Human Medicines (Amendments relating to Registered Dental Hygienists, Registered Dental Therapists and Registered Pharmacy Technicians) Regulations 2024

Debate between Lord Markham and Baroness Merron

Friday 24th May 2024 Lords Chamber

[Baroness Merron (Lab)]

My Lords, from these Benches, we support the overall terms of these draft regulations, particularly the measures on pharmacy technicians and dental hygienists, who have great value in providing timely and quality care to patients where it is safe and suitable for them to do so.

I know that the dental profession is very supportive of the intention to enable dental hygienists and dental therapists to supply and administer the majority of the medicines listed in the regulations. The Minister described the regulations as “common-sense”, and I certainly share that assessment.

However, I just draw the Minister’s attention to the inclusion of two medicines on the list: minocycline and nystatin. These were not supported by the BDA or the College of General Dentistry—I am sure the Minister is aware of this—for a number of reasons, including antimicrobial resistance. In the case of minocycline efficacy, it is not recommended in any national clinical guidelines and its use in dentistry is no longer accepted practice. Perhaps the Minister can therefore say whether the concerns of the key dental stakeholders were taken into account when the decision was made to retain these two drugs on the list. Can he also assure the House that there has been full and proper consultation with both the British Dental Association and College of General Dentistry on ensuring that the regulations are compliant with both national practice and existing clinical guidelines?

Efforts to increase the skill mix in our NHS dentistry workforce and across pharmacy more generally are welcome, but I am sure that the Minister will forgive me for thinking that we perhaps need to go rather further than technical tweaks if we are to reverse the crisis in which NHS dentistry finds itself. However, as I said at the outset, we support these regulations, and I hope that the Minister will be able to reassure us about the medicines that are included in the list.

As this is the last day that the House is sitting in this Parliament, I, like my colleagues before me and, I am sure, after me, would like to take the opportunity to say to the Minister, the noble Lord, Lord Markham, what a pleasure it has been to work with him while he has been in his role. He has always carried out that role with the greatest courtesy, but also with care and determination to improve things, no matter what obstacles he perhaps found in his way. I thank him for his dedication to his role. As he is standing in for the noble Lord, Lord Evans—who was due to be standing in for the noble Lord, Lord Markham—I also thank the noble Lord, Lord Evans, similarly, for the manner in which he has conducted himself in this House. He too has always been most helpful and a real pleasure to work with and has always tried his best to make progress, as I know we all wish to do.

[Lord Markham (Con)]

I thank the noble Baroness for her kind words. Likewise, if the right words are “thoroughly enjoyed” then I have thoroughly enjoyed working with both the noble Baronesses on the Front Bench on that side, the noble Lord, Lord Allan—he is not here—and many other colleagues, including the noble Baroness, Lady Hayter. There are a number of common-sense things that we have managed to work through together.

I too take this opportunity to thank all noble Lords. It was a baptism of fire when I started two years ago, but I have come to really respect the function of the House and how well it holds our feet to the fire. We are all, in British society and in the Government, much the better for it.

On the questions raised, particularly regarding minocycline 2%, there were concerns raised, as the noble Baroness said, including by the British Society of Periodontology. However, when it was looked at, it was felt overall that it was best to keep it on the list because the concerns are quite low. On balance, it was worth keeping it on the list, but keeping it under watch—for want of a better word. Concerns were also raised around nystatin oral suspension but, again, it was felt that there were certain health benefits for certain groups of patients. But there will be training associated with these medicines, to ensure patient safety.

I will happily write in more detail on these—as is my wont; that is my “get out of jail free” card, in many cases—to make sure those questions are properly answered. I welcome the comments from the other Front Bench that these are sensible arrangements. With that, I beg to move.

Immunisation: Children

Debate between Lord Markham and Baroness Merron

Wednesday 8th May 2024 Lords Chamber

[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.

[Baroness Merron (Lab)]

My Lords, it is concerning that measles cases continue to rise, with a particular spike in London, where certain areas have low vaccination rates. With the advent of microarray patch technology, can the Minister confirm that this is being looked at? Does he agree that the chance to dispense with using needles and special storage, and the opportunity to use less of professionals’ time, could present an opportunity to drive up vaccination rates?

[Lord Markham (Con)]

It has to make sense to take more measures that are easy for people, including maybe less skilled people, to operate. Funnily enough, I was talking just today to the head of Moderna about how it is packing syringes, or has planned to for vaccinations going forward, rather than vials, to take that step out of the process. The easier we can make it, the better.

International Health Regulations: Amendments

Debate between Lord Markham and Baroness Merron

Tuesday 7th May 2024 Lords Chamber

[Lord Markham (Con)]

I do agree: I do not think that it would help to postpone it. I had this exact conversation with the American Health Secretary, who is very aware that we are getting nearer and nearer to an American election and, for all the countries to be able to co-operate fully, the timing is right to reach a solution now. However, we will not reach an agreement at any cost or anything which might impact our sovereignty.

[Baroness Merron (Lab)]

My Lords, the Brownstone Institute, to which the noble Lord’s Question refers, was set up to work against Covid restrictions and lists articles which argue that Covid-19 vaccines do not work, that children should not be vaccinated and that vaccine mandates compare with the crimes of the Soviet gulag. On this basis, perhaps the Minister would like to comment on what note he should be taking of the Brownstone Institute, if any. What assessment has been made of the impact of dangerous propaganda like this on the low take-up rates of vaccinations that we see among minority ethnic groups and where there are regional and social disparities?

[Lord Markham (Con)]

I thank the noble Baroness. All Members of the House, when we had a good Question on the take-up of Covid vaccines, agreed that information supporting the take-up is a vital health message to get across. To any detractors, I say very firmly that it is not the view of the Government, and I know that it is not the view of nearly all noble Lords.

Covid-19 Vaccination: Coronary Disease

Debate between Lord Markham and Baroness Merron

Tuesday 23rd April 2024 Lords Chamber

[Lord Markham (Con)]

Absolutely. We are all very aware of the damage done by all the myths around the MMR vaccine 20 to 30 years ago and the impact that has had on people. The more we can get the message out, the better. As the noble Baroness, Lady Merron, asked me yesterday, we have learned that it is about making sure that we communicate to all groups so that we can make sure that ethnic minorities and other minority groups get that information.

[Baroness Merron (Lab)]

My Lords, after many years of stalled progress, the rate of premature deaths from cardiovascular disease continues to increase, for reasons that the British Heart Foundation describes as “multiple and complex”. The warning signs of this have been present for over a decade. As this phenomenon did not start with Covid, what assessment has been made of the contributory factors of government policy pre Covid and what steps are being taken to turn this around?

[Lord Markham (Con)]

Deaths from heart disease among those under 75 are down by about 20% compared with 2010, which is a clear trend. Notwithstanding that, we are very aware—Sir Chris Whitty is concerned about this—that Covid meant that a lot of people did not get basic heart and blood pressure checks. That is why we have introduced the Midlife MoT, which is designed to give people a 10-year risk analysis; have put blood pressure devices in pharmacies and all sorts of other places to get 2 million checks; and have a workplace heart disease strategy check. All this is designed to get that prevention in place so that people are aware of and understand the risks.

Immunisation: RSV

Debate between Lord Markham and Baroness Merron

Tuesday 16th April 2024 Lords Chamber

[Lord Markham (Con)]

I too add my thanks; the noble Baroness is very good at holding our feet to the fire, and it is very important and appreciated. Regarding the age group, we are being guided by the scientific advice on what is most cost-effective.

[Baroness Merron (Lab)]

My Lords, earlier this year we discussed the busy pipeline of new vaccines, including those for RSV, which, coupled with the concerning decline in the uptake of immunisation, does point to the need for a fresh look at delivery mechanisms. What steps are being taken to move beyond traditional arrangements, and when can we hope to see an improvement plan in place, in readiness for the RSV immunisation programme?

[Lord Markham (Con)]

Of course, the communication needed for each one is different, and that is a vital consideration. As I said, we found that, often, it is easier to put RSV in the infant rather than the pregnant mother. It is a question of considering which is the most effective way to get the best outcome and the highest take-up rate. That is one of the key criteria we are looking at. Regarding general communication, the noble Baroness will be aware that, on MMR, we have challenges in both London and the West Midlands. That has shown that you need other communication routes to get to some ethnic minority groups, using technology such as the app. There is no one silver bullet —you need a series of measures in place.

Children’s Cancer Services

Debate between Lord Markham and Baroness Merron

Wednesday 20th March 2024 Lords Chamber

[Lord Markham (Con)]

I want to be fair to the NHS here. It has done an extensive study, with a lot of professionals rating extensive criteria, and they really did believe that in certain areas, the Evelina scored higher than St. George’s and the Marsden. It is a balanced decision; all I can do is absolutely promise noble Lords that we will take all those factors into account.

[Baroness Merron (Lab)]

My Lords, I appreciate that the Minister is looking at all of this, but given the difficulties of achieving the number of clinical trials in the UK, what effect is anticipated on research because of the proposed relocation of paediatric cancer services? Is there an intention to factor into the final decision the need to expand research capacity for childhood and adult cancers?

[Lord Markham (Con)]

Among the criteria the NHS has taken into account are clinical services, the patient care experience and research, and it scored the Evelina higher on research. I want to understand that, because many noble Lords will be surprised by that finding. I assure the noble Baroness that research and the ability to do clinical trials, which is a vital component of our life sciences industry, is an important factor in this decision.

Cancer: Staffing

Debate between Lord Markham and Baroness Merron

Thursday 14th March 2024 Lords Chamber

[Baroness Merron]

To ask His Majesty’s Government, in the light of warnings by the Parliamentary and Health Service Ombudsman, what assessment they have made of the risk to cancer patients in England presented by the staffing levels, workloads and working conditions of healthcare professionals.

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

I express my regret about the cases referenced by the ombudsman. The department is taking steps to reduce cancer diagnosis and treatment waiting times across England and to improve survival rates across all cancer types. Through announcing the first ever NHS long-term workforce plan, we are taking meaningful steps to build the NHS workforce for the future. The Government are backing the plan, with over £2.4 billion of funding for additional education and training places.

[Baroness Merron (Lab)]

My Lords, the Minister will know that numerous complaints relating to patients with cancer that were investigated by the Parliamentary and Health Service Ombudsman included misdiagnosis, treatment delays, the mismanagement of conditions, poor communication and unsuitable end-of-life care. As the NHS is grappling with over 110,000 staff shortages, how is patient safety being compromised by the Government’s long delay in bringing forward the workforce plan? What immediate action will the Government take to deal with the continuing risk to cancer patients posed by a workforce that the ombudsman describes as “understaffed, under pressure and exhausted”?

[Lord Markham (Con)]

As the noble Baroness says, we see increasing the workforce as a core component here. I was speaking to the president of the Royal College of Radiologists about this the other day, and we obviously need to make sure that the workforce can be as effective as possible at what it does. We are doing a lot of new diagnosis, and 80% of all the medical AI technologies are in the radiography space, which is making a huge difference to diagnosis and productivity. It is clearly fundamental that we get the treatment to these people as quickly as possible.

Prioritising Early Childhood: Academy of Medical Sciences Report

Debate between Lord Markham and Baroness Merron

Monday 11th March 2024 Lords Chamber

[Lord Markham (Con)]

One of the recommendations of the report is a cross-cutting approach of the kind the noble Lord mentioned to avoid silos. The family hubs we are investing in alongside the Department for Education are trying to do exactly that sort of thing to make sure the healthy start for life exists.

[Baroness Merron (Lab)]

My Lords, these Benches will greatly miss my noble friend Lord McAvoy. I had the pleasure and education of serving with him as a Whip in the other place. May his memory be for a blessing.

The Academy of Medical Sciences report highlights the importance of continuity of maternity care, which can reduce the likelihood of pre-term birth by 24%. Given that premature babies are more likely to have complications that affect vision, hearing, movement, learning and behaviour, which will all impact later life, what steps are the Government taking to increase the number of women receiving dedicated midwifery support throughout their pregnancies?

[Lord Markham (Con)]

I agree with the noble Baroness and my noble friend Lady Cumberlege about the importance of continuity of care in the maternity space. We are investing resources as part of the long-term workforce plan to increase the number of people trained in maternity and in this area generally. To give another example, we are investing in family nurses by increasing the number of training places by 74%, because it is understood that we need the workforce to provide all these services in an ever more complex world.

Mental Health Patients: Discharge

Debate between Lord Markham and Baroness Merron

Tuesday 5th March 2024 Lords Chamber

[Baroness Merron]

To ask His Majesty’s Government what assessment they have made of the current level of (1) safety, and (2) patient and carer involvement, where mental health patients are discharged from inpatient settings and emergency departments.

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

In January, the Government published new statutory guidelines setting out how health and care systems can work effectively together to support a safe discharge process for mental health patients from hospital and ensure patient and carer involvement in discharge planning. This is particularly important given that the National Confidential Inquiry into Suicide and Safety in Mental Health has found that there is an increased risk of suicide within three days of discharge.

[Baroness Merron (Lab)]

My Lords, the Parliamentary and Health Service Ombudsman’s recent report found many failings in care around the discharge of mental health patients, with the most common being a lack of involvement of patients, their families and carers. With the pre-legislative scrutiny of the mental health Bill highlighting the need to address this preventable situation, and the Government still not bringing forward this crucial legislation, what immediate steps will the Government take to involve those who are essential to the care and safety of mental health patients?

[Lord Markham (Con)]

The noble Baroness is correct; the question is of the utmost importance. It is about putting more care into the community—that is why we have put £1 billion of extra spend into community support for mental health. Some 160 local mental health infrastructure schemes are being set up, with 19 in place already, and they are starting to work. The crisis cafés have resulted in an 8% decrease in admissions, while the telephone helpline has resulted in a 12% decrease.

NHS: Neurology Care

Debate between Lord Markham and Baroness Merron

Monday 26th February 2024 Lords Chamber

[Lord Markham (Con)]

Yes, absolutely. Of course, this is what the CDCs are about as well in trying to get that diagnosis capacity. At the Neurological Alliance forum I was just at, the main thing was needing help with early diagnosis, because getting treatment is key to it all and, also, seeing whether we can sometimes refer people directly to the CDCs so that the GP is not always the bottleneck.

[Baroness Merron (Lab)]

My Lords, as Lord Cormack was a fellow of Lincoln, as I am, I pay tribute today to his considerable contribution to the City of Lincoln, as well as to this House and to the other place. May his memory be for a blessing.

The Neurological Alliance has expressed concern about the lack of clarity over whether new therapies for those affected by neurological conditions and their changing needs have been factored into the workforce plan. Can the Minister set out how the workforce plan will respond to these changing circumstances both for those with neurological conditions and those with other conditions?

[Lord Markham (Con)]

I echo the noble Baroness’s comments regarding Lord Cormack.

In terms of the long-term workforce plan, I was talking this morning to the national clinical lead in this area and to Professor Steve Powis. The next stage in terms of the detail is looking at the individual specialties and neuroscience experts are part of that. In the last five years, we have seen an increase of about 20% or so in this space but understanding that need going forward is the next stage in the long-term workforce plan.

NHS Dentistry

Debate between Lord Markham and Baroness Merron

Monday 19th February 2024 Lords Chamber

[Lord Markham (Con)]

Yes, it is all about outcomes and output. As I mentioned, there have been sensible moves recently in terms of the contract—the £50 for new patients; increasing minimum levels; and ensuring that dentists get more payment for doing, for example, three fillings versus one. I also agree that some fundamental work needs to be done in this space.

[Baroness Merron (Lab)]

My Lords, the Minister has previously suggested that the 15 mobile dental vans would be able to address emergency situations as well as scheduled appointments. How will this work in practice, particularly in view of the size of the areas each van will cover? How will the Government meet the immediate need for thousands more appointments for emergency dental treatment?

[Lord Markham (Con)]

There will be a schedule of when the mobile vehicles will visit each area, with the ability to pre-book so, if someone calls up with an issue, they will know that a truck will come to their area in a week or two’s time. That is the idea, or people can queue to receive those services as well. I hope this will be successful. It has worked quite well in some areas already. The case will prove itself and the 14 will be just the start. We can do much more from that, because we all agree that we need to expand supply.

Allied Health Professionals: Prescribing Responsibilities

Debate between Lord Markham and Baroness Merron

Tuesday 6th February 2024 Lords Chamber

[Lord Markham (Con)]

I suspect that we are starting to get on to the debate we will have shortly on physician and anaesthetist associates. In both cases there is definitely a role for them, because we want to support doctors in the surgery and allow them to train and teach at the top of their profession. Clearly, however, we need to be sure of what such people can do and where they need extra supervision, and that is what we are setting out.

[Baroness Merron (Lab)]

My Lords, further to the Minister’s reply to my noble friend Lord Bradley, what is the Government’s plan to increase and integrate the number of independent prescribers being trained as part of the long-term workforce plan? Given that community pharmacists are already trained to vaccinate against Covid-19 and flu, will the Government be expanding the service to include the delivery of MMR jabs, in order to help address recent measles outbreaks?

