Health: RSV Immunisation

Lord Markham Excerpts

Wednesday 17th January 2024 Lords Chamber

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government what steps are being taken to ensure that appropriate funding is in place to deliver immunisation programmes for respiratory syncytial virus by the 2024/25 winter season, and when an implementation plan will be published.

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

The Government published a prior information notice on 27 November 2023 outlining the market’s intention to tender against its requirements for infant and adult RSV programmes in 2024. Following the tender and the confirmed potential budget implications, a final decision on programme designs will be taken alongside an implementation plan for autumn 2024.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I thank the Minister for his Answer. For the avoidance of doubt, can he explain to your Lordships’ House what funding has been allocated to the national immunisation programme for the 2024-25 winter season; what proportion of that funding has been allocated for immunisation programmes for adult, infant and neonate RSV; and what conversations have been held with NHS England regarding readiness to implement the RSV immunisation programme, as advised by the JCVI?

[Lord Markham (Con)]

First, I thank the noble Baroness. She has been a tireless campaigner on this issue and very good—quite rightly—at holding our feet to the fire. The exciting news is that the new vaccines that are coming along for both mothers and infants, as well as the over-75s, are now cost effective; that was recognised in the JCVI’s analysis. As part of that, we have plans to fund the programme, as mentioned. I would rather not go into the details of the actual budgets, because they depend on the tender and I do not want to give that information out to the market—but I can reassure the noble Baroness that plans are in place.

[Baroness Manzoor (Con)]

My Lords, RSV is a leading cause of infant mortality globally. Sadly, as my noble friend the Minister will know, 20 to 30 such deaths occur in the UK. I am pleased to hear about the progress that the Government are making to roll out the programme in the UK, but my noble friend will know that rolling out this programme will significantly reduce costs to the NHS by reducing GP visits, reducing attendance at A&E and reducing the 20,000 hospitalisations of infants aged under one year. Can my noble friend the Minister say, as we move towards autumn 2024 and the rollout of the vaccination programme, what the Government are doing to ensure that mothers and families know about the programme so that they can take up this vaccination when it is available?

[Lord Markham (Con)]

As I mentioned, the tender is in place with a view to rolling it out in the autumn. Whether we go for the maternal vaccination or the infant one will depend on the communication plan, but I can assure my noble friend that a communication plan will be part of this ground-breaking rollout. Only one other public health rollout like this has happened in the world—in Galicia, Spain—so I am proud to say that we will be top of the list.

[Lord Allan of Hallam (LD)]

My Lords, during the pandemic, we learned the value of having a clearly identifiable owner of a new vaccination programme. Can the Minister tell us who the owner of the RSV vaccination programme is so that, in a year’s time, we can come back here either to congratulate them on a successful rollout next winter or to hold them accountable if it has not happened?

--- Later in debate ---

[Lord Markham (Con)]

A DHSE team is working closely with the NHS, because that needs to be rolled out. Again, it depends on whether we go for the maternal option or do it via a different process with infants. The final answer on that will depend on the groups that are chosen; likewise, vaccinating the over-75s will more likely be in a primary care situation. When we finalise all those things, there will be a very clear plan, but there is a team in DHSE that is responsible and accountable for this.

[Baroness Merron (Lab)]

My Lords, over the past decade, we have seen the take-up of immunisation decrease. Particularly worrying is the great disparity between white Britons receiving the flu vaccine, where coverage is 83.6%, and black Britons at just 52.2%. In anticipating the RSV immunisation programme, how do the Government plan to address vaccine hesitancy, particularly in the black community?

[Lord Markham (Con)]

The noble Baroness is absolutely correct. This applies to the take-up of a whole range of vaccinations—MMR is another example, as is polio. Inner cities, including London and cities in the West Midlands, seem to be examples where take-up is quite a few percentage points lower, not just because of ethnic minorities but more because those areas have larger migrant populations, who often have not been part of the vaccination programme. Specifically to that aim, we are now publishing information in 15 languages and are trying to reach out to some harder-to-reach groups, such as ethnic minorities, the Traveller community and Orthodox Jews. There is a programme for all this, because it is a challenge. We all know that, during Covid, we talked about an R rate of 1.5. Would you believe that, for MMR, it is 13? That is just to give noble Lords an idea. It is very, very infectious.

[Baroness Davidson of Lundin Links (Con)]

My Lords, I am grateful to the noble Baroness for raising a very important issue. Getting the new RSV immunisation programme up and running correctly will undoubtedly save lives and, to ensure that it happens, it is really important that we learn all that we can from areas of success and failure in recent vaccine rollouts. The latest was the shingles general immunisation programme, which was introduced for all over-70s in September. Can the Minister give some indication of what data capture of rollout, uptake, demand, delivery and efficacy has been instituted and how those learnings can be applied to a future RSV programme?

[Lord Markham (Con)]

My noble friend is quite right. If we take the shingles one, we see quite a disparity. The 70 to 75 element of the programme has a 74% take- up while the 65-plus element has only a 41% take-up—so there is a huge difference. We are starting to collect the data so that we can understand those disparities and then, as I mentioned in answer to the previous question, make sure that we have an action plan to address those groups.

[Lord Blunkett (Lab)]

My Lords, I congratulate my noble friend Lady Ritchie on her tenacity and declare a selfish interest in that I have had this wretched virus two winters running. I will be able to buy the vaccine later this year if it is not available otherwise, but millions of people, including those supporting infants, will not. That is a disgrace, is it not?

[Lord Markham (Con)]

As I say, we are looking to have an infant programme. It is vital in the first few weeks for babies, which is why we are doing this whole plan, thanks to the pressure and the medical evidence. I echo what has been said about the relentless campaign for it all by the noble Baroness, Lady Ritchie. We have got a tender in place. The intention is that we will be rolling it out from the autumn. I repeat that there is only one other public vaccination programme on this so far, in Galicia in Spain, so we really are at the forefront of this programme.

[Baroness Bennett of Manor Castle (GP)]

My Lords, as I discussed with the Minister last year, we have already had approval for private use of RSV for over-60s, so anyone who has up to £200 available has been able to get that RSV vaccination. That is for over-60s. We are talking about a public scheme for over-75s. Is data being collected on the effectiveness and overall health impacts on people who are having the vaccine privately, which might inform whether we should have a broader public programme?

[Lord Markham (Con)]

The JCVI process is similar to the NICE approach. They look through the quality-adjusted years framework and make sure that it reaches within that. That is how they came up with their calculations. So far it is only the older ones, 75-plus, that they think are enough of an at-risk group in terms of hospitalisations and mortality to justify that. But I will inquire further and get back to the noble Baroness I am sure that they are capturing the data so that we can check on the younger ages.

[Lord Kamall (Con)]

My Lords, a number of noble Lords referred to the fact that there were disparities between different communities in the take-up of previous vaccines. My noble friend the Minister acknowledged that. Given the experience of previous vaccine rollouts, what specific lessons has his department learned that it will put into practice to make sure that it reaches some of those hard-to-reach communities in the rollout of those vaccines?

[Lord Markham (Con)]

You have to have the data and the records so that those who you know have not been vaccinated you have to go and get specifically. In London we have been running an under-fives programme, calling all those who have not been vaccinated to come and get a vaccine. That will be rolled out to under-11s and even up to under-25s, having learned precisely those lessons.

National Health Service: Key Targets

Lord Markham Excerpts

Tuesday 16th January 2024 Lords Chamber

[The Lord Bishop of St Albans]

To ask His Majesty’s Government what plans they have in place to ensure the National Health Service meets its key targets.

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

The NHS has made progress against its targets, especially given the challenges of recovering from Covid-19, the changing demography and winter pressures. The Government recognise that there is still a way to go and are working non-stop to support the NHS to do better. I take this opportunity to thank all NHS staff for their hard work to improve performance this winter.

[The Lord Bishop of St Albans]

My Lords, I would like to join in thanking NHS staff, who are doing a fantastic job. There are some structural problems here. In particular, I am concerned about ambulance response times, which are causing a great deal of concern despite the Government having increased the category 2 call response times from 18 minutes to 30 minutes. Category 2 calls deal with such life-threatening events as strokes and heart attacks, so this is deeply worrying. What are His Majesty’s Government doing to reduce the response time? Will they consider returning to the 18-minute response time for category 2 calls?

[Lord Markham (Con)]

I agree with the basic point, as I am sure all noble Lords will, that ambulances are on the front line and are the most important service in all of this. That is why we have invested in 800 new ambulances, with over £200 million of funding. It is early days, but that is starting to take effect. Regarding the category 2 issue, we have managed to halve the time it takes since last year, but it is still too long and we absolutely need to make more progress in this area.

[Lord Bird (CB)]

Does the Minister agree with me that, if you really want to hit the targets for the NHS, you need to deal with the fact that 50% of people who present themselves at the NHS are suffering from food poverty? Why do we not concentrate on lifting the great weight on the NHS by doing serious work on getting rid of poverty?

[Lord Markham (Con)]

I agree with the noble Lord that prevention is key. About half the number of people who turn up at A&E do not need to go to A&E and can be seen in other settings. I completely agree that all the elements in terms of prevention and getting ahead of the problem are key, including where there are issues around food.

[Baroness Browning (Con)]

My Lords, following on from the question from the right reverend Prelate and his reference to stroke patients, given that there is a three-hour window for stroke patients during which, if certain treatments are given, the outcome is so much better, what have the Government done to ensure that, adding on the ambulance time to the time when the patient then arrives at hospital, more patients are being treated within that window? Is there a target specifically for stroke patients? It makes such a difference.

[Lord Markham (Con)]

My noble friend is absolutely correct, and strokes have been a major focus. I am glad to say that was one of the first areas where we rolled out AI everywhere, with the result that we were able to improve treatment times so much—and I will get the precise figures to my noble friend—that the recovery rate has increased by two-thirds as a result. It is absolutely right that this is an area of top focus.

[Baroness Armstrong of Hill Top (Lab)]

My Lords, the Government keep telling us—and I understand why and congratulate them on it—that the number of people employed as doctors and nurses has risen in recent years. Can the Minister explain why productivity over the same time has reduced by 4%?

