondrial dysfunction, which leads to a loss of energy production and therefore fatigue. A drug that has entered its phase 2 trial sounds promising, so we must also support molecular science to find a cure for this condition.

[Lord Markham (Con)]

I thank the noble Lord and applaud the research work that has been done. As I said, we have invested £50 million on top of the £118 million for Covid research. Just as we were one of the front-runners in developing the Covid vaccine, with AstraZeneca, it is very much our ambition to be a front-runner in developing cures for long Covid.

[Lord Allan of Hallam (LD)]

My Lords—

[Lord Dobbs (Con)]

It is this side. Thank you for giving way; I appreciate it. So far, 223,738 people have died from Covid and it has cost this country between £310 billion and £410 billion. Last month, in a Written Question, I asked the Government what they thought were the origins of Covid. The Answer that came back, which was not a reply at all, was that they fully supported the World Health Organization’s study into its origins. But that is an organisation that once speculated that Covid might have come into China on a package of frozen food. The World Health Organization has achieved very little since, and Nature magazine has just revealed that it has “quietly shelved” its second scientific investigation into Covid’s origins. Why do the Government appear so uninterested in the origins of a disease that has cost us so much? Why did it happen, where is it going and how are we going to prevent a second epidemic causing the same sort of chaos that came from Covid?

[Lord Markham (Con)]

We are interested, and the Covid inquiry is all about finding out the origins and learning the lessons. I, among others, am very keen to hear that.

If I am allowed to, I am happy to take the question that was not allowed in. Okay, I am not—I tried.

Gender Identity Services: Children and Young People

Lord Markham Excerpts

Wednesday 19th April 2023 Lords Chamber

[Lord Young of Norwood Green]

To ask His Majesty’s Government what steps they are taking to ensure that, during the closure of the Tavistock gender identity clinic, young people who accessed those services receive appropriate counselling, as recommended by the Cass Review of gender identity services for children and young people.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

NHS England commissions children’s and young people’s gender identification services. All patients at the Tavistock gender clinic receive psychological or psychotherapeutic care. Following the Cass review interim report, NHS England is bringing the GIDS contract to a managed close and transitioning gender services to new providers that will deliver holistic and exploratory counselling. Existing patients will continue under the current care arrangements until they are transferred to new services based in specialist paediatric hospitals.

[Lord Young of Norwood Green (Lab)]

My Lords, I thank the Minister for his reply, but I would like to probe a little more on this. Does he recognise that 80% of the young people who are diagnosed with gender dysphoria, many of whom are girls on the autistic spectrum, realise when they reach the age of 18 that they have gone through a perfectly normal process of puberty? They might end up being gay or lesbian, but they certainly did not need to be prescribed puberty blockers, which are a serious medical risk. Can the Minister assure me that steps will be taken to ensure that those young people receive the appropriate counselling? It could be via CAMHS, but what it cannot be, as he rightly said, is through the discredited Tavistock clinic—and I would like to meet the Minister on this issue.

[Lord Markham (Con)]

Yes. As I have said before, it is one of the privileges of this job that you learn about new areas, and I thank the noble Lord for his Question; this is something I have enjoyed being educated on in the last few days. I am very happy to meet with him. The points he makes are absolutely right: a lot of these people have other issues and going through puberty is a difficult time. So the lessons have been learned and we will make sure that they are implemented.

[Baroness Hunt of Bethnal Green (CB)]

My Lords, I thank the Minister for his thoughtful reply to the Question and his curiosity about this subject area. I think that some issues and data that have just been shared are subject to debate and are not quite as substantial as has been suggested. When might the transition to these new services happen? At the moment, the young people on that waiting list have no knowledge of when they will be transitioning from the Tavistock to another service; there are those who have been waiting for an appointment since 2019, and four years is a very long time when you are a teenager, let alone when you are 43 and a half and a grown-up. We also know that that period is a very confusing time, so could we get some clarity for those young people on when they will be seen, by what service, and how quickly they will be able to get on to the system?

[Lord Markham (Con)]

The points are well made, and they are understood and accepted on this side. My understanding is that the northern and southern hubs, as recommended in the Cass review, have already been set up, so patients are being seen as we speak at the Great Ormond Street and Evelina centres, and a transition programme is being put in place for all those people who are currently there. I will happily pick up with the noble Baroness afterwards to discuss this further.

[Baroness Browning (Con)]

My Lords, the number of autistic children and adolescents at the Tavistock clinic was greater than the number of those in any other group. Would my noble friend just clarify his reply a little? I think this is going to require more than normal counselling, because there is a trait within the autistic mind that often focuses very strongly on a particular issue and, once an autistic person believes something is true, it is quite hard to get them to see it another way. So it is going to need expertise. What is being done to find those experts?

[Lord Markham (Con)]

My noble friend will be aware that I do have some personal knowledge in this area, and I recognise very much the point that neurodiverse people can become fixed on a certain outcome. In terms of the statistics, yes, as many of a third of the people seen at Tavistock do have those sorts of conditions. So, it is something that is understood. Again, I am happy to pick up afterwards. The key point of the Cass review in all this is that these people need to be seen by medical doctors who are considering everything in the round and not just coming at this through a gender identification lens. That is the key thing we need to make sure happens going forward.

