Dementia

Debate between Lord Markham and Lord Warner

Thursday 18th January 2024 Grand Committee

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

I add my thanks to my noble friend Lady Browning not only for bringing this debate but for her commitment generally in this area. I also thank all noble Lords for their contributions. These sorts of debates are always a pleasure, and one thing I have learned in the almost 18 months that I have been involved in the Lords is that it does not matter what the subject is; you always find expertise and learn about colleagues’ experience, such as that of the noble Baronesses, Lady Greenfield and Lady Murphy. I always find having the power of that knowledge around the table a real asset for the Lords and a real contribution to these types of debates.

My noble friend Lady Browning quite rightly said in her introduction that the statistics are gobsmacking, if I can use that word. I note the fact about one in 11 of those over 65. The one that really resonated with me—noble Lords have heard me mention it many times—is the fact that 25% of our beds are occupied by people with dementia. There is a real feeling that not only is that not the right place for them but it is not a good use of money. I therefore totally agree with that sentiment.

We see virtual wards and hospices at home as part of the answer to this. I have seen some good technological advances: at the light end of the scale, for want of a better word, we could look at people’s electricity usage, for example, and start to learn their patterns. For a lot of people, there is a surge at 8 am when they put on the kettle, so if that surge suddenly is not there, that is an early warning that perhaps there should be a call because something is wrong. There are also motion detectors around the house to start to understand their patterns. To my mind there is a spectrum of those sorts of virtual wards from the very heavy intervention ones to just trying to make sure that people are generally fine and going about in their normal way or, if they are not, it can be an early warning.

I will come on to staffing, but a key part of that in the home is dom carers. It is a point that the noble Lord, Lord Allan, made well. We have made a lot of progress in what we are trying to do with career progression, but I want to be assured that we have really got this area right.

My noble friend Lady Browning mentioned the fundamental need for a care plan in all that. In preparing for this, my noble friend Lord Evans said that that was what he needed in his recent situation with his mother. That is what ICSs should be starting to do now. I take the point made by the noble Lord, Lord Allan, that there is probably no better example of trying to learn how they are working than using this as a case study. My general experience of ICSs—of course it is early days, even now I think we are only 18 months or so in—is that, as ever with these things, there are some very good examples and probably some which need to do a bit more work. I am quite happy to take that away to try to find some test cases that we can try to learn from. The NHS has set out best practice guidance that it expects all ICSs to follow. My understanding, which I will check on, is that part of that is having a dementia lead, which my noble friend Lady Browning mentioned.

As the noble Baronesses, Lady Ritchie and Lady Donaghy, and other noble Lords mentioned, diagnosis is key. The target is two-thirds. We are getting quite close to that, but we have been behind, so there has been an investment of £17 million to catch up. I accept the point about whether two-thirds is enough and whether we would accept that in other areas and let one-third go undiagnosed, but step one is making sure that we hit that two-thirds.

The noble Baroness, Lady Ritchie, asked what sort of resource we are putting behind this. CDCs already have the equipment, in terms of scanners, and the ability to do that, but I accept the point made by the noble Baroness, Lady Murphy, that it is probably more about the people. It is less the equipment than making sure that people are trained to do that. I will come on to staffing later, but I take that basic point.

What is the point of diagnosis? First, it is to make sure that people get the right care. Secondly, it is so that we can start to deploy some of these new treatments. Again, it is great to have the expertise of the noble Baroness, Lady Greenfield. In answer to the question from the noble Baroness, Lady Ritchie, we are expecting NICE approval of the drugs to slow dementia down in early summer, and we expect to then roll that out during the summer period. However, we all know that they are only on the nursery slopes, and that is why there is a commitment to research of £160 million per year.

To fuel the moon shot, I am really excited about the power of the data that we own. I was recently on a fact-finding mission to Boston and they were talking about a major $250 million investment that a private venture group had made into the 9 million hospital records in Mayo Clinic. They were saying, “You don’t realise what you have in the UK. You have 50 million records in England, and you have primary care as well”. The whole problem around dementia is that we do not know what we are trying to tackle, in terms of the early causes. The reason we were so good at tackling Covid was that we knew exactly what we were going after. Right now, in things such as dementia and Alzheimer’s disease, it is still a case of shots in the dark.

However, regarding the 50 million records we have, if we look at people who have dementia today, wind back 15 years and ask what they were visiting their GP about then, and throw that all at AI, we can get some of those early-warning indicators. I know some of the anecdotal ones. For instance, as mentioned, urinary tract infections are often an early indicator of dementia because people do not understand that they are there. Throwing all that at AI and making sure that that data exists is a real way to fuel the moon shot so that we know where we should be putting our research efforts to try to find treatments.