[Lord Markham (Con)]

The noble Baroness is correct: staff numbers have gone up but, for a number of reasons that we are exploring, output has not gone up by the same amount. It is a key point, and I think all noble Lords agree that making sure we are getting value for money out of the service is important. We are engaged in a productivity study to discover the reasons right now.

[Lord Allan of Hallam (LD)]

My Lords, back in 2013, the Government set a target for the NHS to become paperless by 2018, which they later extended to 2020 when the target seemed too ambitious. This may come as something of a surprise to the millions of people who continue to have regular paper-based interactions with the NHS. Could the Minister tell the House when he now expects the target for the NHS becoming fully digital to be met? Would he agree that it is now even more important that we achieve it than when it was first set over a decade ago?

[Lord Markham (Con)]

I definitely agree that it is more important, and that is why I am pleased that we have made such progress. If we look at one area in terms of hospital records being available and doctors’ records to patients, that has gone up since the beginning of the year from about 1% of GPs to about 90% today. About 90% of all our hospital records are now digitised, compared to less than 3% in Germany. We have made massive progress, and it is key to all of the reform and to improving productivity across the NHS.

[Lord Winston (Lab)]

My Lords, the Minister well knows that we have raised the issue of primary care again and again in this Chamber. Would he be kind enough to tell the House how the Government feel they are doing with regard to the retention of very highly qualified general practitioners at the height of their career, who are currently leaving early? Up to about 50% are considering retirement before the retirement age. Will he comment on how he feels that is going?

[Lord Markham (Con)]

Staff retention, particularly of GPs, is vital. That is why we listened to the number one reason they were retiring, which was the feeling that their pensions were being adversely affected. We changed the rules in the last Budget to try to address that; it is early days, but I hear that that is starting to make progress. Primary care is the front line. That is why I am pleased that we have increased the number of appointments by more than 50 million, ahead of our manifesto target. But it absolutely needs to be a key focus.

[Lord Kakkar (CB)]

My Lords, I draw attention to my registered interests. The long-term—and, indeed, the short and medium-term—sustainability of the NHS is critically dependent upon active engagement in research and the adoption of innovation at scale and pace. Is the Minister content that His Majesty’s Government are doing enough to ensure that the NHS is resourced to support that research and innovation agenda?

[Lord Markham (Con)]

It is key, and I think we are all aware that a couple of years ago—this was a result of the report of the noble Lord, Lord O’Shaughnessy—we were not doing as well as we needed to be in the clinical trials area. I am glad to say that, since then, there has actually been a lot of progress towards it, so we are now hitting similar levels to comparative nations. Innovation is at the heart of everything we have done. We have some very good examples of that; I mentioned the stroke AI treatment earlier. We have just set a similar thing in terms of AI for looking at chest cancers, but it is absolutely something we need to make sure we continue to progress.

[Baroness Merron (Lab)]

My Lords, the King’s Fund has highlighted a delay to the release of additional funding to help NHS and social care services prepare for winter, which will of course only worsen the situation of missed targets and wait times for patients. Can the Minister tell the House what the reasons are for this delay and what steps are being taken to unblock the money to get it to where it is needed?

[Lord Markham (Con)]

One of the key learnings from last year, which goes back to the whole question about planning, was actually that if you put social care moneys in too late, you do not get nearly as effective spend. That is why we brought forward the £600 million discharge fund much earlier—actually, into the summer—so that local authorities and care providers could plan on that money. It is starting to make a difference. A key thing that noble Lords have heard me talk about is bed-blocking. Actually, we have seen a 10% reduction in bed-blocking since these measures have come into effect in the last few weeks. It is early days, but we are actually making progress.

[Lord Jackson of Peterborough (Con)]

My Lords, the number of over-85s is due to double over the next 30 years. Would my noble friend the Minister give some consideration to government funding for extra care facilities and at-home treatment, such as physiotherapy, in order that pressure be taken off acute district hospital beds in respect of older people?

[Lord Markham (Con)]

Funnily enough, I had this conversation in terms of productivity just today. The virtual wards—the 11,000 extra beds we have put in—are actually making a real impact on that, because of course it is much better that people can be treated in their own home, knowing they have the comfort of these virtual displays and treatment to look after them. We have 11,000 extra beds, with 72% utilisation, and, yes, it is really working.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister keeps talking about progress being made, but if he looks at, say, the four-hour A&E target, he knows that the latest figures show that the NHS reached only 69% in December. In 2010, his party inherited a performance of 98.3%. What does he think that says about his party’s stewardship of the NHS?

[Lord Markham (Con)]

I can talk about what we are doing now, which is showing real progress. But I have to say that the saying “People who live in glass houses shouldn’t throw stones” comes to mind, because, looking at those same targets, I notice that the Labour-run NHS in Wales never reached the four-hour A&E target; the last time it hit the 62-day cancer target was in August 2010, 14 years ago; and the last time it hit the hospital treatment target was in August 2010. I say politely that the noble Lord might want to get his own house in order first.

NHS Winter Update

Lord Markham Excerpts

Thursday 11th January 2024 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, we should start by recognising and thanking the nearly 3 million health and care workers whom we depend on all year but who have to work especially hard during the winter months. We should also show our appreciation for the many millions more informal carers who spent the festive period looking after family and friends. That was the nice bit, but I now turn to some questions for the Government on what I thought was a predictably upbeat, “It’s all going swimmingly except for the strike” Statement; yet within it there were some significant gaps, some of which the noble Baroness, Lady Merron, pointed out.

It is notable that the Statement says nothing about primary care but instead focuses very much on hospital beds, which I will come to next. Can the Minister comment on how GP appointment waiting times remain unacceptably long in many parts of the country? This is a poor outcome both of itself and in terms of the knock-on effect it has on emergency services. I hope that the Minister can confirm that the Government have been monitoring GP waiting times during the winter months, and that he can indicate what they are doing about these.

The Government say they have added 3,000 hospital beds as part of their 5,000 target. That target was part of their response to last year’s crisis. Does the Minister have any new data on the utilisation of those beds and whether this matches up with the predictions the Government made when they set the target, and any analysis they made to come up with the 5,000 number in the first place? The Statement also highlights the 11,000 virtual beds that are now available, which instinctively seems like a positive development to me. But the important thing is how a broad range of people experience these and the health outcomes they deliver. What are the Government doing systematically to collect data about those virtual beds and whether they have been able to deliver a comparable level of care for people who are suffering during the winter pressures?

Another key area of delivering emergency care in winter is the availability of ambulances, which was rightly flagged by the noble Baroness, Lady Merron. The Minister may have seen a report in the Health Service Journal from 30 November last year, which said that in some areas there is a mismatch between the number of paramedics recruited and the number of ambulances available. It is great that the paramedics have been recruited, but if they are sitting around in the base stations because the vehicles are not there, that does not deliver the improved waiting times we are all looking for. I hope the Minister can comment on this report and whether the Government are able to deliver the vehicles in lockstep with the newly trained paramedics, which is what we all wish to see.

A further element of the response is the 111 service for less-urgent services, which, again, is not mentioned in the Statement. There are concerns about whether people are being directed to the right place—111, GPs, 999 or accident and emergency departments. Are the Government monitoring the performance of 111 in respect of flu, Covid and other winter respiratory diseases?

Finally, we have often discussed patient flow through hospital and out into the community with the Minister, who I know takes a particular interest in this. We know that some trusts are piloting systems to improve flow that could be described as like hotel booking systems that enable beds to be made available in a much more efficient and timely fashion. Will the Government compare the performance of trusts that have these systems in place with those that do not, as they go through this acute period of pressure in the winter months?

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

I wish everyone a happy new year and share in the thanks given by noble Lord, Lord Allan—and, I am sure, the noble Baroness, Lady Merron—for the hard work all the staff put in over the Christmas period. We have done a lot of work to prepare for this winter, and that was based on expanding supply. I will go into more detail in answering the questions so far, but that included the 5,000 additional beds, of which 4,000 are currently in place. It included the 11,000 virtual wards and 800 new ambulances, and again, I will answer some of the specific questions about the utilisation of those. It included the £600 million for adult social care discharge and the 141 CDCs, with 6 million more diagnostic tests, and the 50,000 increase in nurses—as well as mental health.

Of course, there have also been 50 million more primary care appointments since 2019, to answer the point made by the noble Lord, Lord Allan. That was accompanied by extensive planning, as I have seen. We have really tried to learn a lot of lessons from last year and get ahead of the curve with earlier plans, putting key management support teams in place to provide help in the areas where it is most needed. Everything is underpinned by a stronger technology infrastructure, digitalisation and the patient flow systems.

We are really trying to get ahead, so we brought forward the flu and Covid vaccines, so that, hopefully, we can make the situation better. I will not say that it is anything more than early days, or that one swallow makes a summer, but there are some promising early signs. On ambulance handovers, we have seen a 20% reduction in lost hours. The figure for category 2 response times is 45 minutes; it is still too long, but it is half that for this time last year. As for patient flow and the use of the system, we have seen a 10% reduction in so-called bed blocking, partly because of the flow mechanisms and partly as a result of early investment in the discharge fund.

All that is against the background of increased activity—and, of course, the strikes. To date, they have cost us 1.3 million lost appointments, 113,000 most recently. I say to the noble Baroness, Lady Merron, that we have tried to behave in a reasonable manner. We have reached agreements with all the other professions—the nurses, physicians, consultants and specialist doctors—and we have shown leadership, alongside the unions, in doing so. In contrast with that reasonable behaviour, the 35% pay demand is not reasonable, and nor is planning strike action at the busiest time of the year. Coming out only twice, when you have been asked 40 times by NHS trusts to act on patient safety, is also not reasonable behaviour. We want to resolve this issue. We have shown a capacity to resolve it in other areas, and we have shown leadership. I ask the BMA and junior doctors to come forward with reasonable expectations, and let us resolve this right now.

