NHS Waiting Times

Lord Markham Excerpts

Tuesday 22nd November 2022 Lords Chamber

[Baroness Merron (Lab)]

With the permission of my noble friend Lord Hunt of Kings Heath, and on his behalf, I beg leave to ask the Question standing in his name on the Order Paper.

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

In February 2022, we published the elective recovery plan, setting ambitious targets to recover services, backed by more than £8 billion in funding from 2022-23 to 2024-25 and supported by a £5.9 billion investment in new beds, equipment and technology. We are providing an additional £3.3 billion in 2023-24 and 2024-25 to ensure that the NHS can take rapid action to improve performance, including urgent and emergency care and getting elective performance back towards pre-pandemic levels.

[Baroness Merron (Lab)]

My Lords, last week’s report from the National Audit Office laid waste to the idea that all of the NHS’s current woes are down to the pandemic. By 2019, NHS England had not met the elective waiting time performance standard for four years, nor its full set of eight operational standards for cancer services for six years. Following the Government’s announcement last week of a review into NHS efficiency, can the Minister confirm whether the Government are still committed to their 18-week target between GP referral and consultant-led treatment, as well as their other targets around A&E waiting times, ambulance responses and cancer treatment?

[Lord Markham (Con)]

I thank the noble Baroness. With reference to past performance, that is what the spending increases were all about. They were an acceptance that we need to do more in this space, and we are doing more. The pandemic clearly brought unprecedented circumstances and that is why we have announced more funding to get on top of that in the next few years, tackling all the areas that the noble Baroness mentioned in terms of A&E wait times, GPs and all the rest.

[Baroness Chisholm of Owlpen (Con)]

My Lords, we know that part of the problem is that ambulances are going to A&E departments but are not able to deposit their patients in A&E. We know that there is a blockage at the other end in social care, with people not being able to be discharged fast enough back into the community or into care homes. Until that is sorted out, I cannot see how we are ever going to sort out the waiting lists. Can my noble friend the Minister tell me what might happen that will perhaps make those problems better?

[Lord Markham (Con)]

I thank my noble friend. Adult social care, as many have heard me say before in this House, is a crucial part of this, because it is all about the flow. That is why I was delighted that, in addition to the £500 million discharge fund for this year, we have secured up to £2.8 billion of funding for next year. That is in addition to the 7,000 extra beds and the tailored help for the 15 worst-performing hospitals with the ambulances, so we have a complete answer to all these areas.

[Lord Patel (CB)]

My Lords, patients with complex and long-term conditions are finding it increasingly difficult to access the care that they need, resulting, as the British Heart Foundation report indicated, in 10,000 excess deaths in people suffering from chronic cardiac conditions. The Minister referred recently to the system being a failure. Does he agree that we need a system that develops care for these patients, one that is accessible and timely, in community and primary care settings?

[Lord Markham (Con)]

I agree with the noble Lord that cardiovascular is one important area in which, over the last few years, patients have not received the number of check-ups that we want, so it is an area on which we want to focus—not just through checks in GP centres but in the community. We all know that it is very easy to take blood pressure and have blood pressure machines. As a team, we are looking at precisely those kinds of measures to make sure that we can get the preventive screening in up front, so we can identify these people before problems occur.

[Baroness Brinton (LD)]

The Minister referred to the worst-performing hospitals and ambulance trusts, but news from the Health Service Journal today has shown that the longest waiting times are mainly in rural, deprived areas, with an elderly population that is much higher than in the rest of the country. Can the Minister say what special resources will be provided for those areas—rather than just using words like “worst”, which punish them unnecessarily?

[Lord Markham (Con)]

I thank the noble Baroness. If I have used a poor choice of words, I apologise. What we are looking at is identifying the areas where we most need to focus resources to solve wait times. That might be because it is a rural area or it might be, candidly, because it is not performing so well. The point that I was trying to make is that there is targeted support. We spent £150 million on ambulance performance and new facilities last year, and it is something that we will continue to do if those rural areas and other areas need the spend.

[Lord Watts (Lab)]

My Lords, will the Minister deal with the issue of 18 weeks? Are the Government still committed to that policy? If they are, when does he think it will be achieved?

[Lord Markham (Con)]

We are committed to timely appointments. The whole point about the community diagnostic centres that were set up—and we have set up more than 90—is so that patients can be referred straight to those centres and get their screening and tests straightaway, getting them more quickly and, I hope, getting peace of mind more quickly as well.

[Baroness Meacher (CB)]

My Lords, I very much welcome the recent change, which enabled GPs to refer patients direct for assessments instead of having to refer to a consultant, and for the consultant then to refer, which I think saved about 30 days. What other procedural changes are the Government considering that would further reduce waiting times, without actually costing more money, and save doctors time—for example, patient self-assessments in the home, which we pioneered in east London 30 years ago?

[Lord Markham (Con)]

I thank the noble Baroness. There are a number of areas where we can do this. I point to the possibility for home testing a lot more. Covid was a perfect example, whereby it became commonplace. Rather than samples being sent away to a laboratory, we came up with lateral flow devices and were able to do it cheaply and pretty accurately, although not quite as accurately. That is a perfect example of using technology to do more home-type diagnosis.

[Lord Kamall (Con)]

My Lords, in learning from best practice in other countries, are my noble friend, the department or the NHS aware of the pioneering work of Dr Shetty in Bangalore, who has pioneered production-line surgery for certain procedures? Are the Government considering that at the moment? If not, why not?

[Lord Markham (Con)]

I thank my noble friend for that. While I am not familiar with that exact case, I saw a very good, probably quite similar, example in Chase Farm Hospital, which has four operating theatres in a sort of barn. It has a complete production line for elective hip replacements and so on to get that capacity and efficiency.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interests. The Minister will be aware that innovation, be it therapeutic or in models of care, is essential to improve efficiency and efficacy in the delivery of NHS services. Is he content that there is sufficient protection in the NHS budget to drive that adoption of innovation and ensure that staff are properly trained for its application?

[Lord Markham (Con)]

I thank the noble Lord. As I have said previously, innovation, and being able to back that up with investment, is key. The House will see that we have protected a lot of the research funds so that we can do exactly that. That is the direction of travel. The new hospital programme, which I look after, is very much about looking at best practice and innovation around the world and making sure that we employ the best in our new hospitals and across all our trusts.

[Lord Reid of Cardowan (Lab)]

My Lords, the Minister is relatively new to his department, but even in the number of weeks he has been there, he must recognise that, whatever statistics on inputs he announces at the Dispatch Box, it is not working. There was a time, two decades ago, when we managed as a Government to reduce the maximum waiting time from three years to 18 weeks and the numbers on the waiting list from 1 million to 500,000. There are now 7.2 million on the waiting list—incidentally, there were 4.2 million before Covid. Whatever the Government have been doing for 10 years is not working and people are remaining in pain for prolonged periods, quite apart from the effect on the economy. Will the Minister institute an immediate review centred particularly around patient choice, which is the only thing that will drive down waiting times and waiting lists? It should never have been abandoned in the way it has been by the Government.

[Lord Markham (Con)]

I believe that customers—call them patients—should drive performance and improvements. Inputs are important, but I totally agree that in a performance culture outputs are very important. I give credit to the work done in the early 2000s, from which I have tried to learn in the short time I have been here, to really bear down and create a performance culture to get waiting lists down by holding trusts, and now the new ICB CEOs, to account. That is definitely the direction of travel, and I am very happy to learn from things that have worked well in the past.

NHS: Waiting Lists and Increased Spending

Lord Markham Excerpts

Tuesday 22nd November 2022 Lords Chamber

[Lord Balfe]

To ask His Majesty’s Government what assessment they have made of the statement by the Institute for Fiscal Studies on 15 November that NHS waiting lists have risen in 2022 alongside increased spending on NHS England.

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

The Government continually assess data and reports on waiting lists from a wide range of sources, including the Institute for Fiscal Studies. The IFS statement confirms that the Government are right to support and challenge NHS England to continue to identify and address factors that constrain further activity, and to reduce waiting lists. The Autumn Statement announced a further £3.3 billion for 2023-24 and 2024-25 to enable rapid action to improve emergency, elective and primary care performance.

[Lord Balfe (Con)]

My Lords, I thank the Minister for his reply. Last week, the Institute for Fiscal Studies said that

“NHS spending in England is, in real terms, 12% above its 2019 level. Yet it is getting fewer people off waiting lists and into hospital treatment than it was … in 2019.”

We used to have a slogan: “Labour isn’t working”. The NHS is no longer working. The Royal College of Obstetricians and Gynaecologists has asked me whether we could ring-fence its money. I do not think we can. Can some of the hundreds of civil servants on six-figure salaries in his department get down to sorting out what is clearly a dysfunctional department?

