Hospices: Funding
Lord Monks Excerpts(2 months ago)
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Lord Monks (Lab)
My Lords, I too am grateful to the noble Lord, Lord Farmer, for allowing us to shine a light on our hospices. They deserve all the help we can give them in return for all the help they give us and our families.
My son, Daniel, died earlier this year under the palliative care of the doyenne of British hospices, St Christopher’s, which has already been mentioned by the noble Lord, Lord Farmer. I told Daniel’s story in the current edition of the House magazine and in a note to all Members of Parliament. Daniel also features in an award-winning ITV documentary, “A Time to Die”—as does the noble Baroness, Lady Finlay—which most people regard as very fair. St Christopher’s created a wonderful atmosphere of warmth, compassion and love at a very difficult time, and my family and friends and I will long cherish it. Daniel quipped near the end of his life, “I am being looked after better now than I ever was when I was ill”. That was not a knock at the local hospital—for the reasons the noble Lord, Lord Howard, gave, hospitals are so hard pressed—but hospices have a standard of care that few hospitals can match.
Many hospices are, like hospitals, under acute financial stress and desperately need more help, and I hope that the Minister is listening carefully to our plea. We all know that there are many demands on the public purse and that the Government face, like the female blackbird, many hungry mouths clamouring to be fed, but every effort should be made to stop hospices falling down the long list of health priorities. Regardless of our views on assisted dying—an issue we will probably come to early next year—we must make the end-of-life experience as good as it can be, and hospices do just that.
Cost of Living: Public Well-being
Lord Monks Excerpts(2 years, 2 months ago)
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Lord Monks (Lab)
My Lords, I thank my noble friend Lady Drake for her characteristic enterprise in securing this debate at this particular time. Not many people will envy the Chancellor of the Exchequer at the moment, as he wrestles with shifting the trajectory of the economy from the feckless spending of his predecessor to what looks like a big bout of painful austerity, with cuts, cuts and more cuts coming our way. As a result of the calamity of the last few weeks, we are poorer, shakier and more feeble. That is bad news for all of us who care deeply for the future of the country. We know from experience who suffers most in periods of austerity, and references have been made to this by previous speakers. We know it is the poor, the old, the young and people who were on the breadline before the crisis and who now face the avalanche of soaring food, housing and energy prices—a devastating prospect. This time it must be the comfortable who step forward and carry the heaviest burdens, not the vulnerable and hard pressed.
For sure, some of the reasons for this are global, as the Government claim. But not all are; some we know are home made. Step forward the team of ignominy—the European Research Group, the Institute of Economic Affairs and the Adam Smith Institute—all of whom have earned a place in the dock for the Truss-Kwarteng calamity. The great irony is that the team of ignominy believed that they were taking back control, as they promised in the EU referendum of 2016. Under their blueprint, we would shake off the EU’s shackles, jettison Brussels’ constraints and become sole masters of our destiny. Yet, “Take back control” was always a delusion and the Government have now been blasted by a reminder that there is no such thing as pure sovereignty. Of course, it was not the EU that dictated a whole new policy direction for our economy; it was the money markets. They have taken back control—not for the first time in British economic history.
The UK has just learned the hard way that it cannot announce £43 billion of unfunded tax cuts as a time of high debt and rising inflation. The markets would not have it and acted brutally to remind the UK of some painful lessons. Many of us across the political spectrum hoped that we had seen the end of post-imperial delusions about the UK as a world power, able to be fully sovereign and free of external constraints. We hoped those days were over. We were wrong; the delusion is alive. It was the underlying principle of the leave campaign in 2016. It was central to the Truss leadership campaign, and it shaped her first few weeks in office. It is a vain dream. Just as Suez made us face our military and diplomatic limitations, so should the Conservative Party stop using nostalgia as its guiding star for the future.
I have three suggestions for the Chancellor on public well-being. First, make sure that the vulnerable and poor do not bear the price of austerity. This is a national crisis, and we need to approach it with the same “all in it together” spirit that we have displayed in previous crises in our history.