I have a polite suggestion to make. I thought that the noble Baroness, Lady Merron, might raise the issue of NHS targets. People know that I am a reasonable person, and the last thing I am going to do is say that all is rosy in the garden, but we are showing some solid improvement. I am definitely not happy with the fact that the England targets for a four-hour wait and 62-day cancer care were last met in July 2015. But I note that they have never been reached in Wales, which Labour has been running. In Wales, the 62-day cancer care target was last reached in 2010. Also, if you are in Wales, you are much more likely to be on a waiting list: 21% of the population are on a waiting list, compared with 13% here. In Wales, you are likely to wait five weeks longer, on average; and 50% of the time, you will wait for more than four hours in A&E, compared with 40% in England.

The England results need to be better, and we are working to make them better, but I politely suggest that the Opposition might want to look at where they are running the NHS and see what they can do to improve that, because on every standard you see a poorer performance from the Labour action in Wales. That is what all the evidence tells us.

I will try to answer some of the specific points. On ambulances, 300 new vehicles have been delivered to date. There is an issue with one supplier, but we are confident that the 800 new vehicles will be delivered. It is those, alongside the paramedics, that are allowing us to address ambulance wait times and bring them down. The 111 number is now on the app and is really directing traffic; it is up 8% versus last year, so, again, we are seeing real improvements. I think I mentioned that patient flow is improving as well.

On Covid, bringing forward the vaccinations has been helpful in terms of prevention. While we would all accept that 2.5 million is a large number, if we look at the number of beds being taken up by Covid and flu this year, we can see that it is half the number that it was last year. It is still a big number, but it is half what it was. We are in the early stages and a lot more work is needed, but one reason we are starting to see these improvements is that we have tried to get ahead of the curve with those vaccinations.

As regards virtual wards, so far we have about 70% utilisation of those. We need to collect the data; noble Lords have heard me say before that the results from virtual wards in places such as Watford and elsewhere show good results in terms of both satisfaction and, most importantly, not returning to hospital. Where people have gone into a virtual ward rather than just going home, there has been a reduction of as much as 50% in people having to return to hospital environments. So we are seeing results.

In terms of primary care, as I mentioned, we have seen 50 million more appointments take place. Pharmacy First, which will be introduced shortly, is a key way of expanding that supply still further. So I say politely that, yes, there is a lot more work that will need to be done, but we really have expanded supply. We have put plans in place, and the early signs are promising. I hope, like all of us, that we will see far more of this and I look forward to updating the House as the season progresses.

--- Later in debate ---

[Lord Markham (Con)]

The noble Lord is correct; London is always our most challenging place. I have found that across the board, funnily enough. He is right in terms of Covid and flu vaccinations, but it is also the case for the take-up of all sorts of different services. We see technology as a key enabler; in fact, the number of people who have booked their vaccinations and follow-up through the app has multiplied significantly. I do not have the precise figures in my head, but they really have gone up. A lot of that is through people seeing their reminder through the app as well. It is recognised that London in particular needs more targeted action—in fact, noble Lords will see an advertising campaign come out in the next couple of weeks or so. We are really trying to promote usage of the app, which is a tool for all these sorts of things as well.

[Baroness Finlay of Llandaff (CB)]

My Lords, I should declare that I am a registered doctor with the GMC. I live in Wales, but I do not want to get into data-hurling over Wales, but I do have a comment to make. I would like to follow up on the question from the noble Lord, Lord Allan of Hallam, about virtual wards. The Minister may be unable to tell us now, but how many of those patients were actually terminally ill; how many of the virtual wards were providing 24/7 effective cover for these patients; and what is happening across the whole country in relation to 24/7 palliative care cover? All the evidence that is emerging is that it really is grossly inadequate. Families are left unable to access the care and support they need.

Ten years ago, NICE recommended that every area in England should have a helpline so that families can phone if there is a crisis, 24/7, when they are looking after someone with palliative care needs at home; yet the Marie Curie report Mind the Gaps—I should declare that I am a vice-president of Marie Curie—which has been developed with the Cicely Saunders Institute—again, I should declare my interest there as an international adviser—has shown that only one in three areas has such a helpline available. Two-thirds of the country has nowhere for people to phone.

Is the Minister prepared to meet me and others from palliative care to mirror what is happening in Ireland now? From this February, the Irish Government will be funding 100% of hospice clinical services, because they have recognised the inadequacy of relying on voluntary sector funding. We know that good care costs less than poor care. We know that where there is good palliative care in place, with 24/7 support, the number of emergency admissions goes down, the pressure on acute beds goes down and inappropriate transfers drop. Although I am not expecting an answer today, I hope the Minister will seriously consider looking at that situation.

I shall just make a comment from Wales and point out that in Wales, paramedics are now being trained specifically in palliative care. Some consultant paramedics are now attached to palliative care teams and are able to administer palliative care drugs out of hours as required.

My other question for the Minister is on what discussions he has had with the GMC over retention. Those doctors who were temporarily registered have received notice that, as from March, for those who had retired, their temporary registration because of Covid will cease. I just wonder, with the figures we have seen come out today, whether it would be wise to negotiate with the GMC, first, for that to be deferred and, secondly, for all those doctors to be contacted and asked directly how they would like to contribute to improving some of the services. There is a lot of skill there which is currently being unused and underutilised. Again, I guess I should declare an interest because my husband is a dermatologist and has been in that position but has never been called up and would have been quite willing to go and help with clinics. Those are some of my questions for the Minister.

[Lord Markham (Con)]

I thank the noble Baroness for those points. Absolutely, I will need to come back on some of the detail on the virtual wards and how they are being used. One thing I will say about them, though, from my knowledge, is that the ability of people to communicate on a regular basis is one of the key advantages. On the point she makes about palliative care and the ability to have 24/7 communication, the beauty of the virtual wards is that they have that inbuilt, for want of a better word—they have that advantage. As noble Lords know, I am always eager to learn from practices all around the world, so I will very happily meet people and learn from them.

On retention, absolutely, we all know that the supply of doctors and medics is the key thing that we need, so I personally feel that we need to look at every avenue to make sure that we can maximise that supply. Again, it is something that I will inquire into as a result of that, and maybe when we have our meeting we can discuss that further.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I too thank the Minister for the Statement and his response, but it takes the biscuit in terms of the Government really seeking to exploit the plight of the NHS by putting so much emphasis on the industrial action being taken. As the noble Lord has said, even before Covid the Government were way off meeting any of the core targets. In 2010, they inherited a health service that was running very well and met all the targets. They threw away that inheritance. When Covid hit, the health services were already running so hot that there was just no headroom at all to cope with the pressure that then came, with—my noble friend is right—hugely dangerous occupancy rates. There was simply no headroom.

Looking at the funding, from 1948 to 2019-20 the NHS received funding of 3.6% real annual growth, on average, per annum. The coalition Government slashed it to 1.1%. The May and Cameron Governments gave it 1.7%. Only with the Covid expansion were resources over that 3.6% average. It is no wonder that the health service is tackling such a momentous challenge. We need to hear from the Government some real plans to get investment back in the health service, to give it the kind of headroom it needs to start meeting the targets that are so important—would the Minister agree?

[Lord Markham (Con)]

I happily agree that we are investing record sums. The latest figures show that we are investing around about 11% of GDP in the National Health Service. I believe the figure in 2010 was somewhere in the 7% to 8% range—I am speaking from memory and so I will correct that if it is not quite right, but that is the sort of massive expansion we have seen. If I take one area as an example, the cancer workforce has trebled since 2010.

What we are seeing more than ever is a record level of investment in the health service but also a record level of demand. I was hoping to show in the Statement how we are looking to tackle that. I will freely admit the challenges, and that it is early days, but I believe we are showing signs of getting on top of it. As I have said many times, I really think that technology will be its future, and there will be lots more we can talk about when we show the profound changes it is going to make.

[Baroness Bennett of Manor Castle (GP)]

My Lords, one in seven UK-trained doctors has left the country to practise overseas. That is some 18,000 doctors, a figure which is up 50% since 2008. Last year, the General Medical Council did a survey of doctors departing the UK to practise overseas, and one of the key factors identified was that doctors were leaving to work in a place where they felt supported by the state and the employer. Does the Minister believe that the Statement—the Government’s general position—is sending a message to doctors that they are supported and cared for, and truly valued, by the UK Government, given that if we look at the financial valuation, junior doctors’ salaries are down 24% in real terms since 2009?

This is obviously an issue of money, but it is also an issue of attitude. Have the Government got their attitude to the junior doctors terribly wrong?

[Lord Markham (Con)]

I agree with the sentiment expressed by the noble Baroness. Clearly, we want to make sure that we minimise any loss to the profession. Retention is key. The long-term workforce plan was all about trying to put a long-term footing in place, one which looked at not just the recruitment of doctors but their retention, which, as I say, is key.

Money is an element of that, clearly. As I say, I have not heard or seen anyone suggesting that we should be paying the 35% increase. I do not think that is a reasonable approach; I have not heard any noble Lords come forward and say that. The correct attitude of the noble Baroness is key as well. We need to make sure that we get that right and I like to think that we are trying to do that. The Secretary of State has been very positive in terms of trying to do that as well. I absolutely agree that, at the end of the day, this is a key workforce and its members need to feel that they are key, rewarded and motivated by what they are doing. That is key to any profession.

NHS App: Medical Records

Lord Markham Excerpts

Tuesday 19th December 2023 Lords Chamber

[Lord Allan of Hallam]

To ask His Majesty’s Government what measures they have put in place to mitigate the risk of people being coerced into showing their confidential medical records to third parties as records become universally available through the NHS app.

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

The Government want people to have access to their own records. For most, online record access is beneficial but for a minority, having access could cause harm or distress. In many cases, practices can identify these patients and ensure that safeguarding processes are in place. Furthermore, to access the NHS app, users must prove their identity through the NHS log-in and, before entering their record, are advised what to do if they are being pressurised to share their information.