On the funding of social care, as I said, the £8.1 billion investment over two years is a major investment. I learned a lot from my noble friend Lady Berridge. I did not realise that being committed under the Mental Health Act is a main way to get there. On the question from the noble Baroness, Lady Wheeler, about CHC transparency, I do not know the answer off the top of my head, but I will come back on that because it is a good point. As ever, I will try to come back and cover it more fully in writing.

The reform plans that we have announced are about making sure that we have the proper staffing to do this. As I mentioned in answer to the earlier Question today, we are starting to turn a corner, although it is early days. On career progression and training, I believe that what we announced last week is a key part of making this a real profession that people will want to stay and progress in. I agree with the point made by the noble Lord, Lord Allan, that paid progression has to come along with those qualifications; otherwise, you will not get people wanting to enter it.

I understand, as a few noble Lords have mentioned, including the noble Baronesses, Lady Wheeler and Lady Pitkeathley, that the role of the carer is vital and often overlooked. As noble Lords know, I have had personal experience of that as a carer. Quite honestly, all I can say is that we are making some early steps in trying to get some of the funding, but I freely accept, from personal experience, that there is a lot more that could be done in that space.

I have tried to give a flavour—before my throat totally gives way—of what we are trying to do in this area. As ever, I will respond fully in writing, but I hope there is an understanding from the Government’s side, as echoed by all noble Lords, that this is something we do take seriously.

[Lord Warner (CB)]

I am sorry to test the Minister’s vocal cords, but he mentioned that there was good practice guidance issued to ICSs. My experience as a Minister is that the department is extremely good at sending out guidance but extremely bad at checking whether anyone ever follows it. What arrangements has the department got to see if that good practice guidance is put into operation?

[Lord Markham (Con)]

The noble Lord makes a very good point, and it is one I have some personal experience of as well. The hope, when setting up 42 ICSs, was that this would be the right size for them to pool resources and take a holistic view, and that 42—while still a lot— would be a manageable number. As Ministers, we have divided those up into seven each that we can get to know, and live and breathe and understand; we also have dashboards that we can use to monitor progress in these areas. That is the way we plan to do that. I freely admit, again, that it is early days; I accept the noble Lord’s point that you can give out guidance until you are blue in the face—and they will receive a lot—but it is the follow-up that really matters.

I thank the noble Baroness again for the debate. I hope there is a feeling that we understand and that we are trying to give the parity of esteem that this deserves, and I look forward to following up more thoroughly in writing.

NHS GP Surgeries: Purchase by US Companies

Debate between Lord Markham and Lord Warner

Monday 5th June 2023 Lords Chamber

[Lord Warner]

To ask His Majesty’s Government, in the three years up to 31 March, how many GP surgeries providing NHS services have been purchased by private companies of which one of the controlling shareholders was a United States company; and whether they intend to take action with regard to such purchases.

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

This information is not held centrally because local commissioners arrange appropriate services for their populations by contracting with providers. Commissioners do not normally request details of corporate structure. Our focus is on high-quality services and patient experiences, regardless of practice ownership. All GP contract holders and providers of NHS core primary medical services are subject to the same requirements, regulations and standards. We expect commissioners and regulators to take action if services are not meeting the reasonable needs of patients.

[Lord Warner (CB)]

My Lords, I am a little surprised by that particular Answer. I would have thought that, given the problems of shortages of GPs in the NHS, there might be a little more interest in the Department for Health and Social Care in finding out about this. Is the Minister aware of the scale of acquisition of GP practices that has been achieved with very little public transparency? Let me give him the example of Operose Health, which is a UK subsidiary of Centene Corporation, a major US health insurer, which now owns nearly 70 GP practices serving nearly 600,000 patients. I would have thought that the centre might want to take a little more interest in this, because what is very clear is that the APMS system is an offering that many corporate individuals can exploit to get a hold of very large numbers of GP practices—and, just for afters, Centene is in deep trouble in the United States.

Cancer Referral Targets

Debate between Lord Markham and Lord Warner

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

The noble Lord is correct. I have a friend who is in that situation. We all understand the stress of waiting and what it can cause. I will come back to the noble Lord on the research into the impact on mental health. I absolutely accept that a lot more needs to be done, but one of the main things is the target of diagnosis within 28 days, which we are now hitting 75% of the time. That gives people peace of mind quickly, particularly as 94% of those people end up being negative—only 6% are positive. Peace of mind is crucial here.

[Lord Warner (CB)]

My Lords, is the Minister aware that in 2017 this House, under the distinguished leadership of the noble Lord, Lord Patel, produced a report which said that the sustainability of the NHS was in doubt unless there was a workforce plan? Would he like to remind his friend the Chancellor, who was the Health Secretary at the time, of that report?