[Baroness Burt of Solihull (LD)]

My Lords, whatever one’s views on trans issues, surely the first imperative is to ensure that young people are properly looked after. Would the Minister agree with me that every young person suffering from gender dysmorphia, whether they have attended the Tavistock or not, should receive professional counselling and support? If he does agree, can he ensure that the resources are available in a timely manner, so that these young people do not have to wait years while they try to unravel the complex set of issues they face concerning their gender identity?

[Lord Markham (Con)]

Again, my understanding—and I freely admit that the benefit of having these questions is that you then delve into them, which I very much support in terms of how this process works very well —is that these people who have been through these services need to be looked after and catered for, so that is something we are very much on.

[Lord Winston (Lab)]

My Lords, leaving aside the issue of the serious psychological problems some of these children undoubtedly display, can the Government clarify one issue? Do they regard so-called gender dysphoria, which is a very broad term, as a pathological condition or simply a medical one? Is it a pure choice of the individual? Therefore, the question is: at what stage should the National Health Service be intervening in these cases?

[Lord Markham (Con)]

I feel I am probably outgunned to some degree by the noble Lord. I would like to make sure that I answer that in the proper way and give him a detailed written response. I am happy to follow up, because I want to make sure that I am answering in completely the right way.

[Lord Sandhurst (Con)]

My Lords, the Times of 23 February reported that GIDS patients were still receiving puberty blockers. What arrangements are in place—as recommended by Dr Cass in her report—to monitor patients who receive treatment, both during it and in subsequent years by way of follow-up, to ensure a proper longitudinal study of the effects?

[Lord Markham (Con)]

My noble friend is absolutely correct: one of the main findings from the Cass review was that more research has to be done in the whole space of puberty blockers. The NHS is moving on that as we speak. At the same time, I can assure the House that, from now on, no puberty blockers can be prescribed unless they are part of that research programme, because it is vital that that does not happen as a matter of course until we understand far more about this subject.

[Baroness Wheeler (Lab)]

My Lords, the Cass review interim report underlines that the expansion of gender identity services to regional centres can be successful only if the NHS can attract and engage the workforce within those centres and for crucial network secondary services. This week, however, as we have heard, we have seen just how under pressure these key services are. Over a quarter of a million children in Britain with mental health problems are awaiting NHS referral due to major shortages of psychiatrists and specialist nurses. How are the holistic, person-centred services that young people desperately need going to be provided in the continued absence of a clear government workforce strategy?

[Lord Markham (Con)]

I am glad to say that there is a workforce strategy, which, unfortunately, we have not been able to publish yet. I assure your Lordships that a lot of work is being done, and there is a lot of work in place. I would be happy to meet with the noble Baroness and go through the findings of that, because it needs to cover a lot of these specialisms.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, we have a virtual contribution from the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, in reply to the question from the noble Baroness, Lady Hunt, the Minister referred to the new GID services at the Evelina and GOSH. But the original proposals were for regional clinics in Manchester and London—so when will the Manchester clinic open? Since March of this year, the waiting list and all new referrals are being held by the Arden and Greater East Midlands commissioning support unit. There is real confusion about how this list will be integrated with the existing case load as the new services open. Can the Minister explain what will happen? If he does not have the answer to hand, please will he write to me?

[Lord Markham (Con)]

As ever, I am very happy to write. In terms of the northern hub, I mentioned GOSH and Evelina just as examples. The Royal Manchester and Alder Hey are the northern sites that will be used to provide these services. The idea is that we will have eight regional centres—but I would be happy to provide the detail on both cases and follow up in writing.

Adult Social Care: Challenge Procedures

Lord Markham Excerpts

Wednesday 19th April 2023 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The Government have noted the findings in the report. Encouraging a culture of feedback and learning is vital if we are to improve services and people’s experiences of social care. The CQC’s local authority assessment framework, which went live on 1 April, includes oversight of local authority assessment and eligibility frameworks for adults and unpaid carers accessing social care and support. This includes looking at transparency and accessibility and whether people can appeal decisions effectively.

[Baroness Tyler of Enfield (LD)]

I thank the Minister for his reply. The EHRC report clearly demonstrates the problems facing social care users who have challenged local authority decisions, and it is a pretty bleak picture. But while there is much for local authorities to do to improve their complaints system, there are also important recommendations in the report aimed at government, including making the Local Government and Social Care Ombudsman the statutory complaints authority for social care in England. When and how do the Government intend to respond to these recommendations? Does the Minister agree with me that the shortcomings at local level will be remedied only by long-term sustainable funding of adult social care—not made easier by the Government’s announcement on 4 April, when Parliament was in recess, to hold back £50 million of the money promised to help plug staff shortages?

[Lord Markham (Con)]

First, we will respond in detail to the report the noble Baroness mentions. On funding, as I have mentioned before, the £7.5 billion over the next two years is a 20% increase and is substantial by any measure. I spoke to Minister Whately about this issue this morning, and she was at pains to say that, in terms of funding and overall numbers, everything is in place in this latest programme. Also, £600 million is being held in reserve to follow up in the areas that really need it.