[Lord Allan of Hallam (LD)]

My Lords, the design goals for the NHS app should be to make it as easy and frictionless as possible for legitimate users to access the system, while making it as difficult and frictionful as possible for people trying to gain unauthorised access. But there is a natural tendency to focus on the first part of this equation as developers believe in the systems they build and find it hard to put themselves in the shoes of the cunning and resourceful attackers who will try to break them. Given this dynamic, can the Minister confirm that the NHS has a red team tasked with trying to identify all possible vectors of attack on the NHS app, and that the requisite resources will be put into mitigating any risks that they identify?

[Lord Markham (Con)]

The noble Lord is absolutely correct on getting that balance right between the two; that is why the NHS has a safeguarding reference group on exactly this, which has been putting in protections as well as messaging patients, telling them to be aware and that they have the opportunity to redact their records if they are concerned. There are other features, such as multi-factor authentication and making sure that, for log-in with facial ID, you cannot have anyone else in the picture, to ensure that people are not being coerced. So, there are a number of measures in place, but I completely agree that we need to keep them under review with user groups checking all the way.

[Baroness Owen of Alderley Edge (Con)]

My Lords, with the abundance of health data available to the NHS, what future technologies are being developed to identify patterns and trends to improve patient outcomes and reduce the pressure on the NHS?

--- Later in debate ---

[Lord Markham (Con)]

My noble friend is correct. As the noble Lord, Lord Allan, said, there are many good uses for the app and data. As we all probably know, AI is only as good as the data that underlies it. The good situation we have—it is lovely to have a story for Christmas cheer—is that our 50 million primary care and hospital records are probably second to none around the world. We are already using that to positive effect, such as for image reading and using AI for cancer scans and strokes. We can also use that data for intelligent screening and, in future, for cause and effect to find cures, hopefully one day even for dementia.

[Lord Turnberg (Lab)]

While it is obviously important to control confidentiality of patient data, it is vital to be able to use data for medical research. Much research, such as epidemiological research, the relationship between smoking and ill health—obesity, diabetes and all sorts of diseases—would not be known much about unless we were able to handle patient data. In the rush to control, let us make sure we can still do research with patient data.

[Lord Markham (Con)]

Absolutely; it is about getting that balance correct. I welcomed the support of all sides of the House when we were introducing the FDP. A lot of work was done with noble Lords on that. The fact that the federated data platform was as well received as it was in the circumstances is because of support from all Members of the House on all sides, knowing the vital role of data in improving health outcomes.

[Baroness Brinton (LD)]

My Lords, following the question from my noble friend Lord Allan about a red team, in the past not health data but personal financial data has been sold by subsidiaries or contractors of UK firms based abroad. I notice that we now have a deal with America on health data and GDPR. Is that true for other countries, such as India? Personal data, particularly medical data, would be seen as very valuable.

[Lord Markham (Con)]

The fundamental principle underlying all this is that none of the data leaves the control. The data controllers today—be it GPs, the NHS or the hospital—stay as they are, and any use of that data has to be approved outside of that. The noble Baroness is absolutely correct. We want to make sure that it is not used for any purposes that are not going to improve health outcomes, such as the ones we have talked about.

[Baroness McIntosh of Pickering (Con)]

My Lords, could my noble friend update the House on where we are with sharing data—in particular, the outcomes of clinical trials—with our European partners?

[Lord Markham (Con)]

Clinical trials are among the key areas that are vital to the life sciences industry. We are all aware that, post-Covid, we were falling a bit behind. I am glad to say that now we have improved, so that 80% of the time we are doing the clinical responses in time. We can still do better; that should be 100% but 80% is good. Most importantly, our data is the envy of the world. Just to give noble Lords an example, about 90% of our hospital records are digitised. In Germany, it is less than 1%.

[Baroness Merron (Lab)]

My Lords, easy access to medical records on the NHS app is indeed positive and helpful to many, but of course there are parents whose abusive spouse or partner might use that sensitive clinical information to undermine legal cases of custody of dependants in the family courts. What discussions have taken place with the Ministry of Justice to assess both this risk and how to avert it?

[Lord Markham (Con)]

In terms of averting it, there are some of the measures I was talking about. For instance, with facial recognition, if anyone else is seen in the picture, it disregards it, so that you cannot have someone else holding it or holding their head in to do it. If the person’s eyes are shut—if someone is trying to do it while you are asleep—it does not work either. Those safeguards are in place, as well as multi-factor authentication, so that if anyone tries to change their details by email or whatever, it comes back to them. We have worked with user groups on this. I will come back to the noble Baroness specifically on the Ministry of Justice conversations, but we are doing a lot in this space.

[Lord Scriven (LD)]

My Lords, digital transformation of the NHS at pace is being held back by the number of vacancies for digital roles within the NHS, particularly when many people are going over to the private sector for higher pay. What could the Government do to deal with this, particularly regarding the inflexible Agenda for Change?

[Lord Markham (Con)]

The noble Lord is absolutely correct. Digital resource is well sought after. I was approving something just the other day which gives us more flexibility in that space, because sometimes you have to pay over and above to get people on it. As we all agree, this is vital to the future of what we are trying to do.

[Baroness Bull (CB)]

My Lords, as more people who are able to are switching between the National Health Service and private medical care for specific operations, is the Minister confident that relevant information is then transferred back to a single patient record? This will be very important if, for instance, somebody needs emergency care or is involved in an accident. Is the data all being kept in one place?

[Lord Markham (Con)]

Patient records is what the federated data platform is very good at, in terms of drawing data and information from all sorts of sources into one place, so it is always in the ownership of the person, the GP or the individual place. You can make your data available to the private care providers, if you are having an operation with them, for instance, but the data always remains within the NHS and in the ownership of the person.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, following the question from the noble Baroness, Lady Bull, is the Minister confident, in all the talk about advances in technology, that data-sharing within the NHS is fit for purpose? We frequently encounter an apparent disconnect between different departments in the NHS, or different levels of care, where information which should be available to everybody is palpably not or, if it is, it is not being taken any notice of.

[Lord Markham (Con)]

The noble Baroness is absolutely correct. While I think everybody would say that 90% digitisation is pretty good—it is not 100%, but it is pretty good—always making sure people are talking to each other is often the issue. I am sure we have all had examples of that. That is what the federated data platform helps to do, in terms of drawing it all in. For example, Chelsea and Westminster has put what was on 10 different spreadsheets and records into one place. We are getting a lot better at that, but is it perfect and seamless? No, there is still some work to be done.

[Baroness Finlay of Llandaff (CB)]

My Lords, given the importance of medical research, for the development of advances in knowledge and for inward investment into this country in research, what consideration is being given to ensuring that patients in different disease groups can be asked whether they would consent to being informed about clinical studies that may be relevant to their condition? This is so that pre-consent to being approached is being built into the system, because we know that one of the big delays in recruitment into clinical studies is the process of case finding and consent, particularly for less common conditions and when patients are living in more rural and remote areas.

[Lord Markham (Con)]

It is fair to say that we have made massive improvements. At the beginning of the year, we only had around 10% of patients with GP records available in the app but today it is 80%, which is a massive change. That allows us to do things like “Be Part of Research” which we have had hundreds of thousands of people volunteer for. We have not yet taken it to the next stage, so that you can get ahead of the curve for approvals for certain types, as the noble Baroness said, but the beauty of all this is that it gives all the opportunities for the future. As it is my last time standing up this year, I would like to finish by wishing everyone a happy Christmas.

In-patient Mental Health Care: Learning Disabilities and Autism

Lord Markham Excerpts

Wednesday 13th December 2023 Lords Chamber

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

I too add my thanks to the noble Baroness, Lady Hollins, for her terrier-like qualities—I hope that is seen as a compliment—in getting and maintaining our attention. I feel that this has been an excellent series of debates that have complemented each other and added to that basis of knowledge. I had useful feedback from the round table yesterday, and I hope the feeling from it is that this is a not a one-shot deal: it is an ongoing conversation with ongoing engagement.

One of the things that probably struck me the most —the noble Baroness, Lady Merron, mentioned it as well—was the change in the culture. When we think of where we were in the 1980s, and of all the things that we know need updating from the Mental Health Act 1983, we need to make sure we are reflecting that change of culture in all this. I will not pretend that we have an answer to that, but I think we are all committed. We need an Act; I understand everyone’s disappointment in that. We know we need to correct this at the earliest opportunity, but the round table was a good way of starting to talk about the things that we could do. We saw some very promising examples, particularly the Somerset model, which I am looking forward to hearing more about.

The point we need to reflect and come back better on is how we are changing those cultural attitudes as well. The example of Ash, given by the noble Baroness, Lady Hollins, sets out very clearly that these are real people, as the noble Baroness, Lady Merron, said. Thankfully, in some ways, they are not a large number of people, but this brings home what needs to be done. The figure of 5.2 years as the length of stay really struck us all.

It is a good question and challenge: are we setting the right target with 50%? It is a round number, and I am not saying that in any way to try to move away from it, but is it the right target? As we have said, we all care about whether we are building the right support going forward. To answer the question raised, I can confirm that there is commitment to this beyond March 2024. In some ways, the figure of 50% by March 2024 has almost created a false sense of “That is a deadline, and what happens beyond it?” Candidly, we all know that this is an ongoing problem, which will work only if we have the supply.

It is well recognised that adult social care is a crucial component to the supply of places, as mentioned at Questions yesterday. Post pandemic, we had first to put in place action to stabilise adult social care. That is what the investment has been about, so that we are finally at a place where we have managed to increase the supply of places and increase the staffing there. It is only when you are on that stable footing that you can then look to the reform action that needs to come in, of which the care excellence certificate is very important. I will freely admit that we are at the start of that journey to completion.

The second part of that is the individualised mental health supply. That is what the £2 billion investment is all about, with the 2 million extra places that we need to provide in the community for people, including 300,000 young people. In that, we all have experience that a stitch in time really does save nine. If we can get there early, then that really helps and supports people.

As other noble Lords have pointed out, while progress is being made on the number of people who have a learning disability without the autism diagnosis, the real challenge is the autism diagnosis in-patient numbers. That is the one where we need to really understand what action is needed. That is why, as I say, the Building the Right Support delivery board is an ongoing thing, not something that stops in March.