The Chancellor could start, for example, by opening discussions with the TUC and following the example of ex-Chancellor Sunak when the furlough scheme was introduced. I think all sides in those talks were surprised by the positive outcome. This would be more practical and useful than introducing yet another anti-trade union law, in the form of the Bill that is to be published. The current Chancellor has taken a fresh perspective on things; he should now attempt to stop this Government smacking the unions. Specifically, the Chancellor should prioritise benefit claimants, particularly those on universal credit, and increase the real value of UC, as was done in the lockdown. That was important then and would be important now. That was a recommendation, by the way, of the Economic Affairs Committee of the House of Lords.
Secondly, the Chancellor should protect our already creaking public services. Whether it is health, social care, education, benefits, the police and justice, prisons or many others, they are all struggling and are ill equipped to cope with a new period of austerity. It is tax that must take the strain to avoid a further deterioration in our public services. The financial burdens must fall on those best placed to pay.
My final suggestion is that, having carried through Brexit—a decision I still bitterly resent, by the way—we must get Brexit done properly by aligning the UK very closely with the EU single market. Our export performance has been woeful since Brexit. Firms, especially small and medium-sized enterprises, have given up trying to export to the EU because of the hassle and red tape involved. The existing treaty is not working, not just in Northern Ireland but between Britain and the EU generally. We need to reset the relationship with the EU and do it quickly. There is much to do, particularly by the rich and comfortable, to help poorer citizens on low pay and benefits, who are more dependent on public services, to get through this crisis. Let there be no more wallowing in past glory. In his Statement in a couple of weeks, the Chancellor must relegate nostalgia to the Last Night of the Proms.
Neurological Conditions
Lord Monks Excerpts(2 years, 6 months ago)
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Lord Monks (Lab)
My Lords, I thank the noble Lord, Lord Dubs, not just for initiating this debate but for his work over many years in championing the fight that needs to go on all the time against MS and related neurological problems. I also thank the MS Society, which produced some very useful briefing material for this debate.
There is no need today to labour the destructive nature of these diseases, MS in particular. Like others in this debate, I come from the front line in the battle against MS. My son, for whom my wife and I care, is in the National Hospital for Neurology and Neurosurgery today, with complications to his advanced secondary progressive MS. He and we have had 20 years of it—20 years of overworked consultants and stressed MS nurses, and 20 years of feeling like poor relations to more fashionable illnesses.
The basic problem, in our view, is the shortage of skilled staff. I must say that, despite the shortages that exist, we have had excellent treatment at King’s College Hospital under the care of Dr Silber. But the pressures are obvious. As soon as you enter the clinic’s waiting room, large numbers of patients are milling around awaiting a consultation. Sometimes it resembles a railway station in the rush hour; the atmosphere is like that, rather than the calm and friendly system that you like to see when you go into a hospital.
How come, as the noble Lord, Lord Dubs, said, the UK ranks as 44th out of 45—I did not even know there were 45 European nations but apparently there are—in the number of neurologists if it is adjusted on a per capita basis? Do the Minister and the Government recognise these figures, which are so bad in comparison with France and Germany, which were mentioned earlier?
The Government often boast that the UK is a world leader in this and that. Occasionally, they might even be right. On MS, however, we are shameful laggards and I wonder whether the Minister would accept what I am saying with that particular charge? Is MS treatment not a prime candidate for the levelling-up agenda? I mean levelling up internationally, of course, against the best in class in Europe, rather than being right at the bottom of the league, but also levelling up nationally among the four nations. We have sharp regional imbalances; some parts of the country are better off than others at tackling MS by providing access to disease-modifying drugs and treatments.
Thankfully, there are exciting new drugs emerging to combat secondary progressive MS but, as has been said, their rollout is slow and they are subject to a postcode lottery. The MS Society’s survey found Northern Ireland to have the best access, while Wales and some of the English regions have the worst. The society is also worried about the establishment of integrated care systems and that these might widen the differences in MS treatment in particular, as different priorities are chosen within different systems. I wonder whether the Government share these worries. If so, how can we guard against even more inequality developing as far as the treatment of MS is concerned?
I ask the Minister: is it not time to launch a major levelling-up exercise for the neurological illnesses, with our place in that European league table firmly in our minds? Next, what can be done to address the urgent shortages in the workforce of people with neurological skills who can work together and provide the kind of holistic treatment that others have referred to? Finally, I agree very much with my noble friend Lord Dubs, and with what has just been said, about the need for a neuro task force that brings together all the relevant bodies in all four nations of the UK to address the challenges that we face on the MS front. What is the Government’s view on this proposal?
