Inflammatory Bowel Disease

Debate between Lord Markham and Lord Kamall

Monday 20th May 2024 Lords Chamber

[Lord Markham (Con)]

The Getting It Right pathway was very much informed from that best practice around the world and, in the last year, NICE has approved four new drug treatments. We are trying to look at the best medicines around the world. One of them, risankizumab, has resulted in a 44% reduction in the disease—so, yes, we are trying to learn from the best in the world.

[Lord Kamall (Con)]

My Lords, the noble Lord, Lord Hunt, asked about awareness. We know that certain communities are vaccine hesitant or less aware of some of the conditions and less likely to come forward. What lessons have been learned from some of the other programmes? Are there communities that are underrepresented for this? What efforts have been made to learn from other programmes to make sure that those communities come forward?

[Lord Markham (Con)]

First off, it is trying to learn the lessons: the best parallel that I have so far is around the bowel cancer screening and that faecal screening programme. The real thing here is the difference between the 10% of the population who suffer from irritable bowel syndrome, a lot of which is diet-based in terms of the cure, and the 1% which really is serious in terms of inflammatory bowel disease. That is where we need the education and awareness.

Immunisation: Children

Debate between Lord Markham and Lord Kamall

Wednesday 8th May 2024 Lords Chamber

[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.

[Lord Kamall (Con)]

My Lords, the right reverend Prelate rightly spoke about the role of faith communities in reaching those hard-to-reach communities. I know that my noble friend the Minister has answered these questions previously, but I wonder what lessons the department has learned from previous vaccination campaigns—Covid, MMR, et cetera—to make sure that the initiatives it is using to reach those hard-to-reach communities are more effective.

[Lord Markham (Con)]

It really is about having the whole toolkit. Clearly, it is about making sure that we are using communications in 15 different languages. It is about the outreach groups and, particularly, the catch-up programmes. We have been doing one for 17 to 25 year-olds for polio and MMR. It is about all those strategies and the pop-up clinics, so that it is very easy to catch people in places that are convenient for them.

NHS: Dementia Commission Report

Debate between Lord Markham and Lord Kamall

Thursday 22nd February 2024 Lords Chamber

[Lord Markham (Con)]

As ever, my colleague the noble Lord is correct. The blood biomarkers are central to this. We have set up the NIHR biomarker challenge to try to understand those, and my understanding is that a Swedish blood test is quite promising. NICE is bound to approve the two early-stage drugs that the noble Lord mentioned over the summer, in July and September, but then we need to look at scale-up issues. Often, we are talking about having to deliver them through drips, which means a whole workforce scale-up. So there are a lot of issues around this that the noble Lord rightly brings up, and I hope the panel can discuss them further.

[Lord Kamall (Con)]

My Lords, I would like to ask the Minister about the role of music therapy in helping dementia patients. It is well known that when someone listens to music, sometimes it takes them back to a place and time immediately. There has been research on the role of music therapy. I quickly skim-read the report but did not see music therapy mentioned in any way or in detail. If I am wrong, perhaps the Minister can correct me, but could he also tell me about the role that music therapy can play?

[Lord Markham (Con)]

My noble friend is correct; I did not see reference in my noble friend Lord O’Shaughnessy’s report to music therapy either. I am familiar with some of the principles behind it. My personal experience myself with the elderly dementia patient that I cared for was that bringing my five year-old son along took them out of their position and made them care for that child and forget about their own situation. Those sorts of therapies—and music is similar—have a vital role that we will look into further as part of this plan.

Care Home Staffing

Debate between Lord Markham and Lord Kamall

Thursday 18th January 2024 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is correct that the numbers are a result of flow. We are seeing thousands more people hospitalised through A&E, so the fact that we have managed to reduce the back end indicates a positive way forward. To measure precisely what the noble Baroness asked about, we have now set up a kind of flight control system for each integrated care board, as I have mentioned, which looks at data across the system to monitor the number of hospital beds and places needed on a case-by-case basis. The noble Baroness is absolutely correct that having that data is key.

[Lord Kamall (Con)]

My Lords, my noble friend the Minister mentioned the importance of a career structure to encourage people to work in the care sector. On the question from the noble Baroness, Lady Pitkeathley, about visas for carers, one issue that has not been addressed is that of personal carers. It is very difficult to sponsor or get a personal carer for individuals, and therefore there is a massive shortage. Can my noble friend the Minister say what the Government are doing to make sure that we can have more personal carers, whether from a domestic workforce or through immigration?