On that supply, that is what the £121 million investment in community support people is about, and making sure that every integrated care board has to have an executive lead on learning disabilities and autism. Those are the people we are really holding to account in all of this, to make sure that support is there at a local level.

On the point made by the noble Baroness, Lady Merron, the dynamic support registers are all centred on the individualised plans that need to be given to these people, so we can make sure that dynamic support is there for them all. A national development team for inclusion has been commissioned to work in 20 areas to give the bespoke support that is needed.

I reassure the House that we will continue to take forward non-legislative commitments to improve the care and treatment of people detained under the Act, as the noble Baroness mentioned, and in particular to pilot models of culturally appropriate advocacy, which will provide tailored support to hundreds of people from ethnic minorities to better understand their rights when they are detained under the Mental Health Act.

The importance of the right workforce has rightly been raised, to make sure that people with a learning disability and autism get the right support at the right time. That is what the strategy to put people at the heart of care is all about. Comments have been made about whether we have got that strategy right and whether it is covered in the long-term work force plan. It is harder in this area, as we know; as I mentioned yesterday, there are 17,000 independent providers in the adult social care setting and so co-ordinating across it is harder. But again, that is what the reforms and the care certificate are all about, and the digital platform that has been put in place to provide the qualifications and the payment mechanism is key to all of that.

I hope from these comments we are showing that we are alive and responding to the ongoing conversation and dialogue that the noble Baroness, Lady Hollins, has set in place and which will continue. I will not pretend for one moment that we have got all the parts in place. That is why it needs to be a continuing dialogue, to which I am committed. As noble Lords saw yesterday, Minister Caulfield is definitely committed to this as well. We look forward to further round tables in the new year and increasing our knowledge from them. Noble Lords can rest assured that the Building the Right Support action plan is an ongoing live document that does not stop at March. It is key to everything going forward.

At this point, I thank all noble Lords, and especially the noble Baroness, Lady Hollins, for her continued dedication to this.

House adjourned at 6.53 pm.

Adult Social Care: Staffing

Lord Markham Excerpts

Tuesday 12th December 2023 Lords Chamber

[Baroness Pitkeathley]

To ask His Majesty’s Government, further to the report of the National Audit Office Reforming adult social care in England published on 10 November (HC 184), how much of the £265 million allocated to reforming social care staffing between 2022–23 and 2024–25 has been spent so far, and what problems they have encountered in spending the allocated money.

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

The Government have made up to £8.1 billion available this and next year to strengthen adult social care provision. Specifically, we have invested over £15 million so far this year in supporting our workforce reform programme. The Government remain committed to our 10-year vision to put people at the heart of care and make long-term sustainable investment to future-proof the sector. Further announcements of support will be made shortly.

[Baroness Pitkeathley (Lab)]

I thank the Minister for that reply. He will know that the NAO’s report said that only £19 million of the very welcome £265 million that was originally allocated has thus far been spent. Even if the Minister does not agree that this is an utterly inadequate response to the crisis in social care, as the King’s Fund has said, he must admit that the slowness of progress is somewhat frustrating. Is it because there are not enough staff in the DHSC to distribute the money? I understand there are about 100 vacancies. Alternatively, is it because there have been many ministerial changes in his department, or because—as many in your Lordships’ House will suspect—social care is simply not a priority for this Government and, once again, millions of unpaid carers will be left to prop up a crumbling system?

[Lord Markham (Con)]

I share the noble Baroness’s concern about the speed of deployment. At the same time, it is fair to say that we are developing a whole new set of social care qualifications, which we think we can all agree are key to this. We are also developing a whole new payment mechanism, because there are 17,000 independent providers and we need a mechanism to allow payment. It is a complex programme, but I agree that we need to do everything we can to speed it up.

[Lord Allan of Hallam (LD)]

My Lords, a key part of the equation for long-term social care sustainability is charging reform, yet the National Audit Office report points out that the Government have scrapped their charging reform programme board and have no overarching social care programme in place. Can the Minister confirm where responsibility for charging reform now sits, and whether we can expect any progress in this critical area in 2024?

[Lord Markham (Con)]

Charging reform is still part of the Government’s commitment. At the same time, I think we all recognise that, largely as a result of the pandemic, we had to stabilise the social care situation first. That is what the £8.1 billion in funding has been all about and what the investment and recruitment have been for—so that we can stabilise first. I am glad to say that we are reaching a more stable footing. For the first time, staffing went up over last year and, likewise, the number of people in social care went up. We have to stabilise before we move on to the reform. I think we would all agree that the speed of reform needs to be a bit quicker, but it is sensible that we stabilise the situation first.

[Lord Patel (CB)]

My Lords, in the Government’s search for long-term sustainable funding for adult social care, what assessment have they made of the successful models that operate in Germany and Japan, for instance?

[Lord Markham (Con)]

The shorthand for the German system is the “double doughnut”, which tries to give wraparound care. We can learn many things from that system, which is why a part 2 reform needs to happen here. I accept that we are clearly not there yet.

[Lord Forsyth of Drumlean (Con)]

My Lords, is not the truth of the matter that the Government have just shuffled off responsibility on to local authorities? Can the Minister tell the House what percentage of expenditure by local councils is now being spent on social care to fill the gap, at the expense of vital local services?

[Lord Markham (Con)]

My noble friend is correct: on average, it is about 74% or 75% of a local authority budget. I think we would all agree that that is not a good situation, because obviously a local authority has a number of matters it needs to deal with. This is one of the issues around long-term reform that we will need to consider.

[The Lord Bishop of London]

My Lords, we are very familiar with the pressure on the social care workforce. As the Minister pointed out, we have seen vacancies fall within the social care sector, which is very welcome, but that is supported by the recruitment of 70,000 staff from overseas. I am glad that the health and care sector is exempt from the new visa charges, because we are clearly reliant on assistance from overseas. However, given that they are no longer able to bring dependents on their visa, have the Government considered the impact that this will have on recruiting workers from overseas into the social care sector?

[Lord Markham (Con)]

We have tried to adopt a balanced approach here. While we all understand the necessity in the healthcare sector, I think most of us would agree that 750,000 net migration is a very high number. The balance we have struck is to protect this sector. Our figures generally show that we will be able to keep the recruitment coming. We are now moving on to part 2 of the reform, through the other things we are doing, particularly around qualifications—we know that people who are qualified are far more likely to stay in a social care setting. That is what the whole investment is about. It will be rolled out next year and will fund hundreds of thousands of places. I think it will make a real difference to the motivation, recruitment and retention of staff.

[Lord Hunt of Kings Heath (Lab)]

My Lords, to respond to the right reverend Prelate’s question, if I may, the Migration Advisory Committee has said that the reason we recruit so many people from overseas is poor terms and conditions in social care. The Government set the market for social care, through their poor funding of local authorities. When will they grasp the nettle and realise that we actually have to give care workers decent pay and conditions?

[Lord Markham (Con)]

It is absolutely understood that, to have a highly motivated workforce, you need to look at everything—pay and conditions, and training and motivation. We see that while, on average, staff turnover is almost 30%—which is way too high—about 20% of care home providers have a turnover of less than 10%. Why is that? It is because they are investing in their staff and they have a training programme. That is why we are trying to do a similar thing. The national care certificate that we are putting in place will take time; for it to be valuable, we will need to put the right things in order, including the digital platform to pay the 17,000 providers. These are all parts of the reform, which will make a difference.

[Baroness Watkins of Tavistock (CB)]

My Lords, does the Minister accept that many delayed transfers of care from hospital are associated with difficulty in getting social care in people’s own homes? In rural areas, we are still not paying for time spent travelling. Surely there is something we could do much more quickly, before the training certificate, to employ local people in a fair way to provide care in people’s homes, particularly in rural areas.

[Lord Markham (Con)]

The noble Baroness is correct about that; it is a key pillar of this reform. This is why we have tried to learn one of the main lessons from last year, by putting the £600 million discharge fund out early, so we can get those sorts of measures in place. That is why we have expanded the virtual care ward network to 10,000 beds, with the idea that people can be cared for in their own home but with support from the staff there. That is absolutely the direction we are moving in.

[Lord Shipley (LD)]

My Lords, the Minister said a moment ago that three-quarters of local government spending is on adult social care. I would ask him just to check that figure, because if we add to it children’s social care, it basically means that every local authority will, before long, be issuing Section 114 notices. It is very important to get the facts absolutely clear here. What the Minister said demonstrates that local authorities are seriously underfunded for adult and children’s social care, and are cutting other public services as a consequence.

[Lord Markham (Con)]

I will absolutely clarify the number to the noble Lord in writing. It is of course a range, according to different local authorities, but I think we would all agree that it is a level that, as a percentage, is too high.

[Baroness Wheeler (Lab)]

The Nuffield Trust has called the NAO findings a

“damning indictment of the Government’s progress towards delivering social care change”.

To follow on from my noble friend’s question, the NAO points out that only 7.5% of the much vaunted £265 million allocated by the Government to addressing social care staff shortages and recruitment for 2023-35 has actually been spent, heavily impacted by the DHSC’s staff recruitment freeze. What specific actions are the Government taking to address this and ensure that the money they say is there is actually paid out?

[Lord Markham (Con)]

There were five parts to the programme of reforms mentioned and the £265 million. There was international recruitment, which we have done; it has worked well, and we need to continue doing that. The second part was a volunteer programme, which, again, we have done and it is working well. Thirdly, there were digital skills passports, so that staff could swap from place to place and take their qualifications with them; we have done that. The two other things will take longer. The care workforce pathway is out for consultation. It will mean that people can have a long- term qualification that can get them into other professions as well, such as nursing. Lastly, there is the care certificate qualification. That takes time. Everyone knows that, for that qualification to be meaningful, it will take time to set it up. That is the key expense item. The digital platform is going to be launched next June, so it will be rolling out from there.

Organ Donations

Lord Markham Excerpts

Tuesday 12th December 2023 Lords Chamber

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

I add my thanks, particularly for all the work that the noble Lord, Lord Hunt, has done, not just in bringing this debate today but, obviously, in putting the Act through in the first place. On a personal note, one of the pleasures of this job is looking into an area that is fascinating and something we are all involved in and have experiences of in our everyday lives. There are lots of hard things about the job, but sometimes these are the fun bits.

