Inflammatory Bowel Disease

Debate between Lord Markham and Baroness McIntosh of Hudnall

Monday 20th May 2024 Lords Chamber

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister has twice mentioned the bowel cancer screening programme, which I think is universally accepted to be very successful, and is also very reassuring to those people who are part of it, whatever the outcome of the tests. He will also know that that screening programme and others drop people once they reach a certain age, which coincidentally is the age at which they become more likely to develop the cancers that the screening programme is intended to detect. Do the Government have any plans to increase the age up to which people can be routinely included in bowel cancer screening and other screening programmes?

[Lord Markham (Con)]

The noble Baroness makes an important point. In this and other areas, we are guided by the science; we have been guided by the science on the advice to date. I will go back and ask for the latest thinking on that, and get back in detail in writing to the noble Baroness, but, generally, being guided by the science will be the approach.

Immunisation: Children

Debate between Lord Markham and Baroness McIntosh of Hudnall

Wednesday 8th May 2024 Lords Chamber

[Baroness McIntosh of Hudnall (Lab)]

My Lords, on the Wakefield effect, as the Minister called it, he will remember that the impact it had on a lot of people was very profound. In particular, some of that was associated with incidence of autism, which again was completely unjustified. Can he tell the House whether any work has been done, in the interests of public information, on what happened to the children who were not vaccinated at that time, and what the outcomes were for them? As a deterrent, it might be useful for people to know what the worst that can happen is if you do not get your children vaccinated.

[Lord Markham (Con)]

The noble Baroness is quite right. I had two young sons at around that time, and it was a concern. Of course, we did go ahead, but it was a consideration. It is an excellent question. I have not seen the study of those various cohort groups but I will go back, because it is something we need to bring out.

NHS App: Medical Records

Debate between Lord Markham and Baroness McIntosh of Hudnall

Tuesday 19th December 2023 Lords Chamber

[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.

Sexually Transmitted Infections

Debate between Lord Markham and Baroness McIntosh of Hudnall

Tuesday 5th December 2023 Lords Chamber

[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.

Paediatric Care: Wating Times

Debate between Lord Markham and Baroness McIntosh of Hudnall

Monday 16th October 2023 Lords Chamber

[Lord Markham (Con)]

Unfortunately, industrial action is impacting on waiting times; we estimate that about a million appointments have been lost to date. Clearly, that is a matter of regret and not good news for anyone.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, I take the Minister back to the question from the noble Lord, Lord Allan, who referred to the necessity for parents to do a lot of running around and following up for themselves. Does he agree that this is a particular problem with the management of long-term conditions in young people—for example, ADHD and other things relating to autism—where the challenge is not just to get the diagnosis but to then get a consistent level of treatment over the long term? Can he comment on what steps have been taken to improve that? Can he also comment on the reported limited availability of appropriate drugs for treating young people with ADHD?

[Lord Markham (Con)]

I am aware from personal experience that, when you have a child with neurodiversity or developmental needs, it is a long journey. We are seeing this manifest itself much more in recent years; I was talking to Minister Caulfield about this just this morning. One-to-one is always preferable but, where capacity is constrained, group education and help can sometimes lend themselves to this space. It is a long-term condition, and clearly it will not be solved by treatment over a few months but needs many years.

NHS: Staff Numbers

Debate between Lord Markham and Baroness McIntosh of Hudnall

Tuesday 12th September 2023 Lords Chamber

[Lord Markham (Con)]

In every area, anaesthetists being a very good example, we need to be looking at where the bottlenecks are and moving to free up those situations. I think we would all agree that with practitioners such as anaesthetists and in other areas, it is a very sensible approach to make sure that the most highly skilled are focused on the most highly skilled jobs and that they can have people underneath them who can be trained to work within that. So hearing that there is a certain amount of opposition from certain colleges and the BMA to those sorts of roles is quite disappointing. I hope they would accept that this is a key way of addressing the issue.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, can I take the Minister back to the original Question from my noble friend Lord Clark? He put before the House some quite startling statistics about the number of medical staff—particularly but not exclusively doctors —who are leaving following or shortly after the completion of their training, either for other countries or for private practice? What view does he take of that drain away from the National Health Service and the effective loss of the investment that the country makes in the very expensive training of clinicians?