[Lord Markham (Con)]

My noble friend is correct. Efficiency is very important, as pointed out in a previous Question. I have done some work in this space, and there are some trusts that are absolutely on the path to the 130% increase in elective treatments compared with 2019, for which the funding is in place. There are other trusts that are not. Clearly, my job and the job of all the department’s civil servants is to understand why that is and to challenge those trusts that are not; to support them where they need that support; and to ensure they are introducing best practice and innovation in order to make sure they all get back towards that level. There are some very good performers and others that are not so good.

[Lord Stirrup (CB)]

My Lords, we hear a lot in this House about the recruitment of doctors and nurses. However, any organisation facing the kind of challenges confronting the NHS would ordinarily be doing its utmost to retain its talent. The NHS, in many ways, seems to be doing the opposite. When will it develop a comprehensive strategy for the retention of its experienced clinical personnel, without whom it would simply be unable to function?

[Lord Markham (Con)]

I thank the noble and gallant Lord for his question. I was delighted to see in the Chancellor’s Statement a commitment to a workforce strategy for five, 10 and 15 years, something that all of us in this House have been asking for. It will look at all the needs in respect of recruitment and, crucially, retention. That is very much part of the agenda.

[Lord Woodley (Lab)]

My Lords, the current shortage of 60,000 nurses is devastating, and its impact on waiting lists even more so. It is obvious—to me, anyway—that the main cause of this staffing crisis is low pay, with many nurses opting to leave for jobs in supermarkets and other sectors for better wages. Does the Minister accept that the best way to tackle these problems is to allow more qualified nurses into the UK from the EU and beyond, grow the economy and fill the gaps in the skills that the NHS needs? Most importantly, we need to pay our heroes, who we all clapped for, a decent living wage to live on.

[Lord Markham (Con)]

I thank the noble Lord. For the record, there are 29,000 extra nurses since 2019-20, so we are well on course for the 50,000 increase. At the same time, we do need to recruit from overseas, and that is very much part of the plan. Again, this will go into the workforce strategy, but I completely agree that we should be looking to recruit from around the world, which we are. I am delighted that we are adding more and more people to the essential workers list, so to speak, to enable us to do that, because we all know that the workforce plan will show that we need to recruit people and retain them.

[Baroness Brinton (LD)]

My Lords, the last time the figure of 92% of patients being seen within 18 weeks was achieved was in 2016. Since then, the numbers who are waiting have doubled: it is now 7.1 million. What does the Minister say to the 16 year-old in Shrewsbury who has just been told that he has to wait nearly three years for a first appointment at his local hospital? The hospital says that it has recruitment problems. When will we see the details of this workforce plan, particularly for rural areas?

[Lord Markham (Con)]

I thank the noble Baroness. As I say, we have committed to that workforce plan, and it will be detailed. We will look at every place in every part of the country because we understand that that is needed, and it is part of the critical plan to get on top of the 7.1 million waiting list. As I think we have accepted, it is not a quick win; it will get higher before it gets lower again. Clearly, however, we need to get on top of it, and we are focused on it. It is very much about the plan and the new spending plans that we put in place to address it.

[Baroness Wheatcroft (CB)]

My Lords, last year NHS trusts paid an interest bill of almost £500 million on PFI hospital contracts. This year, that bill will rise again. Can the Minister tell us what proportion of the increase in NHS budgets will go just to pay interest charges on these dreadful contracts, and what plans he has to try to renegotiate them?

[Lord Markham (Con)]

I thank the noble Baroness; I will need to get back to her in writing on the detail of that. However, looking into the PFI contracts is very much part of my agenda; I had a meeting on that just last week, and we are reviewing it.

[Lord Brownlow of Shurlock Row (Con)]

My Lords, with the increasing conflict between inputs and outputs that the noble Lord, Lord Reid, mentioned earlier, does my noble friend the Minister agree that the need and time for a royal commission on the NHS is fast approaching?

[Lord Markham (Con)]

I thank my noble friend. To be honest with him, I am hoping we can act quicker than that—that is absolutely the plan. I can tell him that we know the areas where they are performing and they are on the elective recovery plan, and we know those that are not. I do not need a royal commission to tell me that. To my mind, it is about understanding what those hospitals are doing well and putting in place focused action and support to help those that are behind the plan.

[Baroness Merron (Lab)]

My Lords, on an earlier Question, I and other noble Lords asked the Minister if the Government were still committed to their target of 18-weeks between GP referral and consultant-led treatment, and their other targets for A&E waiting times, ambulance responses and cancer treatment. I offer the Minister another opportunity to say to your Lordships’ House whether this is the case.

[Lord Markham (Con)]

I thank the noble Baroness. As I am sure the House is aware from the statements of the Chancellor and the Health Secretary, in a lot of areas we are trying to make sure that we place fewer targets on the health professions and GPs and allow them to manage. At the same time, we make sure that if they are not performing, action is taken, but generally we trust them to manage. The beauty of Google is that I have been able to check the 18-week target, and it is a statutory commitment, so I can give that assurance. However, on the others, we are making sure that we look at the performance measures that really matter.

[Lord Howarth of Newport (Lab) [V]]

My Lords, whatever efficiencies are achieved, given that the growth in demand for NHS services will continue to exceed the growth of our ailing economy, should not the Government be making a major commitment to preventive strategies to stop people becoming ill or injured in the first place? With the Government’s reversion to austerity, however, has not the prospect deteriorated for the investment needed in public health and non-clinical approaches such as the successful warm home prescription pilot? How can we hope that the Government will systematically address the social determinants of health, such as poor housing?

--- Later in debate ---

[Lord Markham (Con)]

I thank the noble Lord, and I agree that prevention is better than cure. I refer to the earlier Question and analysis by Chris Whitty, the Chief Medical Officer, who pointed out his concerns about cardiovascular health arising from people not having had the check-ups they should have had during the pandemic. I completely agree that there are some very cost-effective measures which can really help with the prevention agenda, such as heart blood pressure machines and lateral flow screening devices that can be sent to homes. We are looking at that issue, because I agree that prevention is better than cure.

Health: Pancreatic Cancer

Lord Markham Excerpts

Monday 21st November 2022 Lords Chamber

[Lord Black of Brentwood]

To ask His Majesty’s Government what steps they are taking to improve survival rates for pancreatic cancer.

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

Improving early diagnosis is incredibly important to help boost cancer survival, and the Government are committed to the NHS Long Term Plan ambition of diagnosing 75% of cancers at stage 1 or 2 by 2028. Pancreatic cancer is difficult to diagnose due its unspecific symptoms. To help diagnose these cancers, we have opened 91 community diagnostic centres and 96 non-specific symptoms pathways which are transforming the way those with symptoms not specific to one cancer are diagnosed.

[Lord Black of Brentwood (Con)]

My Lords, this is Pancreatic Cancer Awareness Month, a time to remember those who have died prematurely of this cruel and unforgiving disease, but also a time angrily to reflect on the shocking statistics that surround this least-survivable and quickest-killing cancer: three in five pancreatic cancers are diagnosed at a late stage—worse than any other cancer; half of those diagnosed die within three months—worse than any other cancer; almost 60% of people are diagnosed in A&E—worse than any other cancer. These statistics are shameful. Would my noble friend tell us what has happened to the 10-year cancer plan, which is so vital in this area, and commit to a strategy within it to ensure early diagnosis of pancreatic cancer patients within 21 days of presenting with symptoms? Will he explain why there is so little investment in research in this area—just 3% of the total UK cancer research budget—when we vitally need a test to stop this horrible disease in its tracks?

[Lord Markham (Con)]

My noble friend is correct: pancreatic is probably one of the cruellest of cancers. We have a 10-year cancer plan; to answer his question, we are going through 5,000 responses, and we are analysing them and will report back shortly. On research, we are performing over 70 different pancreatic cancer studies. Key to all of this is not just early diagnosis; more important than ever, in this awareness month, is making sure that people are aware and go to their doctors early if they have any concerns at all.

[Lord Turnberg (Lab)]

My Lords, one of the problems of this nasty cancer is that, by the time any symptoms occur, it is often too late. We desperately need some sort of screening test. Recent research has suggested that we may be able to pick it up in the bloodstream using a so-called liquid biopsy. What research is being done on this now?

[Lord Markham (Con)]

I understand that the leader in this field is GRAIL. This blood screening is happening in America right now, and NICE is undertaking studies in this field to see whether it should be brought to the UK. We will have its findings. I agree that pancreatic cancer is an area where early detection is key. It is not just about the screening but about people going to their doctor if they have any concerns at all, as I say. We have non-specific symptoms pathways to help doctors to detect what is wrong.

[Lord Aberdare (CB)]

My Lords, the UK ranks 29th of 33 countries for five-year pancreatic cancer survival rates. At the very least, we should ensure that pancreatic cancer patients get the best possible treatments in the short time usually available to them, with over half dying within three months. One such treatment is pancreatic enzyme replacement therapy—PERT—which helps them to eat and digest their food, but only about half of pancreatic cancer sufferers are offered this treatment. What are the Government doing to understand why this is the case and to ensure that all pancreatic cancer patients who need PERT are offered it?