[Lord Markham (Con)]

My noble friend is correct that the recruitment of personal carers is harder. I know that this is close to his heart. I can probably serve him best by giving him a written reply setting out the details of what we are doing.

Health: RSV Immunisation

Debate between Lord Markham and Lord Kamall

Wednesday 17th January 2024 Lords Chamber

[Lord Markham (Con)]

The JCVI process is similar to the NICE approach. They look through the quality-adjusted years framework and make sure that it reaches within that. That is how they came up with their calculations. So far it is only the older ones, 75-plus, that they think are enough of an at-risk group in terms of hospitalisations and mortality to justify that. But I will inquire further and get back to the noble Baroness I am sure that they are capturing the data so that we can check on the younger ages.

[Lord Kamall (Con)]

My Lords, a number of noble Lords referred to the fact that there were disparities between different communities in the take-up of previous vaccines. My noble friend the Minister acknowledged that. Given the experience of previous vaccine rollouts, what specific lessons has his department learned that it will put into practice to make sure that it reaches some of those hard-to-reach communities in the rollout of those vaccines?

[Lord Markham (Con)]

You have to have the data and the records so that those who you know have not been vaccinated you have to go and get specifically. In London we have been running an under-fives programme, calling all those who have not been vaccinated to come and get a vaccine. That will be rolled out to under-11s and even up to under-25s, having learned precisely those lessons.

Suicide Prevention Strategy

Debate between Lord Markham and Lord Kamall

Thursday 26th October 2023 Lords Chamber

[Lord Markham (Con)]

It is understood that people’s financial well-being—or lack thereof—is one of the key causes here. Interestingly, as I looked at the statistics, there was a big jump up in the suicide rate from 2008 onwards, following the financial crisis. It is about making the point that, when people feel under more stress, they are, unfortunately, more likely to commit suicide. However, if you look at the statistics over the past five years, the rate has been pretty flat; so far, there is no evidence to show that, in the past year or so, the cost of living crisis has caused more suicides. None the less, it is something that we absolutely need to stay on top of and ensure that we are monitoring closely, as the right reverend Prelate the Bishop of London mentioned.

[Lord Kamall (Con)]

My noble friend the Minister rightly said earlier that suicide prevention is all our responsibility—or something like that—and that we need more awareness. Can he enlighten us on some programmes to increase awareness of suicide prevention so that we recognise that it is the responsibility of someone’s wider family, wider community and others and so that they are aware of the signs to look for?

[Lord Markham (Con)]

Yes. Effective bereavement support comes into this in a similar way. There are a number of communication methods, which I will happily share in writing so that noble Lords can see them, but there is also a full marketing and support plan around them.

Paediatric Care: Wating Times

Debate between Lord Markham and Lord Kamall

Monday 16th October 2023 Lords Chamber

[Lord Markham (Con)]

I like to think that we have good contact on this, centred around, as I said, Start for Life, which is a £300 million joint programme between ourselves and the Department for Education. There are also other things; for example, noble Lords might remember me mentioning the Bradford pilot previously, where we are looking at children’s scores in test environments and using those where there may be early indicators of ADHD or other neurodiverse needs. There is quite a bit of work going on in this space. No doubt we could always work more closely, but there is some promising work being done.

[Lord Kamall (Con)]

My Lords, looking at the waiting lists, there is clearly an issue of different needs and levels of seriousness in the conditions that people are suffering. Can my noble friend the Minister tell us what sort of prioritisation process has been put in place to make sure that those who need care immediately are prioritised over those who could possibly wait a little longer?

[Lord Markham (Con)]

Probably the best example of that is in the whole area of cancer, which we all agree has to be the absolute priority. We have set up children’s cancer networks precisely around that. They are also set up so we can do whole genome sequencing for all children with cancer and start to introduce specific point-of-care medicines especially for them. These are examples of where we are saying that this really is the priority and that it is what we will devote all our resources to.

Respiratory Syncytial Virus

Debate between Lord Markham and Lord Kamall

Tuesday 25th July 2023 Lords Chamber

[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.