[Lord Markham (Con)]

First, on the long-term workforce plan, yes, we want to increase the number of allied health professionals by 25% by 2030. We see a lot of that group—some 20%—coming through via apprenticeships. It has been proven just how well pharmacies managed to supplement MMR vaccinations in the Covid and flu space, so it is a good idea. I will need to take that idea back to the department, rather than agreeing to it on the hoof, but I will come back on it because it is an excellent one.

Premature Deaths: Heart and Circulatory Conditions

Debate between Lord Markham and Baroness Merron

Tuesday 6th February 2024 Lords Chamber

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

The Government are committed to reducing premature deaths from cardiovascular disease. The NHS long-term plan aims to prevent 150,000 heart attacks, strokes and dementia cases by 2029, as well as preventing up to 23,000 premature deaths and 50,000 acute admissions over 10 years. The major conditions strategy will look at how best to tackle the key drivers of ill health and increase the healthy years of life for people with major conditions such as cardiovascular disease.

[Baroness Merron (Lab)]

My Lords, the Office for Health Improvement and Disparities reports a persistently high number of excess deaths involving cardiovascular disease since the beginning of the pandemic, avoidably cutting short more than 100,000 lives in England alone. What are the urgent plans for treating the thousands who are waiting for healthcare? How will the Government extend the roles and joined-up working of a range of healthcare professionals beyond GPs to support the millions who are living with an undiagnosed risk of high blood pressure, raised cholesterol, diabetes and obesity?

[Lord Markham (Con)]

I thank the noble Baroness and draw attention to my register of interests: I am a shareholder in a small health company that does high-end heart tests for the private sector.

It is fitting that February is Heart Month. The concern that the noble Baroness raises is exactly the one that noble Lords will have heard me speak about. This is precisely the concern that Chris Whitty, our Chief Medical Officer, was worried about during Covid, with missed appointments because people stopped going to see their doctor meaning that we missed things such as high blood pressure and high cholesterol. To tackle the problem urgently, as the noble Baroness suggests, we have put 7,500 blood pressure checkers in pharmacies. They have done 2 million checks to date. We have sent 270,000 blood pressure monitors to houses and have instigated mid-life NHS health checks to look specifically at early heart indicators so that we can try to tackle the problem that the pandemic caused.

Medical Devices (In Vitro Diagnostic Devices etc.) (Amendment) Regulations 2023

Debate between Lord Markham and Baroness Merron

Tuesday 6th February 2024 Grand Committee

[Baroness Merron (Lab)]

My Lords, I also thank the Minister for setting out the provisions in the regulations and for trying to unravel the many pages before us. This seems to be one of those innocuous measures that are needed just because that is where we are, but I very much take on board the comments of the noble Lord, Lord Allan, which are worth wider government consideration.

Clearly, these regulations are needed to support the implementation of new EU regulations that came into operation in Northern Ireland in May last year. They are important in that we have to secure continuity of supply and trade in medical devices within the UK and the EU, and the draft regulations affect a diverse range of equipment and systems to examine specimens in vitro, including items such as blood grouping reagents, pregnancy test kits and hepatitis B test kits, to give just a few examples.

As the noble Baroness, Lady Finlay, said, it is important that we support innovation. The medtech sector provides a huge contribution to our health service and our vibrant life sciences sector, from catching killer diseases early all the way through to preventing infections. The products we are talking about are found in doctors’ surgeries, hospitals and our own homes. They are part of our daily lives. We certainly know from the pandemic how difficult it can be to replace them if supply is disrupted, so we are here to ensure that supply disruption does not happen.

As has been said, the Explanatory Memorandum sets out that these regulations should affect only some 19 businesses in Northern Ireland and cost less than £5 million to implement, but it is important to acknowledge and put on record that they are a valuable part of the UK medtech ecosystem. On these Benches, we certainly support the regulations, which we believe will secure unfettered access to the British market for Northern Ireland businesses and ensure continuity of supply.

I also have a few questions that I hope will be helpful for the Minister. It is welcome that the previous fee structure is being retained to reduce disruption for Northern Ireland operators, but could he say what assessment has been made of any impact on the MHRA’s responsibilities as a regulator? Could he also confirm that it will be resourced to fulfil those responsibilities?

Previously, Ministers have talked about future realignment of regulations on medical devices following our departure from the EU, including consideration of alternate routes to the British market. Can the Minister say a bit more about what opportunities there might be in this area? What is the timeline for the future regulatory regime that the Government want to bring into force? As the Government have not yet set out their proposals, is there a timeline for doing so?

I note that medical devices did not receive attention in the Windsor deal, which was understandably disappointing to some suppliers, which cited the complexity of navigating the current system. Is the Minister considering adding other product classes, such as other devices, to its scope? Will he also clarify the status of devices on which a conformity assessment has been performed by a UK notified body? Following on from the questions from the noble Lord, Lord Allan, in this regard, will it be possible to place devices bearing a “CE” conformity mark, as well as the EU Northern Ireland mark, on to the EU market? Is it the case that no UK notified body has been appointed? If that is the case, when will this be dealt with and what is the delay down to?

In summary, we are pleased to support these amendments to the regulations to secure continuity of supply for the critical medtech sector. I look forward to hearing the Minister’s response.

[Lord Markham (Con)]

I thank noble Lords for their contributions and the spirit in which they were made in terms of helpfulness and trying to make the market as open and productive as possible.

I shall try to answer the questions in turn. To the noble Baroness, Lady Finlay, I say, yes, this is part of the four SIs.

On the noble Baroness’s whole question about making the UK market attractive to innovation, that is exactly what this is all about. On her point about clinical trials, my understanding is that there was a period when we slipped down the league on timings. I am told that a lot of that was because we were trying to prioritise Covid issues but, as I understand it today, we are now back within the timeframes. While we slipped down to 10th place in the league, the understanding from recent business coming in is that we think that we are making our way back up into the champions league spots, for want of a better phrase. I am assured that we have seen quite an improvement in the time taken in clinical trials.

On the noble Baroness’s question about what this means for the MHRA—the noble Baroness, Lady Merron, asked a similar question—we do not believe that this should have a significant impact. At the same time, I am totally with the sentiment that we do not want the MHRA to be a bottleneck, not just in this area but generally because speed to market is important here. In the last Budget, we agreed quite an increase in the MHRA’s budget, exactly so that it is able to pass such things through more quickly.

On the points about mutual recognition, it is absolutely our direction of travel. We are looking to do that with other authorities. Again—this also goes to the question of the noble Lord, Lord Allan—we are recognising the “CE” marks until 2030. That is probably a good example of mutual recognition.

NHS: Fracture Liaison Services

Debate between Lord Markham and Baroness Merron

Monday 5th February 2024 Lords Chamber

[Lord Markham (Con)]

The noble Lord is correct; there has been some good evidence gained. As I mentioned previously, it shows that the probability of suffering from a fracture if you have been in a clinic is 10%—some studies have shown as much as 30% to 40%. It also shows, as my noble friend Lord Black was saying, that there is actually a good cost saving: it is thought that £65 million per annum will give a return of more than £100 million. There are some very good statistics around this, and I assure noble Lords that we are making a strong case for their expansion.

[Baroness Merron (Lab)]

My Lords, the Minister has previously confirmed in your Lordships’ House that just 51% of ICBs have a fracture liaison service, and that the rest of the country has what he described as “different versions of it”. Will he explain what is meant by this, so that it can be understood whether this means a full fracture liaison service or not in the remaining 49%? When will Minister Caulfield’s promise to establish more fracture liaison services actually be delivered?

[Lord Markham (Con)]

I believe that the latest number is 57%, but the general point stands that that leaves 43% which are making other types of provision. The work we are doing right now is trying to understand the success of those versus what we see as prudent with that 57%. That is the case we are making and the case that Minister Caulfield was referring to as well. I believe personally that it is a strong case, so it is something that, as I say, we are looking to work further on.

Smoking

Debate between Lord Markham and Baroness Merron

Thursday 25th January 2024 Lords Chamber

[Lord Markham (Con)]

First, my understanding about New Zealand is that one of the biggest bones of contention was that it was looking to reduce the number of smoking retailers from 6,000 to 600; that is where their Bill came into difficulty. I am afraid I must disagree with my noble friend on the importance of this. It costs the economy about £17 billion a year and causes about 80,000 deaths, and 80% of people who have taken up smoking wish that they had never started. I think those are very strong reasons which I know the majority of this House is behind, and that is why I am delighted to be introducing that legislation shortly.

[Baroness Merron (Lab)]

My Lords, it has been reported that the decline in smoking has nearly ground to a halt since the pandemic, with many former smokers lapsing and many more young people now taking up smoking. Now that the smoking cessation drug cytisine is available, what is the Government’s assessment of how its availability will contribute or otherwise to the progress towards the smoke-free ambition by 2030? What plans are there to ensure its availability across the country, particularly among hard-to-reach groups of smokers?

[Lord Markham (Con)]

Hopefully, my previous answer shows that we are investing major money in cessation services. I must admit to not being that familiar with the drug the noble Baroness mentions, so I will follow up in writing to give her the details.

Health: RSV Immunisation

Debate between Lord Markham and Baroness Merron

Wednesday 17th January 2024 Lords Chamber

[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.

NHS: Drug Shortages

Debate between Lord Markham and Baroness Merron

Wednesday 17th January 2024 Lords Chamber

[Lord Markham (Con)]

My noble friend is correct that this so-called off-label use of these diabetes drugs for weight-loss-type treatments is causing some of the shortages she mentions. That is exactly what we have been tackling, and we have been making sure that the only way you can get the Wegovy weight-loss drug is actually on a very tightly controlled weight management programme normally run through hospitals, and not through normal GPs, exactly to get on top of that issue.

[Baroness Merron (Lab)]

My Lords, there are reports in the media today of pharmacists having to deal with frustrated and worried customers who are faced with shortages of medicines including HRT and the drugs for ADHD, diabetes and cancer. Can the Minister indicate what action is being taken to support and gather feedback from pharmacists who are dealing with such an unsatisfactory situation? What steps are being taken to ensure that, in the future, the supply system is able to cope as soon as demand for medicines increases?

[Lord Markham (Con)]

We find that each one is a different case in point. HRT is an example: we actually saw a 50% increase in demand for it over the last year, so suddenly that is quite a dislocation for the market, and you need to gear up very quickly in terms of the supply chain issues. Strep A was the example last year that we will all be familiar with; normally, it does not come until later in the year, but suddenly there was a very early outbreak in October, which caused the demand there. You find that every single drug tends to be a different case in point. There is a range of tools that they work with; it is working with the NHS, MHRA suppliers and pharmacists, and it is case by case. As I say, sometimes it is the MHRA expediting medicines to get new supply in; sometimes it is working on alternative suppliers; sometimes it is buying internationally—that is what we did in the case of strep A—and sometimes you do have to go as far as the serious shortage protocols, finding substitutes or, in extreme cases, changing doses. There is a range of programmes on it, which by and large are managing to tackle it.

National Health Service: Key Targets

Debate between Lord Markham and Baroness Merron

Tuesday 16th January 2024 Lords Chamber

[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.

NHS App: Medical Records

Debate between Lord Markham and Baroness Merron

Tuesday 19th December 2023 Lords Chamber

[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.

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

Debate between Lord Markham and Baroness Merron

Wednesday 6th December 2023 Lords Chamber

[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?

Sexually Transmitted Infections

Debate between Lord Markham and Baroness Merron

Tuesday 5th December 2023 Lords Chamber

[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.

Cancer Research UK Report

Debate between Lord Markham and Baroness Merron

Tuesday 5th December 2023 Lords Chamber

[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.

Health Protection (Coronavirus, Testing Requirements and Standards) (England) (Amendment and Transitional Provision) Regulations 2023

Debate between Lord Markham and Baroness Merron

Monday 27th November 2023 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I thank the Minister for introducing these regulations, to which we too are pleased to give our support. We have clearly moved on from where we were in 2020, when the original Covid regulations for testing service providers were agreed and “lateral flow device” was not a household term. Looking back to 2020, these Benches supported the regulations then because we recognised the urgent need to enable new service providers to meet the demand for testing services. We also noted that that had to be balanced with the importance of public health protections and regulations to build safeguards into the system and, so importantly, to give people the confidence that services could be trusted to keep them safe.

As the Minister outlined, the regulations apply to clinical Covid-19 testing services such as diagnostic laboratories or those that carry out point-of-care testing. The regulations will mean that these services are no longer subject to the additional requirements introduced early in the pandemic and, as such, reflect an update to meet us where we are now. They also reflect the update to the international standards since last year.

It is important to acknowledge what the regulations will not change. As the Minister said, providers will still be required to seek accreditation against the appropriate ISO standard. Test devices will still need to meet the requirements set out in the Medical Devices Regulations 2002, just as they did before the pandemic. In my view, this strikes the right balance. As the UK Health Security Agency has noted, accreditation was not mandatory prior to the pandemic but NHS England and Public Health England endorsed all medical laboratories being accredited with the United Kingdom Accreditation Service. The process for laboratories to achieve accredited status took anywhere between six and 12 months. Given the changes we are discussing, how long does the Minister expect the accreditation process to take now?

As it is so important that we learn lessons from the past and apply them to the future, I have a few questions on this generality to the Minister. What confidence does he have that new providers will be able to meet the various deadlines to meet the new ISO requirements? How will the regulations we are discussing be enforced? Does the United Kingdom Accreditation Service have the resources it needs for enforcement? How many fines have been issued to non-compliant providers since the 2020 regulations came into force?

I am sure that the Minister will agree that it pays to think about the state of the market now. How many UKHSA-accredited providers were there at the pandemic’s peak, and how many are there now? As some companies wind down their Covid-19 testing capacities because of reduced demand, what assessment has the department made of how the market is changing and how such diagnostic capabilities could be deployed to meet other ends?

In concluding, I take the opportunity to ask the Minister about one of the biggest scandals among private providers during the pandemic: that relating to the company Immensa. Local public health experts were baffled as to why an NHS Test and Trace contract had been given to the company while high-quality diagnostic services, such as those at the University of Birmingham, were being wound down. Immensa was awarded more than £100 million in a contract to carry out Covid testing in September 2021, without going through the normal tendering process. It was subsequently found to have been one of 50 firms that had been put into the priority lane for test and trace contracts worth billions. It was also found that PCR test results from Immensa’s Wolverhampton lab had misreported around 40,000 positive results as negative between September and October 2021, leading to significant additional infections at a critical time and an estimated 20 extra deaths.

I have specific questions on this issue and I would be grateful if the Minister could respond to me, if not now then in writing. Neither Immensa Health Clinic Ltd nor its related company Dante Labs Ltd was accredited by UKAS at the time of the scandal, despite the regulations that we are amending today. Immensa was a new entrant to the market and was supposed to go through the three-stage process, yet it was awarded vast sums of public money to rapidly expand the capacity of NHS Test and Trace in the autumn of 2021. One would expect high standards from a private provider in exchange, but that did not appear to be the case. An investigation by UKHSA found that, despite requirements for accreditation being written into the contract, the department and NHS Test and Trace decided that they would not apply. As such, Immensa was not accredited at the time of the false negatives scandal, even though the department claimed otherwise. Is the Minister able to confirm what actually happened in this case?

The findings of the UKHSA report risk undermining the rest of the system, if providers could not be encouraged to circumvent the correct process and there were no consequences as a result. Why were the department and NHS Test and Trace so determined that special measures should be put in place for this provider? I am not aware of any consequences for any officials or Ministers responsible for the shocking findings of the UKHSA investigation. Perhaps the Minister can confirm whether this was the case and, if so, why? Given the tens of millions of pounds of public money involved in the scandal and the dire consequences of the mistakes, can the Minister advise your Lordships’ House what efforts the Government have made to get the money back?

In conclusion, these Benches support the statutory instrument. We very much agree that now is absolutely the appropriate time to review the exceptional measures that were taken early in the pandemic while ensuring that appropriate regulation and confidence remains in place.

[Lord Markham (Con)]

I thank noble Lords for their responses and generally for the support they offer for what we are trying to do here. As I say, for a lot of my answers I will draw from personal experience. The whole of that time was extraordinary, as we know. To my knowledge, it was the first time where you had a situation in which masses of people could be tested for something. However, it needed laboratory-based testing, and suddenly the amount of volume needed for the general public was completely out of anyone’s imagination as regards the volume of the market. I remember trying to understand the rules at the time, as somebody who might set up such a company to do this, and I quickly found out that there were no rules, in that nobody had ever quite envisaged such a situation and the only rule that existed was around getting an ISO process, which typically took 12 to 18 months.

What the Government did there—again, I am speaking from the other side of the fence—was to create a good process of trying to funnel people, starting off with quite easy ways to get you through the funnel because they wanted to expand it as much as possible, but then effectively making it progressively harder while still trying to keep the good suppliers in the mix. By and large they did a decent job on that. I saw some providers completely gaming the system, in that they kept ticking the boxes as long as they were allowed to tick them and then as soon as it came to a hard task, for want of a better word, they folded up shop. There was definitely some of that, and the funnel sorted out some of the wheat from the chaff along the way, but at the same time I will not pretend it was a perfect process.

