Children’s Cancer Services
Debate between Lord Markham and Lord Winston(7 months, 2 weeks ago)
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Lord Markham (Con)
I am happy to go through the facts. I hope noble Lords know me well enough to know that I like to look at all the evidence, and, clearly, we are at that stage. I saw an excellent example just the other day in Cambridge, where we are building a new centre to put research and treatment under one roof. That, of course, is what the Royal Marsden has for children’s cancer, so I am aware of the benefits and they will be at the front of my mind.
Lord Winston (Lab)
My Lords, I am sure the Minister understands that cancer cannot be seen as an isolated disease. One aspect of that is how you provide for children in their entirety during the treatment, which does not always involve just cancer but other organs and other parts of the child.
Lord Markham (Con)
Yes, and the Royal Marsden has a very good track record on that. As was explained to me on the Cambridge visit, having all those services together under one roof is a definite advantage. When the pros and cons are weighed up, that will definitely be a pro.
National Health Service: Key Targets
Debate between Lord Markham and Lord Winston(9 months, 3 weeks ago)
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Lord Markham (Con)
I definitely agree that it is more important, and that is why I am pleased that we have made such progress. If we look at one area in terms of hospital records being available and doctors’ records to patients, that has gone up since the beginning of the year from about 1% of GPs to about 90% today. About 90% of all our hospital records are now digitised, compared to less than 3% in Germany. We have made massive progress, and it is key to all of the reform and to improving productivity across the NHS.
Lord Winston (Lab)
My Lords, the Minister well knows that we have raised the issue of primary care again and again in this Chamber. Would he be kind enough to tell the House how the Government feel they are doing with regard to the retention of very highly qualified general practitioners at the height of their career, who are currently leaving early? Up to about 50% are considering retirement before the retirement age. Will he comment on how he feels that is going?
Lord Markham (Con)
Staff retention, particularly of GPs, is vital. That is why we listened to the number one reason they were retiring, which was the feeling that their pensions were being adversely affected. We changed the rules in the last Budget to try to address that; it is early days, but I hear that that is starting to make progress. Primary care is the front line. That is why I am pleased that we have increased the number of appointments by more than 50 million, ahead of our manifesto target. But it absolutely needs to be a key focus.
Domestic Violence and Brain Injury
Debate between Lord Markham and Lord Winston(1 year ago)
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Lord Markham (Con)
It is a very good point. As all noble Lords are aware, often the challenge is getting people to come forward when they have suffered domestic violence. Some of this research shows that there are tools, such as a spit test, to understand whether someone has suffered from a traumatic brain injury. Bringing some of those things into play, so that people are identified and encouraged to come forward, is vital.
Lord Winston (Lab)
My Lords, the Minister is to be congratulated on his call for more research. Would he care to comment on the use of organoids—clumps of generative stem cells—which act as an artificial brain in culture and show clear evidence of certain injuries, such as whether the brain may be easily propagated? That kind of research is important but is often condemned in the press. Can the Minister make sure that the Government will allow that kind of research to continue? It is completely harmless ethically.
Lord Markham (Con)
Yes. The main thing is that £9.5 million is being invested into research on traumatic brain injury, but this is a platform to allow spin-off research from there. When speaking to people on this, I am clear that this is not a cap: if we get good research proposals put forward in areas such as the one the noble Lord mentioned, the money is there to pursue that.
General Medical Council: Internal Guidance
Debate between Lord Markham and Lord Winston(1 year ago)
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Lord Markham (Con)
People should always be treated with respect. That is why we are quite clear that the primary descriptor in this circumstance should be “woman”. However, in a few cases it has also been clear that a secondary descriptor is “people with a cervix”. It is quite clear that we are talking about a woman as a woman. By the way, that is very important for people with English as second language, so they understand very clearly that a woman is a woman. For completeness, in those cases where there might be a change of sex, we are being very clear that it is for everyone with a cervix.
Lord Winston (Lab)
My Lords, I intend no disrespect to anybody, but in view of the fact that the GMC has a really important role in regulating language, particularly for overseas graduates who come to Britain, can the Minister tell me how many male members of the GMC have given birth to a child? If he cannot tell me, maybe he would be good enough to send me a letter.
Lord Markham (Con)
I am very willing to hazard a guess that it is zero, but I will happily follow that up in writing with the exact number.
Paediatric Care: Wating Times
Debate between Lord Markham and Lord Winston(1 year ago)
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Lord Markham (Con)
I am aware from personal experience that, when you have a child with neurodiversity or developmental needs, it is a long journey. We are seeing this manifest itself much more in recent years; I was talking to Minister Caulfield about this just this morning. One-to-one is always preferable but, where capacity is constrained, group education and help can sometimes lend themselves to this space. It is a long-term condition, and clearly it will not be solved by treatment over a few months but needs many years.
Lord Winston (Lab)
The Minister quite rightly referred to the brain development of a child being very rapid and resulting from experience, and to various experiences having a profound effect on children’s development. However, he did not mention the place of primary care and, particularly, general practitioners in this. Does he feel that general practitioners are getting enough resources to be able to assess children on a more routine basis? The app will certainly be useful, but it does not get them clearly involved with medical practice; we need some standard way of doing this. Can he give us some information about the role of the GP?