[Lord Markham (Con)]

I thank the noble Lord. This case has also been brought forward by the noble Lord, Lord Moynihan, who could not be here today, but he is very keen on this as well. We have now put PERT into NICE guidelines, so it should be offered. I am meeting my noble friend Lord Moynihan to make sure that these things are being taken up, and I would be happy to extend that invitation to the noble Lord.

[Lord Forsyth of Drumlean (Con)]

My Lords, the Government’s current campaign to encourage people to go and see their GP if they have symptoms is commendable, but how can this help when people are waiting months to get scans and then weeks to get the results of their scan? What can be done about this?

[Lord Markham (Con)]

This is where we see the diagnostic centres being a key area in this. We have set up 91 community diagnostic centres. In addition, in 2020 we had only 12 non-specific symptoms pathways; we are now rolling those out to 96, so that 75% of the population will be covered by March 2023, with a target of 100% by March 2024.

[Baroness Merron (Lab)]

My Lords, the UK is lagging behind comparative European nations on cancer survival rates. In the landmark How Good is the NHS? report, the UK came last on pancreatic cancer survival rates. Could the Minister give a view as to why the UK compares so unfavourably to elsewhere? How will the recent comments of the Health Secretary about changes to national targets affect waiting times and survival rates for patients with pancreatic cancer?

[Lord Markham (Con)]

We are very clear on the need for speed in cancer treatment; that is one target that will not change, because we know its importance in all this. With pancreatic cancer, we are where we were with prostate cancer about 10 or 15 years ago, and I am glad to see that we have made great strides on that with initiatives such as the Movember campaign and the action on that. Candidly, we are not where we need to be on pancreatic cancer, and we need to adopt those sorts of awareness campaigns, as well as fast action on screening, to improve our performance.

[Baroness Brinton (LD)]

My Lords, 30 years ago cervical screening was developed and introduced; prior to that, cancer of the cervix was as impossible to detect and to find as pancreatic cancer. Will the Minister say whether research will be provided to ensure that screening for pancreatic cancer can be introduced as soon as it is confirmed, because screening was the real game-changer for cervical cancer?

[Lord Markham (Con)]

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

[Lord Kakkar (CB)]

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

--- Later in debate ---

[Lord Markham (Con)]

My understanding is that we do have the capacity for these research trials. Also, on workforce in the cancer space, we have invested £50 million, so we are actually 200 people over our target on that. This is part of the Chancellor’s announcement about the long-term workforce study, which I know will be welcomed by many in this House, where we will be looking, area by area, at exactly what workforce needs we have—and we have a recruitment plan against that.

[Lord Kamall (Con)]

My Lords, in response to an earlier question, my noble friend the Minister talked about the need for more awareness in advance of identifying appropriate screening methods. Given that it is now Pancreatic Cancer Awareness Month, what else are the Government and the NHS doing outside that to ensure there is more awareness for patients to come forward for potential pancreatic cancer?

[Lord Markham (Con)]

I thank my noble friend. Key to this is the Help Us to Help You campaign, which reaches out to lots of different communities, including a number of minority communities. At the same time, we have rolled out the early cancer diagnosis service to GPs, where they are looking out for some of those warning signs, even when people are there for a regular appointment. Clearly, as has been said by other speakers today, a lot more needs to be done; it is a journey, but awareness is the vital first part of that journey. On that point, I thank the Pancreatic Cancer UK charity, which has been excellent in this field.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister has just referred to awareness, to which he has referred many times in the course of this Question. Would he accept that, for some people, it is difficult to understand what you need to be aware of—particularly with a disease which is, as far as I am hearing today, largely asymptomatic for a good part of its early progression? Can he tell the House where people, who perhaps need to be aware, should look for the things that they need to be aware of?

[Lord Markham (Con)]

The noble Baroness is correct: the problem about the so-called invisible diseases—of which cervical cancer is another example—is that you do not know quite what you should be looking for. That is why I mentioned earlier the non-specific symptoms pathways, which are exactly designed for those sorts of things, whereby general checks are included in the area so that, although people do not even go along with a specific symptom, they are starting to be screened. That needs to be rolled out further. As I mentioned before, this would cover 75% of the population by March 2023; clearly, we need to be at 100%, with the target of March 2024 for that.

Social Care Sector: Staff Shortages

Lord Markham Excerpts

Monday 21st November 2022 Lords Chamber

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

As acknowledged by the Chancellor, pressures in the social care sector are a serious issue. We are taking steps to boost the social care workforce, investing up to £2.8 billion of additional funding in 2023-24 and £4.7 billion in 2024-25 for adult social care, raising the national living wage to £10.42 and launching our national recruitment campaign. We will also be publishing a staffing plan for regulated professionals, including nurses and allied health professionals in health and social care.

[Viscount Stansgate (Lab)]

My Lords, I thank the Minister for that Answer. Last Thursday, the Chancellor said that there were 13,500 beds occupied by people who should be at home. When are the Government going to ensure that there are enough staff to look after them in the adult social care sector, given that you can earn more money in a supermarket than in a care home? How much money are the Government intending to save by postponing the Dilnot reforms? Does the Minister agree with Sir Andrew that this delay is “inhumane”? Will it not mean that many more people are going to have to sell their homes in order to pay for the large care costs? In short, does the Minister agree that the longer this Government remain in office, the more people are having to wait for decent, affordable, proper social care?

[Lord Markham (Con)]

The noble Viscount mentioned funding. Clearly, it was a difficult choice, but our priority was to make sure that the funding went into the supply of places over the next two years, because of the impact that has across the system. Noble Lords will have heard me mention many times how that affects the whole flow, which backs up into ambulance wait times and everything else. That is why I am delighted to say that we have secured £2.8 billion of extra funding in 2023-24 and £4.7 billion in 2024-25. That will obviously flow through the whole system, including into staff wages and recruitment.

[Baroness Altmann (Con)]

My Lords, I welcome the announcement of the health and social care visa, but the Government have no separate figures for the number of workers who have come here under the new health and care special visa rules, separately for health staff and social care staff. So can my noble friend tell the House what are the median and top quartile pay rates for social care staff? I am happy for him to write to me if he does not have those figures. Do the new visa’s minimum salary requirements mean there is little hope of immigration filling the 165,000 or more vacancies, leaving 2.6 million older people without the care they need, as estimated by Age UK?

[Lord Markham (Con)]

I will need to write on the detail of the median and upper quartiles, as mentioned. What I can say right now, though, is that the national living wage increase will put them over the current visa levels required, which I think will be a big boost, allowing us to increase our recruitment from overseas. We have already seen month-on-month increases and the national living wage increase will help grow that further.

[Lord Harris of Haringey (Lab)]

My Lords, is it not the case that if the national minimum wage has gone up, therefore affecting the social care sector, it will also have gone up affecting those who stack shelves in supermarkets?

[Lord Markham (Con)]

I was referring in that answer to the visa scheme. That will allow us to recruit more people from overseas who will be eligible for a visa, in the fine traditions of the NHS. We have always recruited from around the world and I am pleased to say that we are recruiting in this space. This is a consequence of a full-employment economy, which I think we would all accept is a very good thing. But, clearly, that sometimes means we need help, in areas such as the NHS, to recruit from overseas.

[The Lord Bishop of London]

My Lords, Enabled Living in Newham has become the first London-based social care provider to pay its workers the real living wage—the first such employer to do so. We have heard that social care workers are among the lowest paid, with one in five residential care workers living in poverty before the cost of living crisis, according to the Health Foundation. What assessment have the Government made of the real living wage and the impact that it could have on retaining valuable social care workers?

[Lord Markham (Con)]

I thank the right reverend Prelate for the passion that she clearly displays in this field. As I mentioned in my Answer to the Question, we have a national recruitment campaign, and looking at the staffing plan for allied health professionals and what needs to be paid to recruit people in the right areas will be part of that. The national living wage is a start, but clearly we need to make sure that this is an attractive career that people want to join and stay in.

[Baroness Watkins of Tavistock (CB)]

My Lords, I draw attention to my interests in the register. Recently, the coroner in Cornwall ruled that some deaths in the county are probably attributable to delays in ambulance services, which are in turn associated with delays in transfers of care from acute services to care homes. There has been a reduction of more than 600 care bed places in Cornwall in the past four years. This is an example of the challenge that we face. Does the Minister accept that the Government’s objectives for the NHS will never be effectively achieved without resolving the social care challenges, and that the difficulty of recruiting from overseas, particularly in rural areas, should be acknowledged?

[Lord Markham (Con)]

I agree and have often made the point that solving this part is key to the flow and to getting people through discharge quickly, which has a knock-on impact on A&E and ambulance wait times. That is why I was delighted to hear the Chancellor recognise this specifically and mention £2.8 billion of funding in 2023-24, which will account for 200,000 new care packages in this space, as well as £4.7 billion in 2024-25 to resolve the exact problems that the noble Baroness brings up.