I say all this from sitting on the other side of the fence and having to jump through necessary hoops, but I actually think it was a decent process at the end of the day. As ever, I will come back in writing on all this, but my understanding was that it was a fairly similar process to that followed by other countries, and they are now going through a fairly similar process to regularise this.

As I said, I absolutely looked at the difference in outcomes versus existing regimes, and I am under no doubt that, if we kept the rules of the existing regimes, the supply would not have expanded in the way required at the time. On what the Government were trying to achieve, the evidence shows that they achieved a decent outcome, where, by and large, the quality outcomes were pretty good, although not perfect—the noble Baroness brought up a good example of where it definitely was not perfect. By and large, they did a decent job on that.

Health Care Services (Provider Selection Regime) Regulations 2023

Debate between Lord Markham and Baroness Merron

Monday 27th November 2023 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I bring more cheer to the Minister by adding our support for these regulations—I thank him for bringing them before your Lordships’ House today—because the provision of this statutory instrument is to define and give relevant authorities greater flexibility to procure healthcare services. This will, I hope—I know that other noble Lords also hope this—benefit patients and service efficiency by better integrating services. Like the Minister, I am pleased to note that the policy behind these regulations has been informed by both a voluntary impact assessment and an extensive consultation that received 70% support from 420 respondents; this is welcome news.

It is the view of the Opposition that the NHS should be the preferred provider of commissioned healthcare services, not least because it embodies not just a public service ethos but efficiency, resilience and democratic accountability. It is also the case, particularly in the short term, that, in order to treat NHS patients and bring waiting lists down, the independent sector has an important role to play where a service cannot be provided by a public body because the capability or capacity just is not there.

Your Lordships’ House may recall that, when the Health and Social Care Act2012, which my noble friend Lord Hunt described as “wretched” on several occasions, went through its various stages in Parliament, these Benches argued that relevant authorities should have the appropriate flexibility to award contracts, which was something for which the Act did not provide. As my noble friend identified, the competitive tendering requirements of that Act did not serve the NHS, patients or the public at all well. Therefore, where we are today with the provider selection regime, which does allow for this, is as long overdue as it is welcome, as is seeing that good sense, flexibility and efficiency will now apply.

During the passage of the Health and Care Act 2022, these Benches also argued for the legislative provision to be made as outlined in these regulations. Although the Government did not take that on at that time, I am glad that the benefit of hindsight has prevailed and that the Opposition’s view, which was set out during the course of that debate, has now been set out in these regulations.

As the noble Lord, Lord Stevens, illustrated so well, these regulations recognise that it would not be an efficient use of resources in certain circumstances for relevant authorities to use competitive tendering, but that there continues and needs to be a procurement process that relevant authorities can and should use. As the Minister will be aware, concerns have continually been raised about the impact of the current procurement framework, which often places additional burdens on community and mental health providers in particular, where services have been much more likely to be subject to expensive and disruptive competitive tendering processes. I therefore welcome the alignment of the PSR’s aim with the spirit of collaboration within health and care systems, as well as the offer to commissioners and providers of a clear and transparent process by which procurement decisions can be made.

The PSR will offer a consistent model for both NHS and local government bodies to follow with regard to health services, and I hope that this will support local relationships and decision-making, as well as integrated care. However, it is important that national bodies engage with all organisations that will be subject to the new regime in an effort to smooth the transition to a new procurement framework.

I ask the Minister for more detail on how NHS England and the department will review the application of the PSR over the course of the next year to ensure that real-time feedback on the operation of the regime can be collected, as well as evaluated and, importantly, acted on as swiftly as possible. I make this point as it will be crucial to capture feedback on whether any difficulties arise for commissioning bodies in selecting which procurement process is the most appropriate across various different scenarios and circumstances, and whether any challenges arise for providers in the application of their approach.

My noble friend Lord Hunt emphasised the need for support, training and guidance—something that other noble Lords also emphasised. This is a point that the Minister would be well advised, as I am sure he is, to pay absolute attention to, so that we support those who work in NHS procurement and the NHS supply chain, not least because the combination of these regulations, other regulations and other Acts is something of a complex field. We should support and guide those who make the interpretation and the application, and, if necessary, adjust in real time any of that training, support and guidance. More information from the Minister about how this will be done will be extremely welcome.

I am aware that NHS Providers has worked with membership bodies for providers in the independent and voluntary sectors, the department and NHS England to make the case for the new regime to include a challenge function for decisions made by commissioning bodies to be reviewed and scrutinised if appropriate. Although the PSR panel does not have legally binding powers, does the Minister consider it appropriate to give providers some opportunity to challenge the application of the regime and raise legitimate concerns where appropriate?

As I said at the outset, I am glad to provide our support to these regulations. I hope that we can look forward to great improvements because of them in the years ahead.

[Lord Markham (Con)]

I thank noble Lords and welcome the support offered. I appreciate their understanding on my lack of comments on 2012 and all that. I also appreciate having the vast experience of the noble Lord, Lord Stevens, and wonder whether he could be here so that I can phone a friend on some of the questions we have, because I fear he may be far better qualified to answer a lot of them. I will take home the “Think like a patient, act like a taxpayer” mantra.

I think we all agree that, although this is welcome, it is complex. We are trying to set out an approach, knowing that really we want sensible people to act sensibly around the table and to co-operate with each other. We all know that it is very hard to put a rules-based system around that. As all noble Lords have mentioned, the training of staff in that is vital. I have some personal experience, as I know the noble Lord, Lord Hunt, does, of many of the people in this space, and I have to say that they are very good people. My experience is obviously much more on the national level, but clearly it needs to be taken down to the local level as well.

I believe we are publishing the strategic framework for NHS commercial tomorrow. That tries to set out the importance of commercial capability, and the investment and critical skills required. It will be accompanied by a programme that sets out what upskilling needs to be done and a programme, with support from the Crown Commercial Service, that I hope we can effectively use to upskill in the way that we all believe is necessary.

To answer the point by the noble Baroness, Lady Merron, whenever you are trying to put in place a value-based system, for want of a better word, in terms of culture, you have to have those guard-rails around making sure that there are appeals processes and lessons learned. My understanding of this independent panel is that companies or providers that feel they have been wrongly excluded will have the opportunity to appeal directly. I have challenged them quite strongly on that, given my experience in this space, and asked how much a company will really want to be awkward. Often you know that if you are being awkward and challenging, that might make life more difficult for you in future, so there are some difficulties involved there. A lot of companies often ask whether that challenge is really worth it. Getting that right, with the panel, is vital, so that it is welcoming and open and that, as the noble Baroness, Lady Merron, says, there is that “lessons learned” kind of constant review. At probably the year stage, we will look to understand how it has gone so far and what we can learn from it.

Having been involved in quite a few start-ups, I am also very aware of the point the noble Lord, Lord Hunt, made. Time really is money in these things; a regulatory process that is opaque or cumbersome is not very helpful. I acknowledge some of the issues the MHRA has had. That is what the £10 million investment behind it is trying to address. I know it is very much looking to act on this.

A very good example of that is what the MHRA is doing in the point-of-care space. One Brexit advantage that I have seen is the ability very quickly to set rules around point-of-care medicines, particularly around when you take a biopsy and then provide an individual patient with treatment according to that for a certain cancer. Clearly, if you follow the strict rules, you would have to be regulating that every single time, and that just would not work. The MHRA has introduced a sensible framework that tries to adopt an umbrella-type approach. I know that the MHRA understands the possibilities in this space and really wants to use this as an opportunity to show that we can be fleet of foot and leaders in that space from it all.

On the point raised about trusts sometimes having a conflict and the example provided by Specsavers, that is what the panels are supposed to be there for. It is important—I will check this out—that, in the rules, we are guiding the 42 ICBs on how they should manage some of those conflict situations and when they should put people aside. We have all managed it in our corporate and public lives, and there are rules about it. Just as we put the emphasis on noble Lords to declare interests and so on, clearly we must make sure that there are similar rules for the trust CEOs, but it is a point well made that we need to pick up. I look forward to going into some of these issues much more when we have the value-based procurement meeting shortly.

On how we can make the analysis available, I have seen a tool that the NHS has recently introduced which is very good in terms of being able to drill down straightaway and provide that analysis. That is a good base point. I will find out some more about how that needs to be tweaked, but there is a basic premise about making that information available—that is a sensible move. On the point made by the noble Baroness, Lady Merron, it should be used to arm providers with the ability to challenge the panels.

I welcome the input. Such is the knowledge base around this, I am happy to suggest that, in nine months or one year’s time, we have that round table where I will appreciate some of the skills here. We can ask how it has gone down so far. We can do that through a debate, but it is probably better done through a round table, so I would like to propose that so we can learn the lessons.

In summary, I welcome the points made and that noble Lords believe that this is the right direction, although it needs work along the way to make sure it stays going in the right direction and does what we hope it does. With that, I commend the draft regulations to the House.

Motion agreed.

Mental Health Act 1983

Debate between Lord Markham and Baroness Merron

Tuesday 21st November 2023 Lords Chamber

[Lord Markham (Con)]

Yes. The data, and fundamentally understanding what is beneath it, is key to all this. We have put an executive lead on each trust board to look at exactly these sorts of issues, including the data, so I am happy to take that forward.

[Baroness Merron (Lab)]

My Lords, the provisions of the Mental Health Act have no clear definition of a safe place in which a sectioned patient may be taken while awaiting medical assessment. That often results in vulnerable people being taken to police stations and forcibly detained by the police. What assessment have the Government made of the frequency of this continuing due to the Government’s failure to reform the Mental Health Act—something that Labour, if we win the next election, will put right? How will the Government ensure that patients are no longer detained in such inappropriate and punitive environments?

[Lord Markham (Con)]

I appreciate the feeling that our response on minimal standards—in our reply, I think, to the report by the noble Baroness, Lady Hollins —did not go far enough to make sure that those patients are in the right quality setting for them, so the noble Baroness, Lady Merron, has made an important point. I was going through with the team what we can do to make sure that that is right. As I mentioned before, the fact that the CQC now has responsibility for those independent reviews will mean that it will look not only at whether it is right that the patients are in those in-patient environments but at whether it is the right environment as an actual place.

Ultra-processed Food

Debate between Lord Markham and Baroness Merron

Thursday 26th October 2023 Lords Chamber

[Lord Markham (Con)]

That is absolutely right. We should always base this on the science. I thank my noble friend for that comment.

[Baroness Merron (Lab)]

My Lords, nearly half of baby snacks and up to three-quarters of baby biscuits and rusks are categorised as ultra-processed. Many of them are high in fat, sugar and salt and if overconsumed, reports suggest, can lead to weight gain, unhealthy eating habits and a wider negative impact on development. Have the Government made any consideration of measures to help parents to be more informed of these risks? What discussions have taken place with industry to address information and formulation?

[Lord Markham (Con)]

To take the second question first, the industry has worked with a lot of comments on reformulation across the board—for younger children and older ones. Noble Lords will remember me saying that foods such as Mars, Galaxy, Bounty and Snickers bars have all been reformulated, as have Mr Kipling’s “exceedingly good” cakes. Clearly, we need to look across the board at it all. I know that the industry is working in the area of young people. I am happy to follow that up in writing with the precise details.

Domestic Violence and Brain Injury

Debate between Lord Markham and Baroness Merron

Monday 23rd October 2023 Lords Chamber

[Lord Markham (Con)]

The hope from this research is understanding all the different causes and some of the protocols. I know it is controversial sometimes, because, speaking as a centre half myself, heading the ball is a key part of the game. However, making sure that children under a certain age are not heading the ball a lot is one of the things that we should be looking at as prevention.

[Baroness Merron (Lab)]

My Lords, as not all brain injury from domestic violence is immediately apparent, will the Minister raise with his colleagues in the relevant departments the consideration of a reappraisal in policing and the criminal justice system? Will the Government also work with those supporting victims of intimate partner violence to actually give a name to the brain trauma that victims may be suffering? If victims know that traumatic brain injury is part of their trauma, it can give a source of strength and guidance to those who are suffering, enabling them to seek the right medical support.

[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.

Reinforced Autoclaved Aerated Concrete: Hospitals

Debate between Lord Markham and Baroness Merron

Wednesday 13th September 2023 Lords Chamber

[Lord Markham (Con)]

In every hospital—and Watford was one of the first ones I visited—there is a programme on which the draw-down of the funding depends; there is already a new car park there, for instance. I can assure the noble Baroness that the plans are in place to make sure that the draw-down is in time. I have also said on all the hospitals I have visited over the summer—I have seen about 20 or so—that I have a quarterback role where I have to project manage across them all and, where there are issues, they can approach me directly. I will raise today’s question with the Treasury and make sure that Watford is well in order.

[Baroness Merron (Lab)]

My Lords, as the Minister said in answer to an earlier question, the Government will replace only seven of the 27 NHS sites confirmed to have RAAC in their construction, while the other 20 are set to be monitored and mitigated until it can be removed. How long will it take to complete the removal on these 20 sites? What assessment has been made of the risk to patients?

[Lord Markham (Con)]

Three of those have already had the RAAC eliminated from them. The remaining ones are part of the programme and the commitment to have their RAAC eradicated by 2035, but in the meantime the remedial measures are there and that is what the £698 million is all about. I visited them first hand to see the work, and all credit to the team—they have become real experts on the subject. At every hospital I visited, you could see that the team were right on their game and understood very well what work they needed to do there, always using expert advice from the Institution of Structural Engineers and others.

NHS: Staff Numbers

Debate between Lord Markham and Baroness Merron

Tuesday 12th September 2023 Lords Chamber

[Baroness Merron (Lab)]

My Lords, the Government’s workforce plan is silent on having enough properly maintained treatment facilities, buildings and equipment, all of which have become increasingly inadequate. Could the Minister confirm what assessment has been made of the physical capacity requirements to deliver the NHS workforce plan? How will he ensure that staff have what they need to do their job?

[Lord Markham (Con)]

The noble Baroness is absolutely correct: a workforce plan needs to be backed up with the physical real estate to deliver it. As noble Lords are aware, I am responsible for the new hospitals programme, which is part of that. In primary care, much of the long-term workforce plan is all about getting upstream of the problem in terms of prevention, and clearly we need to make sure that the physical real estate is there to support that. So the next steps will be to make sure that the capital meets the long-term workforce plan.

Children’s Health: Sugar

Debate between Lord Markham and Baroness Merron

Tuesday 12th September 2023 Lords Chamber

[Lord Markham (Con)]

Yes, as I mentioned previously, our modelling shows that roughly 95% of the calorific reduction that we are expecting will come from the movement of the product positioning. The evidence, almost at the end of the first year, is that this is working. Effectively, the category of non-high HFSS products has gone up by about 16% while products high in fat, sugar and salt have gone down. We know that supermarkets are taking the lead in doing this voluntarily, in terms of the so-called BOGOF, or “buy one get one free”, promotions. Tesco and Sainsbury’s have already stopped that on a voluntary basis and, as I mentioned earlier, the companies are also reformulating their foods. There is a lot of progress in a lot of areas.

[Baroness Merron (Lab)]

My Lords, children from the most deprived areas are four times more likely to be obese and three times more likely to have dental decay than those in the least deprived, with sugar as a key contributor to poor health and future prospects. Does the Minister agree that targeting excessive sugar intake at earlier stages will have more impact on the more deprived communities and, if so, how do the Government propose to do this?

[Lord Markham (Con)]

Yes, the noble Baroness is absolutely correct, and that is why in the major conditions survey we have an ambition to reduce sugar intake by 20%, working right across the board and especially with baby food manufacturers. As I set out earlier, there are a range of things that we have already done: the sugar tax reduced intake by 46%, and the movement of the so-called “pester power” has made a big impact. We are seeing companies reformulate food. But it is something we will keep under review, and we will do more if we need to.

Folic Acid Fortification

Debate between Lord Markham and Baroness Merron

Tuesday 25th July 2023 Lords Chamber

[Lord Markham (Con)]

Yes, the noble Baroness is correct, and the point made by the noble Lord, Lord Rooker—that each year’s delay involves another 200 or so babies—was very well made. The beauty of this process is that it makes me shine a light on this issue, so I will be working on quite hard on it.

[Baroness Merron (Lab)]

My Lords, the last time this issue was raised in the Chamber, the Minister put delays down to co-ordination with the devolved Administrations and consultation with the EU due to Northern Ireland—which he referred to in the previous Question—before allowing industry to get on board. Just yesterday, noble Lords debated two statutory instruments that apply to the devolved Administrations, including one specific to Northern Ireland. Can the Minister explain why timely co-ordination across the nations has been possible on tobacco products and pharmacies but not on folic acid in flour, in respect of which time is obviously of the essence, given the importance of the neural health of babies?

