Maternity Services

Lord Markham Excerpts

Thursday 9th February 2023 Lords Chamber

[Lord Patel]

To ask His Majesty’s Government what steps they intend to take in response to the Care Quality Commission’s Maternity Survey 2022, published on 11 January.

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

My Lords, we are committed to continuing our work to ensure that all maternity services provide safe and compassionate care. We will continue to closely monitor progress in improving the standard of maternity care across the country. We have made significant investment into maternity and neonatal services, with £127 million announced in 2022 to go into the maternity system to help to increase the NHS maternity workforce and improve neonatal care.

[Lord Patel (CB)]

My Lords, I thank the Minister for his Answer. The Ockenden report on Shrewsbury and Telford, the Kirkup reports on East Kent and Morecambe Bay, the current report of the CQC, the fact that the CQC fined a Nottingham hospital the maximum amount—£800,000—for a baby death, and the fact that we are now paying out in maternity litigation costs over £1 billion per year all point to one thing: a question of safety in our maternity units. Mothers and babies should not die in our maternity units without care and compassion, but that is what is happening. I am glad that the Minister, the honourable Maria Caulfield, met Dr Kirkup last week, which is a great improvement and progress. I hope the Government will now take seriously the need for zero tolerance of mothers dying in our maternity units and zero tolerance of normally formed babies dying or being damaged in childbirth. I shall keep pursuing this until we get that.

[Lord Markham (Con)]

I welcome the noble Lord’s pursuit because that is absolutely the right thing to do. I think we all agree with that, and we would all say that what happened in East Kent and the other examples from the Ockenden report are clearly not something that we are happy with or that we should put up with. The Kirkup and Ockenden reports gave us a north star, a way forward. I am pleased to see that we are making progress on that, but I expect the noble Lord to hold us fully to account because I am holding the department to account on this.

[Baroness Manzoor (Con)]

My Lords, building on what the noble Lord, Lord Patel, has said, my noble friend will know that continuity of care is really important and has been recommended by the Better Births maternity review. That builds up with better medical understanding of the woman, the pregnancy and the issues related to it. However, only 37% of women are afforded this, and that drops down to 27% in antenatal care. What are the Government doing to take steps to address this so that the terrible examples that we have seen recently are averted?

[Lord Markham (Con)]

I agree with the work by my noble friends, including the noble Baroness, Lady Cumberlege, to put the importance of midwifery continuity of care at the centre of everything. The survey to which my noble friend’s question refers shows that that is coming through in terms of a consistent message that having that confidence in the person in treating them is vital to all of this. That remains important. Key to this is the workforce, so this is one of the things that is being built into the workforce plan. That is starting with ensuring that we have new people coming in. The 1,200 graduates that we now have going into training each year are a vital part of making sure that we can deliver.

[Baroness Barker (LD)]

My Lords, report after report shows that the current system of treating maternity and reproductive health services on an episodic basis is costly and inefficient. Will the Government undertake to review that so that we can begin to go back to the system where staff were trained in both maternity and general nursing? We could therefore treat women on the basis of the whole of their lifestyle and get back to doing the most important jobs, such as making postpartum contraception available, which in the end would not only enable women to be treated more safely but save the NHS money.

[Lord Markham (Con)]

That question probably deserves a more detailed reply then I can give here in 30 seconds. In terms of the direction of travel, continuity of care, not just in the maternity service but in understanding that person and their needs, has to be the right thing to do to make sure that we have cradle-to-grave treatment with people who know your case. So I agree with that direction of travel and I will follow up with a more detailed response.

[Baroness McIntosh of Pickering (Con)]

My Lords, will my noble friend update the House on the number of midwives available? I understand that there is concern among expectant mothers about the availability of midwives.

[Lord Markham (Con)]

The figure for the number of midwives has been roughly constant over the last few years at about 23,000. We want to increase that, which is why we have made a commitment to increase the number of graduate places to more than 1,000 each year. This year, as I say, we have 1,200 places, so we are making good progress.

[Baroness Merron (Lab)]

My Lords, there is an almost twofold difference in maternity mortality rates between women from Asian ethnic groups and white women, while black women are now 40% more likely to experience a miscarriage than white women. When will there be a report from the Maternity Disparities Taskforce? Could the Minister confirm that Parliament will have a full opportunity to examine its findings and review the progress that has been made?

[Lord Markham (Con)]

The noble Baroness is quite right to point out those figures, and they are something that none of us is happy with. That is exactly what the Maternity Disparities Taskforce was set up to deal with, so I am happy to make a commitment to talk through with the noble Baroness the progress of that.

[Baroness Finlay of Llandaff (CB)]

My Lords, running through the reports that my noble friend Lord Patel referred to are two strands: one is workforce, which relates to numbers and qualifications, but the other is dysfunctional teams and a failure of teamwork across the different disciplines, both within maternity services and relating to general medical services, for providing support to women, particularly those with multiple comorbidities who are then going through pregnancy and delivery. I wonder whether the Government are commissioning a specific piece of work to look at ways in which these teams can alter their behaviours internally and be supported to improve on this dysfunctional behaviour within them, which is having an adverse knock-on effect on the experience of mothers and on the clinical outcomes which, as has been said, are sometimes fatal.

[Lord Markham (Con)]

Yes, one of the Kirkup recommendations—recommendation 3, I believe—was about an improvement in teamwork, and that is what will be done under the guidance of national and regional maternity safety champions. I should say that while there is much improvement that we want to do, the overall context is a 19% decrease in stillbirth since 2010 and a 36% decrease in neonatal mortality over 24 weeks since 2010. So it is an improving picture, but it is something that we want to improve further.

[Lord Allan of Hallam (LD)]

My Lords, another day, another area of the NHS that is suffering from serious staff shortages, and these shortages are having a real impact on the willingness of midwives to stay in the profession, more than half of whom are considering leaving the NHS, according to surveys by the Royal College of Midwives. What is the Minister’s view on the proposals that have come from various groups that there should be nationally agreed minimum staffing levels for maternity and neonatal staff?

[Lord Markham (Con)]

Again, I think there are certain things that we are saying we want to see in place. Continuity of care is part of that, and the workforce plan is how we put teams around to do that. It will always be a feature that we then expect the local health trusts and ICBs to work out how best to do that in their own situations. I also say in this context that we are increasing our numbers but this is not like other demographics where we have an ageing population. The birth rate, as we all know, is actually constant/declining, so it is not like those other areas where we are talking about that. Notwithstanding that, as I mentioned before, we are increasing the number of graduate places.

Hospitals: Maintenance

Lord Markham Excerpts

Thursday 9th February 2023 Lords Chamber

[Baroness Merron]

To ask His Majesty’s Government what assessment they have made of the NHS’s Estate Returns Information Collection data, which show that the cost of maintenance work on hospitals in England exceeded £1 billion in 2021–22.

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

Patient and staff safety is our top priority: that is why the Government are providing £12 billion in operational capital to the NHS over the next three years for trusts to maintain and improve the estate. We support the increasing levels of investment by trusts to ensure that facilities are safe and maintained to a high standard.

[Baroness Merron (Lab)]

My Lords, while the cost of replacing crumbling wards and operating theatres soars, only 10 of the 40 proposed hospital construction projects have full planning permission and the National Audit Office is investigating the programme. Can the Minister confirm how many of the 40 promised new hospitals will actually have been built by 2030? Can he also confirm that they really will be hospitals and not extensions or refurbishments?

[Lord Markham (Con)]

Twenty-one outline or full planning permissions have been given, which is totally on track with the target. Clearly, if some of those hospitals are not being built until, say, 2027, there would be no detailed planning permission yet. So those statistics are not representative of the situation, which shows that the programme of planning applications is on track. I am committed, as are my colleagues, to ensuring that we deliver the 40 by 2030.

[Lord Scriven (LD)]

My Lords, what are the Government going to do to end the ludicrous situation whereby even if NHS trusts have cash in the bank or access to the proceeds of asset disposals, they can be barred from improving major equipment on their estate because of arbitrary departmental capital expenditure limits imposed by the Treasury?

[Lord Markham (Con)]

Clearly, we want to give each trust the freedom to spend where it needs to. Obviously, there are overall Treasury rules but the main thing is the increased allocation we have made available in this space. We have spent £1.4 billion in the past year, which is a 57% increase, recognising that it is a good thing to put preventive maintenance in place to get on top of the backlog.

[Lord Davies of Brixton (Lab)]

My Lords, I may not be doing the Minister much justice but I admire his ability to give straight answers. I also admire his ability to maintain the fiction of 40 new hospitals. Does he accept that the Nuffield Trust puts the number of hospitals that any person in the street would recognise as new at three?

[Lord Markham (Con)]

I know that it is a lot more than that. The number of cohort 1 and cohort 2 hospitals being built at the moment is substantially more. This is a real programme; in fact, I invite all my colleagues here to a parliamentary open day, which I think will happen in the next month or so, when we plan to exhibit exactly what we are doing. We will have virtual reality glasses so that noble Lords can see the hospital of the future. Please come along and see for yourselves how real this programme is.

[Baroness Wheatcroft (CB)]

My Lords, the old joke about how many men it takes to change a light bulb tends not to go down well in PFI hospitals, where the answer can be “Several—and a lot of money”. In November, the Minister said to me that he was re-examining all these ruinous PFI contracts. Can he tell the House what progress he has made?

[Lord Markham (Con)]

We are actually making a lot of progress on them. A number of them, dare I say it, were introduced by Governments of a different colour and we are now working through and correcting those. At the same time, private capital can do a lot of good things. Many in the House will have heard me say just yesterday that if we put LED lightbulbs in every hospital, it would cost £400 million and save £100 million a year. That is the sort of thing private capital will fund every day of the week, probably at a 5% yield, giving us £95 million of savings a year. That is a good use of private capital, and the sort of thing I am looking at.

[Lord Allan of Hallam (LD)]

My Lords, I am surprised that more noble Lords have not dived into this report. It is fascinating, especially sheet 7 of the spreadsheet, which tells us that NHS England is spending £234 million a year on storing medical records. So while some parts of the NHS are working towards all-singing, all-dancing federated data platforms, in other places the height of modern technology is a new shopping trolley to move mouldering files in and out of a dingy basement. Will the Minister share with the House the Government’s plans to digitise or securely dispose of those paper records so that in future editions of this ERIC report, we will see that that £234 million has fallen close to zero?

[Lord Markham (Con)]

The noble Lord makes an excellent point. As he knows, we are investing heavily in a federated data platform, which is precisely about stopping storing paper and making such savings. Even more importantly, it is about improving patient care so that we can ensure that records are transferred instantaneously and really build on the knowledge that will bring.