Social Care and the Role of Carers
Lord Monks Excerpts(3 years, 6 months ago)
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Lord Monks (Lab)
My Lords, I must declare an interest. Like others, my wife and I are carers for our son, who has advanced multiple sclerosis. That takes up a lot of our time.
Members of this House who follow rugby—there are some, I know—will have noted that in the past year or so two prominent players have contracted motor neurone disease: Doddie Weir from rugby union and Rob Burrow from rugby league. Both have been generously supported by their respective games. For example, Rob Burrow’s colleague at Leeds Rhinos, the admirable Kevin Sinfield, ran seven sponsored marathons in seven days and raised £2 million for the Burrow family and medical research. As Rob Burrow said, everyone needs a friend like Kevin.
However, not everyone has the profile of these rugby lads, nor does everyone have a friend like Kevin. That is why having a social care system to be proud of is so important. We must make sure that the most vulnerable and fragile in our society are properly supported. As others have said—I will not labour the point—we are far from that at present. We have been reminded of the landmark report by the Economic Affairs Committee of this House, which has made a notable contribution to pushing forward this debate. Now, after years of delay and dither, we are promised that a plan is imminent. It would not be the first promise on social care that has been broken, but let us take the Government’s word for it this time round.
I have two questions. First, I stress that the expected plans should address the plight of working-age adults as well as the aged and children. Working-age adults already account for half of social care spending. Will the Minister explain whether they will be covered in the first part of the plan or deferred, as I understand was the case in Scotland, until a later date? We need to move forward on the working-age population, and I would like an assurance that that will be the case.
My second question is about the position of the staff in the care sector. Other noble Lords have said what the situation is. There are many unfilled vacancies, high turnover and low pay. Will the Government commit in their plan to lead on measures to improve pay, training and career prospects? If we have learned anything from the Covid crisis, it should be about the need to protect and fairly reward front-line medical and care staff. They have supported us and we must support them.
Health: Multiple Sclerosis Nurses
Lord Monks Excerpts(10 years, 9 months ago)
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Lord Monks (Lab)
My Lords, will the Minister comment on the remarks made to me by an MS sufferer I know very well that MS is a Cinderella service in the NHS and does not get its fair share of resources? Does the Minister agree with those remarks?
Earl Howe
I think that has been true. We are very clear that neurology and, for that matter, specialised neurology, should assume a higher priority than it does. That is why it is so welcome that Dr David Bateman has been appointed as the first national clinical director, which I believe will raise the profile of all neurological conditions. However, the status of NICE guidelines and the quality standard that is coming down the track, which NICE will produce in a year or two, will also help to raise the standing of this very serious condition.
NHS: Mid-Staffordshire NHS Trust
Lord Monks Excerpts(11 years, 6 months ago)
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Lord Monks
To ask Her Majesty’s Government what steps they are taking to issue guidelines about public statements by NHS executives following the announcement of reviews of hospital care launched following the Francis review into Mid-Staffordshire NHS Trust.
The Parliamentary Under-Secretary of State, Department of Health (Earl Howe)
My Lords, in the context of Mid Staffordshire, it is right that prompt action is taken whenever there are concerns about patient safety. We agree that there is a need for an authoritative voice on the quality of hospital care in the NHS. In future, the CQC, through its new Chief Inspector of Hospitals, Professor Sir Mike Richards, will play this role and provide expert judgment.
Lord Monks
I thank the noble Earl for that reply. I can well understand and share the nervousness, as does the whole House, about some NHS managements after the disasters of Mid Staffs and now Morecambe Bay. Does the noble Earl agree that it is important to avoid a lurch to the other extreme with a sort of shoot first and ask questions later culture? Does he further agree that there have recently been some instances of such a trigger-happy approach at Bolton and Leeds hospitals? In those cases the falsely accused were later completely exonerated. What steps can be taken to avoid panicky reactions which cause destabilisation and demoralisation in important parts of the NHS?
