Cass Review

Debate between Lord Markham and Baroness Bennett of Manor Castle

Wednesday 17th April 2024 Lords Chamber

[Lord Markham (Con)]

To take the second point first—it was also made by the noble Baroness opposite—that is absolutely right; it can be a real danger. People with English as a second language might not understand that a “person with ovaries” refers to them. It needs to be very clear. It is fundamental that the first description has to be “male” or “female”; you can then put additional parentheses after that.

The noble Baroness’s first point is exactly right. Until young people are through the age of puberty and its effects, they are not in a real position to make up their own minds. That does not mean that they should not be supported during that process, but it does mean that we should not be doing anything irreversible.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I watched the Secretary of State’s introduction to this Statement on Monday, live from my office. She asked the other place to

“bear the sensitivities of this debate in mind”.—[Official Report, Commons, 15/4/24; col. 55.]

I am afraid that it is clear from the printed record before us, and was even clearer watching the Secretary of State speaking, that it was delivered in a triumphalist, dogmatic tone, which meant that she did not follow her own prescription.

The Statement speaks of “myths” but fails to acknowledge the agency and lived experience of children and young people. I have two questions for the Minister. Can he reassure me that we are not going to lose, in this ideological debate, the need for massively more investment in services for children and young people in the NHS? The noble Baroness, Lady Burt, referred to the huge waiting lists that are behind the report we are discussing today.

The Statement also did not mention—and I think we have to acknowledge this—that hate crime against transgender people hit a record high in figures out last October. I hope that the Minister will agree with me that children and young people seeking gender identity services should not have to live in a society where their experiences are used as a political football. They should not be treated as a weapon in the culture war. They should not have to live in a hostile society.

[Lord Markham (Con)]

First, I think I speak for the whole House in agreeing that no one, under any circumstances, should feel that they live in a hostile society —whatever case it is, whether it is transgender, race, sex or whatever. I totally agree with the noble Baroness there. I will absolutely clarify this in the follow-up in writing, but I know that, in this specific area, the NHS has already committed £18 million in this space. Of course, this is quite separate from the £2.3 billion that I mentioned before in the mental health space generally, which, from memory—and I will absolutely clarify this—is the provision of 350,000 extra places for young people, because we know how much the demand is out there.

Sodium Valproate and Pelvic Mesh

Debate between Lord Markham and Baroness Bennett of Manor Castle

Monday 25th March 2024 Lords Chamber

[Lord Markham (Con)]

That is precisely what I put to Minister Caulfield this morning. She commissioned the review because her feeling was that the period from when my noble friend’s initial report came in until when Maria Caulfield was in post was too long. So it was absolutely she who commissioned it last year, and it is absolutely she who very much said that she is determined that there should be a substantive reply from us in the next few months.

[Baroness Bennett of Manor Castle (GP)]

My Lords, at the launch of the Patient Safety Commissioner’s report the victims of the Primodos scandal expressed great distress as they felt that they had been airbrushed out. Of course, the noble Baroness, Lady Cumberlege, recommended that they should receive redress, and they were treated the same way in the report as the sodium valproate and vaginal mesh victims. Can the Minister tell me what will be done to provide redress and ensure that there is appropriate treatment for the victims of Primodos?

[Lord Markham (Con)]

Again, these are difficult areas. My understanding is that we are working from the conclusions of the expert working group in 2017, and its review of all the evidence was that it could not find a causal link between Primodos and the impact it had during pregnancy. This was again reviewed by the MHRA when more information was brought up in the last year. So I am afraid that, as we stand today, the evidence is not there that suggests that causal link.

NHS Dentistry

Debate between Lord Markham and Baroness Bennett of Manor Castle

Monday 19th February 2024 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is quite correct. Cornwall is one of the areas where we piloted the mobile services. It is probably not the number one area, but it is fair to say that it is one of the main areas where we are putting in more resources for precisely that reason.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I shall switch sides of the country. The campaign group Toothless in England was founded in Suffolk and is calling for contracts for NHS dentists to cover the real costs. It says that this is the only way to solve the drought of dentists in places such as Waveney Valley, where one in three people has been unable to secure an appointment over two years.