[Baroness Wheeler (Lab)]

My Lords, the report underlines just how difficult the current social care system is to navigate and challenge, as we have just heard, yet it showed that fewer than two-thirds of local authorities commission advocacy services that can be accessed by users and unpaid carers to help them challenge vital decisions on care and support. The postcode lottery, the complexity of local challenge systems and the overall lack of consistency, national standards and effective monitoring prevent vital decisions about care being overturned. How are the Government ensuring that, as per the 2014 Care Act requirement, independent advocates are available across all parts of the country to help users and carers understand and access the system?

[Lord Markham (Con)]

As the noble Baroness says, it is a statutory part of the 2014 Care Act that advocacy be provided where people need such additional support. That is why we were keen to bring in the CQC to oversee local authorities, which it has from 1 April. This is one area where it will be making sure that advocacy is provided.

[Lord Allan of Hallam (LD)]

My Lords, Section 72 of the Care Act 2014 empowers the Secretary of State to regulate for an appeals system through which people can challenge social care decisions. It seems odd that we went to the trouble of legislating for this and yet, nearly a decade later, it still has not been implemented. What more evidence do the Government need to come to a decision about whether the benefits of such an appeal mechanism would outweigh the costs?

[Lord Markham (Con)]

The main point is that we already have two levels of appeal. In the first instance, someone can appeal to a local authority and if they are not satisfied with that, they can appeal to the local ombudsman. Thousands of people do this every year, and compliance in terms of replies to them is very high. I must admit that I am not sure whether an additional, third level of appeal is really necessary in this case.

[Baroness Pitkeathley (Lab)]

My Lords, once again, a Question in your Lordships’ House has pointed out the inadequacy of the social care system, be it funding or personnel. In answer to an earlier Question, the Minister teased the House a little about the workforce strategy. Can he be more specific in answer to this Question?

[Lord Markham (Con)]

First, I take issue with the inadequacy comment. Some 89% of people expressed a high level of satisfaction with the social care provided, which, although not 100%, is pretty good, as I think everyone would agree. As I said, the workplace plan has been drafted. I am afraid I cannot give an exact date of publication—I believe there are local purdah issues now—but I can say that it will be soon.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, one of the things this House has heard about many times is our reliance on unpaid carers and the important role they play in helping people who draw on adult social care to navigate the system. The 2014 Care Act put a duty on local authorities to identify unpaid carers, but that is not happening. What can the Government do to identify unpaid carers, so that we can support them more readily?

[Lord Markham (Con)]

I thank my noble friend for that question. The Government absolutely recognise the role that unpaid carers play—I have fulfilled such a role myself for a number of years—and it something we are working towards. We have introduced the leave provisions and a certain level of payments for them; that may be modest but it is a step in the right direction. Again, the whole idea of getting the CQC in this space is that it can start monitoring local authority provision and ensure that it is identifying unpaid carers, among other things.

[Lord Laming (CB)]

My Lords, last week or perhaps it was the week before—time flies—there was a report on the number of people occupying health service beds who are fit for discharge but are not being discharged, largely due to the absence of social care provision. Are the Government taking seriously reports of that kind?

[Lord Markham (Con)]

Yes, we are taking them very seriously. The House has heard me talk many times about the 13% of beds that are blocked. This is a key issue for the whole flow of the system, which is backed up right the way through. That is why we introduced the discharge fund. Again, Minister Whately is very focused on this issue.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, further to the question asked by the noble Lord, Lord Laming, in response to my noble friend Lady Pitkeathley, the Minister referred to an 89% satisfaction rate among people in receipt of social care. However, as the noble Lord, Lord Laming, has just pointed out, the issue is not the people in receipt of social care but those who are not, of whom there are far too many. That is exactly what is causing some of the problems the noble Lord referred to. Does the Minister agree?

[Lord Markham (Con)]

Again, this goes to the point about the massive increase we have put in place of £7.5 billion. I have not heard of but would be pleased to hear about any plans on the other side of the House to increase that funding, since £7.5 billion is a very large figure—a 20% increase. Clearly, we will continue to review whether more is needed; we have put in increases each year. The importance of ensuring social care provision is completely understood.

[Lord Blunkett (Lab)]

My Lords, can the Minister clarify his last answer? In replying to me on a previous occasion, he conceded that a very substantial part of the money he has just announced is from local authority council tax. Can he confirm that?

[Lord Markham (Con)]

Yes, absolutely; a large part of it is from central government funding and a large part is from local authority funding, given local authorities’ ability to use a precept and increase council tax. Of the 153 local authorities, 151 have taken that opportunity to increase the council tax.

[Lord McColl of Dulwich (Con)]

My Lords, does the Minister agree that in talking about the costs of health and social care, we seem to have forgotten that 40 million people in this country are moving slowly towards suicide by putting too many calories in their mouths, which is costing £27 billion every year?