[Lord Markham (Con)]

I thank the noble Baroness for that question; as I am rapidly learning, this is a complicated area. For the benefit of noble Lords who were not present yesterday, the tobacco arrangements are part of the Windsor agreement, so we passed primary legislation to allow us to make those changes. On the items before us, which involve secondary legislation, my understanding—if I am wrong, I will make a correction in writing—is that the co-operation of each of the devolved authorities is needed. That is why we are not able to proceed in Northern Ireland without its involvement. The plan is that we will go forward with GB-only measures if we have to. For obvious reasons, we would prefer not to do that; we want Northern Ireland to benefit from these changes as well but, as I have learned, it is a complex area.

Tobacco and Related Products (Amendment) (Northern Ireland) Regulations 2023

Debate between Lord Markham and Baroness Merron

Monday 24th July 2023 Grand Committee

[Baroness Merron (Lab)]

I start by thanking the Minister for introducing these regulations, which we welcome, and expressing my appreciation for the way he set out their application, the summary of which is that, from October, it will be illegal in Northern Ireland to produce or sell heated tobacco products that have what is called a “characterising flavour”. As the Minister explained, this change is happening because of the requirements of the Windsor Framework and in response to a policy change implemented by the EU—more of that later.

With regard to heated tobacco products, unsurprisingly, some in the tobacco industry have claimed that they are less harmful than conventional smoking. Has the Minister had time to review the analysis by the University of Bath, which has shown that most of the studies referred to in order to back up said claim were either affiliated with or funded by the tobacco industry? Surely that raises a considerable flag. Conversely, the European Respiratory Society has pointed to independent research showing that heated tobacco products emit substantial levels of toxicity as well as other irritant substances. Although the use of these harmful products is said to be very low in Northern Ireland, they are increasingly being marketed, without evidence, as a healthier alternative to smoking.

On that point, I would like to pursue the questions that have been asked by noble Lords in the course of this debate about whether there are plans to adopt similar legislation here so that there is parity between England and Northern Ireland; and whether there have been discussions with the other devolved Administrations in order to ensure that there is parity in legislation and, therefore, not the problems across borders that have been described. The noble Lord, Lord Dodds, explored this matter extremely well. I was particularly taken with the obvious practical example that somebody can purchase a product here and take it to Northern Ireland. What is the implication of that? That is going to happen all the time; it is just a fact. I am sure that all noble Lords will be interested to hear the Minister’s response on that.

Have the Government made any assessment of the prevalence of heated tobacco product use across the rest of the United Kingdom, principally in England, along with the wider health implications of such use? Perhaps the Minister could also outline what action his department is taking to combat the increased marketing of such products—marketing that is often underpinned by spurious tobacco industry-backed research, as I referred to earlier.

As was spoken to by the noble Baroness, Lady Ritchie, and the noble Lord, Lord Allan, can the Minister set out how the Government will assist Northern Ireland in the implementation of the ban, particularly given the possibility of illegal importation from England? It certainly seems strange—this point has come out in the debate—that, following the implementation of the draft regulations, there will be more stringent legislation in place to clamp down on heated tobacco products in Northern Ireland than in the rest of the United Kingdom. Can the Minister assist us in trying to understand how that will help? Are the Government considering implementing a ban on these products in their tobacco control plan, which was promised by the end of 2021? That leads me to the question of when—indeed, whether—we will ever see it published?

I want briefly to highlight concerns in relation to children and young people in particular. I note that the Secondary Legislation Scrutiny Committee referred to the fact that it was in the light of increased sales volumes among under-25s that the EU amended its legislation on heated tobacco products. In this regard, the Health and Social Care Committee in the other place recently took evidence from not only health experts but the industry. It made for interesting reading. The committee heard evidence that the topic of conversation for young people in the playground was often the different flavours that they were trying, such as

“Gummy Bear, Slushy and … Unicorn Milk and Unicorn Frappé”.

This was also referred to by the noble Lord, Lord Allan. These are different flavourings that are clearly not aimed at an adult audience. While we are talking about vanilla and other flavours in heated tobacco products, does the Minister agree that it will not be long before we see them being extended to products that are deliberately constructed to be attractive to children to get them to take up smoking? What is the strategy to deal with this?

It is absolutely crucial, in dealing with tobacco control and ensuring that we reduce harm to the health of people of all ages, that we look ahead. I hope that these regulations and the debate around them, including noble Lords’ contributions, will again alert the Minister to the need to anticipate future developments in tobacco products, not just in Northern Ireland but across the whole of the United Kingdom.

[Lord Markham (Con)]

I thank noble Lords for their contributions. As ever, they showed that there are interesting intricacies in every part of health; it is one of my key learnings over the past nine or 10 months that I have been in this role.

I want to clear up one thing. I admit that there was a bit of confusion on my part, as well. As the noble Lord, Lord Allan, said, we are not talking about vapes here—we are talking about heated tobacco. There is a heated tobacco stick, which basically heats to temperatures lower than that of a cigarette and releases an aerosol. I am sorry if noble Lords knew that already, but I thought that was worth clarifying. Because of that, this product is used by a very small number of people. It is estimated that less than 0.5% of smokers use this product; if you apply that to the population, it is 0.065%. I hope that this gives some sort of clarification behind our decision, when we talk about whether we did an impact assessment, because we are talking about very small numbers being involved here.

Food: Two-For-One Offers

Debate between Lord Markham and Baroness Merron

Wednesday 19th July 2023 Lords Chamber

[Lord Markham (Con)]

As I mentioned in answer to a Question on ultra-processed food yesterday, as a definition that is not particularly helpful because wholemeal bread, baked beans and cereals are all examples of ultra-processed food. The real point is the content of the food, and that is what our regulations should look to.

[Baroness Merron (Lab)]

My Lords, when the anti-obesity strategy was published, this ban was said to be supporting food affordability, citing evidence that multi-buy offers such as “buy one, get one free” increase the amount that people spend on foods by around 20% but often on foods high in fat, sugar and salt. With the Government now making the opposite argument to support this postponement, do they no longer stand by the evidence? Would a ban on these deals make it easier or harder for those who are struggling to get by?

[Lord Markham (Con)]

As we have mentioned before, our general direction of travel is to educate, reformulate and give people the best chances through having choices, and a good start in life through the fresh fruit and vegetables that we have in schools. Those are the things that will really make the difference.

Ultra-processed Food

Debate between Lord Markham and Baroness Merron

Tuesday 18th July 2023 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend; that was excellently put. Again, it is the content of the food that matters and not what it is called.

[Baroness Merron (Lab)]

My Lords, to follow on from the Minister’s comments about the definition of ultra-processed foods, can he confirm what work is taking place to nail down a definition and, upon this definition, will the Government carry out the research that scientists believe to be necessary?

[Lord Markham (Con)]

As I have said, the fact that something is processed is not a helpful definition. I would recommend that we focus all our activity on the contents of the foods—whether they are high in saturated fat, sugar or salt—and not on whether they are processed.

Community Health Services: Waiting Lists

Debate between Lord Markham and Baroness Merron

Wednesday 12th July 2023 Lords Chamber

[Baroness Merron]

To ask His Majesty’s Government what recent assessment they have made of current levels of waiting lists and times for community health services for (1) children and young people, and (2) adults.

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

We regularly monitor community health services’ waiting lists and recognise the variability between the number of people waiting and the time on waiting lists across services in local areas. We are committed to reducing waiting lists; that is why the NHS Long Term Workforce Plan sets commitments to grow the community workforce, with increases in training places for district nurses and allied health professionals and a renewed focus on retaining our existing staff.

[Baroness Merron (Lab)]

My Lords, long waits have a more severe effect on children because delays in assessment and treatment have a knock-on effect on their communication skills, social and educational development and mental well-being. With over 37% of children and young people on waiting lists for community health services for more than 18 weeks, compared to under 16% of adults, when will the Government address this ever-widening gap and what steps are they taking to prevent a disproportionate impact on vulnerable families both now and in the long term?

[Lord Markham (Con)]

The noble Baroness is correct about the urgency for young people; I have personal experience of this as well. We are taking steps by piloting nine early language and support services for all children focused on exactly what the noble Baroness mentioned. There is £70 million behind that pilot, with the intention being that we learn lessons from that and roll it out quickly.

NHS: Doctors’ Strikes

Debate between Lord Markham and Baroness Merron

Wednesday 5th July 2023 Lords Chamber

[Lord Markham (Con)]

I think the morale of doctors is best approached by a number of measures. As I said yesterday, there is not one silver bullet. There are a number of things: clearly, pay is important; pensions are very important, and we have addressed those, and so are working conditions. I was at Whipps Cross Hospital, one of the new hospitals, last week. The morale boost to staff there, knowing they are getting a new hospital, is massive. All those features are vital to improving morale.

[Baroness Merron (Lab)]

My Lords, in celebrating the 75th anniversary of the NHS, I too pay tribute to all NHS staff. It is therefore highly regrettable that the Government are currently presiding over the largest amount of industrial unrest in the history of the National Health Service, with doctors’ leaders warning that the strike action could last until 2025. With that in mind, what is the Government’s assessment of the impact of their failures to resolve NHS disputes?

[Lord Markham (Con)]

As we have seen, it is having an impact, regrettably. We saw that from 14 to 17 June: almost 100,000 appointments were lost during that strike. We are now looking to cover that up. That is why we are firm in our conviction that we want to resolve this situation. These sorts of things are not good for anyone. We have a formula that worked; we have managed to do this with nurses and the Agenda for Change unions, which make up the vast majority of the health service. Our hope is that we can sit down and have sensible conversations and do the same with doctors and consultants.

Lung Cancer: Screening

Debate between Lord Markham and Baroness Merron

Monday 26th June 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord, Lord Kennedy, and I am sorry for the loss of his brother. I agree with his sentiment that while this is good news today and is welcomed by all, it shows that this is a journey and that we need to do more in lots more areas. I take on that point and say, from our point of view, that we agree that we must work together to make further progress.

[Baroness Merron (Lab)]

Could I give the Minister another opportunity to pick up on the key point I raised? We very much welcome the improved diagnosis rates—and my noble friend Lord Kennedy makes a very pertinent point that, of course, we are talking not just about one cancer. I thank him for sharing his views and feelings with your Lordships’ House. That takes me to my reminder to the Minister: I asked about matching improvements in diagnosis with improved access to treatment; otherwise, we are leaving people diagnosed but not matching it by giving them the treatment they need in a timely manner. Could the Minister assist with that point?

[Lord Markham (Con)]

I am sorry; I was answering in a generic format in terms of the new CDCs. The noble Baroness is quite right that diagnosis is one thing—and we all know that the early stages are key—but you then have to follow that up with treatment. Of course, the good news is that if you can detect cancer in people at the earlier stages, they need less treatment. The resources I mentioned, in terms of what is being spent on the programme, take into account the treatment required as well.

Of the people being identified at this stage, only 1.4% from the pilot were then positive and needed treatment, thankfully. Obviously, those resources are in place. There is a second interesting category of people—about 17% or so—who are fine but we want to make sure that what has been noticed is in an okay state.

I am going to grab my notes to make sure I am referring exactly to the right term at this stage. I apologise; about 1.7% have nodules, which is not a problem per se, but it is a problem if those are growing. The idea is that we will be getting those people back in for frequent scans on a three- to six-monthly basis and using AI technology to see whether or not the nodules are growing. If they are not growing, it is not a problem, but we then keep up the frequency of scans. Obviously, if they are growing, that would be a concern at the early stages, and that would then move them into the treatment category.

The other 80% or so of people fortunately will not have any concerns from the scan at all. At that stage, they will be put into this continual programme, where they will be reviewed every couple of years to make sure that we keep on top of it. I hope that this shows that this is a well thought-out, entwined service, with the idea being that for the 1.4% who are identified as needing cancer treatment, the treatment is there to back them up.

NHS GP Surgeries: Purchase by US Companies

Debate between Lord Markham and Baroness Merron

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

My understanding on this is that actually it is not a massively profitable area at the moment. The biggest provider in this area, Babylon Health, as we all know, did not manage to make it work. So, while I think we all understand my noble friend’s concerns, I do not believe that this is the case with the GP funding model.

[Baroness Merron (Lab)]

My Lords, research has shown that GP surgeries owned by some private limited companies have been offering a lower level of care, with unqualified staff seeing patients. So, in view of the Minister’s comments on quality, how much of a concern is this for the Government? On top of this, with some 4,700 GPs being cut over the last decade, cuts to training places and the many years that it takes to train a GP, what response will the Minister make to the latest GP patient survey, which reports that patients are now ever less likely to be able to see a GP?

[Lord Markham (Con)]

Clearly, we have our targets in terms of making sure that people can see a GP. I am glad to say that 70% of appointments are now face to face, and we are on target to hit our 50 million increase in appointments. So it is good to see that we are getting that done. Do we need to do more? Clearly, there is ever-increasing demand from the demographics of the situation, so we need to increase supply through additional training places, as I said.

Cancer Referral Targets

Debate between Lord Markham and Baroness Merron

Monday 5th June 2023 Lords Chamber

[Baroness Merron]

To ask His Majesty’s Government what steps they are taking to ensure that NHS trusts in England meet their target for cancer patients to be treated within two months of an urgent GP referral.

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

My Lords, NHS England continues to actively support those trusts requiring the greatest help to cut cancer waiting lists. This work is backed by funding of more than £8 billion from 2022-23 to 2024-25 to help drive up and protect elective activity, including for cancer. To increase capacity, we are investing in up to 160 community diagnostic centres—CDCs. Within CDCs, we are prioritising cancer pathways to help reduce the time from patient presentation to diagnosis and treatment.

[Baroness Merron (Lab)]

My Lords, nearly 90% of cancer patients in 2010 received their first treatment within two months of urgent referral, which exceeded the operational standard, something the Government have not achieved since 2014, while last year fewer than 65% of cancer patients were treated within this standard. With earlier intervention being key to saving lives, what is the Government’s estimate of how many lives are lost each year due to failure to meet this agreed standard? What is the impact on survival rates of continued delays to a workforce plan promised long before the pandemic and still being reported as not having been signed off by the Treasury?

[Lord Markham (Con)]

The noble Baroness is correct about early diagnosis. That is why we have invested in 160 CDCs, which will be primarily focused on cancer, and why there are 11,000 more staff than in 2010, a 50% increase, as well as 3,000 more consultants, a 63% increase. We are seeing more supply than ever but at the same time, given Covid and the pent-up demand caused by that, we are also seeing more than demand than ever. The major expansion of supply is focused on making sure that we quickly detect those people.

NHS National Health Inequalities Improvement Programme

Debate between Lord Markham and Baroness Merron

Thursday 25th May 2023 Lords Chamber

[Lord Markham (Con)]

Absolutely. We work very closely together. The Healthy Start programme gives seven fruits a day to kids up to the age of seven to make sure that they get fruit and vegetables, and that is very much a joint initiative. Clearly, we need to be joined at the hip on some things, but as regards school meals, the DfE takes the lead.

[Baroness Merron (Lab)]

My Lords, the levelling up White Paper promised to design and test a new approach to ensure compliance with school food standards. Although pilot schemes were meant to start last September, a recent Written Answer from the Schools Minister stated that

“standards are being kept under review”,

with no sign of the pilot scheme. Have the Government given up on their promise and does the Minister consider the existing standards for school meals and the means of compliance sufficient to tackle nutritional inequalities across the country?

[Lord Markham (Con)]

As mentioned previously, the review did not happen because of Covid, and it is very much within the plans that it is time to look at school standards again. Clearly, that is key to making sure that there is a healthy diet in schools, and of course that goes across the board.

Autism: Diagnosis Targets

Debate between Lord Markham and Baroness Merron

Tuesday 16th May 2023 Lords Chamber

[Lord Markham (Con)]

First, I totally agree with my noble friend’s sentiment about the power that AI, when done in the right way, can have in this space. Clearly, the stress is on the words “the right way”. I think it is fair to say that we are all on the nursery slopes as regards what it can do. I have seen how effective it can be in taking doctors’ notes, recording a meeting and drafting action points, which a doctor can then review. I am sure that we would all agree that that is very promising. There are future generations of AI being talked about that may be able to perform diagnosis. In the 10 to 15 years of looking ahead in the long-term workforce plan, these are some of the things that we will have to try to take into account. However, we are in the very early stages.

[Baroness Merron (Lab)]

My Lords, when it comes to autism services, we know that there are major disparities across the country which predate the pandemic but which were made much worse by it. The number of people waiting for an assessment has grown by 169% from pre-pandemic levels. How will the Minister ensure that the national framework and the standards for autism assessment within it are deliverable at a local level and in every part of the country?

[Lord Markham (Con)]

First, each ICB now has to have a lead for autism and learning difficulties. The noble Baroness is correct that there are some disparities— I am sure that she is aware of the two ICBs which have restricted their services quite significantly, although, thankfully, they are now rowing back on that. We need to make sure that we are on top of all of them. As the noble Baroness is aware, I and other Ministers are taking a personal interest in this. Clearly, there is a lot of work to be done.