Earl Howe
I agree with the noble Lord’s general point that it is important to avoid oversensationalising or exaggerating a situation. I am not aware that official NHS spokesmen have been guilty of that in either of the two cases that he refers to. If there is cause for concern about any aspect of the NHS, it is surely right that that concern is made public. The important thing is for those public statements to be balanced and authoritative. That will be one major advantage of having as Chief Inspector of Hospitals a professional who is as widely respected as Professor Sir Mike Richards.
Health: Neurological Conditions
Lord Monks Excerpts(13 years ago)
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Lord Monks
My Lords, I am pleased that my noble friend Lord Dubs initiated this debate, and I congratulate him on focusing the attention of the House on this family of illnesses, which too often can be relegated slightly in the list of priorities. Like many other noble Lords, I have a direct connection. My 35 year-old son has MS. I do not have to labour the impact of that unpredictable illness on people in their prime. It damages and can then shut down different parts of the body as it tightens its hold on the vital organs of life.
It is invidious to compare one serious illness with another, but the neurological illnesses mentioned by my noble friend Lord Dubs and other noble Lords in this debate attack dignity and self-confidence and must be among the worst in the list of illnesses. As yet, there are no cures and, in truth, there is not much early prospect of them. There is a most depressing outlook for the 100,000 or so people with MS in the UK and for the many others with other neurological illnesses. Sometimes the only medical advice available is, in effect, “Grin and bear it”.
My concern today is to lend my support to those who seek for greater priority to be given to these diseases. As we know from a short exchange in the House recently on a Question by the noble Lord, Lord Walton of Detchant, the National Institute for Clinical Excellence seems in no particular hurry to revise its list of approved treatments. I understand its problems in matching limited resources to a wide range of demands, but I want the House to send a message that while perhaps these illnesses tend to lack the massive, fashionable and effective supporters that a few other grave illnesses have managed to muster—and good luck to them—there should be no treating MS and other neurological illnesses as lower-priority also-rans when it comes to the allocation of resources. As I understand it, at the moment, NICE is thinking of 2013-14 for its next major review of MS treatments. That feels a long way off for sufferers, and it is frustrating for them to be denied access to drugs which might help improve their condition on grounds of cost. For example, NICE has just issued a second provisional no for a drug, the first pill licensed for relapsing remitting MS. This was done on grounds of cost. I understand that the decision has been taken in the face of strong support for the drug from the MS medical community and from many sufferers and organisations. NICE has recognised that the drug is clinically effective and highly innovative. It is available in some other European countries, including Germany, Italy, Sweden, Switzerland, Norway, Greece and Denmark. The House will know that some of these countries are less well placed economically than we are.
As the noble Lord, Lord Dubs, said, the recent report for the Department of Health by Sir Mike Richards scored the UK 13th out of 14 regarding patient access to existing and new forms of treatment for MS. This is plainly not good enough. I am long enough in the tooth not to believe all the hype and publicity of the pharmaceutical companies for their latest wonder drugs, but 13th out of 14 cannot be good enough for a country with as many MS sufferers as we have. Nor is it good enough, as a recent Work Foundation report showed, that in the UK 44 per cent of people with MS retire early due to their condition; this is higher than the European average of 35 per cent. Of course, in time this increases the costs to the welfare state by the resulting additional demands on the employment and support allowance system.
I ask the Government and NICE to recognise fully the terrible nature of this family of illnesses and—please—to give them the priority that they need and their sufferers deserve.
Multiple Sclerosis
Lord Monks Excerpts(13 years, 2 months ago)
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Lord Monks
My Lords, referring to what the noble Earl just said about the Richards report, that report ranked the UK 23rd out of 25 EU countries, with only Slovenia and Lithuania more restrictive on access to new treatments than the UK. The NICE guidelines will not be revised until 2014, having last been done in 2003. For sufferers of MS, a horrible disease, that seems a very long time to wait. I hope that in the reviews that are taking place, the Government will do everything possible to accelerate this work and ensure that NICE gets on with it, and that the Government give priority to MS research in future.
Earl Howe
My Lords, I take the noble Lord’s point. NICE is reviewing its clinical guideline. That is not due to be published until 2014. Although we strive to ensure that there is national guidance on the most commonly used medicines and treatments, there will always be instances where decisions have to be made locally. Under the NHS constitution, patients have the right to expect local decisions about the funding of medicines and treatments to be made rationally, following proper consideration of the evidence. We are emphasising to PCTs that they should do just that.