[Lord Harris of Haringey (Lab)]

My Lords, I am not sure that the Minister really addressed the question my noble friend raised about the number of hospitals. He said that it was substantially more than three, then tailed off without giving us a number. He promised us a virtual reality opportunity to look at “the hospital of the future”, but I do not know whether that exhibition will show exactly which hospitals the 40 in question are, what is going to happen and how many of them a normal person in the street would regard as new. While he is on his feet, can he tell us what feedback Ministers have had from NHS staff working in hospitals about the physical state of those buildings and the extent to which that impedes their daily activities supporting patients?

[Lord Markham (Con)]

We have eight cohort 1 hospitals, which all have full planning permission and are in various stages of construction. We have 10 cohort 2 hospitals, of which two have full planning permission, seven have outline planning permission and one is awaiting approval of outline permission. All have had the preparation works done. So that is 17 where massive progress is being made. We then have cohort 3 schemes: the new hospital 2.0 projects, which are introducing modern methods of construction to standardise production and get cheaper and more efficient hospitals at a quicker rate of output. That is what I invite noble Lords to come and see for themselves over the coming weeks. This programme is very real and I will happily take people through whatever detail they want because, believe me, it is all there.

[Lord Foulkes of Cumnock (Lab Co-op)]

Is the Minister aware that, from time to time I have asked his predecessors to discuss with Scottish Ministers how they can help each other? However, in this area I am not going to do that because in Scotland, the children’s hospital in Edinburgh was delayed by a year and the Queen Elizabeth University Hospital in Glasgow has had enormous problems. Is there a competition between the English Tories and the SNP to see who can bring the NHS to its knees first?

[Lord Markham (Con)]

I can speak clearly on the subject of the new hospital programme, which I think the noble Lord will find is world-class. I will happily demonstrate that to him; indeed, people will see how ground-breaking this project actually is. We will see standardised designs with improved clinical standards, and more efficient productivity and costs as a result. It will be world-class, and we will export it around the world.

[Baroness Finlay of Llandaff (CB)]

My Lords, if the Government are saying that these are to be world-class hospitals, what is the comparison? Is it hospitals such as those in the Netherlands, which are extremely well designed and function very well, versus the many hospitals here which do not function well and have appalling design features? As soon as the staff move into them, they deteriorate rapidly.

--- Later in debate ---

[Lord Markham (Con)]

We are assessing best practice around the world in order to design them. That is exactly the point: we are taking on board things from the Netherlands and all round the world to make them state of the art and world class.

[Baroness Foster of Oxton (Con)]

I do not know how many hospitals have been completed, and I accept that there is a huge programme. But what I do know is that, since we came into power, in Liverpool we have had the brand new, state-of-the-art Liverpool University Hospital, a multi-billion pound hospital that has opened recently; Alder Hey Children’s Hospital, a first-class, world-renowned children’s hospital which has been opened in the last few years; and a huge cancer research centre—all within three miles of each other. I am sure there must be many others around the country. Does my noble friend the Minister agree with me on this?

[Lord Markham (Con)]

Yes. Now I am no longer holding anyone up in terms of time, I welcome noble Lords to visit places like Liverpool hospital and Chase Farm Hospital, where they will see brilliant examples of state-of-the-art hospitals. There will be many more—in fact, 40—going forward.

NHS Staff: Food Banks

Lord Markham Excerpts

Tuesday 7th February 2023 Lords Chamber

[Lord Hain]

To ask His Majesty’s Government how many NHS trusts are (1) providing, or (2) planning to provide, food banks for nurses and other NHS staff.

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

I reassure the noble Lord, Lord Hain, that we are working to support the welfare of NHS staff. We continue to support all NHS staff during these challenging times; individual employers across the NHS are best placed to prioritise support for their staff. Information on food banks set up by NHS trusts is not held centrally, but from March 2023 the Family Resources Survey will track food bank usage.

[Lord Hain (Lab)]

My Lords, I thank the Minister for that Answer, but it was not really an answer. An NHS Providers survey last autumn found that 27% of trusts had food banks for staff and 19% were planning to have them. That is nearly half the trusts in England. At least one trust was providing food vouchers as staff were going without meals, and the cost of living has severely worsened since then. Are the Government not utterly ashamed? Why do Ministers not start paying nurses, ambulance workers and other staff properly, instead of forcing them to go on strike for better wages to feed themselves properly?

[Lord Markham (Con)]

I thank the noble Lord. The lowest paid, who are obviously most at risk in this category, we have sought to protect the most. They received a 9.3% pay increase. In all these circumstances, we have been looking to follow the guidance from the independent bodies, which we will continue to do.

[Lord Allan of Hallam (LD)]

My Lords, the Minister will be aware that food price inflation is now running at over 16%. This disproportionately affects lower-paid workers, including many health and social care staff, yet the Government’s approach seems to be, “Crisis? What crisis?” Does the Minister accept that nurses are seeing real-terms pay cuts at present? Is he worried about the effect of these cuts on his long-awaited workforce strategy?

[Lord Markham (Con)]

As has been mentioned many times, the workforce strategy is key; being able to recruit and retain staff, and pay, are vital elements of it, so I accept the challenges in this space. At the same time, I am mindful that we have sought to protect the lowest paid through these increases, as I mentioned. I am confident that the new pay review body, which is coming up, will seek to take the inflationary pressures into account to make sure that there is a fair settlement for everyone.

[Lord Watts (Lab)]

My Lords, why are the Government hiding behind the pay review body? When it looked at wages for the health service, inflation was running at 4% or 5%. We have just heard that food inflation is now running at 16%. Will the Government think about this again and ask the pay review body to look at the facts now?

[Lord Markham (Con)]

Again, April is very close; the pay review body will be looking at the facts then. The noble Lord is quite correct that the real change is inflation, and that is why the priority for all of us has to be to reduce inflation. It is pernicious in its impact on every single one of our pockets, and most of all on those people with the least money. That has to be the priority, but we will continue to support these people.

[Baroness Boycott (CB)]

My Lords, back in 2008, there were only 26,000 people visiting food banks—they were brought in, really, as a response to the crash—but that figure is now 2.56 million people. Back in those days, Ministers were somewhat ashamed that we had them; now they seem to be handy photo opportunities for Prime Ministers. Where do food banks figure in how the Government look at the economics of this country? It seems to me that they count on them a great deal more than they should.

[Lord Markham (Con)]

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

[Lord Lexden (Con)]

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

[Lord Markham (Con)]

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

[Baroness Merron (Lab)]

My Lords, a survey by the Cavell Nurses’ Trust found that 14% of nurses and health workers are using food banks to feed themselves and their families, and nearly 70% are either unprepared or very unprepared for a financial emergency. What assessment have the Government made of the effect this is having on the health and well-being of staff? Does the Minister feel that this ought to provide a greater incentive to the Government to resolve the long- running pay dispute?

[Lord Markham (Con)]

That is a concern; we want to resolve the pay dispute. I know personally how much time and energy are being put into this from our side as well. Clearly, more needs to be done. We are not there yet, but I am hopeful that we will get there. At the same time, we did try to protect those on the lowest incomes, as I mentioned earlier. Everyone received a minimum of £1,400, which is 9.3%. Clearly, we will need to do more for the next year, but we are trying to protect those in the most difficult circumstances.

[Baroness Tyler of Enfield (LD)]

My Lords, can the Minister tell the House what percentage of NHS hospitals have subsidised canteens that staff can use at the end of long shifts, and how many of these are open in the evening and during the night, when access to reasonably priced hot food is hard to find? If the Minister does not have those figures, could he please write to me with them?

[Lord Markham (Con)]

I do not have those figures so I will happily write to supply them to the noble Baroness. However, I have some examples, such as Newcastle upon Tyne, where they have good free meal cards that they can give out to help people buy their meals discreetly themselves, or the Birmingham Women’s and Children’s Hospital, which has subsidised £2 hot meals that are available at any time. So there are some good examples of what trusts are doing to help people in the space, but I will write to the noble Baroness about the other cases.

[Lord Sikka (Lab)]

My Lords, on a recent visit to a food bank at my local hospital I met a nurse, a single parent with two children, who has a gross pay of about £30,000 and income tax and national insurance of £5,600. Her rent has gone up from £1,000 to £1,500—that is £18,000 a year—and she has energy bills of £3,000. That leaves her about £10 a week for food. Yet the Minister seems to be implying that these people are awash with cash. Is he not ashamed that he is not giving these people decent wages so that they do not have to use food banks?

[Lord Markham (Con)]

I do not think I have implied today that people are awash with cash—that has not been my tone for one moment. My tone has been one of complete understanding that we are in a difficult situation, with difficult choices to be made. We are trying to navigate our way through while bearing down on inflation, which is the priority, and making sure that our scarce resources are focused on the areas of most need. The noble Lord talks about taxes but clearly tax is one area where we want to make sure that it is as fair as possible as well. There are a number of measures and the solutions are not easy, but we are definitely mindful of the issue.

[Lord Trefgarne (Con)]

My Lords, most of the publicity we hear about the present dispute refers to percentage increases, not absolute salaries. What is the approximate salary of a junior health service employee?

[Lord Markham (Con)]

Clearly, there is a wide range with regard to that. If I was to take an average overall, we would probably be talking about the mid-£30,000s as a very broad average, but I will quite happily provide my noble friend a breakdown of those detailed figures. However, as I say, we have made sure that as a minimum everyone received at least £1,400, accepting that the lowest paid need the most protection.

Bread and Flour Regulations 1988

Lord Markham Excerpts

Tuesday 7th February 2023 Lords Chamber

[Lord Rooker]

To ask His Majesty’s Government when they expect to announce a decision following the consultation on the Bread and Flour Regulations 1988 which closed on 23 November 2022.

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

The Government will publish an interim response within 12 weeks of the consultation closing, on 14 February, with a fuller government response later this summer. We received 369 responses, and UK officials are currently reviewing them in detail with a review to finalising policy decisions. Following that, the Government expect to lay new legislation early in 2024 subject to clearing parliamentary process. Discussions with industry on the practicalities of folic acid fortification of flour are also ongoing.

[Lord Rooker (Lab)]

I have to say that is the first time the Minister has answered one of my Questions on this, and I am very grateful to him. He gave some positive dates, which we can hold him accountable to, and it looks as though there is some progress. I will make just one point. It is already three months since the end of the consultation. That is another 250 neural tube defect pregnancies, 80% of which will be terminated, and close to 50 live births of children who will have lifelong disabilities. It really needs to speed up. I fully accept what the Minister said, and I am very grateful for that—it would be churlish to be otherwise. However, the fact is that time is of the essence on this. We have a cure for 80% of the issue, but we are not using it at the present time.