NHS: Allocation of Financial Resources

Debate between Lord Markham and Baroness Merron

Thursday 11th May 2023 Lords Chamber

[Lord Markham (Con)]

Yes, and we are doing it. We have committed to an up to £7.5 billion increase in funding over the next two years. We announced last month a social care plan which is addressing this and reforming the sector, and we are starting to see the changes.

[Baroness Merron (Lab)]

My Lords, the Royal College of Emergency Medicine described as unambitious the Government’s plan to see 76% of A&E waits meeting the four-hour standard by 2024. As this target has not been achieved in the past two years, how does the Minister see it working to drive down waiting times? How will the Minister ensure that hospitals are not prioritising patients with minor conditions at the expense of those in greater need of admission simply to allow them to meet the target?

[Lord Markham (Con)]

Numbers out just this morning show that we are now at 75% of people being seen within four hours, so we are close to the 76% target. That is the best since September 2021. I am the first to admit that we want to go further, as the noble Baroness states. It is about making sure we have got the care in the right places. We are triaging to make sure that the most important cases are seen first and, as I mentioned in a previous answer, we have things such as fall services, which can avoid trips to A&E in the first place, and more primary care in place to avoid visits in the first place. That is what the primary care recovery plan is all about.

Life Expectancy: Pensions, Health and Insurance

Debate between Lord Markham and Baroness Merron

Wednesday 26th April 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend is correct: it is a key issue. There have been successes such as the sugar tax levy, which has reduced sugar consumption by about 40%. But clearly, you need only to look at the statistics to see that all western nations, including the UK, are facing this problem. It is a challenge that we have to attack. We can learn a lot in this space from Japan, where employers and the whole society are very much involved in the healthy lifestyles of their workers and people.

[Baroness Merron (Lab)]

My Lords, life expectancy for those with a learning disability is particularly shocking: only four in 10 live to see their 65th birthday, nearly half of their reported deaths are avoidable, and those living in the north-west and the Midlands are at greater risk. What action are the Government taking to address the specific barriers faced by people with learning disabilities in getting access to the timely, quality healthcare which could perhaps extend their life expectancy?

[Lord Markham (Con)]

As noble Lords are aware, we have been putting significant investment into mental health; from memory, there has been a £2 billion-plus increase over the last year. In recognition that learning disability is an issue we particularly need to tackle, as the noble Baroness is aware, we are putting investment into schools so they can identify it early on. Some 35% of schools now have the right educational leads in this space, and the figure will rise to 50% next year. It is a big improvement, but do we need to do more? Absolutely.

Long Covid

Debate between Lord Markham and Baroness Merron

Tuesday 25th April 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness. My understanding is that the 90 specialist adult centres and 14 specialist children’s centres have care pathways which they are supposed to adhere to. Therefore, I hope that the instances which the noble Baroness brings up are the exception, but I am happy to investigate because I think we all agree that a consistent care pathway is vital in this space.

[Baroness Merron (Lab)]

My Lords, despite the provisions that the Minister has outlined, the reality is that just a fraction of the people who have long Covid are seen and supported. What steps are being taken to ensure that GPs recognise long Covid in those who do not self-label as having the condition, and how will the Minister respond to the data that shows inadequate access to specialised health services?

[Lord Markham (Con)]

As I say, the data that I have been working with indicate that 80% are seen within eight weeks, which I think most noble Lords would agree is a pretty good statistic. My understanding is that GPs are fully briefed on referrals and disability types. It is clearly important that people who are suffering in the long term make sure that they get treatment.

Diphtheria

Debate between Lord Markham and Baroness Merron

Tuesday 18th April 2023 Lords Chamber

[Lord Markham (Con)]

As I mentioned, we are doing the screening. We lead Europe on this; my understanding is that no other European country is taking the extensive measures that we are. I can also reassure the House—I was speaking to Susan Hopkins on this just yesterday—that UKHSA has deemed that there is a very low risk to the general population. The uptick in cases that we are talking about is in the migrant population, and the fact that we are vaccinating 88% of them against diphtheria shows that we are on top of the problem.

[Baroness Merron (Lab)]

My Lords, we know only too well from pandemics that diseases do not respect borders, and though, as the Minister says, we ought to be well protected against diphtheria in this country given the vaccination programme, recent increases in vaccine hesitancy have given cause for concern. On the steps that the Minister referred to that should be taken to maximise vaccination rates, can he indicate whether this will reflect regional variations, bearing in mind that the National Audit Office has reported a lower level of vaccine take-up in London?

[Lord Markham (Con)]

Absolutely. As the noble Baroness is aware, vaccination take-up is the responsibility of the ICBs in their areas. Like many other places, London has unique demographics. As I mentioned, our record is pretty good in this area, but it needs to be done nationally on a uniform scale.

Junior Doctors’ Strikes

Debate between Lord Markham and Baroness Merron

Monday 17th April 2023 Lords Chamber

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

“Mr Speaker, the honourable gentleman seems to ignore the fact that we have actually negotiated a deal with the NHS Staff Council, and it is a deal that it has recommended to its members. Indeed, the largest health union has voted in favour of the deal—indeed, it is his own health union—yet he seems to think we should tear it up, even though other trade unions are still voting in response to that offer and their leadership had recommended it.

Secondly, he says that we should sit down and negotiate. We have made an offer of 10.75% for last year, compared with the Labour Government in Wales, who have offered just 7.75%. So the offer, in cash terms, in England is actually higher than the offer that is being put on the table by the Welsh Government, which I presume he supports. He says he does not support the junior doctors in their ask for 35%, and nor does the leadership there. We need to see meaningful movement from the junior doctors, but I recognise that doctors have been under significant pay and workforce pressures, which is why we want to sit down with them.

The bottom line is that the deal on the table is reasonable and fair. It means that just over £5,000 across last year and this year will be paid for a nurse at the top of band 5. The RCN recommended this deal to its members, but it was rejected by just under a third of its overall membership. It is hugely disappointing that the RCN has chosen not to wait for the other trade unions to complete their ballots and not to wait for the NHS Staff Council, of which it is a member, to meet to give its view on the deal. It has chosen to pre-empt that, not only with the strikes that come before that decision of the NHS Staff Council but by removing the derogations—the exemptions—that apply to key care, including emergency care, which is a risk to patient safety.

Trade unions are continuing to vote on this deal. The deal on the table is both fair and reasonable, including just over £5,000 across last year and this year for nurses at the top of band 5. It has been accepted by the largest union in the NHS, including, as I have said, the shadow Health Secretary’s own trade union. It pays more in cash to AfC members than the deal on the table from the Labour Government in Wales. It is a deal that the majority of the NHS Staff Council, including the RCN’s own leadership, recommended to its members. We have always worked in good faith to end the disruption that these strikes have caused and we will continue to do so, but it is right to respect the agreement that we have reached with the NHS Staff Council and to await its decision, which is due in the coming weeks.”

[Baroness Merron (Lab)]

My Lords, last week was the most disruptive in the history of the National Health Service, with some 350,000 patients seeing their operations and appointments cancelled due to industrial action. Does the Minister accept that the public remain supportive of doctors and nurses and also that the public want to see the Government reaching fair, negotiated settlements to bring disruption to an end? If Ministers remain unable to get agreements over the line, what other options are being pursued, including the involvement of ACAS?

[Lord Markham (Con)]

I think we all want fair outcomes and negotiated settlements, and I think we felt that the agreement reached with the Agenda for Change parties was fair and was something, as mentioned in the Statement, that the union leadership recommended to the union members. Of course, we need to wait to see the outcome of the staff council of all the Agenda for Change unions from 2 May to see where we end up on that. Our hope is that, across the majority of those, we will see support. As noted, this is a generous offer; it is higher than the offer made in Wales, for example, and we hope it will be a way forward after 2 May. If that is not the case, we need to sit down and think about next steps.

Junior Doctors’ Strikes

Debate between Lord Markham and Baroness Merron

Thursday 30th March 2023 Lords Chamber

[Baroness Merron (Lab)]

My Lords, junior doctors are being asked to do the work of many. The NHS is short of more than 150,000 staff, yet the long-promised NHS work plan remains just that—long promised. We are still waiting for the general practice plan, the review of integrated care services and the social care update. Do the Government intend to get those plans out over the Recess when Parliament is unable to scrutinise them? With a quarter of a million appointments and operations potentially facing postponement because of the forthcoming strikes, when will the Health Secretary get back around the table with the BMA, this time to take talks seriously to stop the damage to patient care?

[Lord Markham (Con)]

We have taken the talks incredibly seriously. We have proven in other areas with the Agenda for Change unions that, with good will on all sides, we have managed to reach an agreement. I think most people would agree it is not a reasonable position to go in saying that, unless they get a 35% pay increase, they are not willing to have any further talks. That is not something that I believe many of us could support. We are always open to reasonable negotiation, as we have proved in the other cases, and we remain open to having that reasonable negotiation now.

--- Later in debate ---

[Lord Markham (Con)]

As I have mentioned many a time and am happy to mention again, the workforce plan will be announced shortly—soon. I wish I could give an exact date, but it is there. However, I am sorry to say that I do not believe that can be used as an excuse for the strike action that we are talking about now, which puts patients at risk. I know that, in other areas, the Agenda for Change unions have worked constructively with NHS trusts on derogations to protect patients, but I regret to inform the House that that is not the case now. There is lots that we need to do in the workforce space, and there is lots that we want to do around recruitment, motivation and making it a good place to work, but I would like to think that none of that means that the delay of a report is a reason to take this sort of action and put patients’ lives in danger. I do not think any of us would agree that that is a suitable reason.

[Baroness Merron (Lab)]

My Lords, perhaps I could invite the Minister to respond to my first question, building on the points made by the right reverend Prelate. In addition to the NHS workforce plan, which we await, I remind the Minister that we are also waiting for the general practice plan, the review of integrated care services and the social care update. Could the Minister take this repeated opportunity to say whether the Government will be publishing these over the Recess? If this is so, it is obviously of concern that Parliament will not have the chance to scrutinise the plans.

[Lord Markham (Con)]

Like all noble Lords, I absolutely agree that Parliament has to have every opportunity to fully assess, discuss, debate and scrutinise the plans. As noble Lords know, I cannot say when the report will be released, so I cannot say with all honesty whether it will be over the Recess or afterwards. I can only repeat the words “soon” and “shortly”, and say that there is not a definite plan to announce it over the Recess. What we fundamentally agree on is that these plans are being produced with stakeholders and a lot of consultation, and they will absolutely be subject to a lot of scrutiny, as we would expect. I expect to answer on the plans in this House, as I expect my ministerial colleagues in the other place to have to do as well.

Health Education England (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023

Debate between Lord Markham and Baroness Merron

Tuesday 21st March 2023 Lords Chamber

[Lord Markham (Con)]

I think that is probably one element I need to come back to the noble Lord on in writing.

As I said, I will try to follow up the questions in detail. I welcome the contributions of various noble Lords and their understanding of what we are trying to do here. I understand the arguments, as an ex-management consultant, regarding centralisation versus decentralisation and how they go in and out of fashion. This is a slightly different case because it is about bringing a core function in house. To me, that is the key change and the key thing we will be seeking to measure. As well as setting out clinical needs, the key role of the NHS at its centre is making sure that it is recruiting, training and retaining talent to meet the workforce plan needs. On that note, I thank noble Lords for their contributions and hope that my follow-up answers any questions that I missed.

[Baroness Merron (Lab)]

My Lords, I am grateful to the Minister for his response, and to the noble Lords who have spoken in this debate: the noble Lords, Lord Scriven and Lord Allan, and the noble Baroness, Lady Watkins. I did smile when the noble Baroness gave us an update on the workforce plan, which I am sure was helpful to the Minister, and I also wish her well in her new role.

As the Minister and your Lordships’ House will have equally understood, this is not about the actual steps that are being taken. We have had a useful debate to pull out some aspects, but the regret Motion is about the workforce and, in particular, the failure to have produced a workforce plan. This is not something recent from the last year or so. We have to remind ourselves that this Government have been in government for 13 years, and still we wait. For every day we wait, we lose an opportunity—as noble Lords have said—to plan for the future, as well as to deal with the immediate, and that is what motivated me to put forward this amendment.

We are all in agreement today that a workforce plan has to be for health and social care, which are inextricably linked, and has to not sit on the fence—well, it may; we will see. The plan has to not sit on a shelf but be fully resourced and do the job it is intended to do. We will look forward to holding the Minister to account on that point, as I know he expects.

Regrettably, I do not believe that in this debate the Minister has addressed the shortcomings of the regulations before us. Those shortcomings are somewhat unnecessary, which is a great shame because overall the statutory instrument is one that will be beneficial. It is a shame that we have had to debate it in this fashion. With that, I beg leave to withdraw the amendment.

Medical Devices and Blood Safety and Quality (Fees Amendment) Regulations 2023

Debate between Lord Markham and Baroness Merron

Monday 20th March 2023 Grand Committee

[Baroness Merron (Lab)]

My Lords, I thank the Minister for introducing the SI and the important provisions within it. As my noble friend Lord Jones said, it is an important SI, and we acknowledge the role that the MHRA plays and the need to increase the fees that it charges for regulating medicines and related products.

I appreciate that the Minister said that the MHRA has not increased its fees to this extent since 2016-17, which was in an effort to provide the industry with certainty and stability through the EU exit period and the challenges of the pandemic.

The noble Lord, Lord Allan, asked some questions the responses to which I would also be interested to hear. The consultation process was important, and I am glad that it took place and has guided the SI and its provisions, because the views of relevant stakeholders are key in making sure that we get things in the right place.

There is a clear acknowledgement from noble Lords that the MHRA needs to be financially stable, because it needs to be able to deliver regulatory services that protect and improve patient safety with high-quality, safe, effective and innovative medical products. I certainly welcome the greater clarity that the SI provides on the increased costs of providing quality care in our health services. However, I have a question for the Minister specifically on the SI. Where the increased costs of the fee simply cannot be absorbed by the NHS, which is already facing the worst of crises, could the Minister outline how the Government will ensure that the increase will be accommodated without affecting the stability of NHS finances and without impacting patient care? In other words, how will it be done?

I will make some more general points about the work of the MHRA. Innovative companies in this field often say that a key block to their progress—a key block to getting their work through the MHRA—is the speed, or the lack of speed, with which it can be processed. Can the Minister indicate how he will ensure that the MHRA stays up to speed with the latest advances and is able to process them as quickly as possible?

It would also be helpful to know how the department scrutinises and assesses the work of the MHRA. For example, what is the formal matrix for success and the speed at which it processes new devices? How well does the MHRA communicate with other organisations in the sector? What engagement does the department have with the MHRA, both to hold it to account and to improve its practices?

In drawing my more general points to a close, I note and welcome the recent announcement of the extra £10 million of funding for the MHRA. Can the Minister outline the blocks to quick approval to which this money will be targeted? How will the impact of this additional money be measured, and is it sufficient to deliver the service we need to ensure that UK patients have faster access to the most cutting-edge medical products in the world? As part of the additional money, the Chancellor announced last week that treatments already approved by “trusted” regulators internationally would be nearly automatically approved. Which countries are counted as “trusted”? Has an impact assessment been carried out for this change and, if so, can it be published?

We are always looking forward and looking to make further strides in patient safety, it is certainly my opinion that this statutory instrument takes us further along this route, and we welcome it.

[Lord Markham (Con)]

I thank noble Lords for their contributions today and, as ever, will try to reply and follow up in writing where necessary. I shall try to take them in order, for ease. The noble Lord, Lord Jones, asked who is working on the bloods, for want of a better word. We have qualified professionals who are working to WHO standards, such as phlebotomists. Related to this was the question of who is in receipt of these fees. It is twofold. Obviously, a lot of fees go to fund MHRA itself, but a lot of the cost base is when it is hiring in subject-matter experts. In that case, they get the fees.

The general point raised by all noble Lords was the basis of this. As I said, it is a cost-recovery model. There are swings and roundabouts there, but it has tried to ensure that where there are bigger increases, it is only because that is the legitimate cost, but on average it comes to about 12% to 13%. I think that we would all accept that, for something that has not increased since 2016-17, that is reasonable. It is quite a bit behind inflation. That notwithstanding, I am very alive to the impact on SMEs, having been, as I said, in a similar space myself in the past. There are easements and waivers that can be applied, if that is the case.

To the general point about how we are trying to keep up with the speed of advances in the industry, it is very much the understanding that the industry is providing a service. Of course, safety must always be paramount, but it is a service to bring in innovation and attract new people into the sector. It has a transformation programme to ensure speedy replies—but I was pleased to hear that it is also looking to introduce a consulting service to help companies get into the field. That will be different from the regulatory side—obviously, we need a Chinese wall between the two. But it is recognised, especially for a small company, which does not have a regulatory team in place, that being guided and hand-held through the process, and having someone to tell them that this is what they need to do to get in, is very important. That is something that it is committed to doing.