[Baroness Brinton (LD)]

My Lords, the Minister has now referred three times to the money that the Chancellor has said he will invest in social care from April next year. But the crisis is now and the Government’s own plan for patients says this must be resolved and there must be more social care workers immediately to help with the pressure on hospitals. What will the Government do over the next six months to ensure that there are more workers and help to relieve the problems with both discharges and A&E?

[Lord Markham (Con)]

I thank the noble Baroness. In the past few days, local authorities have been notified of the £500 million discharge fund. That funding will go out in December and January, so it is very much going out there. It is very much designed to address the issues of discharge, creating new places and helping to recruit.

[Lord Naseby (Con)]

My Lords, is there not a case for formally involving the Commonwealth in this aspect? There is already a trial going on with Sri Lanka for nursing. I suggest to my noble friend the Minister that there are other Commonwealth countries that would be more than willing to have a two-way flow and help reduce the huge shortage that we have.

[Lord Markham (Con)]

I agree with my noble friend. Overseas and Commonwealth recruitment is a key area here, which is why I am delighted that we have addressed the visa restrictions and entered social care on an essential workers list. We have already seen 15,000 people come in this space, and that figure is increasing month on month. My noble friend is correct that this is a critical area for recruitment for us.

[Baroness Pitkeathley (Lab)]

My Lords, does the Minister agree that the more problems there are with paid workers in social care, the more difficulties fall on the nearly 10 million unpaid carers. Of those who are receiving the carer’s allowance, 40% say that they are already in debt and not sure how they will manage through the winter. Does he also agree that, in view of the myriad problems in social care, it is time to listen to what the noble Lord, Lord Forsyth, asked the House last Thursday, and think about a proper review of the whole of social care?

[Lord Markham (Con)]

My Lords, I thank the noble Baroness. The new funds mentioned recognise that this is critical to the health of our National Health Service and the flow. As part of that, as I mentioned in my Answer, we are looking at staffing plans across allied health professions in the health and social care space, and it is vital that we get the recruitment to this area to solve the overall issue of flow and NHS wait times.

Childhood Obesity

Lord Markham Excerpts

Thursday 17th November 2022 Lords Chamber

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

Addressing childhood obesity remains a priority for the Government and we remain committed to achieving our ambition to halve childhood obesity by 2030. We are delivering an ambitious programme of work to create a healthier environment to help people achieve and maintain a healthy weight. We recognise that there is more that we need to do, and we will continue to work with the food industry to make it easier for people to make healthier choices.

[Lord Dubs (Lab)]

My Lords, first, could the Minister clarify whether the previous Administration’s policy, either to weaken or to repeal much of the 2020 obesity strategy, still stands or whether the Government will do better than that? Secondly, does he agree that health visitors play an important part in educating and informing families and parents so that, when children are young, they are brought up in an environment where they are encouraged to have a diet that tackles obesity?

[Lord Markham (Con)]

I agree that health visitors play a vital role. We all know that a good start to life with healthy eating is a good foundation for the rest of your life. We also know that a lot of the problems around adult obesity obviously start in children under the age of five. I completely agree on continuing to strive to do better in government. I will answer some more questions on the actions we are taking, from which the noble Lord will see that we are very active.

[Lord McColl of Dulwich (Con)]

My Lords, does the Minister agree that, as 40 million people are obese in this country, marching inevitably to a premature death from a variety of very unpleasant diseases, it would be a good idea to encourage them to have one less meal a day? This might encourage children to follow suit and put fewer calories into their mouths, which would help prevent them developing type 2 diabetes before they are 10.

[Lord Markham (Con)]

My Lords, I agree that we—both as the Government and in general—need to be clear about what our recommended calorific intake is each day. Whether you choose to change that by eating one less meal, or however else you distribute your eating across the day, it is our role to help educate people on healthy eating. I agree that it is an issue and a big cost to both the health service and the economy. Our latest estimates are that it could cost the economy as much as £58 billion a year, so it is a critical message to get across.

[Lord Addington (LD)]

My Lords, would the Minister enlighten us on the position of the BOGOF—buy one, get one free—deals? Are we going to remove the disincentive to people buying extra calories in the form of an extra portion? Or will the Government encourage people not to buy the first portion?

[Lord Markham (Con)]

As I think the noble Lord is aware, the position on BOGOF, so to speak, is that we have delayed those restrictions for a year. We have taken significant action in this space, most critically in supermarkets, by moving the promoted items away from tills and prominent aisle endings to remove this so-called pester power. We will very much keep this under review; when we see the impact, particularly of moving those items, we can look again at whether we will introduce more BOGOF restrictions.

[Baroness Hoey (Non-Afl)]

My Lords, the Minister has mentioned that what children eat is very important, but is the amount of proper and physical exercise young children get not just as important? Is he concerned, as I am, that primary schools, more and more, do not have officially registered physical education teachers, resulting in children getting very little properly organised exercise? Does he think that this is important, as far as obesity in children is concerned?

[Lord Markham (Con)]

I agree with the noble Baroness, particularly given her previous position, that sport and physical activity are vital. As I am sure she is aware, we have a 60-minute target for children and £320 million of PE funding to back that up—but active lifestyles and sport are critical to that.

At this moment, as both an Englishman and a Welshman, I take the opportunity to wish both teams all the best in the World Cup.

[Lord Brooke of Alverthorpe (Lab)]

My Lords, is it not a factor that exercise, no matter how much you do, will reduce only 20% of your overweight? Some 80% is from food and drink. Will the Government spend more time looking at fat and sugar? Why will they not promote research into alternatives to sugar, notably stevia? Instead, they leave it to the private sector and the manufacturers to do the work, and they are doing no work whatever on it. In those circumstances, will the Government take action themselves?

[Lord Markham (Con)]

I agree with the noble Lord that a healthy lifestyle in terms of exercise gets only you so far and that the amount we eat is critical to that. We have played a very active role on sugar reduction—of course, I say this in the context of this being Sugar Awareness Week. Obviously, the sugary drinks levy has reduced sugar in soft drinks by 44% by using artificial sweeteners, so this is something we will look to continue to research and to add to, if the evidence backs it up.

[Lord Lansley (Con)]

My Lords, I draw attention to my registered relationship with ukactive. I ask my noble friend whether he would agree that there is, on this occasion, as the noble Lord, Lord Stevens of Birmingham, said once, a silver bullet: it is called physical activity. This is in line with the question from the noble Baroness, Lady Hoey. In supporting physical activity, my experience was that the Department of Health needed to work with DCMS and the Department for Education to promote school sport partnerships. In my former constituency, 51 primary schools benefit from the school sport partnerships. It is a really important priority that every youngster, not just those who are really good at sport, gets the chance for that physical activity.

--- Later in debate ---

[Lord Markham (Con)]

I thank my noble friend and totally agree with him. As we have all mentioned, physical activities are a key part of a healthy lifestyle, regarding not just obesity and healthy eating but mental health. There is a lot of evidence to show that sport and a healthy lifestyle are good for everyone. We are working with the DfE and DCMS on this, but I agree that it we will need to keep it central to our agenda.

[Lord Rooker (Lab)]

I say to the Minister that we do not need to reinvent the wheel. A perfectly good practical policy was worked out at the end of the David Cameron period in government; it arrived on the desk of Theresa May, who scrapped it. Why not go back to that?

[Lord Markham (Con)]

I am afraid the noble Lord is testing my memory as to what that was. If he will excuse me, I will find out what it was and write to him.

[Lord Bellingham (Con)]

My Lords, obviously the situation in the UK is extremely concerning, but we should consider what is going on elsewhere in the OECD: some countries have a better record than us, and others have brought in extremely innovative initiatives. What can we learn from other countries?

[Lord Markham (Con)]

I thank my noble friend for his question. Absolutely, we always need to ensure that we are trying to learn from best examples, either in this country or from around the world. The OECD talks about four major strands: information and education; increasing healthy choices; modifying costs, such as a sugar tax; and restrictions on the placement of food and promotions. Noble Lords can see that we are taking much action in all those areas. Most of all, I am pleased to see that, influenced by a trailblazing initiative started in Amsterdam, we are now funding five local authorities to follow that across Birmingham, Bradford, Nottingham and Lewisham to see what we can learn from those initiatives.

[Baroness Chapman of Darlington (Lab)]

My Lords, what parents, health professionals, educators and retailers want is some consistency and clarity from the Government. Can the Minister confirm whether the Government intend to maintain the previous Prime Minister’s plans to ditch the vast majority of their 2020 obesity strategy, against the advice of the current Chancellor, who just two months ago signed a letter from former Health Ministers on the need for an anti-obesity strategy? We need to know where we are.