[Lord Markham (Con)]

These plans were welcomed by Toothless in England, which was good to see, as well as by Healthwatch. I know personally that making it economic for dentists to work in the NHS rather than in the private sector, or getting that balance right, is fundamental. The changes are a good first step towards that but more probably needs to be done.

Health: RSV Immunisation

Debate between Lord Markham and Baroness Bennett of Manor Castle

Wednesday 17th January 2024 Lords Chamber

[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.

NHS Winter Update

Debate between Lord Markham and Baroness Bennett of Manor Castle

Thursday 11th January 2024 Lords Chamber

[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.

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

Debate between Lord Markham and Baroness Bennett of Manor Castle

Wednesday 6th December 2023 Lords Chamber

[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.

Ultra-processed Food

Debate between Lord Markham and Baroness Bennett of Manor Castle

Thursday 26th October 2023 Lords Chamber

[Baroness Bennett of Manor Castle]

To ask His Majesty’s Government what is their assessment of the impact on public health of ultra processed food; and what steps if any they will take to reduce the amount of ultra processed food consumed.

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

Observed associations between ultra-processed food and health are concerning, but it is unclear whether these foods are inherently unhealthy due to processing or their nutritional content. A diet high in processed food is often high in calories, salt, saturated fat and sugar, which are associated with an increased risk of obesity and chronic diseases. This continues to be the basis of our dietary guidelines and policies to tackle obesity and poor diets.

[Baroness Bennett of Manor Castle (GP)]

I thank the Minister for his Answer, which reflects what he said yesterday in our debate, that the House did not agree on whether processed food per se is bad for you. Common sense has long suggested that food that, to quote the Washington Post, is

“refined, pounded, heated, melted, shaped, extruded and packed with additives”

is bad for you. These dreadful food-like substances do not just contain a terrible balance of nutrients; there is also a problem with the process. The science increasingly demonstrates that. Yesterday I referred to a study based on the French NutriNet-Santé study by Chantal Julia et al; I supplied the Minister with the link. Will he commit to asking the department to look closely at that study, which demonstrates that nutritional quality and ultra-processing are correlated but distinct issues in diet? Will the department provide a substantive response to the study?

[Lord Markham (Con)]

Obviously, I am always happy to look at all the research because this is a vital area. This is the fifth time we have discussed it in the last three and a half months, so I apologise for any repetition. We are ever vigilant on this area but, as the contributors to yesterday’s debate showed, the research is mixed. The key things to get behind are the bad features of ultra-processed foods that are high in sugar, salt and saturated fat.

Domestic Violence and Brain Injury

Debate between Lord Markham and Baroness Bennett of Manor Castle

Monday 23rd October 2023 Lords Chamber

[Lord Markham (Con)]

The noble Baroness makes a very good point; it is often the hidden side of domestic violence. The problem is that there is not much information on this, but a US study shows that as many as between 30% and 74% of women who suffered domestic violence had suffered from traumatic brain injury. It is about making people aware that this is not an edge case; this is something that unfortunately is all too familiar. As the noble Baroness mentions, every strand of society needs to be aware of this and to act on it.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the Minister reflected that many victims of intimate partner abuse sometimes do not report until weeks, months or years later. Will the Minister ensure that there are services available that recognise this medical issue when they may not present primarily as a medical case, making sure that all the support that is available to victims of domestic violence is aware of this issue? In responding to the noble Lord, Lord Hunt, the Minister said that we will wait for the research. I think there is already clearly enough evidence in what we have heard today, and the fact that 3% of dementia in the community is attributed to traumatic brain injury. We need to act now, not wait for research.

