Domestic Violence and Brain Injury

Debate between Lord Markham and Baroness Walmsley

Monday 23rd October 2023 Lords Chamber

[Lord Markham (Con)]

Yes, on both counts. Unfortunately, domestic violence is something that affects all sorts of people from all sorts of backgrounds and minorities. About 5.7% of women and 3% of men, and a lot of children, are thought to suffer domestic violence. I am absolutely happy to give that undertaking.

[Baroness Walmsley (LD)]

My Lords, the Minister has clearly noticed the care taken by both players and officials during the Rugby World Cup to avoid head injury. However, there is no referee on behalf of women suffering brain injury during domestic violence. Will the Government support training programmes, such as those run by Headway, for professionals dealing with survivors and victims, and ensure that that training is extended to the police? Will they ensure that, at the end of those programmes, the trainees have resources to which to signpost victims?

[Lord Markham (Con)]

The noble Baroness is correct. We need to make sure that all our front-line services are trained to identify potential brain injuries—that is A&E, GP surgeries, the police and schools. There is already a programme in schools for children affected by domestic violence. We have also made sure that every ICB has to appoint a domestic violence and sexual abuse lead, so that they can identify these sorts of issues.

Nursing Courses: Reduction in Applications

Debate between Lord Markham and Baroness Walmsley

Tuesday 19th September 2023 Lords Chamber

[Lord Markham (Con)]

Absolutely. We are trying to adopt a modular approach so that you can have units that can build towards getting in there. For people who go into social care, for instance, there is a modular unit that can add towards going into nursing later on. That is a means of attracting people to nursing by having more routes in and making a career such as social care attractive in terms of career progression.

[Baroness Walmsley (LD)]

My Lords, the noble Lord, Lord Hunt, mentioned the attrition rate among student nurses, but I understand that the attrition rate among student mental health nurses is even greater. That is a particularly challenging specialist course, and one of the problems is that very often the clinical placements are a long way from where the student nurse lives. Is there any programme of support available to make sure that we do not lose the student nurses who undertake this very challenging route to nursing?

[Lord Markham (Con)]

The noble Baroness is quite correct that mental health is a particular case in point. When we introduced the £5,000 grant for all nurses each year, we gave additional add-ons, and mental health nurses get an add-on in addition to that £5,000 a year. We also increased the travel and accommodation costs allowance by 50% to cater for those who have to travel far and wide.

Children’s Health: Sugar

Debate between Lord Markham and Baroness Walmsley

Tuesday 12th September 2023 Lords Chamber

[Lord Markham (Con)]

The noble Lord is correct; that has been a success story. Overall, we have seen a 46% reduction of sugar, while at the same time sales of drinks in that category have gone up by 21%—that is 60%-plus if you combine the two. We are now looking at other moves that can help. The movement of product positioning to remove the so-called “pester power” is a key step forward in this. Of all the modelling that has been done, that is the thing that it is thought will reduce calories by the most—by 96%. That is the current focus; it has been in place for almost a year and early evidence is that it is working, but as ever we must keep everything under review.

[Baroness Walmsley (LD)]

My Lords, for the 4 million children in food poverty, the quality of their school lunch is crucial to their health and development. But the school food standard has not been reviewed since 2014, and nobody checks whether schools are adhering to it anyway. With so many children going hungry, is it not time that the standard of school food was brought up to date with the latest research on the impact of sugar and other nutrients?

[Lord Markham (Con)]

The noble Baroness is absolutely correct. What we give children in schools is a key thing that the Government can affect. That is why I am delighted that the level of free school meals, at 33%, is the highest on record, making sure that they have good nutritious food. But the noble Baroness is correct: there was a review taking place in 2019, which was one of the casualties of Covid. I know that it is now one of the things that we are thinking, as we recover from Covid, that we need to look at again.

Folic Acid Fortification

Debate between Lord Markham and Baroness Walmsley

Tuesday 25th July 2023 Lords Chamber

[Lord Markham (Con)]

As I have said, there are complications. The MHRA, for instance, has raised concerns about the side-effects of certain folic acid levels in respect of anti-epilepsy drugs. We are going through various medical areas and checking that we do not have unintended consequences, and these are some of the issues that have been taking time to deal with. I am not trying to give excuses, but to allow noble Lords to understand some of the complexities involved. As I have mentioned, the plan is very much to lay legislation in early 2024. We then have to give notice periods to the EU and the World Trade Organization, so, in order to achieve complete transparency for noble Lords, I am afraid there will be a two-year implementation timeframe from then. But rest assured that I will be pushing hard on this.

