Cass Review

Debate between Lord Markham and Baroness Bottomley of Nettlestone

Wednesday 17th April 2024 Lords Chamber

[Baroness Bottomley of Nettlestone (Con)]

My Lords, this is a deplorable situation. It is a formidably good report and I commend the Government on their firm action following its publication. I question why it took the NHS quite so long to stop the routine prescription of puberty blockers to children under 18—that seems rather slow off the mark.

However, I have a more important point. I fear that one of the great damages from all this is to one of our national and international centres of excellence. The Tavistock clinic has been in existence for over 100 years. It was started by Hugh Crichton-Miller for the treatment of soldiers with shellshock. It has been the home of John Bowlby, Lily Pincus and RD Laing. It has done incredibly important work in terms of mental distress, mental health and emotional well-being. It is a national and international centre of training, with about 2,000 students a year. If I may take up the Minister, for whom, as he knows, I have an inordinate regard, I think he said that the Tavistock clinic had closed. It has not closed; the gender reassignment clinic has closed for ever. I ask the Minister and everyone in this House to try to help reclaim the reputation and the respect that the Tavistock clinic rightly deserves.

[Lord Markham (Con)]

Yes, absolutely, and I thank my noble friend for correcting me and giving me the opportunity to correct that. Again being very honest, this shows that part of the challenge in setting up the new services is that this has become such a difficult, toxic space, and finding and recruiting staff who want to work in this area is a real challenge as well.

NHS GP Surgeries: Purchase by US Companies

Debate between Lord Markham and Baroness Bottomley of Nettlestone

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

I am not aware of any correlation between the type of ownership and the quality of the services from it. If there is one, then we can look at that, but we are focusing resources on the areas where they make most difference, and the focus is: what is the performance of that clinic? That is what we should all care about. How are the doctors there performing in terms of appointment times and everything else? I will not put a false target on who owns it and the structure of it, because that is not relevant. What is relevant is the quality.

[Baroness Bottomley of Nettlestone (Con)]

Is it not the case that the former chief executive of the NHS brought some extremely valuable experience back from America, from UnitedHealth? I remember long ago in the distant past, when the Labour Party was last in power, that Kaiser Permanente was constantly being consulted. Surely it is an arrogance to have a xenophobic approach to where we take advice and where we learn from other people’s experiences?

[Lord Markham (Con)]

I totally agree with my noble friend. I like to think that we will take advice from whoever is best placed to give it, whether they are public sector, private sector, UK or international.

Sodium Valproate

Debate between Lord Markham and Baroness Bottomley of Nettlestone

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

The noble Lord is absolutely correct. Everyone taking sodium valproate who is of childbearing age should be on a pregnancy prevention programme to make sure that those sorts of incidents do not happen. It is vital, when it is necessary for people to take it, that they really understand the risks and do everything to avoid pregnancy.

[Baroness Bottomley of Nettlestone (Con)]

My Lords, mention has been made of the reduction in the prescription of sodium valproate but can my noble friend clarify that with a few more figures? In the report by my distinguished noble friend, which has done so much, mention was made of a redress scheme. In December the Select Committee tasked Dr Henrietta Hughes, the Patient Safety Commissioner, to bring forward proposals of what that might look like. Can he inform the House of progress there?

[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.

Recovering Access to Primary Care

Debate between Lord Markham and Baroness Bottomley of Nettlestone

Tuesday 9th May 2023 Lords Chamber

[Baroness Bottomley of Nettlestone (Con)]

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

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

[Lord Markham (Con)]

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

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

Junior Doctors’ Strikes

Debate between Lord Markham and Baroness Bottomley of Nettlestone

Monday 17th April 2023 Lords Chamber

[Lord Markham (Con)]

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

[Baroness Bottomley of Nettlestone (Con)]

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

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

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

[Lord Markham (Con)]

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