[Lord Markham (Con)]

It is a good point, and there are already some very good examples, such as in Cambridge, where the ICB has a single front door to make sure that all facilities, whether it is neurologists, psychologists, physios or speech therapists, are there and available. The noble Baroness is correct: there are lessons we can learn and roll out straight away, and we are looking to do that.

National Health Service: Major Conditions Strategy

Debate between Lord Markham and Baroness Bennett of Manor Castle

Monday 18th September 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend is absolutely correct, in that we are setting out the whole emphasis of what we are trying to do here. It is really ingrained in those pathways. It is about culture and behaviour as a whole, rather than a silo-based scheme, looking at the whole patient. Once we have got those pathways set up properly, it is Ministers’ job—I have mentioned before that we each look after six or seven ICBs—to hold them to account and make sure they are following those pathways.

[Baroness Bennett of Manor Castle (GP)]

My Lords, on that whole- patient approach, in 2021 when the Office for Health Improvement and Disparities was launched, the then Secretary of State said that the Department of Health would be co-ordinating activity across government, looking at the wider drivers of good health—employment, housing, education and environment—lack of which often drives many major conditions. Can the Minister tell me how that co-ordination is going?

MMR Vaccine

Debate between Lord Markham and Baroness Bennett of Manor Castle

Thursday 20th July 2023 Lords Chamber

[Lord Markham (Con)]

As mentioned, there are outreach programmes, particularly for home-schooled children or children who are not there. There are also programmes in community centres, with the idea of trying to pick them up in as many places as possible. Obviously, there is concern about certain communities that are harder to reach than others. That is particularly the case in London, as I mentioned earlier. That is where we are trying to specifically target those community centres with outreach work.

[Baroness Bennett of Manor Castle (GP)]

My Lords, in April the UK Health Security Agency’s director of public health told the Health and Social Care Committee in the other place that the workload for delivering vaccines now falls disproportionately on general practices—particularly after the 2012 NHS reforms—and that this is one of the weaknesses we are trying to put back together.

In that context, the Minister may be aware of the issue around the quality and outcomes framework payment to GPs. GP practices in deprived areas are missing out on payments for delivering vaccines that could help them deliver more vaccines because it is extremely difficult for them to register the patients whom they have tried to contact multiple times when those patients do not respond. So, the GPs are missing out on payments they need to be able to reach those difficult-to-reach patients.

[Lord Markham (Con)]

I am sorry, I am not quite sure what the question was there. Clearly, we need to make sure that the system is working in terms of making sure that the payments are there so the doctors can follow up. If the noble Baroness would like to follow up with me, so that I can fully understand it, I will get her a response.

Mental Health In-patient Services: Improving Safety

Debate between Lord Markham and Baroness Bennett of Manor Castle

Monday 3rd July 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord for his commitment in this area over the years. With regard to the first question about past evidence, clearly the HSSIB will be looking at what evidence exists. As the noble Lord said, some investigations go back 30 years, so there will not always be circumstances where it can pick out that evidence, unfortunately. However, where there is that information, we are trying to make sure that we pull it out and learn from it. That is very much the direction of travel. Clearly, if part of the HSSIB’s findings is that we need to make sure that every death in such circumstances is investigated under a certain pathway, then I am sure that will come into its recommendations. In terms of the other questions, I think it is best that I write to the noble Lord, if I may.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the Statement includes a number of themes which it is expected the new Health Services Safety Investigations Body will consider. Not included in that list, however, is the growing role of private provision in NHS mental health care services. This is something that patient groups and others are expressing considerable concerns about. Take, for example, the Priory, where the Care Quality Commission reported that the number of deaths at its sites rose nearly 50% from 2017 to 2020. One of those was the tragic death of 23 year-old Matthew Caseby. An inquest jury concluded that his death was contributed to by neglect, and the coroner issued a prevention of future death report because of continuing risks.