As for holding the MHRA to account, to be candid, I see that very much as my job. That is obviously for officials as well, but I have the brief for the ALBs, and I set up regular meetings with them. As I said, I am very much alive to the fact that that is needed to make sure that it really is serving the industry properly. Part of holding it to account is about making sure that it is providing a decent service level. That is something that I will look for it to carry on doing. Consultation is useful as a formal process, but it should always talk to its customers and get that sort of feedback.

I have to fess up that I probably cannot answer some of the nerdy questions right now, particularly on the reclassification of the agency. I will have to phone a friend or get my colleagues to reply on that point. Likewise, I think we would all agree that the extra £10 million is welcome in this space. How the MHRA will go about that distribution and how it will measure that effectiveness is something I will follow up in the detailed letter that I will send.

Similarly, on which countries are counted as “trusted”, my understanding is that often the MHRA looks at the processes that are in place—again, I will come back in detail on this. Rather than a country being trusted, per se, it is more about the scrutiny process that it undertook. Obviously a regulator would be accepted as good in a place, but again, I have some personal experience. If you can see that the CDC or the FDA has gone through a very similar process, does it really make sense to do that all again? Clearly, it is felt that I have not quite answered the question—but I mentioned the waivers.

At this point, I hope I have covered most of the questions that I can right now, but I will follow up in detail. I appreciate that noble Lords are generally supportive of what we are trying to do here, and that we all agree that the MHRA has an important part to play and that the cost recovery is a reasonable approach, particularly with some of the price increases in recent years. As I said, I will happily follow up in writing. On that, I commend the regulations to the Committee.

Patient Deaths: Ambulance Waiting Times

Debate between Lord Markham and Baroness Merron

Tuesday 14th March 2023 Lords Chamber

[Baroness Merron]

To ask His Majesty’s Government what assessment they have made of reports that over 500 seriously ill patients died in England last year after long waits for an ambulance; and what steps they are taking in response.

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

We recognise the pressures facing the NHS and the need to recover performance following the impact of the pandemic. We are working hard to make sure that no one waits longer than necessary, given how important response times are for patient care and outcomes. We are backing the NHS to meet these challenges and our emergency care plan will deliver one of the fastest and longest-sustained improvements in waiting times in history, backed by £1 billion in funding and up to 800 new ambulances.

[Baroness Merron (Lab)]

My Lords, it is alarming that last year, the number of deaths of patients waiting for an ambulance for up to 15 hours more than doubled from the previous year. What action will the Government urgently take, co-ordinated across the whole of health and social care services, to reverse this tragic tide? Can the Minister also explain the lack of a government plan over the years for getting to hospital in time those who have had a stroke or a heart attack, whose breathing has stopped, or who have been in an accident?

[Lord Markham (Con)]

I thank the noble Baroness for that question. As I said, we are providing 800 new ambulances, but there is a flow issue, as she rightly points out. To resolve the issue at the back end, so to speak, £500 million will be provided for new adult social care places, which is a vital part of unblocking 13% of the beds that are blocked and creating space throughout the system. At the same time, providing ambulance hubs will create offloading space so that ambulances can quickly get back on the road again. These are all key aspects. Fortunately, we are starting to see an improvement but there is a lot more that needs to be done.

Communications Act 2003 (Restrictions on the Advertising of Less Healthy Food) (Effective Date) (Amendment) Regulations 2022

Debate between Lord Markham and Baroness Merron

Monday 27th February 2023 Lords Chamber

[Baroness Merron (Lab)]

My Lords, the Children’s Minister recently admitted that the nation had a problem with childhood obesity that should not be ignored. I am sure that noble Lords who have spoken today, and I am grateful to them, will share that view, not least because children with obesity are five times more likely to become adults with obesity, increasing the risk of developing conditions including type 2 diabetes, cancer and heart and liver disease. This is an extremely serious and pressing matter, as the Minister has been reminded yet again.

Two in five children in England are above healthy weight when they leave primary school and we now see the fastest increase in childhood obesity on record, as my noble friend Lord Brooke highlighted in his remarks. But it gets worse. Children starting school in the most deprived areas are three times as likely to be severely obese as those in the wealthiest, while NHS data shows that almost half of boys in England’s poorest areas are overweight or obese when they leave primary school. Last year, there were 3,400 severely obese children aged four or five in the most deprived parts of the country, as compared with 630 in the richest. So will the Minister give some indication as to what account is being taken of this great disparity between those who have more and those who have less in the Levelling-up and Regeneration Bill currently being considered in your Lordships’ House?

As we have heard today, it is absolutely right that we make informed choices about what we eat and drink, but choice can only really be choice if there is no distortion, and if those who are making the decisions have all the information they need and are able to interpret it. As the noble Baroness, Lady Bull, said, we actually need an integrated health approach to tackle the complexities of achieving a healthy weight. So the question for the Minister that has run throughout this debate is: how will the statutory instrument support this integrated health approach to tackle the complexities we know we have?

In the Government’s original analysis, they suggested a watershed on advertising, saying that introducing restrictions to prevent adverts for products high in salt, fat and sugar being shown before 9 pm could lead to 20,000 fewer obese children. I took it that this was, as others have said in the debate today, about shifting the environment, shifting the power of influences, in order to manage the challenges that we all face in supporting our wish to secure good health. So, will the Minister tell your Lordships’ House what will be the change in opportunity to tackle children’s obesity because of this regulation and the change it brings about? I refer in particular to page 33 of the Secondary Legislation Scrutiny Committee report. The noble Baroness, Lady Walmsley, referred to the figures. The report states:

“Analysis conducted to inform the Government’s Impact Assessment of the advertising restrictions found that under current restrictions children were exposed to 2.9 billion less healthy food and drink TV impacts and 11 billion less healthy food and drink impressions online in 2019”.


The committee observes that the effect of the delays means that, presumably, this level of advertising will continue and asks for an explanation as to why this is acceptable given the harms stated. Perhaps the Minister could refer to an answer on this point. The committee also asks for an explanation as to how the Government anticipate that they will still achieve the target of halving childhood obesity by 2030 if various elements of the strategy are delayed. Again, perhaps the Minister can tell your Lordships’ House his view on this.

Of course, there is a difficult balance to strike when seeking to improve public health and also when working with broadcast and online and the advertising industries. The Government have produced a regulation that has been drawn to the attention of the Secondary Legislation Scrutiny Committee once again, and this clearly does not assist the striking of that balance. It is not acceptable that the Explanatory Memorandum is described as “poor”, and that it fails to evaluate the effects on public health and the NHS from this delay. Nor is it acceptable that it fails to explain the use of a different definition from previous legislation. This refers to the unexplained shift from “high-fat, sugar and salt” to “less healthy foods”. The committee rightly asks whether the Government’s intended scope of products that they want to regulations to cover have been changed. Perhaps the Minister could respond on this point.

The SLSC also says that it

“provides insufficient information to gain a clear understanding about the instrument’s policy objective and intended implementation.”

It also says that, worryingly:

“The views of the NHS are not addressed or explained.”


This, I believe, is quite remarkable and suggests a breath-taking lack of engagement with those who should be engaged with. Once again, poor policy-making and poor administration have come together to leave your Lordships’ House unable to properly scrutinise what the Government are doing and why, even though it is the job of your Lordships’ House to do this. Perhaps the Minister could address these points of concern.

The Minister will recall that I have raised many times before the point about his department’s approach to legislation and the criticism that it has attracted. He kindly gave an undertaking that he would look into this with a view of doing better in future. Can the Minister could update the House of progress in this regard? Finally, I hope that the Government will not be diverted from measures that will have an impact on the health and weight of the nation.

[Lord Markham (Con)]

My Lords, I congratulate the noble Lord, Lord Allan—despite his wish to invite people to kick our balls—and the noble Baroness, Lady Merron, for securing the debate to discuss these regulations. I also thank the Secondary Legislation Scrutiny Committee for its report on this, and I thank all noble Lords for their constructive discussion on how to tackle the pressing challenge on obesity. I thank the noble Baroness, Lady Bull, in particular, for her thoughtful contribution showing the complexities of the subject with regard to the impact on eating disorders, as well as obesity.

I like to think that we are all agreed on the scale and the gravity of the issue at hand. Data from the latest child measurement programme, as mentioned by others, shows that 38% of children leaving primary school were either overweight or living with obesity. One in four were living with obesity. This, as we know, is fuelled by the regular overconsumption of food and drink that is high in calories, sugar and fat—or HFSS food and drink for short. As the noble Baroness, Lady Merron, mentioned, we know that being overweight or living with obesity at a young age increases the risk of being overweight as an adult which, in turn, significantly increases the risk of diabetes, coronary heart disease, musculoskeletal issues and certain cancers. This impacts on both the individual’s well-being and wider society. As we all know, it comes at a very high cost. Not only does it cost the NHS £6.5 billion a year in the latest estimates—there is an economic cost estimated to be as much as £58 billion. For all those reasons, this Government are committed to tackling obesity: it is the morally and fiscally responsible thing to do.

GP Appointments

Debate between Lord Markham and Baroness Merron

Thursday 23rd February 2023 Lords Chamber

[Baroness Merron]

To ask His Majesty’s Government what assessment they have made of (1) the impact that the logistical difficulties of getting a GP appointment has on patient outcomes, and (2) the extent to which the needs and choice of individual patients are being met in making healthcare appointments.

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

We recognise that some people have struggled to access timely care from their general practice. We are taking action to expand general practice times to increase the availability of appointments, upgrade practice telephone systems, and publish data about how practices are performing so that patients can make informed choices when registering and commissioners can help the service to improve. In 2022, nine out 10 patients felt that their needs were met at their last general practice appointment.

[Baroness Merron (Lab)]

My Lords, the latest GP Patient Survey shows that more than one in four of those needing an appointment actually avoid making one because it is just too difficult. So does the Minister accept that practices such as being made to ring at 8 am, long phone queues, waiting hours for a call back and no online booking, all stack up more serious problems for the patient and the National Health Service? What are the Government doing to tackle these very basic practices, so that people can get to their GP in a way that suits them?

[Lord Markham (Con)]

Absolutely. One of the things I am very proud to be leading on the NHS side is our whole digital way of addressing access to the health service. This will be fundamental to how people make their hospital appointments and take control of their own health, so it will be the main thing that will help with the 8 am appointments, alongside the increased telephony services and everything else. Just as every walk of life is coming down to being able, at your fingertips, to make appointments and bookings and get your own records, this will also be the case with GP surgeries and I think it will fundamentally change the way that we address our whole health.

Maternity Services

Debate between Lord Markham and Baroness Merron

Thursday 9th February 2023 Lords Chamber

[Lord Markham (Con)]

The figure for the number of midwives has been roughly constant over the last few years at about 23,000. We want to increase that, which is why we have made a commitment to increase the number of graduate places to more than 1,000 each year. This year, as I say, we have 1,200 places, so we are making good progress.

[Baroness Merron (Lab)]

My Lords, there is an almost twofold difference in maternity mortality rates between women from Asian ethnic groups and white women, while black women are now 40% more likely to experience a miscarriage than white women. When will there be a report from the Maternity Disparities Taskforce? Could the Minister confirm that Parliament will have a full opportunity to examine its findings and review the progress that has been made?

[Lord Markham (Con)]

The noble Baroness is quite right to point out those figures, and they are something that none of us is happy with. That is exactly what the Maternity Disparities Taskforce was set up to deal with, so I am happy to make a commitment to talk through with the noble Baroness the progress of that.

Hospitals: Maintenance

Debate between Lord Markham and Baroness Merron

Thursday 9th February 2023 Lords Chamber

[Baroness Merron]

To ask His Majesty’s Government what assessment they have made of the NHS’s Estate Returns Information Collection data, which show that the cost of maintenance work on hospitals in England exceeded £1 billion in 2021–22.

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

Patient and staff safety is our top priority: that is why the Government are providing £12 billion in operational capital to the NHS over the next three years for trusts to maintain and improve the estate. We support the increasing levels of investment by trusts to ensure that facilities are safe and maintained to a high standard.

[Baroness Merron (Lab)]

My Lords, while the cost of replacing crumbling wards and operating theatres soars, only 10 of the 40 proposed hospital construction projects have full planning permission and the National Audit Office is investigating the programme. Can the Minister confirm how many of the 40 promised new hospitals will actually have been built by 2030? Can he also confirm that they really will be hospitals and not extensions or refurbishments?

[Lord Markham (Con)]

Twenty-one outline or full planning permissions have been given, which is totally on track with the target. Clearly, if some of those hospitals are not being built until, say, 2027, there would be no detailed planning permission yet. So those statistics are not representative of the situation, which shows that the programme of planning applications is on track. I am committed, as are my colleagues, to ensuring that we deliver the 40 by 2030.

NHS Staff: Food Banks

Debate between Lord Markham and Baroness Merron

Tuesday 7th February 2023 Lords Chamber

[Baroness Merron (Lab)]

My Lords, a survey by the Cavell Nurses’ Trust found that 14% of nurses and health workers are using food banks to feed themselves and their families, and nearly 70% are either unprepared or very unprepared for a financial emergency. What assessment have the Government made of the effect this is having on the health and well-being of staff? Does the Minister feel that this ought to provide a greater incentive to the Government to resolve the long- running pay dispute?

[Lord Markham (Con)]

That is a concern; we want to resolve the pay dispute. I know personally how much time and energy are being put into this from our side as well. Clearly, more needs to be done. We are not there yet, but I am hopeful that we will get there. At the same time, we did try to protect those on the lowest incomes, as I mentioned earlier. Everyone received a minimum of £1,400, which is 9.3%. Clearly, we will need to do more for the next year, but we are trying to protect those in the most difficult circumstances.

Mental Health Act Reform

Debate between Lord Markham and Baroness Merron

Thursday 26th January 2023 Lords Chamber

[Baroness Merron (Lab)]

I congratulate the Joint Committee on its excellent work and refer to a report in the Times yesterday that the Government have written to universities to ask them to limit the number of medical school places they offer or risk fines. Can the Minister shed any light on what I regard as a baffling move? Can he explain to the House how the Government will address the concerns of the Joint Committee about getting the right workforce in place if they are planning to reduce the number of doctors in training?

[Lord Markham (Con)]

Again, I agree that workforce is key to this. I am not aware of the report; I will look it up. I am somewhat surprised, because I know that we all accept that we need to invest in this space to recruit doctors, nurses and mental health professionals.

PPE Expenditure

Debate between Lord Markham and Baroness Merron

Wednesday 25th January 2023 Lords Chamber

[Lord Markham (Con)]

As I mentioned before, the daily cost is roughly £700,000.

[Baroness Merron (Lab)]

My Lords, the National Audit Office found that during the pandemic one in 10 suppliers processed through the VIP lane were awarded contracts. This compared to less than one in 100 suppliers going through the ordinary lane. In view of this, could the Minister share with the House what particular qualities were required of suppliers to merit VIP status? Following up on his answer to my noble friend Lord Harris, in the event of a future emergency, was the Minister ruling out having a VIP lane?

[Lord Markham (Con)]

I think we all agree that, at the time, some mechanism was needed to sift the thousands upon thousands of offers of goodwill to help with PPE. A decision was made to take recommendations —the so-called VIP lane—and I think we all accept now that was not the right decision. Going forward, a different sifting mechanism would be set up in place of that. Now, of course, we have supply chains set up to do this, so we hope that occasion will not arise in future.

Osteoporosis: Early Detection

Debate between Lord Markham and Baroness Merron

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

As I mentioned earlier, this is the responsibility of all the ICBs. Part of my job is making sure that we as Ministers now regularly communicate with all the ICBs. There are a number of boards that I regularly speak to, check in with and visit on a frequent basis, and one of our checkpoints is making sure that they are on top of services such as these. I am delighted to say that every ICB has now set up a community base fall service, to make sure that if someone should fall in a case such as these, rather than an ambulance and two paramedics, we can have someone specially set up to right these people, put them on their feet and avoid an A&E visit.

[Baroness Merron (Lab)]

My Lords, the UK primary care base trial on screening for osteoporosis in older people examined a systematic approach to identifying older women for fracture prevention, leading to a 28% reduction in hip fracture risk, significantly reducing costs and seeing increased adherence to treatment. What plans are there to extend and learn from this important study?

[Lord Markham (Con)]

I thank the noble Baroness for bringing this to my attention. Clearly a 28% reduction is impressive and something that we should take seriously. If she can give me the reference, I will definitely take it up and write back.

United Kingdom: Future Pandemics

Debate between Lord Markham and Baroness Merron

Monday 16th January 2023 Lords Chamber

[Baroness Merron]

To ask His Majesty’s Government what assessment they have made of the United Kingdom’s readiness for any future pandemics.

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

My Lords, we cannot perfectly predict the characteristics of a new pandemic pathogen, and therefore pandemic preparedness is an area kept under review. The UK has flexible and well-tested pandemic response capabilities. We are continuously enhancing our preparedness using the latest scientific information, lessons learned from exercises and our response to emergencies, including Covid-19. The UK Health Security Agency maintains constant vigilance on emerging infectious disease threats. This includes co-operating globally to detect and counter future pandemics.