[Lord Kamall (Con)]

Further to the noble Baroness’s question about public information, we found previously when rolling out vaccines, not just for this but for Covid, that there were certain communities which were difficult to reach or to persuade to take up the vaccine. As an extension to the question from the noble Baroness, what more is being done to encourage people in those communities who are reluctant to be vaccinated to come forward, or to go to meet them in their communities and take the vaccine to them?

[Lord Markham (Con)]

We had this question on MMR just the other day. Some groups are much harder to reach than others. Very young children are the prime at-risk group. There, it is much easier because, naturally, they are seen by their GP and medical staff either prenatally, if it is maternal, or post in terms of the baby check-ups. The group that we are talking more about here is post 75 year-olds, and there those education programmes will be put in place.

Stroke Care

Debate between Lord Markham and Lord Kamall

Monday 24th July 2023 Lords Chamber

[Lord Markham (Con)]

I agree that last winter was particularly difficult; as we all know, ambulance wait times were too long, which undoubtedly caused issues. We have a recovery plan for the emergency services and have invested more in ambulances, but it is all about flow, which we have spoken about many times in this House, and making sure that people can get to where they need to be as soon as possible.

[Lord Kamall (Con)]

My Lords, I will take this opportunity to ask my noble friend a more general question about guidelines. I am sure he receives correspondence about parts of the NHS not meeting guidelines, not only on strokes but on other issues. What are the Government and the NHS doing to make sure that, where there are guidelines, they are followed through and adopted by ICSs and medical practitioners right across the system?

[Lord Markham (Con)]

I thank my noble friend. As we all agree, there are always two steps involved: setting out the guidelines that we believe are best practice and making sure that they are then implemented. ICBs have that responsibility and regional managers look into them. As I think I have mentioned before, each Minister personally takes charge of six or seven ICBs—I will visit a few of them in the next few weeks during Recess—so we can make sure that they are really delivering on the ground.

Cancer Referral Targets

Debate between Lord Markham and Lord Kamall

Monday 5th June 2023 Lords Chamber

[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.

[Lord Kamall (Con)]

My noble friend the Minister mentioned Covid. One thing we learned from Covid was the importance of testing at home and rolling out home testing. A few weeks ago, I received a letter from the NHS asking me to provide a sample to test for a certain cancer—a test given to people my age. I thought that that was very interesting. How much more rollout of home testing are the Government intending to do, so that we can catch these cancers early—not just colon cancer but a whole range of cancers?

[Lord Markham (Con)]

I am not exactly familiar with the test that my noble friend might have taken but many of us will have heard about the early promise shown by the GRAIL programme. It is a simple blood test and, right now, has a two-thirds success rate for early detection. Those are early indicators, but early diagnosis and innovative approaches such as the GRAIL blood test are important.

NHS National Health Inequalities Improvement Programme

Debate between Lord Markham and Lord Kamall

Thursday 25th May 2023 Lords Chamber

[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—

[Lord Markham (Con)]

Absolutely. Again, there are also very good grounds for locally sourcing in that way in terms of the environment and reducing the carbon footprint. I must admit to not being very familiar with some of the pilots mentioned, so I will find out and get back to the noble Baroness.

--- Later in debate ---

[Lord Markham (Con)]

I agree with the noble Baroness. It was said in answer to a Question not so long ago that the hypothesis about much of the reduction in increases in life expectancy in the G7 nations, apart from Japan, is that it is very much linked to obesity, and that starts early on in life. Education is a key part of that, but the things we are starting to do as regards the placement of foods in supermarkets are already having an impact, and the reaction of the industry to that has been the reformulation of some foods which has already taken out 14% of sugar and 20% of salt—but clearly there is a lot more to be done.

[Lord Kamall (Con)]

My Lords, I apologise to my noble friend the Minister and reassure him that I was not trying to answer the previous question. However, in answer to a previous question, my noble friend the Minister mentioned that the responsibility of school meals and nutrition lies with the Department for Education. Is he aware of any conversations and interaction between the Department for Education, the Office for Health Improvement and Disparities, and the Department of Health and Social Care?

[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.

Autism: Diagnosis Targets

Debate between Lord Markham and Lord Kamall

Tuesday 16th May 2023 Lords Chamber

[Lord Markham (Con)]

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

[Lord Kamall (Con)]

My noble friend the Minister has rightly said that it is important to expand supply and work with the private sector. Can he tell me about the work that the department is doing with civil society organisations and charities in expanding supply?