Coincidentally, I am visiting the NHS blood transfusion service’s Bristol operation on Thursday—so this is very timely. I will put a lot of these challenges directly to them. Obviously, I am speaking personally here, but what we have seen is a mixture of the disruptions of Covid and quite a change in the leadership of the blood transfusion service. The service has been undergoing quite some changes, and it would be good to test the temperature to see just how much it is on this.

One of the things I would probably like to do is set a challenge—“Where are you on this?” Maybe they will give us some fantastic answers; it is always best to hear things from the horse’s mouth. As I say, there is a relatively new CEO and maybe they will give us some fantastic answers and I can just report back to the House—that would be fantastic. I suspect what we really need to do is to say, “You have a couple of months”—or whatever—“to take this away. These are all the issues that were raised. Come back and make a presentation to us”. We could do that as a round table, because I think that is something we would all find illuminating—putting them through their paces.

The noble Baroness, Lady Merron, reminded us of the Churchill quote—it is not the end, or even the beginning of the end; it is the end of the beginning. My gut feeling is that the Act was almost a case of “Right, we’ve done this now and it will all look after itself”. Of course, there is a lot of underlying issues from there. We had Covid, and suddenly everyone was focusing on other things. This is why this debate is very timely: we need to turn our attention back on this and say, “Actually, now, thankfully, we are getting back to normal. How do we need to look at this?”

As many noble Lords have picked up, the real disparity seems to be in the involvement of the family. If the person has consented anyway through other processes, they are much more likely to follow those wishes and rates go up to 90%. If they have not given their consent, and so the family do not know, it is much more like 60% or 61%.

That real disparity, I have been told, means that we need to do comms campaigns all around increasing the level of people proactively going out to do that. It could be when they apply for driving licences or passports, or in other interactions. By doing that, it is much easier for the family; they know that that person made their wishes perfectly clear. As I say, 90% of the time the family then go with it, because they understand those wishes. That is really the thinking on the major facts in the comms campaign.

Within that, it is also about trying to make it as easy as possible. A new lens needs to be used for looking at the whole customer journey, for want of a better term, to make it as user-friendly as possible. The noble Lord, Lord Allan, mentioned some of his Facebook experiences about how you do this. There is a complicated process for which organs you can opt in and out on. Is that needed? Again, there is an argument for giving people choice. I am told that people have an aversion to giving corneas. They will approve a lot of things but are more disturbed by the thought of giving their eyes. I think people like having that choice, but this is almost about having a “yes to all” tick box as the automatic default option here.

Before I reply formally to some of the questions, another observation I make is that, although I am not saying that this should be driven by economics, the economics are clear: transplants save a lot of money as well, particularly in the case of kidney transplants. That is because you have people who are having a lot of dialysis and other treatments. In my research for this debate, I was told that the economics are very clear. It is worth investing in the resource behind this, because the transplant is not only much better for ongoing life; it actually saves the NHS money, because patients are not having to go for those future treatments.

I mentioned my meeting with the staff. The noble Lord, Lord Weir, made points about the recommendations of the Organ Utilisation Group. I am told that DHSC, the blood transfusion service and NHSE have accepted those recommendations and are working towards ensuring that they are implemented. A lot of the time, this is about trying to make sure that we are maximising it. As the noble Baroness, Lady Merron, said, it is not just the number of people who consent but the utilisation. They have managed to increase the number of organs used to about two and a half per person right now. It is about not just converting those people who have consented but how you utilise it, so they are working on that.

On the resource for this, at the moment there are 330 specialist nurses—it is accepted that you need a specialist nurse to do this—and 55 clinical leads. Clearly, that should be one of the things we challenge when we meet on this, given that the economics are clear. On the marketing, again, attention is being turned more towards that. After Organ Donation Week, the impact of that campaign was a 22% increase in registrations. As I said before, it was very much focused on trying to persuade people to proactively go out and consent, because it is much more likely that the families will go along with that when they do so.

There are a lot of small things in this; there is no silver bullet. It is about trying to get across them all. As was mentioned by the noble Lords, Lord Weir and Lord Allan, there is quite a disparity for black and ethnic-minority people, which we need to understand further. I was wondering about the point made by the noble Baroness, Lady Merron, on the disparities between regions. My hunch when looking at that sort of data is that there are younger populations in London and the Midlands and an older population in the south-west, so is there something going on with the age profiles? Perhaps those are driving a difference in behaviour, so maybe the comms campaign needs to try to target certain people some more.

Some international comparisons were mentioned. For me, the biggest lesson is in another point made by the noble Lord, Lord Allan: these things are so cultural as well. From my understanding, it took Spain a good 10 years or so to really do this. We need to think about all those cultural aspects in our campaigns. Just saying, “Now that we’ve changed the Act, it will go ahead and happen” is not a silver bullet. What we have really learned from all this is, as the noble Baroness, Lady Merron, said, that it is just the start. It is not the end of the journey. As the noble Lord, Lord Allan, said, it all comes down to trust in people—and trusting that the process is all there.

I hope I have managed to pick up most of the questions as I have gone through this. To me, the biggest thing is about putting the challenge down to the NHS blood transfusion service and giving it the time to do it properly. We can then invite its people back, and at that point we could invite all the noble Lords who are here today. I really appreciate this being brought up today, as we could do a lot more on it.

House adjourned at 7.37 pm.

Strikes (Minimum Service Levels: NHS Ambulance Services and the NHS Patient Transport Service) Regulations 2023

Lord Markham Excerpts

Wednesday 6th December 2023 Lords Chamber

Moved by

[Lord Markham]

That the draft Regulations laid before the House on 7 November be approved.

Relevant document: 3rd Report from the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument)

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

My Lords, I thank noble Lords for their attendance today at this important debate. I am sure of course that my speech will convince at least three of your Lordships to come the other way.

I pay tribute to the Secondary Legislation Scrutiny Committee for its third report of Session 2023-24, which considered this statutory instrument. I thank the noble Baronesses, Lady Merron and Lady Bennett, for their amendments in relation to today’s debate. I hope I will be able to address these topics and the questions from Members today.

During strike action, our utmost priority is to protect the lives and health of the public. Minimum service levels will give the public much-needed reassurance that vital ambulance services will continue through strike action, ensuring that NHS employers can provide life-saving services when the public needs them most. During this year’s strike action, some unions, including ambulance unions, have put in place voluntary arrangements for covering essential services, but those arrangements are entirely dependent on good will from unions and staff. Even where they are in place, as they were for the ambulance strikes, there is uncertainty and inconsistency across the country, creating an unnecessary risk to patient safety.

I am pleased that we are debating this secondary legislation, which is necessary to enable NHS ambulance trusts to implement minimum service levels for ambulance services during industrial action. Informed by responses to our public consultation, we have set out the MSL to ensure that employers can issue a work notice to provide that all calls about a person with a life-threatening condition, or where there is no reasonable clinical alternative to an ambulance response, receive a response as they normally would on a non-strike day. The regulations also provide for an MSL in respect of healthcare professional response requests, inter-facility transfer services requests and non-emergency patient transport services.

The MSL we have is broadly in line with the services provided on a voluntary basis by most unions when there was strike action in ambulance services last winter. We do not want to restrict individuals’ ability to strike more than necessary. The unions recognised that these services needed to continue then, and by introducing this legislation we are providing a safety net so that the public can be assured that these essential services would continue in any future strike action.

The responsibility for determining staffing levels on both strike and non-strike days remains with clinical leaders at local level. These regulations do not set a minimum level of service generally. Instead, they set a level of service that will allow NHS employers to issue work notices so that, for the services caught by the regulations, the same level of care can be provided to patients as if it was a non-strike day. These regulations do not set a higher level of service than they would have on a non-strike day.

Our Government do recognise that these regulations will restrict ambulance workers’ ability to strike. That is why we have committed to engage in conciliation in the event of national disputes over ambulances in the future, if unions agree that this would be helpful. This is a significant and appropriate commitment; it recognises that we are restricting some workers’ ability to strike so that we can safeguard the public’s right to life and health. We hope NHS employers will do the same for local disputes, and strongly encourage them to do so.

While the territorial extent of these regulations is England, Scotland and Wales, the territorial application of this instrument is limited to England. Employment rights and duties and industrial relations are reserved to Westminster for Scotland and Wales. However, health services are largely devolved and the responsibility for delivering health services in Scotland and Wales falls to the respective Governments. We none the less stand ready to support the Scottish and Welsh Governments should they wish to introduce MSLs, and we have already reached out to offer our assistance.

I now turn to the amendments which have been tabled to these regulations by the noble Baronesses, Lady Merron and Lady Bennett of Manor Castle. I will start with the regret amendment—that the regulations contain detail that was not in primary legislation.

The Government are grateful to the Delegated Powers and Regulatory Reform Committee for its consideration of the Strikes (Minimum Service Levels) Act 2023 during its passage. In its report, the committee commented that the Act did not contain detail on what the minimum levels of service for the relevant sectors were. As discussed during the debates on the Act that Parliament passed earlier this year, the Act establishes the legal framework that enables these regulations. Each sector where minimum service levels can be brought has its own complexities, and it is right that government enables relevant employers, employees, trade unions and their members, as well as members of the public who are affected by this legislation, to contribute to the relevant consultation and have their say on minimum service levels. It is therefore appropriate that these regulations contain the specific details on how the MSL will affect the relevant service, given that the detail was not present in the Act.

With regard to these regulations, the Department for Health and Social Care undertook a public consultation and additional workshops with key interest groups. The responses and feedback we received from employers, trade unions, charities and other representative groups have informed the drafting of these regulations.