[Lord Markham (Con)]

I thank the noble Lord, who has been a tireless campaigner on this issue. Again, a benefit of this position is getting to learn new subjects, and this is one of them. I can see why he campaigns so hard on it. I am delighted to say that we are getting there, albeit that it could be argued that maybe it could be quicker. At the same time, industry is seeing that, and the good news is that it is already adjusting. The majority of breakfast cereals are now fortified and a lot of the rest of the industry is responding. We are making a difference, and I thank the noble Lord again for his campaigning.

[Baroness Walmsley (LD)]

My Lords, does the Minister consider that too low a dose would leave people believing that fortification does not work? Is he aware that the Royal College of Obstetricians and Gynaecologists believes that the proposed level of folic acid fortification will prevent only about 20% of neural tube defects? It recommends that fortification be set at a level that is sufficient to prevent four out of five neural tube defects, which is 1 milligram per 100 grams. Will the Minister consider that?

[Lord Markham (Con)]

I am very aware of the range of scientific advice on this. I am also aware that the official results of the consultation, which will come out, are not clear cut. A sizeable number of people, 40%, are anti-fortification. As ever, it is about trying to get that balance right. We completely agree on the direction of travel. There is some scientific advice that at too high a level there is a potential masking of pernicious anaemia in the elderly. This is the first step. Let us get all the evidence. The critical thing is getting that first step right.

[Lord McColl of Dulwich (Con)]

My Lords, can my noble friend the Minister find out exactly how many people are involved in the decision-making on this subject? How often do they meet?

[Lord Markham (Con)]

I do not know the precise number; I know there are many stakeholders in this. The devolved Administrations have been involved in all of this. Part of the delay is because, once we go ahead, we have to notify the EU, because of the Northern Ireland elements of it, and that is a six-month notification. We also have to notify the World Trade Organization. All these aspects mean that this is not as quick as we would want, and then we need to let the industry have time to adjust. It is a process involving many people, but we are getting there.

[Baroness Wheeler (Lab)]

My Lords, despite their seriously delayed decision-making, the Government promised nearly two years ago that major efforts would be made to step up awareness raising of the importance of taking folic acid supplements, particularly among at-risk groups such as Afro-Caribbean women and women under 20 years old. Can the Minister tell us what actions have been taken, and what measurable impact awareness raising has had among these risk groups and on ensuring that women whose pregnancies were unplanned are not missing out on these vital nutrients in the early stages of their pregnancies?

[Lord Markham (Con)]

The noble Baroness is correct. Key to all these things is awareness that the best advice is to take folic acid supplements, as suggested. I am happy to provide precise figures of how that has moved in recent years. I completely agree that, as ever, education and awareness are key to this.

[Lord Jackson of Peterborough (Con)]

My Lords, I welcome my noble friend the Minister’s very positive tone. I first campaigned on this issue as a constituency MP 18 years ago, but it is 32 years since the Medical Research Council established the causal link between the ingestion of folic acid and the reduction of neural tube defects such as spina bifida and hydrocephalus. Scores of countries have pursued this policy and it has had a significant impact on reducing the tragedy of lifetime disability that has affected many families. Can the Minister ensure that the review is concluded expeditiously so that we can erode these terrible medical conditions as soon as possible?

[Lord Markham (Con)]

Yes, I am very happy to do so. It has been quite a process, as my noble friend says, but we are getting there. As I said, the good news is that the industry is seeing the direction of travel and is responding as well. That is always better when done voluntarily. We are seeing more foods with levels of fortification. We will get there in terms of it being mandated as well.

[Lord Patel (CB)]

My Lords, there has to be some progress. I think the noble Lord, Lord Markham, is the seventh or eighth Minister to answer this Question, the first being the noble Earl, Lord Howe. To get the scientific facts right, the advice given by the Royal College of Obstetricians and Gynaecologists of 1 milligram is based on the surmise that higher doses do not cause any harm. It is wrong science, for which there is no proof, to say that doses as high as 1 milligram mask B12 deficiency. It is completely false and we must not use that. The chief scientific officer of the Department of Health confirmed that at our last meeting, which the noble Lord, Lord Rooker, may well remember.

[Lord Markham (Con)]

To be clear, I was referring to scientific advice I received today about the potential risk of masking, as I said. It is a concern but, as ever, one of the wonders of this House is the expertise available on tap. I will go back to consult on that and write to the noble Lord.

[Lord Cunningham of Felling (Lab)]

My Lords, between 80 and 90 countries now add folic acid to flour, with no known side-effects. What are the Government waiting for? All the evidence is there, all the science is there and this is all well known. I do not know, speaking for myself, what the delay is about.

[Lord Markham (Con)]

As I say, there is a process involving co-ordination with the devolved Administrations. We have to consult the EU, as mentioned, because of Northern Ireland is part of it all, and then allow the industry to get on board. Again, we are all in favour, without a doubt, but 40% of the respondents were anti. So we need to be careful to do this in the right way. I hope and believe this to be the first step but, as ever, the first step is often the hardest. We are getting there and this will make a difference.

[Lord Dodds of Duncairn (DUP)]

My Lords, I join the noble Lord, Lord Rooker, in welcoming the Government’s firm announcement on dates. The delay has been as frustrating as it has been inexplicable for many people. Can I seek an assurance that, when this measure is finally adopted legislatively, it will apply across the entire United Kingdom equally and at the same time?

[Lord Markham (Con)]

Yes, that is my understanding. One of the aspects that has taken time is getting the devolved Administrations on board and the complications of the Northern Ireland situation with the EU.

[Baroness Jolly (LD)]

My Lords, many countries put folic acid into bread to prevent neural tube defects. When it was added to flours in Australia, the number of these defects reduced by 14%. More folic acid in more bread products could save 800 babies a year in the UK from developing birth defects such as spina bifida. The Minister gave your Lordships positive news, but when can we expect it to bear fruit?

[Lord Markham (Con)]

As mentioned, there is a process that we are going through. As I said in my first Answer, we will be laying the legislation early in 2024, but it is happening. More importantly, in the meantime a lot of the industry are voluntarily adopting it.

Urgent and Emergency Care Recovery Plan

Lord Markham Excerpts

Thursday 2nd February 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, as is usual for this kind of Statement, it is peppered with promises of more of everything. I hope the Minister will help us to dig into the numbers we have been given to see how much lies behind them. First, on the new hospital beds, this seems to come from a process of making winter surge beds permanent. For a real long-term increase in capacity, we need the promised 40 new hospitals. How many of these will be on stream by next winter?

The Statement also tells us that there will be 800 new ambulances, which I think most people would interpret as fully staffed, blue-light vehicles. Can the Minister offer a more detailed breakdown of the different types and capabilities of what is being offered here? The Statement itself said that, for example, 100 of these will be mental health emergency vehicles rather than classic blue-light ambulances.

Of course, staffing these beds and ambulances and the other measures in the Statement will depend on good workforce planning. Here, I echo the comments made by the noble Baroness, Lady Merron, and by these Benches over many months. The Statement tells us that the plan will come this year; can the Minister offer any more precision on when this year we might expect it?

The Statement also talks about data and transparency. We are told that integrated care boards will now have to focus much more on data about patient flow. Can the Minister commit to making more of those statistics public, as well as the ambulance wait time statistics?

Finally, the promised new care hubs can add value only if care services are actually there. This brings us back to workforce limitations. I end with three questions for the Minister: where is the staffing for the beds, where is the staffing for the ambulances, and where is the staffing for the care services?

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

First, I thank the noble Lords for their questions. To put the UEC recovery plan in the context of the three plans we will be announcing, there was last month’s elective recovery plan, which we spoke about, followed by this UEC recovery plan, and then, within the next month or so, we will also talk through the primary care recovery plan. That plan will seek to address exactly some of the points the noble Baroness, Lady Merron, rightly made about getting care in the right places, such as primary care.

I hope noble Lords agree that what we see today is a sensible and pragmatic plan. It has been welcomed by NHS Providers and described by the Royal College of Emergency Medicine as a

“significant step on the road to recovery”,

seeking to increase capacity in urgent and emergency care. The 5,000 beds that the noble Lord, Lord Allan, mentioned are a recognition that more capacity is needed in that space.

As has been mentioned many times, and as was raised by the noble Lords today, growing the workforce is crucial. This includes student places and getting to the bottom of whether there is a cap on those numbers, on which a written reply will be given soon. Again, the workforce plan is in draft and will be shown shortly—as I say, in weeks. I cannot give a date, but it will be soon. It is designed to tackle the whole question of how we are going to staff all of this and the points that have quite rightly been made. We need the staff: the nurses, the ambulance staff and all the others. There are 30,000 more nurses than three years ago, so we are on target to hit the 50,000 increase. There are 5,000 more doctors than a year ago, but that is not to say that we do not need more. That is what the workforce capacity plan should be all about.

This plan is looking to show those milestones and what we are trying to do to increase capacity, with the 5,000 new beds, growing the workforce, speeding up discharge, expanding and having better joined-up community services and making it easier to access the right care in the right places, such as primary care. I would say this, probably, because I am biased, but I feel that this is a useful and pragmatic plan because it is trying to build on the evidence of the things that we have seen work, which noble Lords have heard me talk about over the last few weeks. They include the Maidstone “mission control”, which really is making a difference there and we are now looking to roll out to all trusts and ICBs; the Watford virtual wards, which we are looking to roll out to 50,000 places; and, in all instances, using data-driven analysis to make sure we are making the right decisions.

The plan is backed up by funds and is part of a long-term plan. We are using the £1 billion of support for this year and the £500 million for social care capacity, but this is in the context of an increase of £14 billion over the next two years. It is part of a sizeable plan, but it is realistic action. I would love to be able to stand here today and give targets, but we are trying to be realistic about where we are coming from—for example, in setting the 30-minute category 2 ambulance wait time. Likewise, the target of 76% of patients being seen within four hours is not the limit of our ambition. That is the minimum, and from there we would look to increase it beyond that target. I would much rather come to your Lordships’ House with targets we think are realistic, with achievable plans behind them, as a statement of intent from which we can grow, rather than setting unrealistic expectations.