[Baroness Walmsley (LD)]

My Lords, we have heard that there are millions of products, but also that some manufacturers have implemented this policy voluntarily. Industry has had years of notice that this is going to happen. Surely it is for the Government to legislate and industry to comply.

[Lord Markham (Con)]

Yes, and as I have said, a lot of companies are doing that. What we are really talking about is a backstop for “edge” products that are not fast-moving. There are a lot of products out there already, so relabelling takes some time. I would hope and expect to see most of this implemented pretty quickly, as soon as we get into the new year.

As I am out of time and this will probably be the last thing I say, I wish everyone a happy Summer Recess.

Respiratory Syncytial Virus

Debate between Lord Markham and Baroness Walmsley

Tuesday 25th July 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness. The issue is that the current jab, palivizumab, is very expensive and lasts for only one month at a time, so it is logistically quite difficult. Promisingly, a new jab, nirsevimab, has just been agreed by the JCVI. It offers six months’ protection, is more effective and is lower in cost, so that is the one we are looking to roll out to more people. At the same time, there is a promising Pfizer jab which can be given to mothers. There are good new vaccines coming along; the issue is whether they are going to be licensed in time for us to be able to use them this winter.

[Baroness Walmsley (LD)]

When immunisation is rolled out, will there be a public information programme to ensure a high level of uptake among people who are eligible for it? In the meantime, in the absence of a test, what advice is being given to people who believe they may have RSV? Should they go to their local pharmacist or to their GP?

[Lord Markham (Con)]

It depends on the type of jab. For instance, the maternal jab can be given to the mother as part of her prenatal check-ups. Either way, if it is for her or for the baby, there will be an education campaign. The other at-risk group is, as I am sure the noble Baroness knows, the over-75s. We are looking at a targeted programme for them as well, which they can go to their GP to find out about.

Food: Two-For-One Offers

Debate between Lord Markham and Baroness Walmsley

Wednesday 19th July 2023 Lords Chamber

[Baroness Walmsley]

To ask His Majesty’s Government on the basis of what health evidence, if any, they have postponed the planned ban on two-for-one offers for foods high in fat, salt and sugar.

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

The volume price promotion restrictions have been delayed for two years while we prioritise the implementation of the location restrictions. This is the most impactful policy for reducing children’s calorie consumption, and accounts for 96% of the expected health benefits of the promotions policy. Kantar data suggests that it is working. The evidence suggests that this will have the biggest impact on tackling obesity.

[Baroness Walmsley (LD)]

I thank the Minister for his reply, but according to the Food Foundation’s most recent Broken Plate report, the most deprived 20% of families would have to spend half of their disposable income on food to comply with the Government’s healthy diet advice. Bearing that in mind, why are the Government continuing to allow retailers to sell HFSS foods, which can make people ill, at a discount? Do the government really want to encourage people to buy cheap food that could, in the end, kill them?

[Lord Markham (Con)]

First, I thank the noble Baroness for her tireless work in this space. I think we have shown that our restrictions are absolutely placed to inform and educate people so that they can have a healthy diet. I mentioned what we have done on location—the so-called pester power avoidance. It is estimated that these measures will reduce calorific intake by 96%. That is the prize that we are looking at here.

NHS National Health Inequalities Improvement Programme

Debate between Lord Markham and Baroness Walmsley

Thursday 25th May 2023 Lords Chamber

[Lord Markham (Con)]

First, I wish my noble friend a happy birthday. I totally support her question. The most important thing with regard to inequalities—funnily enough, this was the answer to an earlier question—is the use of free school meals. I think we can all welcome the fact that 37.5% of children now receive free school meals and therefore a nutritious start to life. Clearly, that is the best way to make sure that children, particularly those with potential inequalities, are getting a healthy start in life, as well as the under-fours clubs to make sure that they get healthy food.

[Baroness Walmsley (LD)]

My Lords, according to Henry Dimbleby, the Government’s public food procurement system is dominated by a few very large corporations, creating little incentive for innovation or improvement. Can the Minister give us an update on the trials in south-west England, in which small, local, high-quality food suppliers can get into public procurement—for example, to schools and hospitals? I understand that early evidence reports better quality and choice at no increased cost.