[Lord Markham (Con)]

Yes, when I talk about supply, it is in all these fields. There are organisations of which I have personal experience, including the National Autistic Society, which does tireless work and has helped me out personally. So I know just how good they are in this situation. Absolutely, the whole strategy in this space is to expand supply by both the private sector and the independent and charity sectors.

Social Care: Workforce Strategy

Debate between Lord Markham and Lord Kamall

Wednesday 22nd March 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend makes a very good point. I am aware that some homes have half the turnover rate of staff than others, clearly demonstrating much better levels of management and skills. I agree, and that will be part of the training.

[Lord Kamall (Con)]

Following the question from the noble Lord opposite about recruitment from overseas, I thank the Government for acknowledging that we will need immigration to fill some of the skills gaps. An issue that has been raised a number of times in this House is visas for social care personal assistants. Can my noble friend the Minister update us on whether visas are being issued for this category of workers?

[Lord Markham (Con)]

We recognise the contribution that overseas workers can make here, as demonstrated by the 57,000 visas. I will need to come back to my noble friend in writing with details on his precise point on personal assistants.

Stroke Rehabilitation and Community Services

Debate between Lord Markham and Lord Kamall

Wednesday 22nd March 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord. I believe that this is what the national integrated community stroke service is all about. It is the responsibility of each ICS to make sure that there is sufficient capacity in their area. At the same time, it is always good to make sure that that is happening, so I will follow up with the NHS to see what plans are in place to make sure that we really are getting that uniformity of service.

[Lord Kamall (Con)]

My Lords, the noble Baroness, Lady Bull, mentioned the importance of arts therapy for rehabilitation and for other issues. I add to her question by asking about the importance of musical therapy, not only for rehabilitation but to help people address mental health concerns. Could my noble friend the Minister add to his answer specifically with respect to musical therapy?

[Lord Markham (Con)]

As I say, I see social prescribing as taking in a whole range of arts, music and sport. Given that that is a particular interest of my noble friend, I am happy to follow up on both arts and music.

Plastics: Health Research

Debate between Lord Markham and Lord Kamall

Monday 19th December 2022 Lords Chamber

[Lord Markham (Con)]

I understand that this is part of the £500 million Blue Planet Fund that we put in place to help developing countries support the marine environment, and we are a contracting party to the OSPAR convention to participate in marine-limited monitoring programmes.

[Lord Kamall (Con)]

As the Department of Health and Social Care moves towards prevention, is my noble friend the Minister aware of initiatives within the National Health Service and across the health and care system to reduce the use of plastic across our system?

[Lord Markham (Con)]

I thank my noble friend. Yes, the NHS is committed to a 10% reduction in clinical single usage by 2045, and these plans are set out in the NHS long-term plan document, Delivering a “Net Zero” National Health Service.

NHS Waiting Times

Debate between Lord Markham and Lord Kamall

Tuesday 22nd November 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness. There are a number of areas where we can do this. I point to the possibility for home testing a lot more. Covid was a perfect example, whereby it became commonplace. Rather than samples being sent away to a laboratory, we came up with lateral flow devices and were able to do it cheaply and pretty accurately, although not quite as accurately. That is a perfect example of using technology to do more home-type diagnosis.

[Lord Kamall (Con)]

My Lords, in learning from best practice in other countries, are my noble friend, the department or the NHS aware of the pioneering work of Dr Shetty in Bangalore, who has pioneered production-line surgery for certain procedures? Are the Government considering that at the moment? If not, why not?

[Lord Markham (Con)]

I thank my noble friend for that. While I am not familiar with that exact case, I saw a very good, probably quite similar, example in Chase Farm Hospital, which has four operating theatres in a sort of barn. It has a complete production line for elective hip replacements and so on to get that capacity and efficiency.

Health: Pancreatic Cancer

Debate between Lord Markham and Lord Kamall

Monday 21st November 2022 Lords Chamber

[Lord Markham (Con)]

My understanding is that we do have the capacity for these research trials. Also, on workforce in the cancer space, we have invested £50 million, so we are actually 200 people over our target on that. This is part of the Chancellor’s announcement about the long-term workforce study, which I know will be welcomed by many in this House, where we will be looking, area by area, at exactly what workforce needs we have—and we have a recruitment plan against that.