[Lord Markham (Con)]

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

[Lord Forsyth of Drumlean (Con)]

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

[Lord Markham (Con)]

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

Diphtheria

Lord Markham Excerpts

Tuesday 18th April 2023 Lords Chamber

[Lord Roberts of Llandudno]

To ask His Majesty’s Government what plans they have to provide medical support to prevent the spread of diphtheria in the light of reports of a sharp increase in cases linked to Channel migration.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

In response to an increase in cases of diphtheria in November 2022, the UK Health Security Agency issued guidance recommending that new arrivals into initial accommodation sites be offered a diphtheria-containing vaccine and a course of antibiotics in addition to wider health protection interventions. The UK Health Security Agency is working with the Home Office, NHS England and local NHS teams to ensure that this ongoing intervention is delivered.

[Lord Roberts of Llandudno (LD)]

I thank the Minister for those words. It is amazing that the Home Office has rejected the support and experience offered by the Association of Directors of Public Health, whose president criticised

“the lack of information, co-ordination and engagement from the Home Office”.

This resulted in the situation being

“far worse than it could have been”

and

“put both asylum seekers and … hotel workers at avoidable and preventable risk”.

Why was the assistance offered by the directors of public health “rebuffed”? That is their word. Who in the Home Office took that decision, and why? Will it be immediately reversed?

[Lord Markham (Con)]

All I can say is that the Department of Health co-operates very closely with the Home Office. We have a screening programme for all migrants coming in, as I mentioned, and an 88% vaccination rate for diphtheria among them, compared with 93% of UK children. It is a very high rate indeed; that record speaks for itself.

[Baroness Manzoor (Con)]

My Lords, as the Question implies, the UK has an excellent record on uptake of vaccinations, but my noble friend will know that the level has fallen among children for the MMR vaccine. What action are the Government taking to ensure that the most vulnerable are given this vaccination and that rates go back up to pre-Covid levels?

[Lord Markham (Con)]

We are all aware of the rumours and allegations about the safety of the MMR vaccine, which we are all delighted to know were totally unfounded. As my noble friend says, it has been quite a task to regain confidence in it, but we are doing so and vaccination rates have gone up. I will provide her with the exact details of those new take-up rates.

[Baroness Finlay of Llandaff (CB)]

How are the Government working with those countries through which migrants pass when fleeing for their lives from war zones, given that many of them are held in very poor conditions where they pick up infectious diseases, including such things as scabies—which are parasites—TB and other diseases? They may also be exposed to chemicals because they take on farm work or factory work in a desperate attempt to get some money prior to arriving in this country. By working with other countries, we may decrease the burden on our NHS and prevent people presenting late with conditions such as diphtheria or even cutaneous diphtheria, which is extremely rare in this country but is now being seen in some of these very deprived populations.

[Lord Markham (Con)]

To be honest, I think the most effective method is to have the screening when people enter. Refugees come in from across the world so, to concentrate resources, it is best done on entry. The record speaks for itself; an 88% take-up rate is very high, comparable to that of the general UK population. I think we have got it right.

[Lord Hunt of Kings Heath (Lab)]

My Lords, coming back to the original Question, does the Minister accept that during the Covid pandemic the role that directors of public health played locally was critical to ensuring a co-ordinated and effective response? Does he agree that it is a great pity that the Home Office seems to have refused to engage with the Association of Directors of Public Health on this? Will he assure the House that the Home Office will start to engage with this organisation?

[Lord Markham (Con)]

I am probably best placed to speak about how we engage with the Home Office, which we have been doing pretty successfully. I agree with the noble Lord about the role that those public health directors played during Covid and will play going forward. UKHSA is very much committed to doing that as well. As I said, our record on interactions with the Home Office speaks for itself—it is pretty good.

[Baroness Blackwood of North Oxford (Con)]

My Lords, I am very pleased to see that UKHSA has issued guidance in response to the increased number of cases, but it will be important to know how effective the response and the screening are. What plans are there for pathogenic screening and other forms of surveillance going forward?

--- Later in debate ---

[Lord Markham (Con)]

I thank my noble friend. I was just talking about the first stage; we have a follow-up where we look at not just diphtheria but HIV, hepatitis, TB and other cases, on top of surveillance measures that UKHSA takes into account, such as wastewater surveillance screening. We have a full toolset to make sure that we capture any potential diseases early on.

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, we have a virtual contribution from the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, to follow on from the question by the noble Baroness, Lady Blackwood, last week the European Congress of Clinical Microbiology and Infectious Diseases published a report on the rise of diphtheria cases, noting that:

“Linked to an increase in migrant arrivals via small boat in … 2022, the UK experienced a sharp increase in diphtheria cases”.


Its report recommends that border officials and doctors should all have training on screening and identification of symptoms of infectious diseases, such as diphtheria and others outlined by other speakers. Will the Government implement this specific recommendation? Can the Minister say whether, on arrival, all asylum seekers are now offered a full health check and vaccination with doctors?