[Baroness Merron (Lab)]

My Lords, Dame Kate Bingham, former chair of the UK Vaccine Taskforce, told the health and science committees in the other place that many of the initiatives set up by the taskforce have been dismantled, that key recommendations have not been acted on, and that the clinical research environment has deteriorated. Does the Minister acknowledge the pressing need to go further than the Government’s targeted spend on research and development, and can he say why the Government have been so reluctant to act on the taskforce’s conclusions from the last pandemic?

[Lord Markham (Con)]

Our approach to this has been led by the science. As the House is aware, we set up the UK Health Security Agency precisely to make sure that we have a team of experts in place ready to answer what is needed, in any eventuality. We also set up the 100 Days Mission to make sure that we have the ability to deploy effective diagnostics, therapeutics and vaccines within 100 days, which is pretty good.

Excess Deaths in Private Homes

Debate between Lord Markham and Baroness Merron

Tuesday 10th January 2023 Lords Chamber

[Baroness Merron]

To ask His Majesty’s Government what is their assessment of the reasons behind ONS figures showing excess deaths in private homes in England and Wales in the week ending 23 December 2022 were 37.5 per cent higher than the five-year average for the same period.

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

My Lords, while the detailed assessment is not yet available, it is likely that a combination of factors has contributed to an increase in the number of deaths at home, including high flu prevalence, the ongoing challenge of Covid-19, and health conditions such as heart disease and diabetes. On 12 January, the Office for Health Improvement and Disparities will update its excess deaths report, providing further insight into causes that have contributed to excess deaths.

[Baroness Merron (Lab)]

My Lords, while a patient may choose to die at home, the spike in home deaths rings considerable alarm bells. Analysis suggests that record ambulance and emergency delays could be the explanation for a significant number of many more sudden deaths that are occurring at home. Can the Minister point to any government analysis, whether published or ongoing, to explain this unexpected increase in home deaths and a potential link with these delays? If there is no such analysis, how will the Government know how to overcome this shocking state of affairs?

[Lord Markham (Con)]

I thank the noble Baroness. This is an important question, and I had the opportunity to speak to Sir Chris Whitty on this very subject this morning. The statistics show that, over the course of the year, home deaths have increased by about 22%—a lot of that through personal choice, because it was happening over the summer and earlier in the year. Sir Chris told me that a lot of factors are in play at the moment. Flu is a clear example. There were about 1,000 more deaths in the week mentioned than would normally be expected. The cold snap came early, creating more cardiovascular deaths. However, clearly, the challenges are also a component part, which is why we made yesterday’s announcements about the further measures.

Dentists, Dental Care Professionals, Nurses, Nursing Associates and Midwives (International Registrations) Order 2022

Debate between Lord Markham and Baroness Merron

Monday 9th January 2023 Grand Committee

[Baroness Merron (Lab)]

My Lords, I thank the Minister for bringing this order before us. On these Benches, as across your Lordships’ House, these changes are welcomed as sensible and as part of a suite of measures that we will continue to consider. Certainly, the increased flexibility that they bring to the work of the General Dental Council and the Nursing and Midwifery Council by amending the registration and examination processes and procedures so that they are as effective and practical as possible is very welcome. This is about harnessing the capacity and meeting the standards that are needed so that we can ensure that we have the right professionals in place. The noble Lord, Lord Patel, raised important points that I hope the Minister will consider on how the practicalities of this need to be done.

I am grateful to my noble friend Lord Harris, who laid out what the order does but also what it does not do—in our deliberations it is important that we understand that. I noted his comment that there was no ministerial claim that this will solve a workforce crisis, but, as my noble friend Lord Hunt said, we have a challenge in getting a workforce in place to provide the services that we need. In that regard, it is important that we consider the changes today in the current context of the health system in the United Kingdom.

It is important to say that, sadly, in 2021 alone, 2,000 dentists and over 7,000 nurses quit the NHS. There are more than 46,000 empty nursing posts across hospitals, mental health, community care and other services, which means that one in 10 nursing roles is unfilled across the service overall. As we have spoken about many times in your Lordships’ House, the number of NHS dental practices fell by more than 1,200 in the five years before the pandemic, and there are 800 fewer midwives than just three years ago. That is the context in which we are discussing this.

I turn specifically to the order. If, as expected, the GDC begins recouping costs incurred around international registration, including charging applicants more to take the overseas registration exam, could the Minister give an indication of what effect this might have on the number of dentists operating in the UK? I am sure he understands that, given the number of dental deserts that we already face, we cannot afford to lose the capacity of any further dental professionals.

As well as the overseas registration exam, non-EEA dentists also have to go through the performers list validation by experience process to practise here. The Minister will be aware that stakeholders expressed concern about dentists’ PLVEs being disrupted—for example, by being endlessly rearranged or cancelled—and that that is acting as something of a deterrent to working here. Can the Minister confirm whether there is recognition of that difficulty, and whether the department is looking at what needs to be done to make the process as coherent and smoothly run as possible?

In the other place, the Minister of State committed to write further on the breakdown of positive and negative responses to the consultation that was carried out. Can the Minister of State’s response be made available to Members of your Lordships’ House so that we might also better know what stakeholders were thinking when they responded to the consultation on these changes?

The Government’s Explanatory Memorandum states that policy changes that the regulations make following this order

“may potentially impact international applicants and existing registrants with different protected characteristics, particularly with regards to age, sex and race”

but does not provide detail on what that impact might be. Can the Minister offer any insight into this, if the department has correctly forecast what the regulators are planning?

As we have discussed today, the intent of the order is that there will be changes to application processes and so on. Can the Minister indicate what plans there are to review and audit changes to ensure that there is consistency of decision-making, fair treatment of all applicants and the achievement of the right standards?

In conclusion, while we all support the substance of the order, I hope the Minister can give an assurance that its impact and implementation will not be beset with logistical hitches and unforeseen consequences, because we are keen to ensure that changes are made to deliver the right result to get the workforce more into place than it has been hitherto. I look forward to hearing what the Minister has to say about how the order may assist that, if not entirely cure it.

[Lord Markham (Con)]

I thank noble Lords for their contributions to the debate. I shall attempt to answer the questions set. As ever, I will happily follow up in detail afterwards.

I accept the premise that no one believes that this is a silver bullet that answers all the issues around recruitment and workforce needs. At the same time, I think there is a belief that this is one of many things that can, hopefully, help increase access at the end of the day. I reiterate our commitment to independence, in answer to the question from the noble Lord, Lord Hunt. That is fundamental to this issue and, hopefully, something that the noble Lord, Lord Harris, has recognised through this process.

Probably the point I would like to devote most time to is the one about the DCP register. I must admit that it is something I brought up specifically and wanted to go around the houses on. I absolutely understand the issue: are we cutting off our nose to spite our face? On the equivalence argument—our dentists cannot apply overseas—part of that, as it was described to me, was also the feeling that even in the UK our dentists cannot use the DCP route, so to speak, in that they might be a qualified dentist but want to use some other qualifications, rather than be a dentist. So it was felt that there was no consistency there either.

Hospital Beds: Social Care

Debate between Lord Markham and Baroness Merron

Monday 19th December 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness. She is absolutely right that the target of 7,000 beds is a key part of this. All Ministers have been talking about it with every ICB over the last few days to see exactly where they are on the target for both real beds and virtual beds. I will happily provide exact information on the target, but I know that we are making good progress.

[Baroness Merron (Lab)]

My Lords, an estimated one in four hospital beds is occupied by people living with dementia. Many of the admissions would have been avoidable if they had had better community support. Of course, their stay in hospital is typically twice as long as those of other people who are over the age of 65. Does the Minister acknowledge that those dementia patients need to be discharged to a place of their own, or their carer’s, choosing, after a holistic assessment? What steps are the Government taking to ensure that this happens, so that people with dementia do not experience discharges that are inappropriate and unsafe?

[Lord Markham (Con)]

I thank the noble Baroness. We are all seeing different shapes and forms of describing how we need a local care system set up by the integrated care boards that can have an overview of all the needs in their area. That is exactly what we are doing, and exactly what the Patricia Hewitt review is reviewing. It will give advice on how best to do that by looking at the best needs of mental health care patients, or any other kind of patient, to make sure that the proper institutions and places are set up to give them the up-front support so that, as the noble Baroness said, they never need to go to hospital in the first place.

Plastics: Health Research

Debate between Lord Markham and Baroness Merron

Monday 19th December 2022 Lords Chamber

[Lord Markham (Con)]

We have set up a research fund; as I say, £100 million has been spent around plastic waste in the last few years. Again, I have spoken to the chief scientific officers on exactly this, and if there are good research proposals in this space, they are ready to look, assess and commission them if they will be valuable here.

[Baroness Merron (Lab)]

My Lords, air pollution is the largest environmental risk to public health. Can the Minister say what assessment has been made of the contribution to that risk by the burning of plastic in landfill?

[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.

Streptococcus A: Antibiotics

Debate between Lord Markham and Baroness Merron

Thursday 15th December 2022 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend and will take this opportunity to offer that public health advice. A rash, which is often the first sign of a bacterial infection in this case, or a child being floppy, drowsy or dehydrated are all key signs that they should urgently seek medical help. People can call 111 or 999 and be guided through the triaging process to make sure that they get help quickly. At the same time, medics have been told to lower the barrier for prescribing, so to speak, so that they can make sure that people get it early. Although every death is a tragedy, we are clearly now seeing some reduction in the death rate, which is welcome.

[Baroness Merron (Lab)]

My Lords, while many pharmacies are being forced to sell the antibiotics they can get their hands on at a considerable loss, as wholesale prices soar, the Government have been saying that no company should be using this as an opportunity to exploit the NHS. Can the Minister assure the House that the Government have learned from previous mistakes with procurement and are taking measures to ensure that no company profits unduly from the increased demand for medication?

[Lord Markham (Con)]

As I mentioned, no one wants to see profiteering in these sorts of situations. The absolute focus right now is on expanding supply, because that is clearly the first thing you need to do. But you then absolutely need to learn lessons and see that appropriate action is taken against companies doing that.

NHS Industrial Action: Government Preparations

Debate between Lord Markham and Baroness Merron

Tuesday 13th December 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, the Royal College of Nursing and UNISON have said that they are prepared to call off strikes if the Government will negotiate with them seriously regarding pay. So the key question to the Minister is whether his Government will confirm whether they are prepared to do this in order to avoid disruption to patients in the NHS. As today’s devastating King’s Fund report on the state of the NHS, which was commissioned by the Government, so clearly shows, these strikes are not just about pay. Can the Minister give his view on the wider factors that have led to the strikes and give some commentary as to why the Government have not taken preventive action?

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

I thank the noble Baroness. On the other actions, so to speak, we have already met a couple of times with the union and are very happy to meet to talk about other things we can do on terms and conditions. As regards the main element around pay, we are following the results of the independent pay review body, which, as the House will be aware, has been in existence since 1984. Parties from each side have taken its expert advice and followed it, and that is what the Government have done in this situation.

Children in Care: CAMHS Waiting Times

Debate between Lord Markham and Baroness Merron

Monday 5th December 2022 Lords Chamber

[Lord Markham (Con)]

I do not know what contribution it is making to waiting lists. However, I do know that the long-awaited workforce plan—which noble Lords opposite have quite rightly asked me about many times, and I am very glad to say we are now producing it—will include these types of people as well, because they are clearly a very important component of the workforce that we need.

[Baroness Merron (Lab)]

My Lords, care-experienced children and young people are disproportionately affected not only by mental ill-health but by barriers to getting support. Bearing in mind that this group of young people often experience multiple placement moves, which are often far away from home, can the Minister say what work is going on to ensure that services are designed around this specific requirement?

[Lord Markham (Con)]

I thank the noble Baroness. As noble Lords are aware, we think that in-patient care should happen only in the most extreme and serious cases. It is much better to have care in the community and local support around that. That is very much where we are coming from. The response to the independent review of children’s social care, which the DfE is leading, will be published in the new year, and I would be happy to update the noble Baroness when we have those findings.

Invasive Group A Streptococcus and Scarlet Fever

Debate between Lord Markham and Baroness Merron

Monday 5th December 2022 Lords Chamber

[Lord Markham (Con)]

I can probably draw on a personal illustration. In answer to a question a couple of weeks ago, I mentioned how I used 111, and in this case I think the advice would be to use 111. In that instance, I was able to get access to a doctor. On that basis, if the symptoms are there, to take that example, a doctor can arrange for a prescription to be sent to an out-of-hours pharmacy. The most important thing in these circumstances is to get antibiotics quickly. The first thing I would say is to use 111. Obviously, A&E is always there, but a more effective route would be through 111.

[Baroness Merron (Lab)]

My Lords, the Minister and noble Lords will know that parents across the country are deeply worried by this situation. To pick up the point that the Minister has just made about the 111 service, perhaps he can respond to the concerns that have been raised by some medical experts that the NHS’s 111 service is not fit for purpose in effectively identifying and triaging critically ill children.

[Lord Markham (Con)]

All I can say on that is that, clearly, that is not acceptable and we need a situation where it can, and that is why we should have inspectors. If we are using 111 as a backbone service, as we are in this case, it is vital that people are getting proper advice. By the way, I see a lot of that, and it is something that I am personally involved in now, as well as using it digitally—a lot of these things can be done through the use of the apps and so on—but, clearly, we need to make sure the advice people get is sound.

NHS Dental Contract

Debate between Lord Markham and Baroness Merron

Thursday 1st December 2022 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend. We need a 360-degree approach. It is not just about dentists on the ground, although we agree that we need more in the NHS; it is also about healthy eating, water fluoridation, and oral health workers in the family hubs, for which a £300 million budget has just been announced. I agree that we need to take all those actions.

[Baroness Merron (Lab)]

My Lords, following much pressure, including in your Lordships’ House, the Government have promised for next year independently verified workforce forecasts for the number of doctors, nurses and other professionals. Can the Minister confirm that the space to which he has repeatedly referred in this Question will include dentists? If so, can he commit to an assessment within this of the impact of the NHS dental contract on recruitment and retention?

[Lord Markham (Con)]

My understanding is that the staff plan will include dentists, but I will confirm that in writing. I absolutely accept that the contract changes must attract people into the profession. For the dental deserts, we need to encourage, for example, a dentist who has been in practice for eight years to set up a new practice. They are used to being a dentist, but they are not used to raising the money to set up a new clinic in a new area, which is what they need to do. Clearly, that is the sort of support we need if are to tackle the dental desert issue. I am under no illusions as to what needs to be done, and we are working on it.

Food and Feed (Miscellaneous Amendments) Regulations 2022

Debate between Lord Markham and Baroness Merron

Tuesday 29th November 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I thank the Minister for introducing the regulations and the thinking behind them. I accept the assurances that he has given. We on these Benches welcome the regulations, which are about trying to correct the drafting errors and inconsistencies that have inevitably emerged. I say that with no criticism; this is a complex area, and there is a need to tidy up regulations following exit from the European Union.

It is perhaps timely to take this opportunity to praise the work of the Food Standards Agency, and to note that it is one of the strange things about the changes introduced by the Government that Health Ministers now find themselves talking about animal feed. I am sure the Minister is delighted to do so, and I myself have certainly learned a lot today in preparation.

I turn to the regulations. The instrument generally maintains existing regulations and does not introduce new requirements, exactly as the Minister has said. I note that no concerns were raised by the Joint Committee on Statutory Instruments or the Secondary Legislation Scrutiny Committee, so I am sure that is cause for celebration on the Government Benches.

We in this country have a good food safety system, and this SI, as others may do, simply tries to ensure that that continues. The problem is of course that the world did not stop when it came to the implementation period completion day. As paragraph 7.13 of the Explanatory Memorandum tactfully puts it, “certain difficulties” emerge,

“especially in relation to the approval of new, or amendment of currently authorised, substances.”

Could the Minister help by elaborating on the difficulties that are posed and any potential costs? What happens with regard to trade when we operate to different standards from those of our near neighbours? The SI addresses the administrative challenge but does not seek to solve the problem.

Similarly, where the review process is described in paragraph 7.15, it would be helpful if the Minister could clarify the circumstances in which the Food Standards Agency will be required to review the operation and effect of the regulations. If, for example, a new extraction solvent is approved in the EU, does that automatically trigger a review? Will the Food Standards Agency be required to undertake additional processes to deliver on that? If so, has an assessment been done of whether the FSA has the capacity to undertake such duties, or can the Minister advise whether the FSA will be getting additional resources?

There is the issue of the “Do Not Eat” pictograph, which is referenced in paragraph 7.22. This states that we cannot use it because of “uncertainty” over the intellectual property rights applying to the ownership of the picture, which seems a bit strange because there must be similar cases of artwork where such provenance is uncertain. Was it asked whether we could use it, and was any uncertainty flagged up at the time? How much would a licence have cost? It is probably right to say that it seems a strange way to proceed if we cannot agree on joint use of an existing symbol to promote food safety. That suggests some problems on which the Minister may wish to comment.