The Priory Group earns more than £400 million from the NHS, and much more from social services. It is now owned by a Dutch private equity firm after it was sold by its former owner at a loss and is financed by a sale and leaseback deal of 35 properties with rents subjected to annual inflation-based escalators. Through the mechanisms in this Statement or others, are the Government going to consider the risks presented by private ownership—particularly private equity ownership—of mental health care services?

[Lord Markham (Con)]

As noble Lords are aware from some of my previous answers, I think the key thing is the quality of output rather than the ownership of an institution. Around the House, we have very good examples of where we believe the Government need the help of the independent sector to increase supply and capacity. That always needs to be done with the right quality of regulatory regime, and that is what we have put in place. From my point of view, I am always going to be looking at the quality of the output and not the ownership of a company.

Lung Cancer: Screening

Debate between Lord Markham and Baroness Bennett of Manor Castle

Monday 26th June 2023 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I have two questions. My first question is about the timeframe and the role of GPs. The Statement says that, using GP records, current and ex-smokers aged 55 to 74 will be assessed by telephone interviews. Will that require resources from GPs? We all know that there are many different computer systems so where are the resources going to come from? Specifically on GPs, I can well imagine at many GP surgeries tomorrow morning at that terrible time of 8.30 am as everyone frantically tries to hit the dial button that a lot of people will be asking for a scan. Have GPs been equipped to handle that? Do they know what to say and how to manage that kind of scenario?

My other question follows on from the questions about the Khan review. That said that we are grossly underfunding things. Mass media campaigns in particular are funded at 90% under what is needed, while other services are about 50% underfunded. Surely we have to stop these cases happening. Can we see a commitment from the Government within some sort of timeframe to say that we are going to put more money into this?

[Lord Markham (Con)]

I thank the noble Baroness. In terms of identifying the smokers, the telephone is just one way of doing it. The hope is that using the digital data and the app means that more of these things will be on people’s records and identified with them. As ever with these things, electronic means will be the best way to do that, albeit those telephone resources in terms of supporting the GPs are very much part of the plan. It is understood that GPs have a large burden at the moment.

There is not a lot more to add about the Khan review. The ambition is still there to be smoke-free by 2035 and investment has gone behind that. The best example of that, as has been mentioned, is people swapping cigarettes for vapes as one means to do it. Undoubtedly, a lot more needs to be done in that direction as well.

Sodium Valproate

Debate between Lord Markham and Baroness Bennett of Manor Castle

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend. Yes, the number of cases of people of childbearing age—this is a key criterion—taking sodium valproate has reduced by 33% over the past five years. The number of pregnancies has reduced by 73% but clearly that is not zero so more work needs to be done. I was speaking to Minister Caulfield this morning about the Patient Safety Commissioner. We are expecting her report shortly and from there we hope and believe that there will be a lot more we can do on regulation.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I refer to the work of Dr Hughes, the Patient Safety Commissioner, and the initial Question from the noble Baroness, Lady Cumberlege, which referred to where sodium valproate is prescribed in different numbers of pills from the number that come in a packet, so the excess pills are taken by the pharmacist and put into plain paper packaging. The Patient Safety Commissioner has identified this as a real issue because sodium valproate must not be dispensed without the appropriate safety labels, but that is clearly happening. What are the Government doing to stop it?

[Lord Markham (Con)]

The noble Baroness is correct. First, the MHRA is working on guidelines which say that you must always dispense in the original packaging, come what may. In the meantime, secondly, all pharmacists should absolutely be putting leaflets in, whatever the packaging. Thirdly, everyone should have to sign an acceptance form so that they are going into this with their eyes open and understand the risks. Every year they are supposed to renew that acceptance form to make sure that, while it may be necessary in some cases, everyone goes into it with their eyes open to the risks.