[Lord Markham (Con)]

As I mentioned, we are doing the screening. We lead Europe on this; my understanding is that no other European country is taking the extensive measures that we are. I can also reassure the House—I was speaking to Susan Hopkins on this just yesterday—that UKHSA has deemed that there is a very low risk to the general population. The uptick in cases that we are talking about is in the migrant population, and the fact that we are vaccinating 88% of them against diphtheria shows that we are on top of the problem.

[Baroness Merron (Lab)]

My Lords, we know only too well from pandemics that diseases do not respect borders, and though, as the Minister says, we ought to be well protected against diphtheria in this country given the vaccination programme, recent increases in vaccine hesitancy have given cause for concern. On the steps that the Minister referred to that should be taken to maximise vaccination rates, can he indicate whether this will reflect regional variations, bearing in mind that the National Audit Office has reported a lower level of vaccine take-up in London?

[Lord Markham (Con)]

Absolutely. As the noble Baroness is aware, vaccination take-up is the responsibility of the ICBs in their areas. Like many other places, London has unique demographics. As I mentioned, our record is pretty good in this area, but it needs to be done nationally on a uniform scale.

[Lord Allan of Hallam (LD)]

My Lords, in response to the questions from my noble friend Lord Roberts and the noble Lord, Lord Hunt, the Minister has twice told us how well his department’s officials are working with the Home Office. But his department’s officials are not present in local communities; directors of public health are. Can the Minister undertake to lobby the Home Office on behalf of the public health officials to make sure that they similarly have a good dialogue with the Home Office, which does not seem to be the case to date?

[Lord Markham (Con)]

Clearly, I am always going to support good dialogue—that is common sense, and we should do that. The proof of the pudding is in the eating, and 88% is a very good result. That notwithstanding, clearly it makes sense that they should work closely with local officials as well.

[Lord Watts (Lab)]

My Lords, 88% is very good, but why is it not 100%?

[Lord Markham (Con)]

As I say, compared with 93% in the UK population—who have many bites of the cherry, for want of a better term, because there are many opportunities for them through schools and everything—88% is very good. Is it perfect? No, but it is very good and definitely better than anywhere else in Europe.

Junior Doctors’ Strikes

Lord Markham Excerpts

Monday 17th April 2023 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

“Mr Speaker, the honourable gentleman seems to ignore the fact that we have actually negotiated a deal with the NHS Staff Council, and it is a deal that it has recommended to its members. Indeed, the largest health union has voted in favour of the deal—indeed, it is his own health union—yet he seems to think we should tear it up, even though other trade unions are still voting in response to that offer and their leadership had recommended it.

Secondly, he says that we should sit down and negotiate. We have made an offer of 10.75% for last year, compared with the Labour Government in Wales, who have offered just 7.75%. So the offer, in cash terms, in England is actually higher than the offer that is being put on the table by the Welsh Government, which I presume he supports. He says he does not support the junior doctors in their ask for 35%, and nor does the leadership there. We need to see meaningful movement from the junior doctors, but I recognise that doctors have been under significant pay and workforce pressures, which is why we want to sit down with them.

The bottom line is that the deal on the table is reasonable and fair. It means that just over £5,000 across last year and this year will be paid for a nurse at the top of band 5. The RCN recommended this deal to its members, but it was rejected by just under a third of its overall membership. It is hugely disappointing that the RCN has chosen not to wait for the other trade unions to complete their ballots and not to wait for the NHS Staff Council, of which it is a member, to meet to give its view on the deal. It has chosen to pre-empt that, not only with the strikes that come before that decision of the NHS Staff Council but by removing the derogations—the exemptions—that apply to key care, including emergency care, which is a risk to patient safety.

Trade unions are continuing to vote on this deal. The deal on the table is both fair and reasonable, including just over £5,000 across last year and this year for nurses at the top of band 5. It has been accepted by the largest union in the NHS, including, as I have said, the shadow Health Secretary’s own trade union. It pays more in cash to AfC members than the deal on the table from the Labour Government in Wales. It is a deal that the majority of the NHS Staff Council, including the RCN’s own leadership, recommended to its members. We have always worked in good faith to end the disruption that these strikes have caused and we will continue to do so, but it is right to respect the agreement that we have reached with the NHS Staff Council and to await its decision, which is due in the coming weeks.”

[Baroness Merron (Lab)]

My Lords, last week was the most disruptive in the history of the National Health Service, with some 350,000 patients seeing their operations and appointments cancelled due to industrial action. Does the Minister accept that the public remain supportive of doctors and nurses and also that the public want to see the Government reaching fair, negotiated settlements to bring disruption to an end? If Ministers remain unable to get agreements over the line, what other options are being pursued, including the involvement of ACAS?

[Lord Markham (Con)]

I think we all want fair outcomes and negotiated settlements, and I think we felt that the agreement reached with the Agenda for Change parties was fair and was something, as mentioned in the Statement, that the union leadership recommended to the union members. Of course, we need to wait to see the outcome of the staff council of all the Agenda for Change unions from 2 May to see where we end up on that. Our hope is that, across the majority of those, we will see support. As noted, this is a generous offer; it is higher than the offer made in Wales, for example, and we hope it will be a way forward after 2 May. If that is not the case, we need to sit down and think about next steps.