[Lord Kamall (Con)]

My Lords—

Childbirth: Black Women

Debate between Lord Markham and Baroness Walmsley

Wednesday 3rd May 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend is right. I was speaking to Minister Caulfield about this very subject this morning. She pointed out that a lot of the reasons for the differences are underlying health conditions and factors such as smoking, weight and alcohol consumption, as well as diabetes. Education is a key part of this, as is continuity of care, and making sure that there is prenatal and postnatal care is absolutely a focus.

[Baroness Walmsley (LD)]

My Lords, the NHS published equity and equality guidance in September 2021 aimed at improving maternal health for mothers and babies from black and other ethnic groups and those from the most deprived areas. However, no implementation plan or scrutiny mechanism has been developed, so how will implementation and adherence to these strategies and guidelines be assured? Who will report on progress, or the lack of it?

[Lord Markham (Con)]

First, through its local maternity and neonatal systems, every ICB is responsible for publishing an equity and equality plan. It will then be the job of both the CQC and the maternity surveillance system to measure them against that plan and make sure it is being kept up. Every area is different, but each needs a plan to address this issue.

Patient Deaths: Ambulance Waiting Times

Debate between Lord Markham and Baroness Walmsley

Tuesday 14th March 2023 Lords Chamber

[Lord Markham (Con)]

I am convinced that the ICS will make the best decisions for that area. I am very familiar with Sir Jim Mackey’s plans, which advocate setting up so-called hot and cold sites. It is often better to specialise in A&E in one area and “cold” elective treatments in another, in order to have more efficient treatment in both. I imagine that is very much part of the plan, which will see improvements in both A&E and elective services.

[Baroness Walmsley (LD)]

My Lords, may I ask about dissemination of good practice? Some trusts are improving ambulance response times but others are not. I accept that they are working in different geographies with different demographics, and have different A&E capacity in each area, but how are the Government making sure that proven best practice is being disseminated across the country?

[Lord Markham (Con)]

The noble Baroness is absolutely correct. Some 50% of all wait times—I have used this statistic before and I will correct it if I have not got it exactly right—come from I think 20 trusts. Clearly, there is a focus on working on those areas. That is starting to bear fruit, with each of those trusts having specific plans to ensure that they use best practice. We have tried to pick the best practitioners in an area— I have done this on two occasions recently—and bring them into the centre to help us advise across the board. That really is making a difference.

Bread and Flour Regulations 1988

Debate between Lord Markham and Baroness Walmsley

Tuesday 7th February 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord, who has been a tireless campaigner on this issue. Again, a benefit of this position is getting to learn new subjects, and this is one of them. I can see why he campaigns so hard on it. I am delighted to say that we are getting there, albeit that it could be argued that maybe it could be quicker. At the same time, industry is seeing that, and the good news is that it is already adjusting. The majority of breakfast cereals are now fortified and a lot of the rest of the industry is responding. We are making a difference, and I thank the noble Lord again for his campaigning.

[Baroness Walmsley (LD)]

My Lords, does the Minister consider that too low a dose would leave people believing that fortification does not work? Is he aware that the Royal College of Obstetricians and Gynaecologists believes that the proposed level of folic acid fortification will prevent only about 20% of neural tube defects? It recommends that fortification be set at a level that is sufficient to prevent four out of five neural tube defects, which is 1 milligram per 100 grams. Will the Minister consider that?

[Lord Markham (Con)]

I am very aware of the range of scientific advice on this. I am also aware that the official results of the consultation, which will come out, are not clear cut. A sizeable number of people, 40%, are anti-fortification. As ever, it is about trying to get that balance right. We completely agree on the direction of travel. There is some scientific advice that at too high a level there is a potential masking of pernicious anaemia in the elderly. This is the first step. Let us get all the evidence. The critical thing is getting that first step right.

PPE Expenditure

Debate between Lord Markham and Baroness Walmsley

Wednesday 25th January 2023 Lords Chamber

[Lord Markham (Con)]

Absolutely. As ever, we want to learn the lessons. That is why we have set up the Covid inquiry. Yes, supply arrangements are in place. At the same time, as per the answer to the previous question, holding high levels of stock does not make sense. It is cheaper in this case to dispose of it while making sure that the supply lines are in place so that we can rapidly respond to any future event.

[Baroness Walmsley (LD)]

My Lords, I understand from the Minister that it is the department that paid the cost of this useless material, and for its storage. How many doctors, nurses and ambulance staff could be given a decent pay rise if that money had been given to the NHS?