Childbirth: Black Women

Debate between Lord Markham and Baroness Bennett of Manor Castle

Wednesday 3rd May 2023 Lords Chamber

[Lord Markham (Con)]

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

[Baroness Bennett of Manor Castle (GP)]

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

[Lord Markham (Con)]

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

Junior Doctors’ Strikes

Debate between Lord Markham and Baroness Bennett of Manor Castle

Monday 17th April 2023 Lords Chamber

[Lord Markham (Con)]

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

[Baroness Bennett of Manor Castle (GP)]

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

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

Covid Pandemic: Testing of Care Home Residents

Debate between Lord Markham and Baroness Bennett of Manor Castle

Monday 6th March 2023 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

Following the question asked by the right reverend Prelate about what is happening today, I actually agree with part of the Government’s response, which referred to selective snippets of WhatsApp conversations. That is what we are hearing today. While we are waiting for the official inquiry, which will give us a clear, independent view of what happened, it is clear that there were big problems in our care homes. What are the Government doing today to look at the problems that continue in our care homes, particularly those associated with excessive profit taking and privatisation, particularly in homes under the management of hedge funds?

[Lord Markham (Con)]

I know that that is something in which Minister Whately is very engaged. The House has already seen some of the plans around social care and there is further work on discharge going on as we speak. I have spoken many times in the House about the need to resolve this, not just to make sure that the right care is in place for those involved but to free up hospital beds to improve the performance of the whole system.

NHS Winter Pressures

Debate between Lord Markham and Baroness Bennett of Manor Castle

Tuesday 10th January 2023 Lords Chamber

[Lord Markham (Con)]

I have seen very good examples of where that works. You have clinicians in the room with the data—the management and bed information. They make decisions according to the flow and number of people who they see are going to need a bed from the ambulances and the A&E situation, and the number who are ready to release. You have clinicians united with the information to make good decisions. Those are the best. The idea with the longer-term plan is to make sure those “best” have the tools in terms of the flight control system and have management processes in place so that they can adopt and follow best practice. It is key to what we are looking to make sure we have in place in time for next year, as the noble Baroness, Lady Merron, mentioned.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the Minister replied to my Written Question on 5 January about commercial companies promoting strep A tests. The Answer said that these are “not currently recommended” by NICE

“for individuals aged five years old and over … with a sore throat”

and that UKHSA is conducting a

“bedside review of existing antigen-based lateral flow devices”

to

“identify the tests that are most likely to perform well”.

Given that, can the Minister explain why I have a number of emails from DAM Health headed “Concerned about strep A? Order your home test kit today. Only £12.99 per test kit. Quick and reliable results within minutes”? Can the Minister truly put his hand on his heart and say there is sufficient regulation and oversight of private testing companies, and indeed the broader private health sector? Is it not profiteering from the crisis in the NHS, potentially damaging the NHS and putting more pressure on NHS services?

[Lord Markham (Con)]

First, I declare an interest in this space. As many noble Lords will know, I set up a Covid testing company which never did any business towards the Government; I am very pleased to say that it served only the private sector. I am disposing of it as part of my obligations as a Minister. As the question relates to testing, I am quite keen to put that on the record.

Secondly, I would say “absolutely”. Dare I say it, but the reason my company was so successful is that we set the very highest standards according to the regulators. That is why we were able to win the crème de la crème—the Formula 1s and Wimbledons of the world. I cannot speak for other companies which may not be taking that high level of support, but there is absolutely a role for the regulator to make sure that only effective tests are marketed and those which are not effective should not.

Plastics: Health Research

Debate between Lord Markham and Baroness Bennett of Manor Castle

Monday 19th December 2022 Lords Chamber

[Lord Markham (Con)]

Again, my understanding from the science is that that is not a concern here. The presence of nanoparticles in the bloodstream has not caused concern to date. However, again, if there are good research proposals in this space, that is exactly what the research council was set up to look at.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the Minister has said a number of times that there is limited evidence, yet we know, as the noble Baroness, Lady Meacher, said, that there are microplastics in our blood. There is evidence that nanoplastics cause change and inflammation in skin and lung cells, and plastics also contain additives, including bisphenol A, phthalates and polychlorinated biphenyls, which are endocrine disruptors and alter reproductive activity. Is a lack of knowledge, in the light of the Government’s supposed attachment to the precautionary principle, an excuse for not acting while all these risks are clearly evident?