Of course, I say all of this in the context of what the House knows is an unprecedented challenge. It is not just England facing these challenges; I have spoken to colleagues across Europe, the US and Canada, and within the UK, in Wales and Scotland. Every health system is facing these problems off the back of Covid, and there are also the demands coming from flu coinciding with that this winter in particular.

I believe that this is a realistic plan. It is centred on the workforce; I agree on that. Prevention is also a key element of this. The five-year life expectancy improvement target is still key. We are looking at what we realistically need to do to make a difference on that—so, what are the causes of death, and what are the things we need to tackle? Again, the House has heard me speak many times about Chris Whitty’s concern about cardiovascular disease, and that it could be the next cohort of potential excess deaths among 50 to 65 year-olds, because they missed out on their blood pressure monitoring over the last couple of years. We all agree that rectifying those sorts of prevention actions is key.

When this plan is seen in the context of the primary care plan, which will also come out shortly, I hope it is understood that this is about treating people in the right place, which is not A&E. We all know that far too many people go to A&E who do not need to be there, and that is because we need more primary care spaces. We are on target to achieve the 50 million more primary care spaces, but, again, we need to do more. We really need to look to expand capacity in pharmacies, as I have mentioned before. We need to look at what some of our colleagues in Scotland are doing and the ability of pharmacists, for instance, to prescribe a lot more. Longer term, the new hospitals are a key part of this. Just this morning, I was going through the plans and some very good virtual reality examples, which we are going to bring to Westminster Hall for one day in the next few weeks. I look forward to showing colleagues exactly what is happening and how that will be the future.

I hope that noble Lords will see this plan in the context in which it is meant. I will, as ever, write in detail on the points I have not managed to cover in this quick reply. I hope noble Lords will see this as a down payment for the future, within the context of the elective care recovery plan and the primary care plan that we will see later, building on solid things that we know work and making sure that we are expanding those rapidly, so that we have learned the lessons from this winter and have them in place in time for next winter.

[Baroness McIntosh of Pickering (Con)]

My Lords, my noble friend will be aware that this problem is not unique to this country. I am ashamed to say that Denmark, my mother’s original country, is building new hospitals all over the place but people cannot be treated because there are not enough doctors to treat them. Is my noble friend aware of the report from the Health and Social Care Committee in the other place, which noted that there are almost 500 fewer full-time equivalent GPs in a three-year period and that the committee realised that that accounts for the fact that there is an increased challenge in accessing GPs and also a lack of continuing healthcare? Will my noble friend take this opportunity to explain to the House what proposals the Government have to retain GPs so that recently qualified GPs are not working as locums in preference to being salaried or partners in a practice? I declare my interest as an adviser to the Dispensing Doctors’ Association.

[Lord Markham (Con)]

I thank my noble friend and agree that the GP service is the backbone. As per the earlier comments, a lot of the issues and challenges we have with A&E are because people are not getting their appointments in the GP space, and fundamental to that is having enough doctors. I did not quite recognise the figures. I am aware of an increase of over 2,000 GPs since 2019. That is not to say that that is enough, and so, again, the workforce plan will be key to making sure that we are building for that long-term future. However, we are also looking to retain them. We had a very good debate in the House about pensions and what we need to do in that space, and we will make sure that everything we do—including, I hope, the primary care plan—will show that primary care is key to the solution.

[Baroness Armstrong of Hill Top (Lab)]

My Lords, I am sure the Minister has taken note of the House of Lords Public Services Committee report on emergency access to healthcare, which came out two weeks ago. Many of its recommendations have been taken up by the Government. I thank the Minister in particular for the one on the 12-hour waiting list. We found out to our shock that that was not honest, as the witness said to us when they came to talk about it. I am pleased that the Government have done something about it. Our previous report was on workforce, and I urge him to read that too. Any report or plan is worth the paper it is written on only if it will and can be delivered. We were promised the outline of the workforce plan last September—we have had nothing yet.

Can the Minister help me on what I see as a major problem this week? As he has said today, a major part of the plan is increasing capacity. As others have said, you need the staff to do that. However, the Government, having said on Monday this week that increased capacity was really important as part of the emergency plan, wrote on Wednesday to Lincolnshire ICT to say, “You have a deficit. In order to deal with that deficit, you must cut beds”. What are people there to think when on one day the Government say, “We will sort emergency access by increasing capacity and beds” for one thing, and then two days later say, “Oh, you have a deficit—cut the beds”?

[Lord Markham (Con)]

I thank the noble Baroness for her question and her recognition of the 12 hours. In all these spaces, data is always the way that you give a backdrop to better services, and 12 hours is part of that. As regards capacity, I totally agree that we need more of it. I was surprised by what she said—I will find out some more about it. However, the absolute direction is a recognition that, with Covid and flu, what might have been the right number of beds a couple of years ago is not today. That is why we are committed to the 5,000 extra beds and, just as importantly—potentially more so—the 50,000 in virtual wards, because that is using technology to look at how we can expand supply, and absolutely critical to that is having the workforce.

[Lord Forsyth of Drumlean (Con)]

My Lords, my noble friend quite rightly pointed out that there are more doctors than ever in the NHS, but many of them are in training. As my noble friend Lady McIntosh pointed out, we are losing very senior and experienced doctors because of the rules that apply on pensions. My noble friend said that this was being addressed. I remember raising this several years ago—it is a continuing problem. What is worse is that doctors leave the NHS because of the tax implications for their pensions and then come back and cost it even more money. My noble friend says that this is being addressed, but in the autumn I heard the Chancellor say that he was going to freeze the level of the maximum amount that counts towards the pension before you pay tax for the next three years—so how is that addressing the problem? Is it not an urgent problem? We may be putting more people into the service who are in training, but we are losing people out the bottom at a greater rate.

[Lord Markham (Con)]

I thank my noble friend. As I mentioned just now, retaining doctors is critical, and pensions are a key issue. We had an excellent debate on this a couple of weeks ago. Again, we are working on all of that with the Treasury. However, as I said then, the simplest thing is that, while I understand the Treasury’s concern about making special rules for special groups and the potential knock-on from that, we can very quickly make sure that, if people are hitting that pension ceiling, they can get the equivalent pay in their pay package very quickly. As a health department we have the ability to do that, to make sure that no one is financially losing out from that. If it does not make sense for them to get it through their pension, they can get it through their salary instead. I am not saying that that is perfect, and more work needs to be done across the Treasury, but we can do that quickly.

[Baroness Blower (Lab)]

My Lords, the Minister has attempted to give a full response on this. However, there is clearly an absolute urgency about the workforce plan, and noble Lords would have been very pleased to have heard something rather more specific about the date on which it would come before us. If it is in draft, perhaps he could go back and say, “Can we speed up the final drafting of it?” The Minister also used the word “realistic” on a couple of occasions. Can he say whether he understands that the workforce plan will not be realistic unless we can pay staff in an appropriate way to make sure that we can hold on to their services, without which any attempts to remedy the difficulties we are facing are, frankly, a forlorn hope? Finally, on virtual wards, can we make sure that there are not people in the digital divide having difficulty engaging with the virtual ward if they have broadband problems and other problems?

[Lord Markham (Con)]

I thank the noble Baroness. Taking those questions in reverse order, yes, it is understood that virtual wards do not work for everyone. At the same time, I am constantly surprised by the data: for instance, the average age of an NHS app user is in the mid-60s—so it is not a particularly young demographic who use this. Obviously, the examples I have seen, particularly on COPD at Watford, show that an older population is using that. However, we absolutely need to make sure that there is not a digital divide from that.

On the noble Baroness’s points on the workforce, she is quite right. We live in a competitive market, and one of the benefits of full employment is that, again, most people who want to work have a job, but one of the downsides is that there is competition for jobs. We have to face up to those realities and be realistic in terms of workforce, in that if you are going to attract and retain the good people, which you need to have as the bedrock of your services, you need to make sure you have an attractive and rewarding place to work. Clearly, that has to be a feature.

[Lord Bellingham (Con)]

My Lords, the Minister mentioned new hospitals. Is he aware that the biggest obstacle to major health improvements in west Norfolk is the chronic state of King’s Lynn’s Queen Elizabeth Hospital, which I gather is the most internally propped-up hospital in the UK? He will be aware of an all-party campaign to secure the building of a new hospital. Can he tell the House where are we with that process?

[Lord Markham (Con)]

I am very familiar with the problems with the so-called RACC—reinforced, autoclaved aerated concrete—hospitals. King’s Lynn is one of those, and there are a handful of others. There is a recognition that everything we do in the new hospital programme has to ensure that those hospitals are rebuilt in time, because they have a useful life that is fast reaching its end. Our priority number one is making sure that they are replaced.

[Baroness Masham of Ilton (CB)]

My Lords, what are the government plans for long-term rehabilitation? We need more physiotherapists and occupational therapists. There is an idea of getting people out of hospital quickly, but some of them need confidence and ongoing care.

[Lord Markham (Con)]

That is absolutely right. The figure that struck me on one of my many hospital visits was that apparently people lose 10% of their muscle mass each week they are in hospital, making it harder for them to look after themselves. The noble Baroness, Lady Merron, mentioned that we need to make sure the resources and investment are in the right places. All too often, hospitals become the place of last resort, when we all know that it is much better to put resources into the primary care at the front end or the social care and domestic help for physios who can visit homes at the back end. Central to the plans of my colleague, Minister Whately, is recognition that we will solve this in the long term, as all noble Lords want, only if we invest those resources in the right places.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, I welcome the plan and hope that the Government can keep to the targets they have set. I had experience of being in a major London hospital recently, spending five hours in A&E. It was the first time I had been in A&E for a long time. I was surprised at the number of young people there. When eventually I was seen by a nurse, I asked why so many young people were there. She said, “We’re surprised; there was a good football match on tonight, and we thought there wouldn’t be so many”.

It is odd when people are in A&E. Should they be with a GP? We wait with interest to see the report on GPs. I suspect that we have far more people now getting involved in health, for a whole variety of reasons, than need be in the system. This takes us back to prevention. I still do not believe we are addressing prevention as we should—trying to reduce the number of people in ill health. The programmes we have on obesity and in a whole range of areas where we are trying to get people to change their lifestyle are not having any impact. Until we seriously address those and put money and personnel into them to get ourselves reasonably healthy by comparison with the rest of Europe, we will just see the health service getting into even more difficulty, no matter who is in power.

I am sorry for going on at length. I hope the Minister will say something about a proper plan on prevention.