Lord Markham (Con)
The role of the GP is clearly vital. That is what I was trying to get behind in the Start for Life initiative and clear early warning indicators. Clearly, that needs to go right through the development of a child at different key stages along the way. On digital treatments, I was at Boston children’s hospital last week, and it has early indicators for dyslexia—for example, looking at pattern recognition via an app, as it is not until children are older that they can see letters. Similarly, early signs of neurodiversity can be seen in the way that children play online on certain apps. I think we can add some of these digital support tools, but clearly the GP has a primary role.
Cancer Referral Targets
Debate between Lord Markham and Lord Winston(1 year, 5 months ago)
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Lord Markham (Con)
My noble friend is correct that there were knock-on implications of lockdown, cancer detection rates being one of them. Noble Lords have heard me speak of Chris Whitty’s concern about heart disease because those check-ups were missed, and mental health is another area. Clearly, these are some of the things we are hoping to learn from the Covid inquiry, so that we know the impact of lockdowns, not just on restricting Covid but more widely, on the population as a whole.
Lord Winston (Lab)
My Lords, have the Government made an assessment of the cost of false positive tests in this kind of screening and the cost to patients?
Lord Markham (Con)
When the noble Lord says this kind of screening, I am not quite sure which type of screening he is referring to.
Lord Markham (Con)
I did not know whether the noble Lord was referring to GRAIL and the comment from the noble Lord, Lord Patel, about false positives. This question probably deserves a detailed reply but, as with any test, it is not about just specificity but sensitivity, which is key, so that the number of false positives is minimised. I will provide a detailed reply.
Pharmacies: Medicines at Home
Debate between Lord Markham and Lord Winston(1 year, 5 months ago)
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Lord Markham (Con)
Absolutely. That is one of the major reasons why blister packs are not always the right solution, because there are many cases of wastage in exactly the way that the noble Baroness has mentioned. Wastage is one of the many reasons why both NICE and the Royal Pharmaceutical Society have come out against the blanket use of blister packs.
Lord Winston (Lab)
My noble friend on the Front Bench is absolutely right. As somebody who is currently taking hourly medication, I can tell the Minister that it is extremely difficult to keep that up. Does he not recognise that we need to have set blood levels for many drugs, and that it is really important that those are not delayed if we are to have proper pharmaceutical action in the blood stream?
Lord Markham (Con)
Yes. There are occasions when it is absolutely appropriate that medicines are packaged in that way; I am sure we all have plenty examples of friends and relatives for whom that is very useful. The whole point is that the blanket application of blister packs is not the right approach.
Life Expectancy: Pensions, Health and Insurance
Debate between Lord Markham and Lord Winston(1 year, 6 months ago)
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Lord Markham (Con)
I know that my health brief is broad but including pensions and insurance in it is quite a challenge. Like other noble Lords, I am very aware of the impact of inflation on the final salary scheme and on lifestyles, and of the fact that not many employers can afford the schemes any more—apart from, dare I say it, government. That has an impact. However, I am happy to meet my noble friend to go through this in further detail.
Lord Winston (Lab)
My Lords, the Government have made a pledge that they know perfectly well they cannot keep. There is no way that this massive morbidity will be reduced: obesity is not the answer. If he looks carefully, he will see what the Science and Technology Committee—chaired by the noble Lord, Lord Patel, who may want to comment—showed: that it is clearly due to deprivation in poorer parts of the country, which leads to a much shorter life. The Government need to deal with this holistically; it is not the problem of the Department of Health and Social Care but a much wider issue.
Lord Markham (Con)
As ever, there are multiple factors at play. That is what the Office for Health Improvement and Disparities is all about: making sure that we are tackling this in exactly the holistic way the noble Lord mentioned, going back to all the major conditions that are causes of death and tackling each one by one. The 10 million cancer screenings save 10,000 lives a year, and our breast cancer screenings save 1,300 lives. There is a lot to do but a lot that we are doing already.
Gender Identity Services: Children and Young People
Debate between Lord Markham and Lord Winston(1 year, 6 months ago)
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Lord Markham (Con)
Again, my understanding—and I freely admit that the benefit of having these questions is that you then delve into them, which I very much support in terms of how this process works very well —is that these people who have been through these services need to be looked after and catered for, so that is something we are very much on.
Lord Winston (Lab)
My Lords, leaving aside the issue of the serious psychological problems some of these children undoubtedly display, can the Government clarify one issue? Do they regard so-called gender dysphoria, which is a very broad term, as a pathological condition or simply a medical one? Is it a pure choice of the individual? Therefore, the question is: at what stage should the National Health Service be intervening in these cases?
Lord Markham (Con)
I feel I am probably outgunned to some degree by the noble Lord. I would like to make sure that I answer that in the proper way and give him a detailed written response. I am happy to follow up, because I want to make sure that I am answering in completely the right way.