I now turn to the second aspect of the amendment from the noble Baroness, Lady Merron—that the regulations do not reflect the policy positions taken by the Government in their response to the consultation. I have taken from the amendment put forward by the noble Baroness that she was referring to the fact that we were clear in our consultation response, and will continue to be clear, that, if employers are confident that the minimum service levels can be met without issuing work notices, they need not do so. This is implicit in the primary legislation itself—employers have a power to issue work notices, not an obligation to do so. The purpose of these regulations is to provide early certainty for employers about what level of service is to be provided, and a safety net for trusts and reassurance to the public that vital emergency services will be there when they need them. Although, in the main, appropriate derogations were provided by ambulance service unions last winter, our experience of strike action in different parts of the NHS this year has shown that we cannot rely on the good will of unions to provide appropriate derogations.

I now turn to the potential for the regulations to be burdensome. The department is currently considering whether further guidance is needed for employers and trade unions in the health sector to help with implementation of the regulations. This is in addition to the work undertaken by the Department for Business and Trade to publish work notice guidance and a code of practice that provides practical guidance on the implementation of minimum service levels for employers and trade unions. The Government have also committed to working with employers and trade unions to improve and strengthen the process of agreeing voluntary derogations. The department is currently scoping options on how best to take this work forward.

I now turn to the fatal amendment, which claims that the regulations will

“expose trade unions to liability of up to £1 million”.

I agree with the comments of my noble friend Lord Johnson, who spoke earlier today on the Department for Business and Trade’s code of practice. These regulations, however, are not where this £1 million liability comes from. The code will provide greater clarity to trade unions and employers which should help avoid expensive litigation. The code will also protect unions from the very liabilities that the noble Baroness raises in her fatal amendment.

I wish to address the suggestion that these regulations make trade unions enforcement agents of NHS employers and His Majesty’s Government. I wholeheartedly disagree with this suggestion. Naturally, on a strike day, NHS employers will ask staff who have been named in a work notice to comply with that work notice. It is the Government’s view that it is right and proportionate that there is some limited obligation on trade unions to help ensure that the minimum service level is achieved during a strike.

I must reassure your Lordships that these regulations are not at all about straining industrial relations between employers, trade unions and the Government in the NHS. These regulations would help create certainty and clarify expectations between NHS employers and trade unions regarding the level of cover available to the public on strike days. This greater clarity can only be beneficial for the relationships between trade unions and NHS employers. I therefore call on all noble Lords to reject this fatal amendment.

[Baroness Merron (Lab)]

My Lords, in the previous debate, my noble friend Lord Collins ably set out why the Act, the code of practice and the associated regulations will exacerbate conflict in the workplace and do more harm than good, in this case to NHS staff in the ambulance and patient transport service, as well as to employers and the public. I will not repeat the evidenced arguments we have already heard, but I support the view that the Government has got this one in the wrong place.

Noble Lords will have heard and be well aware that Labour has promised to repeal the Strikes (Minimum Service Levels) Act when we get into government, and I reiterate that we stand by that pledge. I note the fatal amendment again tabled by the noble Baroness, Lady Bennett of Manor Castle, and I hope that she will now agree that it is not the role of an unelected Chamber to frustrate the will of the other place, but I hope that she will find it possible to agree with the comments from my noble friend Lord Collins, who said that the only democratic way to get rid of this unworkable legislation will be through the election of a Labour Government.

These regulations are marked by draconian content which does not align with the more conciliatory language in the Government’s consultation response, in which there is significant emphasis on the potential for voluntary arrangements as an alternative to the issuing of work notices, to take one example. As the consultation document says:

“Instead of expecting that employers will always issue work notices to ensure”


that minimum service levels

“are met, we recognise that they may be able to secure the same level of coverage through voluntary derogations, and they can continue to agree and rely on these instead, as long as they are confident that the MSL will be met. Where employers decide that voluntary agreements are sufficient, this will give union members more flexibility on strike days; instead of either being on strike, or not, they can choose to strike but leave the picket line if needed, as they do currently”.

I observe that this kind of language and its tone and content fails to be reflected in the regulations, which are highly prescriptive in their insistence on how things absolutely must be. Perhaps the Minister could explain this disconnect. Does he accept that in times of industrial unrest, it is the language of conciliation that is needed?

--- Later in debate ---

[Noble Lords]

Minister!

[Lord Markham (Con)]

I thank noble Lords. In keeping with other comments, I will be brief in my response. We genuinely see a situation where, as the noble Baroness, Lady Bennett, said, we all agree that we want minimum service levels every day. As the noble Lord, Lord Collins, said in the previous debate, no one is against minimum service levels. All we are talking about here are the tactics to how we achieve that. I also totally agree with the point made by the noble Baroness, Lady Merron, that using the language of conciliation has to be the right approach in disputes. However, all these SIs are designed to do is to provide that safety net. To address the point of the noble Lord, Lord Rooker, there have been other circumstances where there was a genuine concern that strikes would not enable those minimum service levels to be fulfilled. That is what we are talking about today.

In response to the point made by the noble Lord, Lord Allan, I agree that it will be up to the ambulance’s trust, or the other trust when we come to other parts, to use its best judgment on how to achieve those minimum service levels. It is at management level, but it is then our job as the Government to hold them to account. Clearly, if during these strike actions the trust was not achieving minimum service levels, and there were certain standards which put patient safety at risk, in those circumstances I would be expected, as would any Minister, to ask the relevant trust why that was the case and perhaps to reconsider, because its judgment call did not bear fruit on that occasion. This is all about trying to give the trust part of the toolkit to ensure what we all want, which is minimum service levels. We are not compelling it; we are giving it the choice to do it. We hope that it is never needed but we believe it is an important part of the toolkit.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I note that no Tory Back-Benchers are speaking in favour of the Government in this part of the debate. I note also the comments made by the noble Lord, Lord Rooker, who came at it in a different way to how I did. The House is again and again butting against the question “If not now, when?” We have the power to act. Not acting is as much of a choice as acting is. I am sorry to disappoint the noble Lord, Lord Rooker, but I am aware of the time and the pressure to move on to more votes, so I beg leave to withdraw the amendment.

Cancer Research UK Report

Lord Markham Excerpts

Tuesday 5th December 2023 Lords Chamber

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

The Government welcome the Cancer Research UK report Longer, Better Lives, which rightly highlights progress made against cancer. We have invested over £100 million in cancer research in 2021-22 through the National Institute for Health and Care Research. We are working closely with research partners in all sectors, and I am confident that the Government’s continued commitment to cancer research will help us to build on that progress, leading to continued improvement for all cancer patients.

[Baroness Ritchie of Downpatrick (Lab)]

I thank the Minister for his Answer. The CRUK manifesto clearly highlights the priorities required for tackling rising cancer rates with a growing ageing population, including the need for more investment in research, greater disease prevention, earlier diagnosis through screening, better tests and treatments, as well as cutting NHS waiting lists and investing in more staff. Can the Minister outline what steps the Government will take to implement this strategy, allied with resources and updated infra- structure in all hospitals?

[Lord Markham (Con)]

Absolutely. I thank the noble Baroness for the work that she does in this field. I welcome the manifesto, specifically on rebuilding the global position in research. We have done a good job on that: we have gone from a position of 26% of the clinical trial responses being in time to international standards to over 80%. The biggest prevention method that anyone could take is to stop smoking because, as we know, that is the biggest cause of lung cancer, so we are introducing steps to prevent smoking. On early diagnosis, we have introduced an excellent example in lung cancer. Some 60% of people used not to be detected until they were stage 4, which is often too late. Now, through the mobile lung cancer units, we are detecting 70% at stage 1 or 2, where they have a 60% chance of survival. Across the field, we are doing a lot on this that we can feel proud of.

[Lord McColl of Dulwich (Con)]

My Lords, does the Minister recognise that one of the causative factors of cancer is obesity? Some 40 million people in this country are obese, and according to the latest estimate it is costing £100 billion a year. Is it not time to adopt the campaign technique that Norman Fowler—now the noble Lord, Lord Fowler—successfully conducted in the 1980s? He had the courage to state the truth and make sure that it was successful.

[Lord Markham (Con)]

Yes, we are taking extensive action on the obesity front. As well as being a major cause of cancer, it is the cause of a lot of ill health. We have taken a lot of action against 96% of the reasons given in obesity research on calorific intake, with regard to what people buy in supermarkets. Also, the soft drinks industry levy—the sugar tax—has decreased sugar in drinks by at least 14%.

[Lord Patel (CB)]

My Lords, I congratulate CRUK on producing this magnificent report and manifesto. Continuing with the theme of research, the report identifies the necessity of further closing the funding gap in research of about £1 billion in the next decade. This research is in key areas where our scientists are leaders in the world, such as the early detection of cancer using cell-free DNA and technologies such as messenger RNA for vaccine production, using genomes and early protein expressions for early diagnosis. The Minister mentioned the key area of reducing lung cancer using known technology, but it is in discovery science where we need to increase funding, especially when government funding falls far behind charity funding, particularly from CRUK.

[Lord Markham (Con)]

I agree that research funding is key. That is why I mentioned the £100 million that we spent in 2021-22. The Medical Research Council is also spending £125 million per annum on cancer research. That is allowing us to introduce vital things such as the point-of-care cancer treatments that our regulators that have brought in ahead of anyone else in Europe, showing the key flexibility that our regulators now have, meaning that people can have individualised cancer care. I agree that we need to invest in these sorts of activities.

[Lord Allan of Hallam (LD)]

My Lords, I recently had a meeting at one of our excellent specialist cancer hospitals. It explained that it had tens of millions of pounds in the bank that it would like to spend on facilities and equipment to support new cancer treatments, but it cannot. The only blocker is that it cannot get a certificate from the local integrated care board to authorise the capital expenditure. Frankly, I was astonished by that. I invite the Minister to explain, in terms that even I can understand, why the Government think it a good idea to prevent a world-leading hospital trust from spending money that it already has on much-needed cancer research facilities.

[Lord Markham (Con)]

I am not clear on the details of the case but will happily take it up with the noble Lord afterwards. I agree that, clearly, we want our leading institutions spending money where they can really impact change, and that is exactly what we are doing.