[Lord Markham (Con)]

I hope the noble Baroness will forgive me if I am not quite sure which former Prime Minister and Chancellor she is referring to. I could not resist that, but I take her point and will respond in writing.

[Lord Robathan (Con)]

My Lords, is it not the case that we have had strategy after strategy, all well intentioned—we all agree on what we want to do—but it is not working? The Government pussyfoot around this. As my noble friend Lord McColl said, we need to tell people that it is not acceptable to be obese. If you are obese, guess what, your children think that it is acceptable to be obese. Might not we have a bit more of a robust strategy on this?

[Lord Markham (Con)]

I like to think that we have an active strategy in this space. Personally, I prefer carrot to stick in this area. However, as I answered in the previous question, I am prepared to learn from anything that has worked in this country or abroad. If there is evidence of where the stick works better than the carrot, I would be willing to look at that and see whether we should be copying some of it.

Long Covid

Lord Markham Excerpts

Thursday 17th November 2022 Lords Chamber

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

My Lords, I refer to my entry in the register of interests. I thank the noble Baroness, Lady Thornton, for securing this important debate and all noble Lords across the Chamber for their thoughtful and considered contributions. I will try to do their points justice in my response; where I do not, I promise to follow up in writing.

The pandemic has tested us all in many ways, as I am sure noble Lords agree. Governments and healthcare systems around the world are all facing the same set of challenges in tackling long Covid. Although I am to some extent still “the new guy”, I am under no illusions about how these add to the existing challenges facing the NHS, some of which have already been debated in the Chamber. We have done much already, but I shall not pretend that we have got it all right. We must do more, as was well put by my former colleague, my noble friend Lord Bethell, and many others.

Today’s debate has been wide-ranging, and I will do my best to respond to the issues raised. I will set out what the Government are doing on the serious challenges of long Covid, such as NHS healthcare, research, employment and social support. However, with the presence in this House of so many of the key players in the fight against Covid—my noble friend Lord Bethell and the noble Lords, Lord Darzi and Lord Stevens—it is only right that we first recognise the critical role they all played and the support they gave in the unprecedented global challenge we faced. The country acted decisively and, I think we broadly agree, got the big calls right. We were the first country to administer an approved vaccine and the first to administer a bivalent vaccine for the original strain and omicron, and we had the fastest booster programme across Europe. I pay tribute to my predecessor and all other colleagues for the tireless work they did in that area.

As mentioned by many noble Lords, including my noble friend Lord Bethell, we all agree that prevention is better than cure. It is the best defence. Not only have vaccines been proven to stop serious illness, but—I accept, more anecdotally—they are thought to reduce the risk of long Covid. As we all know, we have administered 139 million vaccine doses, 40 million boosters and a world-class programme. On the point made by the noble Lord, Lord Brooke, rather than being one of the worst in Europe, in terms of excess deaths, which is the internationally recognised definition, we are one of the best. However, I agree with my noble friend Lord Bethell that we need to bring what we have done on Covid prevention into our research on long Covid prevention.

The point was very well made by many noble Lords that it is not just about research into Covid but, as the noble Baronesses, Lady Scott and Lady Meacher, said, linking how long Covid might connect with ME, chronic fatigue syndrome and other similar areas. As we know, it is a complex area. Various speakers, including the noble Baroness, Lady Masham, and the noble Viscount, Lord Stansgate, mentioned how complex this is. We need to make sure that our research digs into all these areas. Some 220 different symptoms are included, I believe. The research we have done, such as the REACT study from Imperial, in which the noble Lord, Lord Darzi, has been so involved, and the UCL research on brain fog, mentioned by the noble Viscount, Lord Stansgate, and to which I am sure the noble Baroness, Lady Neuberger, is connected through her UCH connections, is vital. There are honest debates around this; there is also research into weight management and its impact on long Covid, as brought up by the noble Lord, Lord Brooke. We all agree that there must be an honest debate to really understand the drivers behind it. We need to be clear about that.

I can commit that the £50 million for research is protected. As the noble Baroness, Lady Brinton, said during her excellent history lesson—I will look up Pale Rider—there are many lessons to learn from Spanish flu. I agree that Covid is not over, unfortunately, so she has from me a commitment to that research.

In answer to the point made by the noble Lord, Lord Brooke, about the levels of investment, the £50 million we are investing in research is, I believe, second only to the USA, so we are very much among the leaders. This is in addition to the £108 million spent on Covid research to date. To answer the point made by the noble Baroness, Lady Thornton, we are fully committed to international research, and making sure it is a two-way process in which we share our findings and commit our data.

Regarding data, some excellent points were made by the noble Baroness, Lady Thornton, and the noble Lords, Lord Kakkar and Lord Griffiths. Noble Lords have heard me say before that I am a bit of a data anorak, so I totally understand its value in this space. I will make sure that noble Lords have a detailed answer on this, but it is something I very much support and believe we need to be doing.

I say in response to the noble Baronesses, Lady Scott and Lady Meacher, who spoke about trying to understand how long Covid might interact with, or have similarities to, ME and chronic fatigue, that funding is still available. The right reverend Prelate the Bishop of Exeter spoke about the rural impact, and I would say there is scope there. The noble Lord, Lord Kakkar, asked if we need to do more. Funds are still available within that £50 million, but it is something we believe in, and as we know from short Covid—if that is the right term for it—our research was vital and we remain committed to playing a leading role on the world stage.

We all know that research is only of any use or has any point if it actually creates treatments we can use within the NHS. As many speakers have said, only if these are substituted into services will they really help. The UK was one of the first countries to recognise and respond to long Covid, and we set up the national long covid commission guidance with new care pathways. As part of that, as mentioned by many speakers, including the noble Earl, Lord Clancarty, access to information and education for doctors is key. The Royal College of GPs and the HEE have put out information, but to judge from some of the examples given today, it has clearly not been disseminated widely enough.

I appreciate the tips from the noble Baroness, Lady Taylor, about getting extra funding from the Chancellor. As many of us might have seen, extra funding was announced in the other House earlier, but I appreciate the tips and, believe me, I will be using them. I assure the noble Baroness, Lady Neuberger, that the £224 million we have already invested is a commitment, and it has helped set to up 100 specialist treatment centres, many in rural areas. I had a chance to look up the figures, and I think I counted seven in Devon, but I will confirm that, because it is not just an inner-city issue but a whole-country issue. There is also the question of the impact on young people and children, a point made by the noble Baronesses, Lady Watkins and Lady Masham. Fourteen of those 100 centres specialise in treating children and are therefore helping to deal with this issue.

The point that these measures are only any good if we are making people aware of them all was very well made by the noble Baronesses, Lady Donaghy and Lady Pitkeathley, and the noble Earl, Lord Clancarty. I am proud of what we have managed to achieve on the Your COVID Recovery web app: we have had 12 million visits from people looking at advice on how they can recover. However, I am by no means complacent about the need to make sure that there is advice everywhere.

I will get back to the noble Viscount, Lord Stansgate, on ivermectin, as I need to get some detailed advice on that. However, as the noble Earl, Lord Clancarty, talked about people feeling the need to go to private centres and often try unproven medicines, generally I would caution against that, as I am sure many of us would. While this is a complex area and we are still learning about it, I advise people to stick to the proven methods we are trying to adopt through our own NICE guidelines and our own centres. That is what we are trying to do right now through the NHS, but as the noble Baroness, Lady Brinton, and others mentioned, this is not a one-and-done matter. This is a long-run thing, so these services will need to evolve over time, and we will need to keep up.

As we all know, looking at what we are doing health-wise is only part of the picture. The noble Lord, Lord Bethell, started the discussion on this point very well, and a number of noble Lords contributed to it, speaking about the whole impact on employment, work and schools, and—as was well said by the noble Lord, Lord Griffiths—on a personal basis. The impact of long Covid is much wider than just on health, and I very much recognise its impact on employment and work. As many noble Lords will know, I was the lead NED of the Department for Work and Pensions before I came into this role, so I am very aware of the 2.5 million people out of work due to long-term sickness, towards which we now know that long Covid is contributing. Action in this area to help those people is vital not only to their health but to the health of the economy. I know that this is a priority of colleagues at the DWP, and it is part of the £1.3 billion investment to support the long-term sick into work.

I totally accept the point made by a number of noble Lords, including the noble Baronesses, Lady Donaghy, Lady Watkins, Lady Masham, Lady Neuberger and Lady Brinton, about the impact of long Covid on our own NHS staff. We need to make sure that we are supporting them through this. I have done a bit of research on whether long Covid can be defined as an occupational disease, as was mentioned. This is a complex area, because, as we mentioned before, there are 220 different symptoms connected with it. However, the DWP is being advised by the independent Industrial Injuries Advisory Council on this. It has recently published a paper prescribing five complications following Covid which should be considered in awarding personal independence payments. I am sure this will be an evolving picture, but my DWP colleagues are looking at it.