[Lord Kamall (Con)]

My Lords, in response to an earlier question, my noble friend the Minister talked about the need for more awareness in advance of identifying appropriate screening methods. Given that it is now Pancreatic Cancer Awareness Month, what else are the Government and the NHS doing outside that to ensure there is more awareness for patients to come forward for potential pancreatic cancer?

[Lord Markham (Con)]

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

GPs: Anti-depressants and Alcohol

Debate between Lord Markham and Lord Kamall

Wednesday 16th November 2022 Lords Chamber

[Lord Markham (Con)]

On this occasion, that is probably a question about which I need to write back to the noble Lord to give him the detail on it.

[Lord Kamall (Con)]

My Lords, the noble Baroness, Lady Wheatcroft, alluded to the fact that sometimes patients would be more effectively treated through social prescribing, or cultural and arts prescribing. What advice is given to GPs to make them aware of cultural, art and music therapy in solving or tackling depression?

[Lord Markham (Con)]

I agree that we have to make sure that GPs are equipped with the full range of tools for the job and the full range of knowledge. We are probably all aware of some instances of GPs who are very aware and progressive in this space, and others where they do not have that same level of information. We are putting a £2.3 billion increase in 2023-24 into the mental health space to treat an extra 2 million people. We need to make sure that we have a range of help that we can put in place for these people.

NHS: Backlogs

Debate between Lord Markham and Lord Kamall

Wednesday 9th November 2022 Lords Chamber

[Lord Markham (Con)]

I do recognise the importance of primary care. We know that a lot of the people who turn up to A&E would be better served in the primary care system, so making sure we have good facilities in this place is vital, and again it is something that is part of our agenda. There was an excellent report in this space recently, and it is something we are working towards—so, yes, GP surgeries are very much an important part of this £10 billion programme.

[Lord Kamall (Con)]

My Lords, in response to an earlier question about the hospital building programme, my noble friend the Minister mentioned the modern construction techniques of hospitals. I wonder whether he could enlighten the House on some of the leading technology methods we are looking at when it comes to the new hospital programme.

[Lord Markham (Con)]

Absolutely; I look forward to sharing this with the House in a lot more detail shortly. This is a real opportunity to create a world-leadership position. The idea behind it is to have a standardised approach to building hospitals—hospitals 2.0, as I like to call them—where we look as much as possible to have standard processes, procedures and components, so that we can build them quicker, cheaper and more efficiently, and get economies of scale from doing that. I believe that it will not only pioneer the way we build hospitals in this country but give us an opportunity to be a pioneer worldwide and create a major export industry.

NHS: Nurses

Debate between Lord Markham and Lord Kamall

Tuesday 1st November 2022 Lords Chamber

[Lord Markham (Con)]

The Nuffield study was very interesting: of the reasons for people leaving, 43% said retirement, 22% said it was for personal reasons, and 18% said it was due to too much pressure. Again, in quoting those figures I accept that there is work we need to do on this. Clearly, 18% leaving due to too much pressure is something we rightly need to be concerned about. I know that is why we set up the 40 mental health and well-being hubs with a £45 million investment, to look at whether we can address some of those pressures. Most of all, though, I completely agree that we need to recruit as many nurses as we can so that we have as big a supply as possible to ensure that we continue to relieve any pressures that exist.

[Lord Kamall (Con)]

My Lords—

[Lord Kamall (Con)]

I apologise to the noble Lord but it is some time since I have spoken in this part of the House. Given that it was Black History Month last month, does my noble friend the Minister agree that we owe a great deal of gratitude to immigrants from the Commonwealth who helped to save our public services after the war? Now that we have left the EU, can he also assure us that we will no longer give priority to mostly white Europeans over mostly non-white non-Europeans, and treat all equally when we want to recruit health and care staff from abroad?

[Lord Markham (Con)]

I totally agree. My noble friend rightly states that we have had a fine tradition, right back to the beginning of the NHS, of recruiting people from all over the world, predominantly the Commonwealth. I am also delighted to say that, since we moved the cap on visas from people all round the world in 2019, the number of those who have joined has gone up from 25,000 a year to 48,000 a year. That is almost double the number and very much the result of what my noble friend said about making sure that we are welcoming people into the profession from all over the world.