[Lord Markham (Con)]

I agree with the noble Lord. We have a manifesto pledge about five years of healthier living. I am keen to do exactly that, to say, “Okay, let’s unpack this—how can we make that realistic?”. We have all talked about being realistic. What are the causes of death or ill health that we need to get on top of? I mentioned cardiovascular disease earlier. We need to quickly address that because there is a cohort of people of my age who have missed out. Obesity is a clear thing. It is not just the treatments but everything we talk about in terms of supermarkets. I know that there is some discussion in the House on whether we have gone far enough on some of those things, but the action we have taken is hitting the big numbers. It is hitting about 95% of the planned reduction in calorific intake; we are seeing that have an impact already. There is also anti-smoking; I am keen to make that into a coherent plan. We all know that we can spend more and more money on hospitals and the health service, but we will have healthier lifestyles only if we can get up stream on the problem and talk about protection.

[Lord Porter of Spalding (Con)]

My Lords, I declare my interest as a non-executive director of a care company and lead Peer for the Local Government Association.

It is great that politicians are trying to sort out problems with the health service, because those problems have largely been created by politicians—national politicians from both sides of the other Chamber. Clearly, the last Labour Government’s disastrous changes to GP contracts exacerbated the situation we are living in now. The even worse contracts for construction companies to build new hospitals at exorbitant prices were bizarre and are currently impacting the health service.

The coalition Government and this Government are responsible for the chronic underfunding of social care services. We have all contributed to people not being able to see the right GP or whatever at the start of the process, and we are now contributing to people not being able to get out of hospital.

That is not really what I wanted to say, even though I have just said it. I live in Lincolnshire. If a member of staff somewhere in the Lincolnshire health network has suggested, contrary to the Government’s position of increasing hospital beds, that they have to reduce their hospital beds, one way they could save some money is by deleting the post of the person who suggested that. That is probably a good place to start, because a lot of people want to use acute services but cannot because some of the budget is being diverted away to people dressed like me rather than to somebody dressed in those suits they wear in hospitals.

I am quite simple and do not understand why I saw a picture on the news the other day of 40 ambulances queueing up outside a hospital with 80 members of staff and only 40 patients inside the ambulances. Why can we not put up a big inflatable building of some description, offload the 40 people from the ambulances with 40 of the staff, and let the other 40 staff drive 20 ambulances back out again? Nobody seems to be controlling the resources that are being used, even though we all admit that they are scarce.

[Lord Markham (Con)]

I will take it in reverse order. We do have the ability to stand up that capacity quickly so that the ambulances can discharge. I have already ordered a number of those, and some are ready to go, to provide exactly that capacity. Others are coming on stream in the coming weeks, so we are rapidly responding to the exact point that my noble friend raises.

Just as important—I am glad to have the opportunity to talk a bit more about this—is that a lot of the time ambulances do not need to bring the person to A&E. The mental health ambulances we are introducing, or the falls service ambulances that every ICB now has to introduce and have running every day, are critical. They can go there, right the person who has fallen and set them back up again. That needs only one person, not a big ambulance. That sort of care in the community—solving those problems and the right access—is critical in this situation.

On Lincolnshire, I will find out. The key thing here is making sure that we are expanding capacity in terms of beds.

[Lord Hogan-Howe (CB)]

My Lords, I sat with the noble Baroness, Lady Armstrong, on the Public Services Committee for that report. Two things were left with me; they follow up on the point from the noble Lord, Lord Porter, about ambulances attending the scene. We heard numerous cases, the worst I heard being that of a 95 year-old man who lay on the floor for 24 hours with a broken collarbone and hip. His family put a tent around him and no one in the health service—I do not mean just the ambulance service—went to help.

I just cannot understand that. There are over a million people in the health service; the Minister just mentioned that he is trying to get action around this, but why did the bosses not get out and drive an ambulance? Why did a GP not attend? Why did someone in society not think that that guy should not be lying there for 24 hours on the floor with a tent around?

Those examples really shame us. I do not say “the Government” or anybody else; they shame us. A piece of evidence which stuck with me was that one of the paramedics pointed out that one of the good things that has changed in strategy to improve outcomes for patients is that they spend longer on the scene, so they improve the initial treatment and improve the outcome. Of course, I asked what the overall impact of that was; he reckoned that they were able to attend about half the incidents that they did before, so were halving the effectiveness of the number of ambulances that we have. It does not look like the number of ambulances and staff will shift as a result of that change, or that there will be a different model of delivery—perhaps that one person might go or whatever. But those good outcomes for the heart-attack patient, perhaps, were not replicated for everybody: if they never got the ambulance, that did not help them. It just struck me that the change of delivery had not changed as much as the change of the model—spending longer at the scene—had improved the outcomes where ambulances attended.

[Lord Markham (Con)]

Yes, what the noble Lord talks about is critical. To my mind, this is where the data—I know data and analysis sound dry—is needed to arm the local decision-makers. This is the whole idea behind the ICSs: that they can invest in the right services in the right places. We have often got too much into thinking that the one-size-fits-all model of the ambulance with the two paramedics is the solution, whereas we know that the full service can do things far more effectively and keep the person in the home. To my mind, that is the whole sense of direction of the ICBs, which need to understand and own their areas. I saw a fantastic example in Spain: Ribera Salud, with which many people here are familiar, I think. It ran the local hospitals and local primary care. There was investment in primary care, and A&E entrances plummeted. That is what I want ICBs to look at, and what I want the workforce plan to do: to make sure that we give the right care in the right places, and have flexible delivery of different types of ambulances and types of staff, who will go and problem-solve. Sometimes that is problem-solving as per the example that we gave, but mainly it is trying to give the local ICBs the analytical tools, powers—for want of a better word—and resources, so that they can properly shape things. Some of them will do very well, and others will probably take longer. But that is the critical thing about letting people run their own areas: making sure that they adopt best practice, but that they have flexibility in that approach so that they can solve the problems on the doorstep.

Mental Health Act Reform

Lord Markham Excerpts

Thursday 26th January 2023 Lords Chamber

[Baroness Buscombe]

To ask His Majesty’s Government what reforms they are proposing to the Mental Health Act 1983.

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

The Government published their draft mental health Bill on 27 June 2022, which contains our intended reforms to the Mental Health Act 1983. I am grateful to the joint pre-legislative scrutiny committee on the Bill for its report, which was published last week, on 19 January. The Government will now review the committee’s recommendations. We will respond in the coming months and introduce a revised Bill when parliamentary time allows.

[Baroness Buscombe (Con)]

I thank my noble friend the Minister for his comments on the Joint Committee’s report. I had the privilege of chairing its inquiry and I am grateful for the contributions of Members of both Houses. The Government must of course spend time considering with care our recommendations, but as a committee we feel strongly that a Bill should be introduced to Parliament as soon as is practicable to bring about the really important reforms to the mental health system that people so dearly deserve. Will my noble friend give an assurance that the Government will introduce a formal Bill to Parliament in the current Session?

[Lord Markham (Con)]

First, I thank my noble friend and all noble Lords who took part in the pre-legislative scrutiny committee. I think all noble Lords agree that what we are trying to do with the mental health Bill is a very good thing. We would like to bring it forward as soon as we can. From my side, I know that we are ready to go, but we are working with the parliamentary authorities to make sure that we can get the legislative time. We want to do it as soon as possible.

[Lord Touhig (Lab)]

My Lords, due to the current mental health legislation, autistic people are being detained in hospitals not because they have a separate mental health issue but because they are autistic. Autism is not a mental health condition, but more than 2,000 autistic people are currently locked up. This is a stain on Britain’s reputation for defending human rights and a challenge for us to define the liberty and freedom of some of our most vulnerable citizens. So will the Minister ask his noble friend sitting on the Bench with him, the Government Chief Whip, for a debate in government time on this matter, so that the voices of some of these people, some of whom have been locked up for decades, can at last be heard?

[Lord Markham (Con)]

I have some personal experience in this space, so I understand exactly what the noble Lord is saying. I think we all agree on its importance. We have a commitment to decrease the number of in-patients with learning disabilities and autism by 50%. It is something that every ICB must have a lead on, so that they can really tackle it, and I personally would be happy to meet the people the noble Lord mentioned to understand further.

[Baroness Berridge (Con)]

My Lords, this process began four years ago, with the then Prime Minister announcing the initial reason for the review, which was the disproportionate way that the Mental Health Act is applied to many black and minority ethnic communities. Beyond the review and the White Paper, the Joint Committee recommends the abolition of community treatment orders, which are disproportionately applied: if you are black you are 11 times more likely to be under a community treatment order. Most of the recommendations of the Wessely review were to be enacted by changes within NHS England. Can my noble friend the Minister assure us that he will hold its feet to the fire to change the culture, practices and training of many of our mental health professionals, because those communities are being disproportionately affected by the way the Act operates?

[Lord Markham (Con)]

Yes, I too saw the statistics on the number of black people who are detained. Clearly that is not right and is something that we need to get on top of. I know that the NHS has set up a patient and carer race equality framework to try to tackle this, but clearly we need to act on it. Again, it is the responsibility of every ICB to ensure to tackle this as well.

[Baroness Barker (LD)]

My Lords, a key reason why people with learning disabilities and autism are wrongly detained under the Mental Health Act is that mental health professionals are not trained to recognise autism and learning disabilities. Without waiting for legal reform, will the Government work with the professional bodies now to train and retrain psychiatrists and psychologists in learning disabilities and autism so that we can stop the scandal of these people being locked away wrongly for years and years?

[Lord Markham (Con)]

Yes, and understanding starts in schools. Again, I am very aware of that, and of the fact that training in schools is vital. We have increased the proportion of schools with trained mental health assessors from 25% last year; it will shortly be about 35%. The target is 50% next year. It is not 100%—we need to do more—but it is rapid progress.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, like other noble Lords who have spoken, I was a member of the scrutiny Joint Committee. I should say in parentheses that I entirely support the legislation being brought forward, but one of the things that came through very strongly from all the evidence we took was quite serious anxiety about resourcing for the kinds of reforms that are required. That is about not just money but, to go to the point made by the noble Baroness, Lady Barker, the recruitment of appropriate people to deliver the services that are needed, and the retention and training of those people. Can the Minister tell the House whether the Government will review the resource allocation for the proposed changes to the Mental Health Act, to ensure that these workforce issues are addressed?

--- Later in debate ---

[Lord Markham (Con)]

The noble Baroness is correct; these things do need resources. We have committed to £2.3 billion of extra spending next year and an increase of 27,000 in the number of mental health nurses; I am glad to say we are well on the way, with a 7,000 increase over the last year. This all comes back to workforce planning—I am sure I will be asked that question later. And, yes, we will publish our plan soon.