Of course, this issue is much wider than the NHS; it should be embraced by all employers. I am very pleased that I have an opportunity to speak at the CBI conference shortly about health in the workplace. This is something that I plan to bring up then, because it is important that all our employers recognise that health is everyone’s business, as was said in a consultation document that recently went out, to which we will respond shortly. Clearly, the role of employers is key to all that.

Personally, I would like to see the sort of approach taken in Japan, in which employers take on a big role in the health of their workforce and very much look at prevention. As my noble friend Lord Bethell said, it should not just be our health service looking at prevention methods; we need to be giving people over 50 health MoTs, and looking at cardiovascular impacts as well as how employers can help in that space.

I hope I have answered many of the points raised today. I commit to cover any I have missed in a detailed response. I finish by again thanking the noble Baroness, Lady Thornton, and all the speakers. I found this a very informative debate. We can all say that we have much more to learn about long Covid and that we continue to be guided by the science. But the virus has definitely not gone away and, unfortunately, as many noble Lords mentioned, we will have to live with Covid and long Covid for a long time to come. We must continue to be proactive to prevent through our vaccine programmes, to treat through NHS services, to research to continually improve understanding, and to support people to get back into work. I thank noble Lords.

GPs: Anti-depressants and Alcohol

Lord Markham Excerpts

Wednesday 16th November 2022 Lords Chamber

[Lord Brooke of Alverthorpe]

To ask His Majesty’s Government whether they will review the purpose, effectiveness, and the cost, of GPs prescribing anti-depressants to patients who continue to consume alcohol.

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

Decisions about what medicines to prescribe, and in what circumstances, are rightly made by the clinician caring for the patient. At the same time, NICE guidelines are clear that anti-depressants should not be used to treat alcohol dependency. Prescribers must be free to make their own decisions, based on their clinical judgment and discussion with their patients, with the appropriate care for the individual always being the primary consideration.

[Lord Brooke of Alverthorpe (Lab)]

I am grateful to the noble Lord for his reply. As we face public expenditure cuts and as the College of Medicine has estimated that 110 million items prescribed every year are wasted at a phenomenal cost, what steps are the Government going to take? Will they have discussions with GPs about the ways in which we can cut back on wasting money on useless prescriptions?

--- Later in debate ---

[Lord Markham (Con)]

I agree with the premise of the question. Clearly we want the most efficient use of our resources. As I am sure the noble Lord is aware, there is a national review of overprescribing, which is looking at precisely these sorts of guidelines to make sure that medicine is used only when it is needed.

[Baroness Wheatcroft (CB)]

My Lords, there is clear evidence that the prescribing of activities, particularly cultural activities, is very effective in treating depression in many cases. What steps are being taken to encourage the prescribing of culture and other activities, as opposed to expensive drugs?

[Lord Markham (Con)]

I agree that the first step should normally be cognitive talking-type therapies. As the House will be aware, we have been investing quite considerably in the mental health space. We have had a 25% increase in referrals to talking therapies, to 1.8 million in the past year alone. I very much agree that there should always be action to see whether we can help with those cognitive behavioural-type therapies first before resorting to prescribing drugs.

[Baroness Blackwood of North Oxford (Con)]

For some patients talking therapies and CBT may be an appropriate treatment for depression, as discussed, but for others next-generation SSRIs may be quite literally life-saving, and I am sure that no one in this Chamber would want to shame or discourage any patient who has been appropriately prescribed such a therapy. The Minister, I know, would want to suggest that GPs should be spoken to before any such action would be taken.

[Lord Markham (Con)]

I thank my noble friend and agree. It should always be down to the GP, working closely with the patient, to decide the best form of treatment, whether talking therapies or drugs, and that is why we are quite clear in the guidance that first and foremost it has to be the local clinician who makes the decision.

[Baroness Brinton (LD)]

My Lords, the noble Baroness, Lady Blackwood, made the very important point that there are differing results with different anti-depressants and different reasons for depression. A 2007 study showed that the use of anti-depressants reduced alcohol intake in those who drank a lot while they were very depressed. However, a 2011 study showed that SSRIs and alcohol often produced disinhibition. The one thing those two studies both showed was that where the physician was able to talk to the patient and explain, the patient reduced their alcohol. When will more time be available for GPs to talk these things through properly with patients?

[Lord Markham (Con)]

We all agree that GPs are best placed to do this. I think the House is aware of our commitment to increase the number of GP appointments by 50 million, and we are well on course to meet that target. At the same time, we have the independent review of drugs by Dame Carol Black, which looks at mental health, drugs and drink and how they are closely related, to make sure we have the best advice. First and foremost, I totally agree that the best-placed person is a GP talking to their patient.

[Baroness Merron (Lab)]

My Lords, the Joseph Rowntree Foundation reports that the number of anti-depressant prescriptions is twice as high in the most-deprived areas compared to the least-deprived, with the differential even more marked when it comes to severe conditions. With the long-promised health inequalities White Paper now seemingly sunk without trace, where is the Government’s strategy to change the conditions that affect mental well-being in the most deprived areas?

[Lord Markham (Con)]

My Lords, as set out in the draft mental health Bill, mental health activities are very focused on where help can be given in areas of inequalities. As to the position in the White Paper, I am afraid that the answer is the same as in the previous case: I do not have any information at the moment on any date.

[Baroness Browning (Con)]

My Lords, the medication for mental health conditions, including addictions, can be vastly improved in outcome and the proper use of that medication if the doctor is able to test the DNA of the patient to marry up the correct medication. When is genetic testing going to become an integral part of the NHS?

[Lord Markham (Con)]

We all see the great promise in genetic testing, and I know that this is something very close to my noble friend Lady Blackwood’s heart. It is a progressive area, where we are seeing new treatments all the time that can be helped by the use of genetic testing. As they come down the stream, this is very much on the agenda of NICE as well to make sure that those are available as required.

[Lord Mackenzie of Framwellgate (Non-Afl)]

My Lords, regardless of the misuse of alcohol with drugs, is there also not a danger of patients taking anti-depressants, painkillers and sleeping medication, such as codeine, becoming addicted over time? Is this carefully monitored?

[Lord Markham (Con)]

First and foremost, it is the role of the GP and the local clinician to monitor that. Again, the guidance given by NICE is that we very much back up and work with the NHS performance teams to make sure that things are integrated. Not only is there the meeting of the patient with the GP in the first place, but these are reviewed very frequently, on a six-monthly basis, to ensure that exactly the issues mentioned by the noble Lord are controlled.

[Lord Sikka (Lab)]

My Lords, the Government can help to reduce the use of anti-depressant drugs by tackling the root causes, which are anxiety, insecurity and poverty inflicted by the Government’s own policies. Will the Minister tell us when the Government will be in a position to reduce the NHS waiting lists back to the numbers they were at in 2010?

--- Later in debate ---

[Lord Markham (Con)]

I believe that the House is very aware of our plan for patients. It is very much the focus of my activity. I was just talking to the NHS and the CFO this morning on where we are on the recovery of the elective treatments and the plan for that, so it is very much in the front of our minds.

[Lord Teverson (LD)]

My Lords, I very much welcome the Government’s initiative on environmental prescribing, particularly for depression and mental illness. Will the Minister say what assessments they have made of the success of that programme so far, and whether they will promote it further?

[Lord Markham (Con)]

On this occasion, that is probably a question about which I need to write back to the noble Lord to give him the detail on it.

[Lord Kamall (Con)]

My Lords, the noble Baroness, Lady Wheatcroft, alluded to the fact that sometimes patients would be more effectively treated through social prescribing, or cultural and arts prescribing. What advice is given to GPs to make them aware of cultural, art and music therapy in solving or tackling depression?

[Lord Markham (Con)]

I agree that we have to make sure that GPs are equipped with the full range of tools for the job and the full range of knowledge. We are probably all aware of some instances of GPs who are very aware and progressive in this space, and others where they do not have that same level of information. We are putting a £2.3 billion increase in 2023-24 into the mental health space to treat an extra 2 million people. We need to make sure that we have a range of help that we can put in place for these people.

[Baroness Altmann (Con)]

My Lords, I echo the words of my noble friend that GPs are absolutely critical to sorting out these issues, and the Dame Carol Black review on overprescribing presumably will look into that too. Does he agree that one of the problems that urgently needs to be sorted is the pension issues that are driving our GPs to retire early? Might we look forward to some early resolution of that problem?

[Lord Markham (Con)]

I am very aware of the issue. Funnily enough, just today I had a meeting on this with the noble Baroness, Lady Finlay. It is something on which we are working closely with Treasury and other officials.

NHS: Backlogs

Lord Markham Excerpts

Wednesday 9th November 2022 Lords Chamber

[Baroness Merron]

To ask His Majesty’s Government what assessment they have made of (1) the backlog of the maintenance of NHS buildings, and (2) the impact of the backlog on the capacity of the NHS to deliver services.