[Lord Markham (Con)]

Again, the research bodies are very happy to look at any good proposals. The only place I would disagree with this is on whether you would want to ring-fence a certain amount to a space when you do not know whether there is a health risk there. Therefore, if there are good research proposals, we are definitely ready to take that forward. I will caution against some of the quotes where they are based on a sample size of 22 people, in terms of the common-sense study. That is why we place caution on this, but if there are good research proposals, I say: absolutely, please bring them forward.

East Kent Maternity Services: Independent Investigation

Debate between Lord Markham and Baroness Bennett of Manor Castle

Monday 24th October 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord. As he rightly points out, the vast majority of workers are very diligent and good at what they do, and that should rightly be recognised. At the same time, I do not think any of us here wants to sweep under the carpet the problems that clearly exist. We need to be sure that, among the fantastic work, we are ever vigilant to root out the bad.

[Baroness Bennett of Manor Castle (GP)]

My Lords, a Department of Health statement on the appointment of the first ever patient safety commissioner—on which, as your Lordships’ House well knows, the noble Baroness, Lady Cumberlege, was a driving force—noted that the NHS Patient Safety Strategy was published in 2019

“to create a safety learning culture across the NHS”.

The statement also noted that it had introduced a statutory duty of candour, which requires trusts to inform patients if their safety has been compromised. I think everyone in your Lordships’ House is well aware that our NHS staff are exhausted, overstretched and overworked. When I read that statement, I could not help thinking about how there are different reports, strategies and approaches coming from all kinds of directions. Can the Minister assure me that staff are being given clear leadership from the very top and a clear framework in which to work, rather than a continual barrage of directions without the resources to deliver them?

Health and Social Care Update

Debate between Lord Markham and Baroness Bennett of Manor Castle

Monday 10th October 2022 Lords Chamber

[Lord Markham (Con)]

We live in a time of a very competitive jobs market and such a competitive market brings challenges with it, as the noble Lord says. We need to make sure that people feel that these jobs not only are recognised as important but make sense economically for them as well. We are investing £15 million in expanding our recruitment and resourcing to attract more people into the industry. We also need to look overseas and I think many are aware of our plans to do that. It is not lost on the team over here that we need to make sure that this is an attractive job and career for people to move into.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I join others in welcoming the Minister to his new place. I acknowledge that he has stepped in very late in the piece to pick up this Statement, but we are right to ask questions on it. Unlike the noble Baronesses on the Front Benches, I want to address the issue of the number and supply of doctors, particularly GPs. There are some strong statements here about “setting the expectation” of getting an appointment within two weeks, “opening up time” for 1 million more appointments and helping practices “improve performance”. Think about what GP practices have done in improving performance: there were 4.9 million more appointments in December 2021 than there had been two years previously—a 20% rise. A BMA survey found that nine out of 10 doctors reported that their workload was excessive and dangerous. This Statement says that there will be more and more GP appointments, but where will the doctors needed to provide this service in a healthy and safe manner come from?

[Lord Markham (Con)]

As I mentioned, we have 3,500 more doctors, but the 50 million more appointments target, which we are well on the way to delivering, is from not just GPs but across the piece. It is also from nurses and community pharmacies. I think we would all agree that doctors are our most precious resource. Given the comments on not wishing to overburden them and the stresses of that, we need to make sure that their limited time is focused on the patients that most essentially need that time. We are expanding supply and spreading it among nurses—as I mentioned, from my experience with my mother, they are very capable and willing to pick up a lot—and among pharmacies as well.