[Baroness Merron (Lab)]

My Lords, while any benefits of early cancer diagnosis will not be realised without timely treatment, the Government continue to not nearly meet the NHS target of 85% of patients starting treatment within 62 days of an urgent referral for suspected cancer. What assessment have the Government made of treatment delays on death rates, as well as anxiety levels for patients? If the Minister accepts the statistics that increased waiting lists for cancer treatment predate the pandemic, what will the Government now do differently?

[Lord Markham (Con)]

We absolutely need to bear down on cancer wait times. That is why we have been expanding supply in this area: the 130-plus CDCs, which have done 5 million tests, are all about that, as are the 50 surgical hubs. This means that we are treating 26% more cancer patients this year than last year and that we have managed to reduce the 62-day backlog by 27%. More work needs to be done, but we are getting on top of it.

[Baroness Armstrong of Hill Top (Lab)]

My Lords, the problem that the Minister faces is that things may well be getting worse. Because of the extensive waiting lists, one major cancer centre in London is saying that the number of people referred to the cancer pathway has rocketed, because of a large number of people on other waiting lists. Among those that it is now seeing for the cancer pathway, only 2% actually end up having cancer. At one level we can celebrate that, but we know that it is not because the numbers with cancer are reducing. People are being referred into the pathway because it is the only way that they will be seen at the moment.

[Lord Markham (Con)]

No, I do not believe that is why people are being referred; it is to give them peace of mind. People know their own bodies and, if they are concerned about having cancer, they know that we want to put their minds at risk. I am familiar with that statistic. I had heard that 95% of people who go to these referrals, thankfully, do not end up with cancer but, boy, do they have peace of mind since we are able to give them that assurance.

[Lord Harries of Pentregarth (CB)]

I declare an interest, as I have a son who is an oncologist. As the Minister knows, one of the most serious forms of cancer—and growing at this time—is melanoma. The melanoma charities are campaigning to reduce the VAT on sun cream in order to reduce the incidence of this terrible cancer. Have the Government come to a view on this reduction of VAT?

[Lord Markham (Con)]

I do not think that the Government have come to a view but I understand the point. I will take that back to the department and the Treasury.

[Lord Turnberg (Lab)]

My Lords, we are doing reasonably well with certain cancers—leukaemias and breast cancer—but very badly with pancreatic cancer and colon cancer. Most of these are asymptomatic for a long while, until it is too late. We desperately need a test that will indicate that there is a disease coming. What research is being done in this area and what money is being spent on it?

[Lord Markham (Con)]

The noble Lord is absolutely correct that, while we have made good progress in many areas, pancreatic cancer is the hardest one and one where we need to do more. That is true all around the world, because the symptoms are so hard to detect. I will happily write with the details to give him an answer on that.

Sexually Transmitted Infections

Lord Markham Excerpts

Tuesday 5th December 2023 Lords Chamber

[Lord Black of Brentwood (Con)]

My Lords, in begging leave to ask the Question standing in my name on the Order Paper, I declare an interest as a patron of the Terrence Higgins Trust.

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

We remain committed to improving sexual health in England. The UK Health Security Agency conducts comprehensive surveillance of sexually transmitted infections and supports local areas to use this data to inform sexual health services delivery. We are working with it and other key delivery stakeholders to explore options for the best use of both existing and innovative preventive interventions, as well as strengthening messages to the public on how to reduce the transmission of STIs.

[Lord Black of Brentwood (Con)]

My Lords, PrEP has been a game-changer in the fight against HIV, and making sure that as many people at risk of infection as possible have access to it is fundamental to meeting the target of ending new HIV cases by 2030, but at the moment we are failing to ensure that access because of the immense pressure on sexual health services. Nearly 60% of people are forced to wait more than three months to access PrEP through that route. Does my noble friend agree that one way to deal with this problem is to make PrEP available through pharmacists, as contraception now is—an initiative backed by the Royal Pharmaceutical Society—and does he recognise that such a policy, in line with the ambition of Pharmacy First, would not just relieve pressure on sexual health services but encourage uptake among women, who make up 31% of people accessing HIV care but represent only 2% of PrEP users?

[Lord Markham (Con)]

I thank my noble friend for all the work he does in this space and absolutely agree that we are world leaders in the use of PrEP. We have 86,000 people currently using it. It is a key prevention tool and something that we want to expand as widely as possible. There is an excellent pilot happening in Brighton at the moment, where you can get PrEP online, and I absolutely agree that we should look at Pharmacy First as a way to expand that even further.

[Lord Fowler (CB)]

Does the Minister remember reports on the AIDS campaign in the 1980s, which showed not just a reduction in AIDS but a fall in all other sexually transmitted diseases generally? How much is now being spent on such public education campaigns in this area? Is this spending increasing or decreasing?

[Lord Markham (Con)]

Overall, we spend £3.5 billion on public health. I do not have the breakdown of the advertising within that, but I will happily follow up with that. That is a small increase over the last year. Education is key to all this. Part of the reason for the increase in sexually transmitted diseases is that people used to use condoms because they were scared about two things: pregnancy and HIV infection. As both those risks have gone down, so has the use of condoms, which has resulted in the higher level of sexually transmitted diseases—so education is key.

[Baroness Barker (LD)]

My Lords, in 2022 the rate of STIs went up by 22% and, at the same time, the public health budget has been reduced by 29%. The strain on those services is now intolerable. Is it not time to have a proper, real increase in that budget?

[Lord Markham (Con)]

The figures are slightly misleading because, of course, that was in comparison to a Covid year, when there was much less testing. In fact, if you look at it versus pre-pandemic figures, the numbers are 16% down compared with 2019; that is the real comparison we should look at here. At the same time, I think we would all agree that £3.5 billion is a big investment in this space. It has gone up slightly over the past year but, as I mentioned earlier, education is also key in this space.

[Lord Hunt of Kings Heath (Lab)]

My Lords, can we come back to the issue raised by the noble Lord, Lord Black: whether community pharmacies could play a bigger role in relation to PrEP? Does the Minister accept that, although there is much that community pharmacies could do, they face a fundamental financial crisis at the moment, with many going out of business? Will the Government accept that they are going to have to give more support to community pharmacies for them to do the kind of things that the noble Lord is asking for?

[Lord Markham (Con)]

Yes. I believe that there is a real win-win possibility here, where we can get more services through Pharmacy First—obviously, that is good for primacy care access—and give further support to pharmacies. I was having this conversation just this morning. We made contraception available through pharmacies in April 2023; we will get the results of that back shortly. Things such as sexual health and PrEP are absolutely what we are looking at.

[Lord Bailey of Paddington (Con)]

My Lords, in view of the fact that it is often the hardest-to-reach communities that suffer the greatest pain from the uplift in sexually transmitted diseases, can the Minister tell us what work the Government are doing to reach such communities, particularly the young, to educate them so that they can protect themselves?

[Lord Markham (Con)]

My noble friend is absolutely right: young people—15 to 24 year-olds—represent one of the highest levels of this. In 2020 we made relationships, sex and health education classes available compulsorily in schools. We are currently reviewing that to see the effectiveness of it, with a view to expanding it further.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, can the Minister tell the House what the current rate of take- up is for vaccination against HPV—human papillomavirus —and what efforts are being made to make sure that all those who should be vaccinated are?

[Lord Markham (Con)]

I will need to come back with the exact figure for the vaccination rate. I know that it is proving quite effective, which is important. On the measures we are taking, we are investing £25 million in women’s health hubs precisely to enable these sorts of vaccination programmes. I will happily follow up in writing with the detail.

[Baroness Cumberlege (Con)]

My Lords, does my noble friend the Minister agree that, in this technological age, it is very important that people are able to access everything they need from the NHS via their phone or a laptop? I am working to ensure that all women have access to their maternity record via the NHS app, but only 23% of sexual health clinics currently allow online booking. Can my noble friend tell me how the Government plan to address this issue?

[Lord Markham (Con)]

I thank my noble friend. As she knows, I am a big advocate of everything that we can do with the app. We are absolutely looking to extend its services, which will include sexual health clinics. In the past year alone, we have increased from around 10% of GPs allowing someone to see their records to around 70% today. Sexual health clinics are clearly an area that we need to look at next.

[Baroness Merron (Lab)]

My Lords, with a real-terms cut of nearly a third for sexual health services over the past eight years, it is ever more difficult to get an appointment. Given that STIs increased by 24% last year alone, what assessment have the Government made of the potential to improve access to sexual health services through the universal provision of postal STI tests in England—something that Wales already offers?

[Lord Markham (Con)]

We are leading the world in all these areas. In a recent survey across the European nations, we came out top in sexual and reproductive health services, which I want on the record. Just last week, everything that we are doing in the HIV space was recognised as part of all this. This is another area in which we are looking to widen access as much as possible. I mentioned the examples of an online service in Brighton and, to the noble Lord, Lord Hunt, Pharmacy First. We are looking to make sure that access and testing are as widely available as possible.

[Lord Turnberg (Lab)]

My Lords, chlamydia is a cause of infertility. A vaccine has been developed and is in use. How far have we got with the programme of vaccination against chlamydia in both boys and girls?

[Lord Markham (Con)]

The noble Lord is correct: about 50% of all cases are of chlamydia, and it is undetectable in a lot of people. That is why we have started screening programmes of chlamydia in women, so that it can be picked up when it has been undetected, which we know can be done. As the noble Lord mentioned, we have a programme of chlamydia vaccinations for both females and males. From memory, I think the rate of boys vaccinated is about 30%, but I will come back in writing with the exact numbers.

[Lord Herbert of South Downs (Con)]

My Lords, the biggest single cause of death of people with AIDS globally is tuberculosis. Coinfection is a real issue. Although this problem is not nearly as serious at home, there are still thousands of cases a year and they have started going up again. Will my noble friend confirm that, post Covid, the Government will look again at what more needs to be done to eliminate tuberculosis—an entirely treatable disease—from our shores?

[Lord Markham (Con)]

Yes, absolutely, as we are in all cases. I want to be clear on this. My noble friend mentioned AIDS: the UN targets are 95%, 95% and 95% for diagnosis, treatment and viral load detection, and we are at 95%, 98% and 98%. We are beating the targets and leading the world on this.