Branded Health Service Medicines (Costs) (Amendment) Regulations 2023

Debate between Lord Markham and Lord Warner

Thursday 25th May 2023 Lords Chamber

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

I thank noble Lords for the debate, and I particularly thank the noble Lord, Lord Hunt, for bringing forward this important subject. It was clear from the contributions of noble Lords that we all want the same thing here, and this is a discussion about how best to achieve it. We all want the UK to be a

“science and technology superpower by 2030”,

as quoted by the Prime Minister. We all want a thriving life science sector, we want access to the best medicines for the NHS and we all want to ensure that the NHS is achieving value, in terms of money for the front line—I think we are united on those things. I also commend the fact that this debate was very much a discussion, so I will respond in that vein, rather than reading out a speech. I will try to discuss this from the Government’s point of view. I apologise if that means that I might not come across as quite as polished, but I would rather respond directly to the points raised.

We would all accept that we are striking a delicate balance here: between having value for the NHS—through, for example, the funding of £2.5 billion this year—and having value and making savings for frontline services, which we all want to see. While we are focusing on those, we also want to make sure that we do not go too far and damage what is, and what we want to be, a thriving sector.

The noble Lord, Lord Hunt, asked whether the Government are being complacent about this. The words of the Prime Minister, saying that he wants a negotiated outcome with the ABPI, are probably the strongest sentiment in terms of wanting a sensible, negotiated outcome. At this point, I say to the noble Lord, Lord Warner, that I am responding on behalf of the Government.

As the noble Lord, Lord Warner, pointed out, just today, the Chancellor is having a round table with the life sciences industry. That, too, is very much about getting a solution that works all the way round. Having said that, please remember that some of the comments I am making in this debate are about a balance. We are all aware that we are entering into a negotiation and obviously, in any negotiation, sides make points—sometimes at the negotiating table and sometimes publicly. Please take my comments in that vein; we want to make sure that a balance is brought to the debate.

[Lord Warner (CB)]

I am sorry to interrupt the Minister’s flow. He said that we are having the fruitful discussions that the Prime Minister wants with the industry and that they are starting to progress. However, the industry itself is starting with a figure in the single figures, nowhere near 27%. I am curious as to why we are having this discussion about progressing these regulations, as they seem to be going in totally the opposite direction from the aspirations the Prime Minister has.

[Lord Markham (Con)]

The mechanics behind this debate—I was planning to say that my noble friend Lord Lansley made this point—are about the alignment of the voluntary and statutory schemes. I think that we would all agree that it is sensible that the two are roughly aligned. We can argue over how high or low that figure should be, but we would agree, I think, that it is quite sensible that the two are aligned. If you had large disparities between the two, you would disadvantage, for instance, the members who have joined the VPAS system.

[Lord Warner (CB)]

I am sorry to interrupt the Minister again. We are talking about signals given to the outside world, in these discussions that are now taking place about the voluntary scheme. As the noble Lord, Lord Lansley, asked, rather elegantly, why do we have two schemes in the first place? There is something very odd about levelling up to a voluntary scheme’s level with a big increase and, at the same time, sitting down with the industry and saying how much we love it and that we want a new, agreed programme, when the industry is talking about figures which are nowhere near the figures in these two schemes. It seems almost politically inept.

[Lord Markham (Con)]

As I said, this is about the scheme and the pricing for this year. The negotiations happening now are about future years, while, technically, this debate is about making sure that the alignment is there for this year and its pricing. Given that the discount has been decided on for this year for the voluntary scheme, having alignment will ensure fairness, so that members in the voluntary scheme are not suddenly disadvantaged against the statutory scheme—which would happen if we were not putting in a similar price. It does not in any way predicate what a negotiated outcome might be for future years.

In terms of a future negotiation, if there was a VPAS-type scheme—again, everything is on the table—you would have the argument about alignment. Most people would accept, as my noble friend Lord Lansley was saying, that having an alignment between the two is a sensible mechanism. The real debate today is about what level that discount should be. Regarding the balance—and I am not making any value judgment about what the right level is—when this was first forecast in 2018, a forecast was put out about what the discount would be over a five-year period, and in year 5 it showed a discount in 2023 of 31.1%. Those were the projections made, at that time—in 2018—the ABPI welcomed the scheme as an innovative one. In fact, today, the discount is less than that, at 26.5%. This was all known and projected as part of the scheme at the time. That is not to say that, in these negotiations, it should not be reset or that we should not make sure that there is a sensible conversation, but I am trying to do this while making sure that there is a balance in the negotiation.