[Lord Markham (Con)]

My first point on that is to ask what the real facts are. Five years on from qualification, around 95% of doctors are still registered with the General Medical Council and still practising in the UK. So the fact is that retention is very high. That notwithstanding, we want to do everything that we can to retain people, and professional development is what the long-term workforce plan is all about. Also, we all know that pensions were a big reason for a lot of the brain drain and doctors leaving the profession, and that was something we were quite radical in supporting and changing. We are going through this bit by bit, asking what key things we need to do to retain our staff and resolve this.

Ultra-processed Food

Debate between Lord Markham and Baroness McIntosh of Hudnall

Tuesday 18th July 2023 Lords Chamber

[Lord Markham (Con)]

On any advisory body you clearly want to get experts in the field. Necessarily, they will often be experts from companies as well. It is vital that they abide by the principles of conduct in public life and make sure they declare any conflicts. As such, we are content that we have a proper expert panel.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, may I take the Minister back to the question from my noble friend Lord Brooke, who asked about the content of school meals? The Minister replied that school meals are a good thing and more people should have them, with which I do not suppose anybody would want to disagree. However, I did not hear him say in what way the Government are ensuring that the content of those school meals is appropriate and free from salt, sugar and fat in the way that my noble friend Lord Brooke was asking for.

[Lord Markham (Con)]

My understanding is that those guidelines are there; it is absolutely the right question. The Department for Education, working with the Department of Health, makes sure that a nutritionally balanced diet is there. There is also a joint DfE/DHSE programme in respect of nursery milk and fresh fruit and vegetables for young children, to give them a good start in life.

NHS Long-term Workforce Plan

Debate between Lord Markham and Baroness McIntosh of Hudnall

Tuesday 4th July 2023 Lords Chamber

[Lord Markham (Con)]

I would like to think, as I mentioned before, that increasing the supply and training of the whole medical profession would help the whole sector. This is quite close to my heart; as I have mentioned before, my mum became a nurse later on in life and went through an apprentice-type route, for want of a better phrase. Having different entry points is a very positive thing. I sincerely hope that people going into a social care environment will see that as a building block to onward career progression and that it will set them up to take further qualifications later on in life, if they wish, in the nursing profession. We are looking to expand the whole sector, and the general belief is that that will benefit both social care and the NHS.

[The Deputy Speaker (Baroness McIntosh of Hudnall) (Lab)]

My Lords, the noble Baroness, Lady Brinton, is contributing remotely.

[Baroness Brinton (LD) [V]]

My Lords, while this NHS plan is welcome, can the Minister say whether this Government will undertake to commit to the plan and, crucially, to its funding and not change the number of education and training places, as happened last year and in too many previous years, causing chaos in planning for doctors, nurses and allied healthcare professionals? On hospital training places for junior doctors after they have finished their medical school courses, last year 790 medical graduates could not begin their junior doctor in-hospital training because the NHS did not have enough placements. Given that university medical school places are already capped and highly competitive, this is a complete waste of newly qualified medical graduates.

Mental Health In-patient Services: Improving Safety

Debate between Lord Markham and Baroness McIntosh of Hudnall

Monday 3rd July 2023 Lords Chamber

[Baroness McIntosh of Hudnall (Lab)]

My Lords, on the Minister’s last observation, I think there are a number of noble Lords here who would say that the quality of the output has not been that great from some private providers. It is just an observation.

However, the question I want to ask will take us back to the original observations by the noble Baroness, Lady Buscombe—I was also a member of the Joint Committee. The Minister gave a very brief reply to her questions about what has happened to the many recommendations, the vast amount of evidence and a great deal of hard work that went into producing that report. He even mentioned that it was going to be responded to in a “timely” manner. I think the moment for that has passed. Will the Minister have another go at explaining what has happened to the report and when there will be a response to it?

[Lord Markham (Con)]

I am afraid I do not have the timing of a response on that. Minister Caulfield is very engaged in this area. A number of things have been mentioned. I mentioned the community treatment orders, where we are very mindful of the point made earlier by the noble Baroness, Lady Uddin, about black males being eight times more likely to be given one, and the recommendation that they should be abolished altogether. Those recommendations are very much in our thinking and our knowledge base. I know that Maria Caulfield is working on them, but I am afraid I cannot give the noble Baroness an exact time yet.