[Lord Allan of Hallam (LD)]

My Lords, the Secretary of State in the other place rightly referred to the workforce plan as essential to dealing with some of the stress that is contributing to the industrial action. I checked the record, and the Minister first told us that this plan was going to be released “shortly” on 2 February. Yet Valentine’s Day came and went, and there was no plan. Now, Easter has come and gone, and there is no plan. I wonder if the Minister could tell us whether “shortly” is getting shorter or longer? Should we be expecting the plan closer to the Coronation or the 75th anniversary of the NHS in July?

[Lord Markham (Con)]

I am afraid I cannot provide a lot more information to the noble Lord, except that complications now include the purdah for local government elections, so I am trying to find out more details on this very subject as to when a date could be set. I am afraid to say I cannot give much more of an update than to say it will be released shortly. What I will say is that, among all this, we are still seeing increases in staff. I was delighted to see that we now have 5,100 more doctors in place than last year, and we have had an increase over the last few years of 30,000 nurses. So, there are movements in the right direction, but clearly more needs to be done.

[Baroness Falkner of Margravine (CB)]

My Lords, we still call it the National Health Service, but the Minister will be aware of the alarming figures for people who have no choice but to move to private provision of care. The numbers registering even for GP services privately must give cause for alarm, because we have got to be in this together to retain the national character of the National Health Service. I appreciate the Government’s concern about higher inflation due to very large settlements, but perhaps the answer is to sit down through ACAS, as the noble Baroness said, and think about slightly more generous one-off payments, because that will not bake in the inflation or increase costs in the longer term.

[Lord Markham (Con)]

I thank the noble Baroness. As I mentioned, we felt we had put a fair offer on the table—something that was recommended by the trade union leaders themselves. I think we need to see the overall verdict come out across the board on all this. I note that less than a third of the membership of the RCN actually turned it down in the end, so we have to see what the overall outcome is. There is an absolute commitment on our side to continue meeting constructively with the RCN and to use all means possible to get to a solution.

[Baroness Bottomley of Nettlestone (Con)]

My Lords, those who have awarded degrees to doctors and heard them take the Hippocratic oath that they shall do no harm can scarcely be impressed by action being taken in which the public—patients—are suffering and in which enormous pressure is put on other colleagues in the health service. I, for one, think this is a very miserable occasion, and I hope to goodness that all those in the health service involved in action will think again.

I would like my noble friend to remind us about the importance of the pay review bodies, which were fought for long and hard. If we jeopardise or undermine them, that will be a long-term legacy that not only this Government but a Government of any other persuasion may pay the price for. Can he also say a little more about junior doctors and the steps being taken to increase their remuneration and deal with their working patterns?

All will agree that the health service today is extraordinarily complex. When I was Secretary of State, we spent 5% of GDP on health. That figure is now 12%, and there is not an infinite pit. I hope that reason will prevail.

[Lord Markham (Con)]

I thank my noble friend for her questions and the wise points borne out by her own experience. The impact this is having on patients is a regret to us all. On derogations, the history has been that the unions have sat down and made sure that life is protected. It is a regret that the BMA junior doctors have not done that in this instance, and that the RCN is saying right now that it is not considering derogations in its new strike. I hope that this position will change. I do not think anyone in this Chamber would want to see life threatened in this way. I know that we are doing everything we can on our end—as I say, offering more than devolved Governments—to solve this situation. I ask for good will on all sides so that we can protect patients first.

[Baroness Bennett of Manor Castle (GP)]

My Lords, in following on from the last question, I point out that the rising percentage of GDP spending reflects a fast-ageing population and the fact that we have terrible levels of public health, terrible housing and terrible diets. All sorts of other issues that are putting huge pressures on our NHS are at historically high levels.

I want to focus on the junior doctor situation in particular. There are currently 9,000 NHS doctor vacancies. The rate of departure of doctors from the NHS is twice what it was a decade ago. Does the Minister acknowledge that the situation of doctors in particular—and, in fact, that of all medical professionals—is rather different from other professions in the sense that we have a huge global shortage of medical professionals? We are seeing many doctors voting with their feet over their current terms and conditions and leaving the NHS, and the Government are not in what you might call a normal industrial situation of saying, “Well, we’ll just have to play tough and negotiate”. There is a huge risk that we are going to lose a whole generation—or generations—of doctors from the NHS who are irreplaceable. The Government have to look at this in a co-operative way to find a way forward, rather than setting out a confrontational approach to the strike action.

--- Later in debate ---

[Lord Markham (Con)]

I thank the noble Baroness. Yes, we do live in a global market. We absolutely have to be mindful of the fact that if our working conditions are not attractive, people will vote with their feet. At the same time, I am glad to say that we have 5,100 more doctors than we did last year, as I mentioned earlier. Clearly we want to do more work on that, but the proof of the pudding is in the eating, so to speak. That is not to say that we do not want to retain as many doctors and nurses in all their professions. Of course, that is what the workforce plan will be all about as well.

House adjourned at 7.30 pm.