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

The NHS publishes the annual Estates Returns Information Collection, which provides a detailed breakdown of backlog maintenance. Patient and staff safety is our top priority. While individual NHS organisations are responsible for their estates, we recognise that backlog maintenance can have a significant impact on NHS services. That is why £12 billion in operational capital will be provided to the NHS over the next three years for trusts to maintain and improve the estate.

[Baroness Merron (Lab)]

My Lords, last month, NHS Digital reported that the maintenance backlog had increased by 11% from last year to over £10 billion, with more than half of it posing a high or significant risk to safety or the delivery of healthcare. So does the Minister agree that, if more facilities, operating theatres and buildings had been properly maintained, they could have been used to provide care and reduce waiting times? Having allowed the maintenance backlog to double over the past 12 years, will the Government now fix this?

[Lord Markham (Con)]

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

[Lord Lexden (Con)]

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

[Lord Markham (Con)]

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

[Lord Morse (CB)]

My Lords, the Minister will no doubt be aware that for a long time it has been the practice of the NHS to rob Peter to pay Paul by appropriating capital budget to supplement revenue deficits. That really needs to stop, as it has led to a massive deficit in estate maintenance across the NHS. Care is being delivered in dilapidated surroundings across the system. That means that this building programme really matters—it is not a question of leaping forward but of making good long-term neglect. So I express to the Minister that if, as a result of the financial review, we find the programme being either delayed or cut, that would be deeply unsatisfactory.

[Lord Markham (Con)]

I agree on the importance of that; as the noble Lord says, often these are easy savings to make, but they are not the right ones. I assure the House that it is a key priority of mine that even such things as operational maintenance, which sounds very unsexy, are a key element in all this. As I say, that is why we have seen a 57% increase in the past year. At £10 billion a year, I hope we all agree that this is a good plan, albeit that there is a lot that needs to be done.

[Baroness Manzoor (Con)]

My Lords, the Public Accounts Committee has stated that £8.6 billion was lost by the DWP last year in overpayments to benefit claimants and fraud. That is £8.6 billion that could be used to maintain the NHS estates. Can my noble friend the Minister say what the Government are doing to ensure that not only are the inefficiencies cut in the NHS, but efficiencies are made within the wider government departments?

[Lord Markham (Con)]

Thank you. I am sure the whole House will agree the need for efficiencies to make sure every pound is well spent. I have a little knowledge in the DWP space. Although it falls outside my responsibilities now, I was the lead NED there and I know that the team worked very hard during the pandemic to make sure that universal credit reached people quickly, and as a result they did not proceed with as many checks as they would do normally. It was deliberate policy to make sure money was paid quickly to those who needed it. At the same time, they absolutely understand that they need now to get on top of it and it is key to their action because, as my noble friend says, the more money we can free up in other departments, the more we can focus it on the front line where we really need it.

[Lord Blunkett (Lab)]

My Lords, I recognise that the noble Lord is new in post and the Secretary of State is sort of new, having been in and out and then back again. But the backlog in repairs is mirrored by the exponential increase in waiting lists. Has this something to do with the atrophy that now exists in the health service due to the changes brought in by Matt Hancock, which have led not to the integration of services but the integration of bureaucracy?

[Lord Markham (Con)]

I can assure the noble Lord that bureaucracy is not the aim of the game and that getting money to the front line is the priority. We have record levels of investment in this area. We are currently devoting about 12% of GDP to health spending, which sits alongside the highest in the world. That is not to say we do not have to make sure every penny of that is spent effectively and, where possible, on the front line rather than on back office and bureaucracy.

[Lord Stoneham of Droxford (LD)]

My Lords, the key test of any organisation with a backlog of maintenance is whether it sustains that expenditure when it is under financial pressure. So will the Government commit that the extra money they have budgeted for maintenance in the health service will be maintained in real terms when inflation is running at 10%?

[Lord Markham (Con)]

We understand the importance of the programme, as I mentioned, and, in terms of the finances of the country, we have people in high positions who know its importance in the health debate. So the noble Lord can rest assured that it is top of our agenda, and we will be fighting hard to make sure that the capital programme is given the priority it needs.

[Baroness Masham of Ilton (CB)]

My Lords, would the Minister like to visit Masham GP surgery, where I live? He will find it is a GP surgery that needs updating. It was turned down, and one of the doctors left and went to Canada. It is now totally unsuitable for a growing population, for both patients and the staff working there.

[Lord Markham (Con)]

I do recognise the importance of primary care. We know that a lot of the people who turn up to A&E would be better served in the primary care system, so making sure we have good facilities in this place is vital, and again it is something that is part of our agenda. There was an excellent report in this space recently, and it is something we are working towards—so, yes, GP surgeries are very much an important part of this £10 billion programme.

[Lord Kamall (Con)]

My Lords, in response to an earlier question about the hospital building programme, my noble friend the Minister mentioned the modern construction techniques of hospitals. I wonder whether he could enlighten the House on some of the leading technology methods we are looking at when it comes to the new hospital programme.

[Lord Markham (Con)]

Absolutely; I look forward to sharing this with the House in a lot more detail shortly. This is a real opportunity to create a world-leadership position. The idea behind it is to have a standardised approach to building hospitals—hospitals 2.0, as I like to call them—where we look as much as possible to have standard processes, procedures and components, so that we can build them quicker, cheaper and more efficiently, and get economies of scale from doing that. I believe that it will not only pioneer the way we build hospitals in this country but give us an opportunity to be a pioneer worldwide and create a major export industry.

[Lord Berkeley (Lab)]

My Lords, I believe that Prime Minister Johnson promised 40 new hospitals, but the Minister has mentioned five—what has happened to the other 35?

--- Later in debate ---

[Lord Markham (Con)]

The other 35—I will happily read them out if the noble Lord wishes—are very much part of the programme, and extensive work and business plans are being performed. I visited one myself, Watford General Hospital, just the other day to go through the plans, so the noble Lord can rest assured that the other 35 are very much still part of the programme.

Bereavement Support

Lord Markham Excerpts

Wednesday 9th November 2022 Lords Chamber

[The Lord Bishop of London]

To ask His Majesty’s Government what steps they plan to take in response to the report by the UK Commission on Bereavement, Bereavement is Everyone’s Business, published on 6 October, which found that over 40% of respondents who wanted formal bereavement support did not get any.

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

Ensuring that bereavement support is available to those who need it when they need it remains a priority for the Government. The Government have set up a cross-government bereavement working group to ensure better join-up across government. We will use this group to address the recommendations raised in this report, and we will continue to work with the voluntary sector and across all four nations to improve access to support for bereaved individuals.

[The Lord Bishop of London]

I thank the Minister for his response. During a Westminster Hall debate on 5 July this year, the former Minister for Care and Mental Health, now the Secretary of State for Education, made a commitment that the Government will formally respond to the commission’s report. Now that the commission has published its findings, highlighting the challenges that bereaved people face today and setting out our detailed recommendations for improving support in the future, will the Minister reaffirm the Government’s commitment formally to respond to the commission’s report?

[Lord Markham (Con)]

First, I say on the record that I welcome the support in this area—the title of the report encapsulates the whole issue, in that bereavement is everyone’s business. That sums up the whole approach, which is one I totally agree with. We have set up a new policy team to work in this area, and it is meeting with the commission next week to talk about how to address those recommendations. The right reverend Prelate and I have a meeting shortly afterwards, to which I am intending to bring some members of that team so that we can discuss it further.

[Baroness Whitaker (Lab)]

My Lords, one group in particular need of bereavement counselling is young men from the Gypsy and Traveller population. Although the absolute numbers are not very large, the proportion of suicides among that group is far higher than in any other group. Nevertheless, they are not on the NHS register of groups particularly at risk. Will the Minister ensure that they get proper recognition, in spite of the fact that the absolute numbers are not large, because of the huge preponderance of suicides?

[Lord Markham (Con)]

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

[Lord Lexden (Con)]

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

[Lord Markham (Con)]

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

[Baroness Finlay of Llandaff (CB)]

My Lords, will the Government ensure that groups who are undertaking good bereavement support of children, particularly in schools, are actively engaged in cross-departmental working, given that a large number of children who are acutely bereaved do not get any support at all and often do not have the language with which to express their feelings? Will the Government also ensure that, through the Ministry of Justice, the Prison Service is actively involved? It has been estimated that about four out of five remand prisoners have had a seriously traumatic bereavement experience with no support at all, which has culminated in progressive anger resulting in criminal activity.

[Lord Markham (Con)]

I was very struck when I read the report by the breadth: for every death, five to nine people are bereaved, and often they are young people or people in prison. The truth, as we know, is that it is people across the board. That is why I particularly welcome the new policy team, which has members from the DfE and, I think, the Ministry of Justice; however, I will check, because the point the noble Baroness has made is a good one. The whole point of the policy team is that it is cross-functional, to try to ensure that we really can touch every single point where there are institutions which can help the bereaved.