Cancer Referral Targets

Debate between Lord Markham and Baroness McIntosh of Hudnall

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

I did not know whether the noble Lord was referring to GRAIL and the comment from the noble Lord, Lord Patel, about false positives. This question probably deserves a detailed reply but, as with any test, it is not about just specificity but sensitivity, which is key, so that the number of false positives is minimised. I will provide a detailed reply.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the noble Lord has referred at several points in this discussion to early diagnosis. He will be aware that cancer very often develops later in life and that the older you are the greater the risk is. Yet older people are excluded from routine screening tests past a certain age. Can he explain the thinking behind that?

[Lord Markham (Con)]

It is about trying to make sure that we are screening those of highest risk, given the impact on quality of life, and catching it early. I know that is very specifically the thinking around it. Beyond this, while we know the challenge around waiting lists, we have increased the supply through a 15% increase in activity. We are supplying more than ever, but we know that a lot more needs to be done to meet the demand.

NHS National Health Inequalities Improvement Programme

Debate between Lord Markham and Baroness McIntosh of Hudnall

Thursday 25th May 2023 Lords Chamber

[Lord Markham (Con)]

I would be happy to. I need to find out more first, and I would be delighted if there was some information or if we could meet on this, but I would be happy to take it up.

[Baroness McIntosh of Hudnall (Lab)]

The Minister has twice cited the figure of 37.5% of children now receiving free school meals, which, as he rightly says, is an achievement of a sort. However, if the standard of food those children are receiving is insufficiently good—and there appears to be some evidence of that from the information that has been going around the House this morning—adding to the number on the list of those receiving free school meals, although admirable in terms of the numbers, may be contributing to the problem. Does the Minister agree?

[Lord Markham (Con)]

I do not think anyone would say that the current school food standards are insufficient. I think the feeling is that it has been a while since they were changed because of Covid, and it is time to ask whether improvements can be made, because this is an ever-evolving situation. So I would not agree with that categorisation, but we should indeed always be looking to see whether we can make better choices.

Pharmacies: Medicines at Home

Debate between Lord Markham and Baroness McIntosh of Hudnall

Wednesday 17th May 2023 Lords Chamber

[Lord Markham (Con)]

I am sorry: I will try to be clear to make sure that I am fully understood. There are many, many people for whom a blister pack is absolutely the right solution. Basically, what has been put in place here is a structured medicine review, so that, in each case, it will be the responsibility of the pharmacist to make sure that they have the right solution for the patient. What I am saying equally is that blister packs are not a blanket solution, and it needs to be done on a case-by-case basis.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, I cannot claim any expertise in this matter; I have just been listening to the conversation that has been going on. My noble friend’s original Question referred to the burden on carers. I have not heard the Minister say much about that, particularly when the negotiation over what is the right way of dispensing certain kinds of medicine presumably has to go on between a patient, a pharmacist and, presumably, a doctor somewhere in it, or somebody representing the patient who would, in many cases, be the carer. In what way are carers being helped to engage in that negotiation, with all the knowledge and expertise that they bring about what actually works in the circumstances?

Autism: Diagnosis Targets

Debate between Lord Markham and Baroness McIntosh of Hudnall

Tuesday 16th May 2023 Lords Chamber

[Lord Markham (Con)]

We are working closely with the Department for Education. The Bradford pilot scheme I mentioned takes the early years foundation stage profile scores of children. It knows that if you have a low score, you are far more likely to have autism. That triggers a multidisciplinary team to come in and inspect. That is a way that we can use that as an early warning indicator and then follow it up with volume. I hope that working very closely with the DfE in this space will be a real way forward.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister has already anticipated receiving this question—I would not want to disappoint him. He is clearly aware that there is some question over the reliability of some diagnoses that are being offered, particularly in the private sector, for ADHD, which is another neurodevelopmental disorder. Is he confident that, in trying to scale up the availability of diagnosis, which is obviously an admirable aspiration, the quality of those diagnoses will be maintained? Are the NICE guidelines sufficiently robust to ensure that?