Social Care

Lord Markham Excerpts

Thursday 30th March 2023 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

My Lords, it is my pleasure to respond to the excellent debate today, to follow so many distinguished speakers and, probably most of all, to hear, in my noble friend Lord Polak’s words, the politics being taken out of care. Today has been an excellent example of that, and I hope I can follow in that vein.

I regret that our social care report has not been published today. As noble Lords will be aware, we were hoping it would be published yesterday, and we were going to offer an embargoed copy of the report so that everyone could contribute. That is the reason for the delay in responding to both committee reports. I undertake that we will respond to both reports after we publish our social care report, and I personally offer a round table to everyone who is interested, where I will seek to bring the relevant officials along as well. I hope we can have a productive conversation in a similar vein to this one, where we all get around the table as people who care about this issue and, as mentioned, take the politics out of care.

I thank the noble Baroness, Lady Andrews, for securing today’s debate, all noble Lords across the Chamber for their thoughtful and considered contributions, and all those who have sat on the committees that have been mentioned. I feel that they have really added impetus to this whole debate. I hope the report that we offer will answer many of these points, build on the progress made so far in this space and bring a vision into reality.

Before I go into detail and respond to the reports, starting with the Lords Select Committee report, I would like to say how fitting the words “gloriously ordinary life” are. I was struck by the whole sense that, if I caught the phrase right, we can live in a place we call home, with the people we love and the things we care about. That is something that we can all agree with and commit to as our North Star and vision for what we hope to do.

Not only is it vital that we allow people to live in the way that they want but it is a vital part of our health service, as mentioned by my noble friend Lady Shephard and the noble Lord, Lord Turnberg, who had many brave words to say today. We all know it is vital to unblock the system. Some 13% of our beds are blocked at the moment, to answer my noble friend Lady Shephard’s point. As the noble Lord, Lord Turnberg, said, it is often as difficult to get out of hospital as it is to get into it. We have put in funding to help with this issue: £700 million of funding this year alone to help with discharge and £1.6 billion over the next two years. This whole debate shows that it is vital not just to the well-being of our people that we have a good system of social care but to our health service in improving the whole flow of the system.

On that, I reassure noble Lords that the Government recognise the importance of responding to the Lords Select Committee report. As mentioned, we will release a response shortly after the social care report is published—I hope, as I say, next week. I assure the committee that the Government agree with the vision in the report. We particularly welcome the committee’s view that social care does not have the voice and the visibility that it deserves. That often means that people are not supported to meet their ambitions. By rethinking attitudes to care and support, we can ensure that people access the care and support that meet their needs.

Equally, I thank the most reverend Primate the Archbishop of Canterbury, the right reverend Prelate the Bishop of Carlisle and the Commission on Reimagining Care for its recent report, Care and Support Reimagined: a National Care Covenant for England. I was struck by the words, “care based on faith and values”, where we recognise that we all have a mutual responsibility in delivering that. That struck a chord with me, along with the idea of the need to develop a national care covenant, where we all look to do our part in delivering the system. I look forward to developing those thoughts more at the round table.

It is important that we recognise the important contribution that communities and faith organisations make to adult social care. We echo the commission’s vision for care and support that is inclusive, universal and fair, and recognises our mutual responsibilities as citizens. The Government are keen to work collaboratively to make change a reality, and, having spoken to Minister Helen Whately, I know how much she enjoyed the meeting she had with the commission and how keen she is to drive forward the report.

I turn to the Government’s vision for adult social care. Again, I apologise; I feel that my hands are slightly tied behind my back, having to make this speech prior to the publication of our report. As we all know, back in December 2021 the Government published People at the Heart of Care. This set out a 10-year vision that put people at the centre of social care to make sure that everyone who draws on care and support feels empowered to have the choice, control and support they need to live independent and fulfilling lives. This is a vision that aims to make social care fair, accessible and of high quality, and to lead to better outcomes for people who draw on, work in and provide care and support. This Government remain committed to that vision.

I am pleased to report that the Government’s upcoming plan will outline how we will make progress towards this vision. It will also provide the clarity asked for by this House on key policy areas, including outlining how we plan to allocate the funding set aside for reform. Ahead of that publication, I would like to share some of the progress that the Government have made so far.

I start with the workforce, the importance of which the noble Lords, Lord Lipsey and Lord Prentis, and the noble Baronesses, Lady O’Grady and Lady Tyler, to name just a few, focused on. This was a point reiterated by our Prime Minister the other day. We all know that the social care workforce is one of our biggest assets, but we recognise the challenge we have right now to recruit a workforce of the right size, with the right skills, that feels appropriately motivated and rewarded. The Government have taken action to boost workforce capacity with recruitment opportunities both at home and abroad, with over 55,000 visas granted for care workers and senior care workers last year. This is complemented by our national recruitment campaign, Made with Care.

To respond to the points made by the noble Lord, Lord Turnberg, and the noble Baroness, Lady Wheeler, our upcoming plan for adult social care will include proposals for a new adult social care workforce pathway, building on our commitments in the People at the Heart of Care White Paper to give a career structure for people in this vital sector. Our chief nurse champions and raises the profile and visibility of nursing in social care, working alongside the Chief Social Worker for Adults to increase the recognition and appreciation of all our care workers.