[Lord Markham (Con)]

Again, I would take issue with the words “useless material”. It was bought based on a projection of how the pandemic could progress and what would be required. The fact that it did not progress that far was thanks a lot to the work we did in being the quickest country to vaccinate in the world. So, we did not need that level of PPE; that was a good thing. We bought for a worst-case scenario and, thank goodness, we did not require it because of the action we took to get on top of it all. Now, we are dealing with the surpluses bought for that worst-case scenario and quickly disposing of them.

Respiratory Syncytial Virus

Debate between Lord Markham and Baroness Walmsley

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend is correct in that, for the vast majority of people—infants in this case—it is mild, flu-like symptoms at most. At the same time, it is responsible for 35,000 hospitalisations and 20 to 30 deaths a year, so it is a serious thing that we need to get on top of. We are looking for the best of both worlds. That 90% of two year-olds will have had RSV and so will have that natural protection is a good thing. But in the most serious cases—the risk groups are those with congenital lung or heart disease or spinal muscular problems—these new treatments really will help and are very important.

[Baroness Walmsley (LD)]

My Lords, the innovative vaccines and treatments mentioned by the noble Lord, Lord Patel, all require UK clinical trials. The number of clinical trials initiated in the UK declined by 4% between 2017 and 2021. What are the Government doing to reverse this decline so as to bring valuable industry money back into the NHS and cutting-edge treatments, such as RSV vaccines and treatments, to patients?

[Lord Markham (Con)]

The noble Baroness is correct. In fact, my maiden speech was in a debate about how we can bring life sciences to bear more. The point about NHS clinical trials and the fact that we are not using this massive potential asset was very much a feature of that. It is key to the work we are doing—I had a meeting on it just this week—so I agree with the noble Baroness and hope we will see improvements in this space.

Nursing: Recruitment

Debate between Lord Markham and Baroness Walmsley

Wednesday 26th October 2022 Lords Chamber

[Lord Markham (Con)]

Indeed, and towards that aim we have set up the nursing associate role, which is a stepping-stone to allow people to ease in and have qualifications on the way to becoming a fully trained nurse. The overall point I make, as before, is that by putting in a £5,000-a-year grant for student nurses, we are recruiting the numbers. I reiterate that 72,000 is a big pipeline but also that it is an uncapped pipeline. The more we can attract, the merrier—whether domestically or, as in the fine tradition of the NHS, from overseas sources.

[Baroness Walmsley (LD)]

My Lords, is the Minister aware that the percentage of nurse vacancies is much higher in community care than in any other part of the sector? What is the department doing to ensure not only that we have enough nurses but that they are in the right places?

[Lord Markham (Con)]

That is an excellent point. One thing I probably should have said is that the number of 36,000 leavers includes people who have left NHS trusts and gone into community care, working in GP surgeries. We do not catch that number who come back in again, so the real number is less than 36,000, but the basic premise of the question—making sure we are attracting nurses to the right place—is absolutely the right one. I believe that is the plan in place, but I will check on that and make sure we are doing as requested.

Health and Social Care Update

Debate between Lord Markham and Baroness Walmsley

Monday 10th October 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness, Lady Finlay, for those excellent points. I have to declare a further interest: my wife is not only a dentist, she is a dentist originally from the Dominican Republic who practised in Spain for 20 years before coming here. So many of the excellent points the noble Baroness made are well recognised here. I am in the market for good ideas, so I will meet with the noble Baroness with pleasure to understand and discuss some of the ideas she spoke about.

[Baroness Walmsley (LD)]

My Lords, the health service is suffering from inflation in the same way as the rest of us. Julian Kelly, NHS England’s chief finance officer, told the board recently that it will have to find £20 billion in efficiency savings over the next three years because of the increased cost of goods and services that it buys. He said that

“clearly you have to completely revisit investment in cancer and mental health, primary care … diagnostic capacity and you would have to look at what it meant in total for what the NHS could deliver.”

With that situation, could the Minister say how on earth we are going to deliver the plan for patients?

[Lord Markham (Con)]

As I mentioned earlier, yes, there are inflationary pressures, but as a percentage of our national wealth—our GDP—we are investing more than ever before, at around 12%. That level is very high compared with most other OECD countries. So, the investment and the staffing are there. I think the correct challenge, which I have heard from a number of Members today, is whether we are getting the best performance out of that money and investment. Again, that is very much where I have been brought in—to make sure that we are taking those areas that are performing well and disseminating that good practice. That is where I would like to focus my attention, to make sure that we really are getting the maximum output possible from this record level of investment.