[Baroness Watkins of Tavistock (CB)]

My Lords, can the Minister comment on why it is 50 years since we have had a revision, and say whether in fact the Government are delaying this legislation because of the resources that will be required, as has just been referred to?

[Lord Markham (Con)]

No, I hope that all noble Lords will see that there is no sense of delay on this side—and we are not waiting for the legislation to introduce a lot of these measures. It is very important, and we are ready to push on as soon as parliamentary time allows.

[Lord Bradley (Lab)]

My Lords, declaring my interests in the register, particularly as a trustee of the Centre for Mental Health and a member of the Joint Committee, perhaps I might press the Minister on one of our key recommendations: to establish a statutory mental health commissioner to oversee the implementation of the draft Bill, which we fully support, and to have a laser focus to ensure consistency across the country in the services required, underpinned by investment in community services. Unless those are forthcoming in a timely way, the Bill’s intentions will be undermined. Will the Minister confirm today that he will accept the recommendation for a mental health commissioner?

[Lord Markham (Con)]

I hope noble Lords accept that the report came out only last week and we need a little time to consider it. What I can say is that we are all focused laser-like on making sure that change is happening in this space. If the best way to do that is by appointing a mental health commissioner, that will have my support. At the same time, I am very aware that ICBs are responsible for this, and I want to give them the space to make sure they can properly manage mental health and other health services in their area.

[Lord Selkirk of Douglas (Con)]

Some years ago I visited a health centre with a lot of autistic patients who were quite young. One of them came up to me and said, “What is your favourite film?” I replied immediately, “Chariots of Fire”—whereupon he took me through every detail of “Chariots of Fire”, which revealed that in one respect he had a problem but in other respects he had great ability. Does the Minister accept that there is much to be hoped for in young people who have this difficulty?

[Lord Markham (Con)]

I agree 100%. As I say, I have some personal experience. In many ways, these children or young people have incredible skills and are gifted in many directions, and the economy we live in, with IT and everything, gives more and more opportunity for these people to thrive.

[Baroness Merron (Lab)]

I congratulate the Joint Committee on its excellent work and refer to a report in the Times yesterday that the Government have written to universities to ask them to limit the number of medical school places they offer or risk fines. Can the Minister shed any light on what I regard as a baffling move? Can he explain to the House how the Government will address the concerns of the Joint Committee about getting the right workforce in place if they are planning to reduce the number of doctors in training?

[Lord Markham (Con)]

Again, I agree that workforce is key to this. I am not aware of the report; I will look it up. I am somewhat surprised, because I know that we all accept that we need to invest in this space to recruit doctors, nurses and mental health professionals.

PPE Expenditure

Lord Markham Excerpts

Wednesday 25th January 2023 Lords Chamber

[Lord Harris of Haringey]

To ask His Majesty’s Government what is their latest estimate of expenditure incurred in purchasing faulty personal protective equipment (PPE) during the COVID-19 pandemic; how much had been recovered by 31 December 2022; and how much they forecast to recover by 31 December 2023.

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

The department’s Annual Report and Accounts 2020-21 confirm that 817 million items of PPE worth £673 million were not fit for any use. By December 2022, the department had reduced the number of contested PPE contracts from 176 to 60, with an associated recovery of value for the taxpayer of around £1 billion. Given commercial sensitivities, we cannot comment on our forecast for further recovery.

[Lord Harris of Haringey (Lab)]

My Lords, I am grateful to the Minister for that reply, but when I look at the National Audit Office report it produces some slightly different figures from those that he has given. It says that his department had identified 3.6 billion PPE items that were not suitable for use, at a cost of £2.9 billion. The point I want the Minister to comment on is that 53% of those suppliers who came through the VIP route provided materials which were not fit for use. Does that raise any questions about the procurement processes operated during the pandemic?

[Lord Markham (Con)]

I thank the noble Lord. Given the recent press, I want to start by setting out the position of Cignpost, the private sector Covid testing company in which, as many noble Lords will be aware, I own a stake. To be clear, Cignpost did not bid for any government PPE contracts and has only private sector clients. None the less, upon taking up the role as an unpaid Minister of Health, I resigned my directorships, made an undertaking to sell my stake, and in conjunction with the Permanent Secretary, ensured that I was not engaged in any areas where there could be perceived to be a conflict—I just wanted to make that clear.

Turning to the question, I was giving the most up-to-date figures. The £1 billion reflects the money that we have continued to recover. Right now, the only amount that has been written off is the £600-odd million that I have mentioned, and we are continuing to pursue the other amounts. When we close the accounts, we will have an update on where that will go. On the VIP lane, I think we accept that, given our time again, we would conduct that in a different way. I will check but I do not recognise those figures as to the level of faults.

[Lord Allan of Hallam (LD)]

My Lords, as well as the financial cost of failures in the PPE procurement process, does the Minister agree that it is important to remember the human cost paid by care workers who became ill when looking after vulnerable and elderly people without adequate PPE? Does he understand how frustrated care workers must now feel to see this level of wastage when their services are crying out for more investment? We could buy a lot of care packages for “£600-odd million”.

[Lord Markham (Con)]

In the circumstances at the time, I think we were all worried that we were going to run out of PPE. If the noble Lord remembers, it was the Wild West out there in terms of trying to purchase it, with planes gazumped literally on the runway and flying to other countries. That is why we stepped in. We bought to a worst-case projection, because we knew we could not afford for PPE to run out in our social care homes or our hospitals. We ended up buying 20% too much as a result, and that is what we are dealing with now. However, only 3% of everything that we bought ended up being faulty, which I think people will agree was a pretty good result.

[Lord Forsyth of Drumlean (Con)]

My Lords, will the Minister indicate how much we are paying for storage of PPE? Are the press reports that we paying for the storage of PPE on a substantial scale in China correct?

[Lord Markham (Con)]

Right now, less than 1% of stock is held in China—to answer that question directly. In terms of cost, we are currently paying about £700,000 per day, which is why we are writing off the stock and effectively disposing of it. We have tried to donate as much of it as possible to people who want it, but we have to bite the bullet on the rest and say, “You know what? It’s no longer required so we are disposing of it as rapidly as possible.” We are bringing down those costs; we will be saving £200 million a year through that rapid disposal.

[Baroness Finlay of Llandaff (CB)]

How many health and social care staff are now off long-term sick with long Covid? What correlation has there been between long Covid and their perception that they did not have adequate PPE for the job to be done?

[Lord Markham (Con)]

I will write to the noble Baroness with the statistics. I can be clear that the endeavours undertaken to buy the PPE were to make sure that we did not run out. Again, there is quite a bit of hindsight going on in saying, “Ah, we bought too much of it”, when at the time everyone was scrambling to say, “You need to buy more.” That was the result of the situation, and to try to apply hindsight now is quite wrong. They did a pretty good job regarding the amount that they bought; they got 97% of it right, which I think we would agree is a pretty good result.

[Lord Whitty (Lab)]

My Lords, the reference to hindsight is misplaced. The Minister accurately described the shambles and panic that happened at the beginning of the pandemic, but there had been several reports in the 10 years before it that indicated that one measure the Government could take for any pandemic was to have standby contracts whereby there were arrangements with companies to provide PPE and laboratory facilities. That was recommended by, among others, your Lordships’ own Science and Technology Committee. Do such contracts now exist so that, were another virus to hit us, we should not go through the same shambles and corruption that we did on that occasion?

[Lord Markham (Con)]

Absolutely. As ever, we want to learn the lessons. That is why we have set up the Covid inquiry. Yes, supply arrangements are in place. At the same time, as per the answer to the previous question, holding high levels of stock does not make sense. It is cheaper in this case to dispose of it while making sure that the supply lines are in place so that we can rapidly respond to any future event.

[Baroness Walmsley (LD)]

My Lords, I understand from the Minister that it is the department that paid the cost of this useless material, and for its storage. How many doctors, nurses and ambulance staff could be given a decent pay rise if that money had been given to the NHS?

[Lord Markham (Con)]

Again, I would take issue with the words “useless material”. It was bought based on a projection of how the pandemic could progress and what would be required. The fact that it did not progress that far was thanks a lot to the work we did in being the quickest country to vaccinate in the world. So, we did not need that level of PPE; that was a good thing. We bought for a worst-case scenario and, thank goodness, we did not require it because of the action we took to get on top of it all. Now, we are dealing with the surpluses bought for that worst-case scenario and quickly disposing of them.

[Baroness McIntosh of Pickering (Con)]

My Lords, can my noble friend tell us the amount of this stuff in UK warehouses, and how much that costs daily?

[Lord Markham (Con)]

As I mentioned before, the daily cost is roughly £700,000.

[Baroness Merron (Lab)]

My Lords, the National Audit Office found that during the pandemic one in 10 suppliers processed through the VIP lane were awarded contracts. This compared to less than one in 100 suppliers going through the ordinary lane. In view of this, could the Minister share with the House what particular qualities were required of suppliers to merit VIP status? Following up on his answer to my noble friend Lord Harris, in the event of a future emergency, was the Minister ruling out having a VIP lane?

[Lord Markham (Con)]

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

[Lord Lexden (Con)]

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

[Lord Markham (Con)]

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

[Lord Patel (CB)]

How long will we continue paying £700,000 a day to the Chinese?

[Lord Markham (Con)]

As I said, less than 1% of the stock is being held by the Chinese. Most of the money being spent on storage costs is in the UK. Notwithstanding that, we clearly want to get rid of it as quickly as possible. As soon as I came in, I said, “Let’s bite the bullet, write it off, get on with it and dispose of it.” That is absolutely what we are doing. We are accelerating that to the maximum extent. Those accelerations have already saved £200 million this year.

Health and Social Care Information Centre (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023

Lord Markham Excerpts

Wednesday 25th January 2023 Lords Chamber

Moved by

[Lord Markham]

That the draft Regulations laid before the House on 15 December 2022 be approved.

Relevant document: 25th Report from the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument).

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

My Lords, to make sure that all noble Lords have the right version of this SI, I draw attention to the correction slip amending two points:

“Page 3, regulation 5(3)(a): omit ‘annual’; and Page 22 … paragraph 63(a): ‘…paragraph (b);’ should read ‘…paragraph (a);’.”


These regulations are intended to transfer the statutory functions of the Health and Social Care Information Centre, which operates as NHS Digital, to NHS England, and to abolish NHS Digital. This will create a central authority responsible for all elements of digital technology, data and transformation for the NHS, which was a key recommendation of the review by Laura Wade-Gery into how we can improve the digital transformation of the NHS. The recommendations were accepted by the Government in November 2021; we announced that we would merge NHS Digital into NHS England as soon as legislation allowed.