[Lord Rennard (LD)]

My Lords, I lost my father at the age of three and lost my mother just before I was 17. At that point, my schoolfriends did not know what to say, my teachers’ concern was confined to my academic progress, and when I was suffering from the consequences of bereavement while at university, I found no sympathy or support from staff. Recently, half of the respondents to a Childhood Bereavement Network survey said that they had little or no support from their educational setting after bereavement. What can be done to improve access to bereavement services, to improve the training of education professionals in helping young people manage their lives after bereavement, and to help children better understand the process of dying and managing their emotional feelings in those difficult circumstances?

[Lord Markham (Con)]

I thank the noble Lord, and I agree. I have to admit that when I was a child, I failed a friend, because I did not know what to say. As I mentioned, the DfE is part of this working group and we are training 10,000 early years practitioners in this space to try to ensure that they can provide the training that is needed in schools. The number of schools supported in this way is increasing, but today it is still only 35%, so clearly there is more work to be done. The noble Lord can rest assured that we take this very seriously.

[Baroness Browning (Con)]

Does my noble friend agree that the pain of bereavement, for all people, under whatever circumstances somebody has died, is a pain like no other? Will he consider the need to act swiftly for people whose loved ones have died—perhaps I might use the word—prematurely? Sudden death brings with it a shock that requires professional support from well-trained people, and which lasts for a very long time, if not a lifetime. Will he also consider whether registrars of death should hold in their offices a lot more localised information, with good contacts and reliable resources that can be made immediately available when a death is registered?

[Lord Markham (Con)]

Yes, and again, that is where I welcome the report, which sets out how we must all ensure that we are training people to respond in the most appropriate way possible. I see our role in this as enablers, so that we can get the right people and put the right support in place at every level and in every circumstance. Clearly, where there is a sudden death, that adds a particular circumstance that needs a different approach. Again, that is why I welcome the report and the policy team, and I look forward to meeting with the right reverend Prelate the Bishop of London later to ensure that we are covering all these different examples.

Ambulance Delays

Lord Markham Excerpts

Wednesday 9th November 2022 Lords Chamber

[Baroness Merron (Lab)]

On behalf of my noble friend Lord Hunt of Kings Heath, and with his permission, I beg leave to ask the Question standing in his name on the Order Paper.

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

I hope I will get better at this with practice.

We are increasing NHS capacity to reduce delays and support ambulance services in getting to patients as quickly as possible. This includes action to deliver the equivalent of 7,000 extra NHS beds and £500 million in funding to help speed up patient discharge. NHS England is providing direct support to our most challenged hospitals on ambulance handover delays, as well as £150 million of additional funding for ambulance trusts and a further £20 million to upgrade the ambulance fleet.

[Baroness Merron (Lab)]

My Lords, has the Minister been able to watch the ITV investigation broadcast in which we saw case after case of paramedics graphically describing the desperate situations they are trying to deal with? I note that, in response, his departmental spokesperson said that they recognised the problem. Will the Minister agree to report back to your Lordships’ House on what the Government are doing, when and how, to ensure that people are not left waiting for ambulances, particularly with the anticipated winter crisis on the horizon?

[Lord Markham (Con)]

I thank the noble Baroness. I have been made aware of the TV series and it is on my watch list. I am looking forward to going out overnight on an ambulance control shortly to learn at first hand. Tomorrow, I am visiting ambulance response teams and leaders in the field in the Maidstone and Tunbridge Wells area. Ambulances are of key importance; they are the “A” in the ABCD plan, and that plan very much features in everything we are doing. We are active on that and will rightly report, as we are here, on a continuing basis, and, as the noble Baroness knows, regularly report the statistics to ensure that we are on top of the problem.

[Baroness Chisholm of Owlpen (Con)]

My Lords, the delayed response to category 1 incidents by ambulances is really due to a systems failure, whereby those who should be treated in the community are unable to be, and those who are in hospital blocking beds are unable to go back into the community, where they should be treated. I ask my noble friend the Minister what plans there are to improve social care. I also congratulate him on answering four Questions today. As a nurse, I prescribe a strong drink at the end of the afternoon.

[Lord Markham (Con)]

I thank my noble friend for probably the best advice and question I have received in my marathon series. I could answer her question at great length, because I agree that this is a whole-system issue and we need a whole-system response. I would happily talk about every aspect of that but I will pick up just a couple of the specific points that she made. Social care is clearly vital to this. That is what the £500 million discharge fund is for. We are all aware—noble Lords have probably heard me say it enough times—that 13% of our beds are occupied in this way. As my noble friend states, an ambulance will visit a home and 50% of the time will not end up conveying someone into hospital. Is having an ambulance there, with three people in it, the best use of our resources when perhaps a paramedic on a bike could solve it just as well? In a similar vein, my understanding is that roughly 50% of all A&E attendances are people who do not really need emergency treatment. Again, that goes to the point about making sure that they have opportunities to receive primary care appointments, which is what the pledge to increase appointments by 50 million is all about. This is a whole-system problem and something that we are working on with a whole-system approach.

[Lord Tomlinson (Lab)]

The Minister referred to the ABCD. I remember from when I read about it—it treats us rather like kindergarten children, does it not? —that “A” is for “ambulances”. But the big idea for ambulances in that document from the former Deputy Prime Minister was to create an auxiliary ambulance service. As the problem with the ambulance service at the moment is getting patients out of ambulances and into hospitals, what good will an auxiliary ambulance service do if it merely gets more people into hospital car parks, where more of them are waiting in more ambulances?

[Lord Markham (Con)]

The noble Lord is referring to the whole-system issue here, which I mentioned before. There is a £450 million investment to increase capacity in A&E facilities; that has already worked to upgrade 120 trusts to enable them to offload quickly. There are also 7,000 extra beds, and the £500 million social care discharge fund is all about freeing up more beds so that ambulances can discharge quicker.

[Baroness Watkins of Tavistock (CB)]

My Lords, I must declare that I am a former deputy chair of an ambulance trust that was an exceptional performer but is no longer, associated with the fact that, in some circumstances, it cannot get patients admitted to two of its largest local hospitals in under four hours. The problem is social care, not increasing the number of ambulances on the roads. Will the Government consider much more innovative approaches to respite care support for people who are ready to leave hospital and whose families cannot afford to leave work to look after them but, with incentives, probably could do so? That would be a practical way of moving the system forward at the moment.

[Lord Markham (Con)]

I agree with the noble Baroness that social care is a key solution to all this. As I said, that is what is behind the 13% of beds that are currently blocked and the £500 million spend in this area. However, we can be more innovative. That is what the virtual ward initiative, which I saw working so well in Watford, is about; it has reduced reattendance rates after 90 days from 46% to around 8% for COPD patients. This is an area where we need focus and innovation, and which is very much top of my agenda.

[Lord Rennard (LD)]

My Lords, as the Minister has already suggested, part of the problem is unnecessary call-outs to ambulance services for people who do not need admission to hospital. Care homes regularly call on ambulance services to lift their fallen residents, even though more than 45% are uninjured and do not require transportation to hospital. If care homes had the right equipment to lift people safely, an ambulance may not be needed after a fall. Some ambulance services are providing this kind of equipment to care homes, from their own resources, to reduce the number of unnecessary call-outs. Should we not ensure that all such homes and blocks of sheltered accommodation have access to this kind of equipment, which would get people up more quickly, reduce the number of call- outs and save money?

[Lord Markham (Con)]

Many noble Lords have talked today about what is a whole-system problem, which the noble Lord has mentioned in terms of care homes. It is all about treating people in the right place, with the right equipment, so I absolutely agree with this approach. It is the approach that we are taking to make sure that people are treated in the right place, so I will take the noble Lord’s suggestion back to the department.

[Baroness McIntosh of Pickering (Con)]

My Lords, I remind the House of my interest in the Dispensing Doctors’ Association. My noble friend has rightly identified the problem of underfunding in primary care. What is he going to do at this time to address the chronic underfunding in the delivery of primary care in rural areas?

[Lord Markham (Con)]

The government pledge of 50 million additional appointments is across the country. It is the job of the ICBs to make sure that each area is well catered for; the idea is that this is felt in every area, including rural areas. I am glad to say that we are making good progress on our target to increase appointments by 50 million and, rest assured, I am working with the integrated care boards and their systems to ensure that they touch every part of England, including rural areas.

[Lord Patel (CB)]

My Lords, the Minister said that this is a systems failure. Who in the Government is responsible and when will the system be fixed?

[Lord Markham (Con)]

I think I said this is a systems issue. It is something on which we—including me and the Secretary of State—are very focused, because we need to address it across the piece. That is what the ABCD plan is all about. I am very confident that, over the coming weeks and months, we will start to see improvements from the investment we are making in 7,000 more beds and £500 million more into adult social care discharge.