[Lord Markham (Con)]

As we all know, it is a complex area, and there is no black and white diagnosis of autism. The noble Baroness’s point is absolutely correct: we need to make sure that the quality is there. The Bradford pilot has now been running in 100 locations. Every child has to get an early years profile score. If we can show the linkages and follow that up with the screening programme, that will be very promising; but, absolutely, we have to make sure that the right assessment is made.

Childbirth: Black Women

Debate between Lord Markham and Baroness McIntosh of Hudnall

Wednesday 3rd May 2023 Lords Chamber

[Lord Markham (Con)]

The point I was trying to make is that I think all noble Lords would agree that the NHS does a fantastic job in addressing and reaching people of all ethnic minorities. That is something we can all support.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister omitted to answer the first question put to him by my noble friend Lord Hunt of Kings Heath about the frequency with which the task force met and the gap between its last meeting and the moment at which its report was put forward, if I understood the question correctly. Can he answer that now?

[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.

Adult Social Care: Challenge Procedures

Debate between Lord Markham and Baroness McIntosh of Hudnall

Wednesday 19th April 2023 Lords Chamber

[Lord Markham (Con)]

Yes, we are taking them very seriously. The House has heard me talk many times about the 13% of beds that are blocked. This is a key issue for the whole flow of the system, which is backed up right the way through. That is why we introduced the discharge fund. Again, Minister Whately is very focused on this issue.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, further to the question asked by the noble Lord, Lord Laming, in response to my noble friend Lady Pitkeathley, the Minister referred to an 89% satisfaction rate among people in receipt of social care. However, as the noble Lord, Lord Laming, has just pointed out, the issue is not the people in receipt of social care but those who are not, of whom there are far too many. That is exactly what is causing some of the problems the noble Lord referred to. Does the Minister agree?

[Lord Markham (Con)]

Again, this goes to the point about the massive increase we have put in place of £7.5 billion. I have not heard of but would be pleased to hear about any plans on the other side of the House to increase that funding, since £7.5 billion is a very large figure—a 20% increase. Clearly, we will continue to review whether more is needed; we have put in increases each year. The importance of ensuring social care provision is completely understood.

Mental Health Act Reform

Debate between Lord Markham and Baroness McIntosh of Hudnall

Thursday 26th January 2023 Lords Chamber

[Lord Markham (Con)]

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

[Baroness McIntosh of Hudnall (Lab)]

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

Health: Pancreatic Cancer

Debate between Lord Markham and Baroness McIntosh of Hudnall

Monday 21st November 2022 Lords Chamber

[Lord Markham (Con)]

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

[Baroness McIntosh of Hudnall (Lab)]

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

[Lord Markham (Con)]

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

Abuse and Deaths in Secure Mental Health Units

Debate between Lord Markham and Baroness McIntosh of Hudnall

Wednesday 9th November 2022 Lords Chamber

[Lord Markham (Con)]

We are investing, and I understand and agree with the point that training is key to this. We have committed to spend £2.3 billion more in 2023-24 in the mental health arena, exactly around this space. It is something that we are working on, and we understand that we need to ensure that the mental health of all our citizens, whatever their race or colour, is well served and looked after.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, as a member of the committee that the noble Baroness, Lady Buscombe, chairs, may I ask the Minister to especially note what she said about the importance of acting quickly on whatever recommendations come forward? Will he also acknowledge that mental health services, not just in secure institutions but across the country, are under very severe strain and that it is when people get into crisis that they are then put into secure units, often because they have not had the help they need before that crisis arrives? Will he please accept that there is a very serious shortage of mental health provision across the country? It would be interesting to know what real impact the numbers he has been able to tell us about today will have on that.

[Lord Markham (Con)]

As previously mentioned, we are investing to increase the provision—I believe it is £2.3 billion in 2023-24, which is a significant sum. We have increased the workforce by 7,000 in this last year alone, and there are plans to increase it further. Clearly, we need to keep that under review. I agree with the premise that prevention is always better than cure in these instances, and we need to make sure that mental health services, training and support are given at the point of need.