On funding in this space—this is a point noble Lords have heard me make many times before but it is worth reflecting on—the £7.5 billion increase over the next two years will flow through to workers. The vital point is that it will largely flow through into the workforce.

Many noble Lords talked about technology. We all know that to increase workforce capacity we have to significantly increase the use of digital tools. Last year, we made £35 million available to the integrated care systems to support sector digitisation, including the adoption of digital social care records. As a result, approximately 52% of providers now have a digital social care record, up from 40% in December 2021, and we have plans to extend this much further. These records can provide up to 20 minutes per care worker per shift, and allow more time to provide care and support. Good data is fundamental to the delivery of high-quality care and, as the noble Baroness, Lady Barker, mentioned, sharing that data is vital as well. Our use and understanding of adult social care data is better than it has ever been, but we know there is a lot more to do.

From next month, our flagship client-level data project will become mandatory for local authorities in England. This will transform our understanding of people’s experiences and outcomes. For the first time, we will be able to track an individual’s journey through the health and care system to aid with navigating its difficulties—again, as mentioned by the most reverend Primate the Archbishop of Canterbury and my noble friend Lord Polak. Also as of Monday, the Care Quality Commission will begin to assess local authorities’ delivery of their Care Act duties, including those for unpaid carers. This will make good practice, positive outcomes and outstanding quality easier to spot locally and share nationally, while identifying where improvement and additional support is needed. But as much as data and technology could help, I totally agree with the point made by the noble Baroness, Lady Bennett: there is no substitution for the loving care of a human.

To ensure that care and support is personalised to people’s needs, our White Paper rightly sets out our ambition to support high-quality, safe and suitable homes, recognising that they can help people of all ages stay independent and healthy for longer. That is why, alongside the Department for Levelling Up, Housing and Communities, we will shortly launch the older peoples’ housing taskforce. It will bring together experts from across the sector to make recommendations on how people can access the housing they need.

I turn to the area of unpaid carers, which we all agree is the backbone. As noble Lords are aware, it is something that I have personal experience of. The point was brought out very well by my noble friend Lady Fraser, among others, because it is important that we recognise the vital role that unpaid carers play in our communities. We all owe them a debt of gratitude. Under the Care Act 2014, local authorities are required to undertake a carer’s assessment for any unpaid carer who appears to have a need for support, and to meet their eligible needs on request from that carer. This year, we have earmarked over £290 million for unpaid carers through the better care fund, including to provide short breaks and respite services. It is a step in the right direction; I use those words advisedly because carers are a vital area, as many noble Lords, particularly the noble Baroness, Lady Pitkeathley, have recognised, and there is a lot more that we need to do.

I hope that I have addressed many of the questions as I have gone through. I will try to pick up a few others and, as ever, follow up in writing in detail. It will be after the reports are published next week—and, to answer the noble Baroness, Lady Andrews, yes, we are planning to publish more on people at the heart of social care next week.

In answer to the noble Lord, Lord Bradley, yes, the ICBs will be at the forefront of this system for the planning and provision of social care. However, I will need to come back in writing on his question around the role of the DWP in analysing and reporting in this space.

In answer to the noble Baroness, Lady Campbell, we definitely embrace the principles of co-production. I hope that will come out in the report itself, as we work with 200 stakeholders in the provision of it all. We really hope to see the ICBs at the forefront of this and the better care fund being a key part of co-production.

I was struck by the point made by the noble Baroness, Lady Jolly, about 90 year-olds caring for 70 year-olds. I await my next Oral Question after the Recess.

The noble Baroness, Lady Donaghy, asked about help for providers on energy funding. Again, I hope noble Lords would agree that we have provided significant help. I am glad to see that, the last time I looked, gas prices were lower than last summer, when the action was prompted. They are moving in the right direction, but it is probably an example of needing to watch this space, while being mindful of the issue at stake there.

I hope that I have answered many of the questions raised. In conclusion, over the past year, the Government have invested significantly and have secured another £7.5 billion of funding for over the next two years—but this is only the start of the journey.

[Baroness O'Grady of Upper Holloway (Lab)]

Before the Minister sits down, can he provide an answer to the question about the media reports on cuts to the £500 million workforce budget?

[Lord Markham (Con)]

This is one of the areas covered in the report that will be published next week. At this stage, I can say only that the need for the training and development of our social care staff is understood and recognised in that report. I hope that it will give a response to the noble Baroness’s question, and that she understands why I cannot say more at this point.

Taking the words of the Select Committee’s report, I hope that these actions show that we are moving in the right direction

“to live in the place we call home, with the people … we love”,

based on faith, value and our own mutual responsibility in delivering that aim. Once again, I thank the noble Baroness, Lady Andrews, for securing the debate and this valuable opportunity to discuss the future of adult social care. I reiterate the hope that we can all gather at a round table to discuss this once the report has been announced and we have responded to the various other reports. Finally, I extend my thanks to everyone who works in the social care sector and to the unpaid carers for everything they do to support others.