I know that noble Lords had concerns about this transfer during the passage of the Health and Care Bill last year, which we have sought to address. I will also seek to address the points raised by the report of the Secondary Legislation Scrutiny Committee, which are echoed in the regret amendment tabled by the noble Lord, Lord Hunt.

First, I reassure this House that the transfer will not weaken the existing protections of people’s data and that the protection of data remains a priority for NHS England, which at senior levels takes these new responsibilities very seriously. All statutory functions of NHS Digital relating to the protection of data are being transferred, including the rules and safeguards required by law. This has been a guiding principle. NHS England will be subject to the same rules on collecting and disseminating data as are applied to NHS Digital.

NHS England can establish an information system only when directed by the Secretary of State or in response to a request from another body. All directions and requests that NHS England complies with must be published, so there is full transparency on what is being collected and for what purposes, and a clear upfront control. It cannot exceed the requirements of the direction or request. It must also publish its procedures for receiving and considering requests to establish information systems and for requests to access data. NHS England will report annually on how effectively it has discharged its transferred data functions, seeking independent advice to inform this report and consulting with the National Data Guardian for their views.

Concerns were raised during the passage of the Bill that we would lose the excellent practice that NHS Digital has followed in protecting people’s data and the crucial separation between those responsible for collecting and de-identifying data and those in NHS England analysing it. We therefore committed to place further requirements on NHS England, alongside the transfer of statutory functions, to ensure it would be a safe haven for data via statutory guidance. This is a new requirement.

This statutory guidance sets out measures that we expect NHS England to protect confidential information. There was some disquiet that the guidance did not seem to go far enough and that we had not added new duties to the regulations. This was not considered necessary; this is a straightforward transfer of functions under a legal framework which goes back to 2012 and has stood the test of time. That framework includes duties under the 2012 Act to have regard to various matters such as the need to respect people and promote the privacy of service users.

Additionally, we will issue statutory guidance, and I will come on to its contents in a moment. NHS England must have regard to this guidance; that means that it would have to demonstrate that it had justification for any decision not to follow it. Case law has shown that clear and cogent reasons would be needed to depart from guidance which is subject to a statutory duty to have regard. However, we have added strength here, as there is also a new power of direction, introduced in the Health and Care Act 2022, which could be used in cases of non-compliance with the guidance—namely, in Section 13ZC of the NHS Act 2006. Together, these mechanisms create a strong, binding commitment on NHS England to maintain the highest levels of data protection and safeguards.

NHSE is a long-established public authority which is experienced in processing personal data, including that of patients and employees. It does so in accordance with a robust legal framework which includes UK GPDR and the Data Protection Act. The lawful and proper treatment of personal data by NHS England is extremely important to maintain the confidence of service users and employees, and NHS England is well versed in processing personal data lawfully and correctly. It is aware of the importance of seeking independent advice and will be able to do so where necessary, including on the recommendation of staff transferring from NHS Digital. NHS England will also be able to approach the Information Commissioner’s Office as the independent regulatory body if it needs an independent view on particular matters.

I also reassure noble Lords that this statutory guidance covers all confidential information as defined in Section 263(2) of the 2012 Act. Therefore, it covers all data identifying an individual and all data identifying an individual which is subsequently identified or pseudonymised where an organisation, including NHS England, holds both the de-identified data and other data which would enable reidentification.

The guidance requires NHS England to obtain independent expert advice on its data access processes and procedures and, where appropriate, on individual decisions around data access. This will enable these experts to provide advice and assurance for both external and internal requests for access to data for purposes other than direct care. NHS England will be required to secure this independent advice or have a very good reason for not doing so. It is not optional or a case of doing so only when convenient.

Central to this should be a data advisory group, comprising appropriate experts and lay members, including one or more members with expertise in social care. This last point is not currently spelled out by the draft guidance, which we will amend. It would be appropriate for some internal representation to support this group to add expert knowledge and insight, such as the organisation’s Caldicott Guardian and data protection officer. However, the majority of members should be independent advisers. Minutes of the data advisory group meetings should also be published.

I know that some noble Lords have been concerned that NHS England will receive data which is still identifiable and which NHS Digital would previously have de-identified before sharing. The statutory guidance requires that the organisation will de-identify data before its internal analysis and use—the same role which NHS Digital undertook previously will be done internally, by a team separate from those who need to use the data. It explicitly states that responsibilities and accountabilities for using the data should be organisationally separate from the functions providing assurance and advice on this, such as information governance and Caldicott Guardian functions, to ensure that there are no conflicts of interest.

NHS England must ensure that there is the right governance for considering internal requests to access data, based on the same principles of risk-based assessment as for external requests for data, and drawing on the same independent scrutiny and advice. Furthermore, the Secretary of State will issue a direction in relation to NHS England’s internal use of data, which will be published. This will make clear the legal responsibility for NHS England to de-identify data before analysis, so that an individual cannot be directly identified either from the data to be accessed or analysed from the results of the analysis carried out. The guidance also calls for NHS England to develop a register of internal data uses mirroring that which currently exists for external data uses.

In response to the concerns of the Secondary Legislation Scrutiny Committee, although we are moving at pace, we are doing so because we are keen to see the benefits of creating a single statutory body responsible for data and digital technology for the NHS delivered quickly. The statutory guidance has been neither rushed nor piecemeal in development. The guidance has been in development for a number of months; a version was shared with some noble Lords and stakeholders before Christmas, and we have been discussing it with stakeholders—including the National Data Guardian, the Information Commissioner’s Office, NHS Digital and NHS England—revising it to reflect their comments and strengthening the requirements on internal use of data, which was a predominant concern.

We have now published the second draft, which we have drawn to the attention of noble Lords. This was also shared with the Secondary Legislation Scrutiny Committee and the British Medical Association and other professional organisations, to seek their feedback. I am sorry that we did not share the guidance before with the BMA.

--- Later in debate ---

I have one last question: after the regulation moves the powers to NHS England, will the new arrangements allow a patient to log into the NHS app and see whether data about them has been accessed? There are, as I am sure the Minister has heard, many questions. I hope that he and his team will take them in the spirit in which they are intended, because this debate and the contributions today are all about getting it right for the NHS and for patients.

[Lord Markham (Con)]

I thank noble Lords for their contributions and agree that we are all trying to achieve the same thing: to ensure the digital benefits come from this system and maybe—who knows?—create a UTOPIA, but also, vitally, maintain confidence. I take all these comments in the helpful spirit in which they are intended, and I hope that noble Lords will like my replies. At the same time, anything that I do not properly cover now—I suspect there will be some things I am not able to cover—I will, as ever, follow up on in detail in writing. Such is the importance of this that I am happy to meet again as well. The various meetings that we have had have been very productive, so I will make sure that those written answers come out quickly. I invite noble Lords to please come back if they feel there are some bits that still need further clarification. I will definitely set that up quickly and ensure that the officials are there as well. I have had various bits of feedback from the officials—I have tried to be engaged all the way through this. As the noble Baroness, Lady Merron, said, we have tried to get this right. I accept that we have not always done it perfectly, but I hope noble Lords can see that the good will is there.

On the specific questions asked by the noble Lord, Lord Hunt, I agree not only to publish the review but, happily, to brief Parliament on that. On the idea of including the LGA in the composition, I am very happy to do that. Regarding the points made by the noble Baroness, Lady Brinton, on the ability to use Palantir outside of the agreed research, the intent is absolutely that it can be used only for the agreed purposes and it cannot be used or sold elsewhere without suitable agreement. Again, the annual report will address how well it is working in practice.

I hope that the merger will not be like the PHE closure. I think they have been working on the new timing, in terms of February, since October, when it was announced, and have been working with the staff on that timing. I know that the plans that I have seen have taken into account the ability or need to retain people, which is obviously crucial to this, as we know that you need additional skills in this space and the importance of retaining them.

On the questions asked by the noble Baroness, Lady Finlay, my understanding regarding Wales—and I will make sure that this is followed up properly in writing—is that it has consented to the transfer arrangements in this. Generally, NHS England will continue to play the same role it has currently; that has been agreed. I entirely take and accept her point about the hacking risk, that the more attractive you make the data pool, for want of a better word, obviously the more essential it is to make sure that security and protections are in place.

As ever, I enjoyed the points made by the noble Lord, Lord Allan. He was talking about UTOPIA. He mentioned the geeks, and I am sure he is aware that that word came out of the Second World War, when they were looking for general engineering and electrical knowledge in their recruitment of soldiers, so that is one for him. Going forward, those extra forms of transparency and the quadruple lock all sound very sensible to me. I had a quick note from my team, saying that they also thought that it sounded sensible. Again, I think that we will probably need to put some detail around that, but I thank the noble Lord for those suggestions. Let us try to make sure that we work with those.

I absolutely take all the points made by the noble Baroness, Lady Merron, again, in the spirit in which they are intended. I do not think that I have a good answer to the “marking their own homework” point, to be fair. I hope that the noble Baroness knows me well enough to know that I will never try to argue that black is white from where we are. I think that is, quite rightly, the concern that all noble Lords have raised tonight, and it is obviously these protections, such as the quadruple lock and the other things that we need to put in place, that we need to make sure are there.

On the kind of things mentioned, the advice and the minutes from the meetings and the advice given by the independent groups—absolutely. I spent a bit of time today on how we would involve the ICSs, and my understanding—again, I freely admit my understanding is probably at GCSE level right now, so I need to do a bit more work on this—is that a lot of this is around the data standards that the ICSs are starting to deploy to make sure that the formatting of the data is correct so that everything can be kept in this common data warehouse. That is something that they are working on already, in terms of establishing those standards. A number of trusts have worked towards that, accepting that it cannot be completely finalised until we know who is going to win the tender for it.

National Health Service (Primary Dental Services) (Amendment) Regulations 2022

Lord Markham Excerpts

Tuesday 24th January 2023 Lords Chamber

I hope that the Minister can address all these points, because I am afraid that NHS dentistry in this country is going in the wrong direction. We need to see it provided so that people can be assured of their health in all ways.

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

My Lords, I start by declaring an interest: as I have mentioned before, my wife is a dentist, and so interested in this. She has been able to join us here, as part of a celebration for my father’s 80th birthday. Who knows why they would want to come and listen to me on such a night?

I thank the noble Lord, Lord Hunt, for securing the debate on this important matter and thank noble Lords for their contributions. We all agree that dentistry is a vitally important area. On the points made by the noble Baroness, Lady Bennett, I agree that health and oral health are indivisible. This is a key part of levelling up. I agree with the premise that these SIs are a start, not a finish—a point made by the noble Lord Allan.