I want also to reference the need to reinstate powers to extend the transitional period for the trace presence of withdrawn genetically modified organisms. There is considerable interest in genetic modification, as we know, and some concern that rules on imported products are inconsistent with rules governing domestic production. Can the Minister say a little about the scale of the issue? For example, just how much oilseed rape is there with traces of the withdrawn GM products referenced in this case?

If the Minister is not able to answer the detail of the points that I have raised, I will be pleased to hear from him in writing. We from these Benches certainly welcome the statutory instrument, and thank him and his team for their efforts.

[Lord Markham (Con)]

My Lords, it is my duty to close this important debate. Your Lordships perform an essential role in scrutinising the measures we have put forward today, and I thank all noble Lords for their contributions. Let me turn, as best I can, to answering some of the points raised. Where I do not quite succeed, I will gladly follow up in writing.

First, my noble friend Lady McIntosh of Pickering asked for an explanation about the pictograph. My understanding is that it is a picture which does not depend on a specific language to understand it. On what happens regarding the IP rights behind it, my understanding—again, I will confirm this—is that a number of questions were asked as to the ownership of those rights. The IP ownership was unclear, so the process for even trying to license it was not clear. That was the issue at hand, but I will come back with further detail on it.

Turning to the other questions, my noble friend Lady McIntosh asked how the SI will affect the retained EU law Bill. The Food Standards Agency is carefully considering the scope of the powers in the retained EU law Bill and whether they can be used to deliver a better, bespoke British system of food safety. Those will all be part of what we go through in the coming weeks and months.

On the labelling of GM and other foods, there are regulations requiring mandatory measures in the traceability and labelling of GM products. This is seen as necessary to inform a consumer about their choice whether to buy and eat GM food, so that will take place in all these cases. The noble Baroness, Lady Merron, asked about the level. My understanding is that it is a minor trace level, consistent with what exists today, but, again, I will follow up on the detail of that. We have been working with the FSA in these areas, which feels that it is in a position to answer and regulate in this area.

Perhaps my favourite question related to edible insects; I only wish I had known about this before “I’m a Celebrity… Get Me Out of Here!” They are apparently for human consumption. I can write on this if noble Lords let me know whether they would like the Latin or the English version, but they are apparently: the lesser mealworm, the house cricket, the yellow mealworm, the banded or decorated cricket, the bird grasshopper or desert locust, the migratory locust, and the black soldier fly. I will not try to read the Latin out for each of those, but I will happily put them down in writing.

I was asked why this could not be included in the precision breeding Bill. The wider question of the future of precision breeding and gene editing is not considered by this SI and would be a matter for the Secretary of State for Environment, Food and Rural Affairs. For now, the commercial cultivation of gene-edited plants and any food products derived from them will still need to be authorised in accordance with existing GMO rules.

On the question of the noble Baroness, Lady Bakewell of Hardington Mandeville, on safety going forward, as I said, our approach to food safety is and always will be underpinned by three principles: that UK food remains safe and what it says it is; that the high standard of food safety and consumer protection that we enjoy in this country is maintained; and that, following our exit from the EU, a robust and effective regulatory regime is in place, which means that business can continue as normal.

I hope that I have answered the detailed questions. Like the noble Baroness, Lady Merron, I did not expect to need to understand this as part of my brief, but it is part of the rich variety of my job. I thank noble Lords for their questions and their support, generally, for our proposals. To reiterate: these regulations are critical to ensure that the UK consumer continues to enjoy the high standards of safety and quality provided by UK food and feed regulations. This instrument makes no changes to policy or to how food and feed businesses are regulated, and it is limited to necessary amendments to ensure that.

Tobacco Control Plan

Debate between Lord Markham and Baroness Merron

Wednesday 23rd November 2022 Lords Chamber

[Lord Markham (Con)]

I am not aware of those figures, but the general feeling is that the savings to the health system would far outweigh them. I would always err in favour of doing everything we can to reduce smoking, whatever the impact on the tax we raise, because the savings on the health side are far, far greater.

[Baroness Merron (Lab)]

My Lords, despite the Government pledging to explore additional measures to clamp down on the sale of e-cigarettes to under-18s, no plan has yet materialised, while vaping among 11 to 18 year-olds has more than doubled. What assessment have the Government made of this alarming trend, and what action is being considered to keep children and young people away from this gateway to a smoking habit?

[Lord Markham (Con)]

This is a difficult area. On the one hand, I think we all agree that vaping is much better than smoking, so we are trying to get the message out to people to stop smoking and use vaping if need be. At the same time, we do not want vaping to be a gateway, as she says. Giving those mixed messages is never an easy thing to do, which is why we must consider as part of the Khan review the best way to get that message out. The recent Cochrane review shows that vaping is as safe as all other methods of stopping smoking, such as patches, so it should be our key way of stopping smoking.

NHS Waiting Times

Debate between Lord Markham and Baroness Merron

Tuesday 22nd November 2022 Lords Chamber

[Baroness Merron (Lab)]

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

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

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

[Baroness Merron (Lab)]

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

[Lord Markham (Con)]

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

NHS: Waiting Lists and Increased Spending

Debate between Lord Markham and Baroness Merron

Tuesday 22nd November 2022 Lords Chamber

[Lord Markham (Con)]

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

[Baroness Merron (Lab)]

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

[Lord Markham (Con)]

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

Health: Pancreatic Cancer

Debate between Lord Markham and Baroness Merron

Monday 21st November 2022 Lords Chamber

[Lord Markham (Con)]

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

[Baroness Merron (Lab)]

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

[Lord Markham (Con)]

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

GPs: Anti-depressants and Alcohol

Debate between Lord Markham and Baroness Merron

Wednesday 16th November 2022 Lords Chamber

[Lord Markham (Con)]

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

[Baroness Merron (Lab)]

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

[Lord Markham (Con)]

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

NHS: Backlogs

Debate between Lord Markham and Baroness Merron

Wednesday 9th November 2022 Lords Chamber

[Baroness Merron]

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

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

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

[Baroness Merron (Lab)]

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

[Lord Markham (Con)]

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

Ambulance Delays

Debate between Lord Markham and Baroness Merron

Wednesday 9th November 2022 Lords Chamber

[Baroness Merron (Lab)]

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

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

I hope I will get better at this with practice.

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

[Baroness Merron (Lab)]

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

[Lord Markham (Con)]

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

Abuse and Deaths in Secure Mental Health Units

Debate between Lord Markham and Baroness Merron

Wednesday 9th November 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, week after week we return to this Chamber to hear of patients dying when their deaths could have been prevented and patients being bullied, dehumanised and abused, and their medical records falsified, in a scandalous breach of patient safety. This cannot continue. In reflecting that it feels as though it is being left to undercover reporters to expose such terrible failings in patient care, will the Minister action a rapid review of mental health in-patient services? What are the Government doing to ensure that patients’ complaints about their care are being taken seriously?

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

I thank the noble Baroness. I first want to apologise for the failings in the care that Christie Harnett, Nadia Sharif and Emily Moore received. My thoughts, and I am sure the thoughts of this whole House, are with their families and friends. The death of any young person is a tragedy, all the more so when they should have been receiving care and support in a safe place.

The Minister in the Commons is looking much more towards a rapid review rather than a public inquiry, as the feeling is that rapid action is needed. We have seen some good examples of that recently, with Dr Bill Kirkup. It is very much at the top of the agenda and I agree with the noble Baroness; this is the third time I have spoken on similar incidents in the short time I have been here. We clearly need to make sure the proper action is in place to identify these issues.

NHS: Discharge to Assess Policy

Debate between Lord Markham and Baroness Merron

Tuesday 8th November 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, with the permission of my noble friend Lady Wheeler, and on her behalf, I beg leave to ask the Question standing in her name on the Order Paper.

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

It is vital for carers to be involved in critical decisions regarding their loved ones’ care. The Government will publish shortly new statutory discuss charge guidance, which will include the new statutory requirement to involve carers. NHS bodies and local authorities will be able to use that guidance as a resource to support carers from the point of hospital admission through to post-discharge care and support.

[Baroness Merron (Lab)]

My Lords, today’s State of Caring report from Carers UK paints a bleak picture, with one in two carers still not involved or properly listened to over their loved ones’ discharge from hospital. When will the Government live up to the promise of their Health and Care Act to properly involve both patients and carers in moving from hospital to social care? While there is repeated reference from Ministers to the promise of a £500 million adult social care fund, intended to support the discharge process, when will this reach the front line?

[Lord Markham (Con)]

I welcome the Carers UK report that came out today. It has provided much valued information which will be part of the information that we are using as part of the guidance we will be putting out shortly. It has taken some time because we want to get it right. We have involved NHSE, local authorities and carers, and we are using this report and the Carers UK conference that will take place on Thursday as vital inputs to make sure that we get that guidance out properly. As the report rightly states, the fact that 50% are not getting the guidance and support they need clearly shows that more needs to be done in this space. On the £500 million discharge fund, that has now been agreed, and I understand that that will go out very shortly—in a matter of days.

British Heart Foundation: Tipping Point Report

Debate between Lord Markham and Baroness Merron

Tuesday 8th November 2022 Lords Chamber

[Baroness Merron]

To ask His Majesty’s Government what assessment they have made of the report by the British Heart Foundation, Tipping Point, published on 3 November; and what steps they intend to take in response to the finding that from the beginning of the Covid-19 pandemic to August 2022 there were 30,000 excess deaths involving coronary heart disease in England.

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

This is a detailed report that requires time to be fully considered. NHSE has been monitoring excess deaths and has put in place the cardiovascular disease prevention recovery plan. This prioritises support to help systems, including prevention planning, risk-factor diagnosis, monitoring and management, to recover to pre-pandemic levels; it also tracks progress and ensures that interventions are effectively targeted. The plan includes resources to create CVD prevention leadership roles in every integrated care system from April 2022.

[Baroness Merron (Lab)]

My Lords, British Heart Foundation analysis has found that millions of missing heart patients, both diagnosed and undiagnosed, are struggling to get care for conditions such as high blood pressure. At the same time, modelling by NHS England suggests that a decline in blood pressure management could lead to more than 11,000 extra heart attacks and nearly 17,000 additional strokes in the next three years. What are the Government doing to identify and treat these missing patients? How will they address the backlogs in every part of the system, which are affecting time-critical emergency care?

[Lord Markham (Con)]

It is quite right that blood pressure management or hypertension is a key indicator. That is why we have put in place many points when people’s blood pressure can be measured. Anyone who has had a Covid vaccination recently would have had their blood pressure taken. This can now be performed at—

NHS: Nurses

Debate between Lord Markham and Baroness Merron

Tuesday 1st November 2022 Lords Chamber

[Lord Markham (Con)]

The plans are very much those that we are doing, which I believe are successful. As mentioned before, it is not just that the number of nurses has gone up by 29,000; we have seen significant increases in doctors and the other medical professions as well. We should remember that we have 200,000 more people working now within the profession than in 2010. That is not to say that we will rest on our laurels; I completely agree that we need to carry on expanding supply to ensure that we properly meet the demand.

[Baroness Merron (Lab)]

My Lords, given that the Minister has previously stressed that nurses should rely on the vocational appeal of their work for their rewards, how does this square with the reasons that he acknowledged exist as to why a record 40,000 nurses left the NHS in the past year alone?

[Lord Markham (Con)]

I am very aware of the Nuffield figures but that 40,000 includes people who have gone back into other parts of the nursing profession. The actual net number as cited by Nuffield is a 27,000 reduction, which is why we have had the growth. However, we should ensure that it is as attractive a profession as possible for people to work and progress in. That is very much what I would like to see.

Nursing: Recruitment

Debate between Lord Markham and Baroness Merron

Wednesday 26th October 2022 Lords Chamber

[Baroness Merron]

To ask His Majesty’s Government what progress they have made towards meeting their target of recruiting 50,000 extra nurses by 2024.

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

This Government are committed to delivering 50,000 more nurses and putting the NHS on to a sustainable long-term workforce supply. We have set up a comprehensive work programme to improve nurse retention, support return to practice, diversify our training pipeline and ethically recruit nurses internationally. We are over half way towards meeting the commitment, with nursing numbers over 29,000 higher in July 2022—our latest available data point—than the September 2019 starting point for this commitment.

[Baroness Merron (Lab)]

My Lords, recent analysis shows that there are over 50,000 registered nurse vacances across all settings in England alone. What assessment have the Government made of the impact of current vacancy rates on patient safety? What is the Minister’s response to the warning of the Chief Nursing Officer that the Government’s pledge for additional nurses, even if it is reached, will not be enough?

[Lord Markham (Con)]

We appreciate that recruitment is an ongoing process, and while I think the whole House would agree a 29,000 increase is a good record—up 9,000 in the last year alone—we cannot rest on our laurels. Vacancies of 50,000 is partially a function of a full-employment economy, which I think we would all support. We are showing that our recruitment is working and, as I say, we are over half way towards our target of 50,000 more nurses.

Maternity and Neonatal Services

Debate between Lord Markham and Baroness Merron

Tuesday 25th October 2022 Lords Chamber

[Lord Markham (Con)]

Yes.

[Baroness Merron (Lab)]

My Lords, Dr Kirkup’s extraordinary report cites a lack of junior staff and, critically, a shortage of midwifery leadership as contributing to the tragedies at East Kent. In the absence of a comprehensive workforce strategy from the Government, and more midwives leaving than joining, what is being done right now to tackle the considerable number of midwifery vacancies that the NHS is suffering? It currently stands at well over 2,000.

[Lord Markham (Con)]

The number of midwives has been stable over the last four years. We have seen a slight decline over the last year, which is why we have a training and recruitment programme to recruit 1,200 more midwives. In my main point, I echo the comments that Dr Kirkup made: working under pressure is no excuse for staff being rude and aggressive. While we want to recruit the extra numbers, I think that the whole House agrees that there is no excuse for what happened at East Kent.

Childhood Obesity

Debate between Lord Markham and Baroness Merron

Monday 17th October 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, analysis of the national child weight management programme by the Local Government Association has found that not only are the Government heading towards missing their goal of halving child obesity by 2030 but, on current trajectories, childhood obesity is increasing. Do the Government remain committed to their target and if they are, what will they do differently?

[Lord Markham (Con)]

My understanding is that the figures for childhood obesity have been fairly flat for a number of years, apart from for the year of Covid, when they all went up. The year after that, they came down again. To me, that demonstrates the importance of free school meals and the action we are taking there for people to have good, calorific and sensible types of food. We have seen significant reductions in childhood obesity in the last year. To my mind, what is important in all this is the emphasis we are putting on the free school meals programme. We have the highest ever number of people on free school meals, up from 15% in 2015 to 23% today. Part of that is free school meals for all infant schoolchildren, so that we can make sure that their food is as healthy as possible.

NHS: Winter Challenges

Debate between Lord Markham and Baroness Merron

Monday 10th October 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and, before the Minister responds, warmly welcome him to your Lordships’ House and to his ministerial role. I wish him well.

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

I thank the noble Baroness. If I may respond personally first, I am delighted, honoured and privileged to be taking on this role. I look forward to working with all noble Lords and learning from the vast experience and expertise around the Chamber. The Government are aware of the pressures facing the NHS this winter due to potential surges in Covid-19, the return of respiratory conditions and impacts arising from cost of living challenges. The Government are taking a range of actions, including increasing NHS capacity this winter by the equivalent of 7,000 beds and allocating £500 million of funds to speed up the safe discharge of patients from hospital. We will keep the House updated as we progress.

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, NHS Providers reports that 72% of trusts are extremely concerned about the cost of living impacting on their ability to manage winter pressures, tackle care backlogs and meet targets. Can the Minister tell your Lordships’ House what assessment has been made of the impact on health services of the ever-widening gap between the Government’s original assumption of inflation and the spiralling increase and, to protect patients, what will be done about it?

[Lord Markham (Con)]

As I am sure the noble Baroness is aware, we are investing an unprecedented amount of money into the NHS and have recruited more doctors and nurses. We are setting up 7,000 new beds to cope with it all. At the same time, I accept that we are in a period of unprecedented challenge from not just the cost of living crisis but the effects of Covid and the likely impact of flu this year. That is why I very much see our role as making sure that that record level of investment is used to the best effect and that we drive performance across the NHS. I am sure we all have lots of examples of brilliant services and examples of where more needs to be done, candidly. My role in this, as someone with a background of business experience, is to try to take those areas of best practice that I have seen in some of the hospitals I have already visited and make sure they are allocated across the whole NHS.

Health and Social Care Update

Debate between Lord Markham and Baroness Merron

Monday 10th October 2022 Lords Chamber

[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.

[Baroness Merron (Lab)]

My Lords, I appreciate the answers that the Minister has given your Lordships’ House, but would he be good enough to write to address a number of the more detailed questions raised and give the information requested?