I will try to address the points made by the noble Baroness, Lady Merron, about the defects of the SI. I am not defending some of the other things but I would like to think that this regret Motion and the one that we had the other day are more about having a debate because we think that we can do better, rather than disagreeing with the SIs themselves. If that is the case, I agree that they are the start and not the finish; there is definitely more that we want and need to do in this space. These regulations are a sensible first move. Some changes have been mentioned already tonight but the UDA changes—to put the minimum value in place and ensure that it more fairly reflects the complexities of some of the treatments—are steps that we worked with the BDA on. I think we would all agree that they are sensible steps.

I have also heard various variants on some dentists, for want of a better word, gaming NHS contracts. I have definitely seen some of that behaviour. I will need to take away some details on the points that the noble Lord, Lord Hunt, made about pension qualifications, but we generally recognise that that is going on. At the same time, the provisions within the SI to give more support, 110% or even more, to those who are properly contributing to the system are welcome. I hope that that would be generally agreed.

I hope that we would all agree that the other measures, such as using teams to get a better skill mix and DCPs to do more of that work, are sensible. I agree that we need to reduce those obstacles. I did not realise that we had the Tim Berners-Lee of the dentist directory among us today, but I hope that we would all agree that moves on dentistry website information are sensible, modest though they are. I know that water fluoridation is a great favourite of the noble Lord, Lord Hunt. We are making moves on it. On the changes we were discussing the other day on GDC international recruitment, the mutual recognition of qualifications is a good first step and should definitely be a way forward in easing access. There clearly has to be a better way forward on intelligent use of recalls, rather than those people who are already lucky enough to be with an NHS dentist automatically getting a six-monthly reminder. We all know that, in many cases, those appointments could be better used elsewhere.

As mentioned, we all agree that these measures are just the start and definitely not the finish. The steps we need to introduce have to centre around supply and workforce. On when the workforce strategy will be published, fairly advanced drafts are being circulated, as I mentioned the other day. A lot of work has been and is being done in that space. While I cannot give a precise date, I think it will be in the not-too-distant future—let me put it that way. We recognise that more needs to be done on it. As the House has heard me say before, a lot of that is around the flexibility between qualifications and having much more of a modular, escalator-type approach. For instance, it surely makes sense for a dentist to be qualified as a nurse along the way, two years in, and then to be able to start work in the dentistry profession and hone their skills, rather than supplementing their income down at Wetherspoon’s as they finish the rest of the course. I think we all agree that those have to be sensible measures, and I know this is very much the direction of travel being worked on.

The critical element is dental deserts. We all know this is the nut that we have to crack. When I have conversations with colleagues normally, having a bit of knowledge can sometimes be a dangerous thing. In this instance, I try to describe it. I ask them to think about a situation where we want a dentist who has probably been there for about 10 years and is in their mid-30s. We might say, “We would now like you to set up your own practice.” The dentist says, “Great, I’d like that. I’m up for that.” We say, “And in an NHS dental desert, because that’s where we need it.” The dentist says, “That’s good, I really want that. What do I have to do?” We say, “Well, raise 400 grand to set up a practice; set up payroll so you can employ six to eight people; start marketing yourselves; fit it all out, get the chairs, and off you go.” They say, “Hang on a moment, I’m a dentist. I’m good at being a dentist. I’ve done it for 10 years, and I think that qualifies me. I’m not in a position to go out there and set up a dental practice like that.” So, I think there is recognition that, if we are really going to move the dial in that area, we have to give them far more help and support: the know-how, some of the funding, the whole package. Clearly, if you are going to get that support, you need to be committed to doing it in that area, but that is the kind of direction of travel that I know colleagues are working on. So while I portray a personal view in terms of my feelings towards it, I know that is very much recognised by colleagues in the House.

Respiratory Syncytial Virus

Lord Markham Excerpts

Thursday 19th January 2023 Lords Chamber

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government whether they have plans to introduce PCR testing and an annual vaccination programme for young infants, children and older adults in relation to seasonal Respiratory Syncytial Virus (RSV).

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

PCRs test are already in use to diagnose RSV and monitor its prevalence. Current RSV immunisation is targeted at infants at high risk of severe complications. New immunisation products, including vaccines, have been developed and are being reviewed by the Joint Committee on Vaccination and Immunisation, JCVI, which will potentially provide advice later this year. His Majesty’s Government will decide on future vaccination programmes once they have received that advice.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, as the Minister will know, RSV-related hospitalisations in the under-fives cost £48.2 million in the UK annually. At a time when the NHS is facing increasing pressures, both financially and through capacity, will the Minister clarify how the Government plan to reduce the infant burden associated with it to ensure that the NHS does not experience the same situation next season? If there are plans, will they publish them? If there are no plans, why not?

--- Later in debate ---

[Lord Markham (Con)]

I thank the noble Baroness for her question. I am pleased to say that there are promising new vaccinations. The current vaccination unfortunately requires monthly injections, which is why it is not very effective, and costs £2,000, so it is not an effective way ahead. A new injection, nirsevimab, has just been licensed which is showing in tests to be 75% to 80% effective and immunises people for six months, so we are hopeful that it is the way ahead. The JCVI is currently conducting a study on it, and we are hoping its recommendations will suggest a good way forward.

[Lord Patel (CB)]

My Lords, two days ago Moderna from the United States announced that it had used messenger RNA technology to develop a vaccine for RSV. The report was of a late-stage trial and the vaccine has an efficacy of 84% for adults. There are similar results from both GSK and Pfizer, with an efficacy of 66%, but we already have antibody prevention treatment developed by AstraZeneca and Sanofi for prevention of RSV in children and young infants. That has been approved by the European Medicines Agency, and the Moderna vaccine is seeking FDA approval. Why does none of these have market authorisation in the United Kingdom?

[Lord Markham (Con)]

I can report best on nirsevimab, which has just been licensed, is shown to be 75% to 80% effective in the trials and has the approach of immunising people for six months. I am aware of Pfizer developing a maternal vaccination for whooping cough, which will give the baby immunisation through the mother. The House will also be aware of the recent announcement we made with Moderna on the investment in new R&D facilities here, so that we are at the forefront. I hope the noble Lord can see that we are looking at all these new innovations and will roll them out.

[Baroness Buscombe (Con)]

My Lords, have we not learned some lessons, from Covid and long Covid, of the need for children, babies and all of us to build our immune systems? Long Covid is proving that we have a real problem. I caught this virus from my granddaughter, a baby. I am told that the more she catches these wretched things now, the healthier she will be and the better she will be at putting off some serious diseases later in life. While accepting that high-risk babies obviously need particular regard, is it not right that we should be mindful of continually looking for a vaccine every time a new virus is discovered?

[Lord Markham (Con)]

My noble friend is correct in that, for the vast majority of people—infants in this case—it is mild, flu-like symptoms at most. At the same time, it is responsible for 35,000 hospitalisations and 20 to 30 deaths a year, so it is a serious thing that we need to get on top of. We are looking for the best of both worlds. That 90% of two year-olds will have had RSV and so will have that natural protection is a good thing. But in the most serious cases—the risk groups are those with congenital lung or heart disease or spinal muscular problems—these new treatments really will help and are very important.

[Baroness Walmsley (LD)]

My Lords, the innovative vaccines and treatments mentioned by the noble Lord, Lord Patel, all require UK clinical trials. The number of clinical trials initiated in the UK declined by 4% between 2017 and 2021. What are the Government doing to reverse this decline so as to bring valuable industry money back into the NHS and cutting-edge treatments, such as RSV vaccines and treatments, to patients?

[Lord Markham (Con)]

The noble Baroness is correct. In fact, my maiden speech was in a debate about how we can bring life sciences to bear more. The point about NHS clinical trials and the fact that we are not using this massive potential asset was very much a feature of that. It is key to the work we are doing—I had a meeting on it just this week—so I agree with the noble Baroness and hope we will see improvements in this space.

[Baroness Wheeler (Lab)]

My Lords, we know that older adults are at greater risk of serious complications from RSV infections in children, because our immune systems weaken as we get older, which can lead to exacerbations of underlying lung and cardiac disease. What action is being taken to address the serious underestimation of older adult RSV infections and to improve testing, reporting and treatment for this key group?

[Lord Markham (Con)]

I thank the noble Baroness. The key risk groups in the elderly as well are, as I mentioned earlier, those with congenital lung or heart disease or spinal muscular atrophy. The problem is that the current vaccination needs monthly immunisation to be effective, and I think most people will agree that it can be used in only the most severe cases because it is not a very practical way forward and is very expensive. That is why I am really excited by the new treatments, particularly nirsevimab, which is 75% to 80% effective, versus palivizumab, which is more around 50%. I think we have a good way forward.

[Baroness Wyld (Con)]

My Lords, has the Department of Health done any assessment of how many children may have missed their routine vaccinations during the pandemic lockdown? Is the department doing anything to follow up with these children? If so, can the Minister say what?

[Lord Markham (Con)]

I know that this, like all those areas that were unfortunately missed out during the pandemic, is something the department is working on. There are catch-up activities. I have seen it personally with my four year-old, who of course was two and three during this time. I will happily provide the detail in writing.

[Lord Allan of Hallam (LD)]

My Lords, does the Minister agree that it is wise for the UK to maintain a good level of baseline PCR testing so that we can ramp it up when confronted with novel viruses such as Covid-19? In that respect, does he agree that it is important to consider this resiliency benefit when looking at the business case for PCR testing for other viruses, such as RSV?

[Lord Markham (Con)]

Yes. I should probably declare an interest, having set up a PCR business—in the private sector, I might add. I know at first hand from that how versatile these PCR machines are. They can be used to diagnose all these sorts of treatments, so we absolutely have to make sure we keep that strategic capacity alive.

[Lord Turnberg (Lab)]

My Lords, we were obviously ill prepared for the Covid outbreak. How prepared does the Minister think we are now for track and trace and delivery of PCR tests? What resources do we have in place to cover that?

[Lord Markham (Con)]

We have the PCR capacity in place. Clearly, as responsible Ministers spending-wise, we are ramping some of that down because we do not need the sort of capacity we had before. From personal knowledge, I can promise that there are a lot of these PCR machines knocking around, so that capacity really is there. There was a Question a few days ago about how prepared we are for the next epidemic. Clearly, we will get the findings of the Covid inquiry, but the whole purpose of setting up the UKHSA was to make sure we have the proper preparations around for next time.