Cancer: Older People

Lord Patel Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Merron (Lab)]

My noble friend is quite right that the incidence of cancer is expected to rise across the UK, especially in older people. I agree that older people can face specific barriers when accessing care. Following on from the independent review by the noble Lord, Lord Darzi, I assure my noble friend that the 10-year health plan and the subsequent cancer strategy for England, both to be published next year, will help us do more to prevent cancer, identify it early and treat people quickly. They will have regard to older people.

[Lord Patel (CB)]

My Lords, I am delighted to hear that we will have a new cancer strategy. I have tried to get a debate in this House on that for two or three years now. Maybe the Minister will use her influence with the powers that be so that we can have a government-led debate on the cancer strategy. However, one of the reasons why our outcomes are poor is late diagnosis of cancer. Only 54% of cancers are diagnosed at stages 1 and 2. What plans do the Government have to improve early diagnosis of cancer?

[Baroness Merron (Lab)]

I am sure the powers that be heard what the noble Lord said about a debate. On the point he raised, I absolutely agree that diagnosing cancer earlier, at stages 1 or 2, improves outcomes and survival. I refer again to the report by the noble Lord, Lord Darzi: we need to do more to diagnose people at an early stage. Work is already being undertaken to improve cancer screening uptake. We will continue to roll out targeted interventions such as the lung cancer screening programme, which has a particular effect and impact on the most disadvantaged areas. Members of your Lordships’ House will know that the Budget also committed to £1.5 billion of capital funding for new surgical hubs and diagnostic scanners, which will increase capacity.

Type 2 Diabetes: Continuous Glucose Monitors

Lord Patel Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Merron (Lab)]

The noble Lord makes a very fair observation. Work is going on in a wider equality monitoring programme exploring how to keep an eye on equality repercussions, including ethnicity, by reference to protected characteristics in the Equality Act 2010. Importantly to the point he raised, the review includes consideration of how NHS ethnic group categories can be updated. The outcome of the review—this is the point I really want to emphasise—will ultimately guide a process of reducing inequalities, but I accept his challenge and his point.

[Lord Patel (CB)]

My Lords, there is a strong link between body mass index, BMI, and type 2 diabetes. People with a body mass index of 25 to 30 have an 8% chance of developing type 2 diabetes; those with 30 to 40 have a 20% chance; and those with a body mass index of 40 or over have a 40% chance. One way of monitoring long-term glycaemic glucose levels is to measure haemoglobin A1C. It might therefore be an idea to use haemoglobin A1C levels to diagnose early type 2 diabetes, initially in people with a BMI of 40 or over, as a screening tool. It might be an idea to ask NICE or the screening committee to evaluate that likelihood.

[Baroness Merron (Lab)]

The noble Lord makes a helpful point. I can tell your Lordships’ House that diabetes testing is included as part of the NHS health check. If a person is identified as being at high risk of type 2 diabetes, they should be offered a blood sugar glucose test or a fasting glucose test. NICE produces guidelines on preventing type 2 diabetes in people at high risk, and that includes recommendations on risk assessments, including blood testing, which can include people with a high BMI. His point is extremely valid, some of that is in place and we will ensure that it continues.

NHS: Independent Investigation

Lord Patel Excerpts

Tuesday 8th October 2024 Lords Chamber

[Lord Patel (CB)]

My Lords, if this were a Committee stage, I would have been delighted to engage in a debate with the noble Earl, Lord Howe, who is a class act at presenting a case even though he might not believe in it. He is a lovely man. I would have taken issue with him on the 2012 Act—maybe not all of it, but a significant part of it.

I congratulate my noble friend Lord Darzi on his report. It is an honest report about the state of the NHS currently, whatever the genesis of that might be. As this is a Statement, I can only ask a question. One of the areas the report refers to is the need for capital investment. This has been neglected for some time, and without it, we are unlikely to be able to deliver quality care in all the aspects the report seeks. So, what is the Government’s plan for capital investment in the NHS?

[Baroness Merron (Lab)]

I begin by agreeing with the noble Lord, Lord Patel, in his assessment of the noble Earl, Lord Howe, as I am sure your Lordships’ House does. On the issue of capital, the total maintenance backlog stands at £11.6 billion, an increase of nearly 14% on the previous year. As I mentioned in my opening comments, this is holding back the productivity, ability and capacity of the National Health Service. Our financial situation is well documented, but we have asked the department and NHS England to review the health service’s capital requirements, and that includes NHS England’s assessment of long-term estate needs across a range of areas. We will have to establish the position and where we are to go from there, but I assure the noble Lord of the importance of this matter.

Palliative and End-of-life Care: Funding

Lord Patel Excerpts

Wednesday 4th September 2024 Lords Chamber

[Baroness Merron (Lab)]

The Prime Minister has already reiterated his commitment to allow time for a Private Member’s Bill and a free vote. I recognise that this is an extremely sensitive issue with deeply held views on the various sides of the debate. Our commitment is to ensure that any debate on assisted dying in Parliament will take place in a broader context of access to high-quality palliative and end-of-life care and that we will have robust safeguards to protect vulnerable groups, if the will of Parliament is that the law should change.

[Lord Patel (CB)]

My Lords, the Minister mentioned funding—I am glad that the Government will look at funding—as well as the NHS England dashboard. Both are processes that do not deliver care, particularly for children who require hospice and end-of-life care. I will give an example that the noble Baroness, Lady Brinton, briefly referred to. Because NHS England has devolved funding to ICBs, average funding for ICBs supporting hospices for children is £149, with a range from £18 to £376 per case. ICBs are legally bound to deliver hospice care, but the accountability to do so is not there—and that is what NHS England needs to focus on.

[Baroness Merron (Lab)]

I am grateful to the noble Lord. I will ensure that my colleague, the Minister of State for Care, is fully aware of the comments that he and other noble Lords have made today. They will form part of our looking at the situation to make sure that services—not just processes—are provided.

NHS: Breast Screening Programme

Lord Patel Excerpts

Tuesday 3rd September 2024 Lords Chamber

[Baroness Merron (Lab)]

It is important to ensure that the service is there for those who are at greater risk. The noble Baroness is right to refer to the growing interest in and potential use of AI, which is indeed very exciting. The National Screening Committee is very aware of this point. The committee is working with the National Institute for Health and Care Research and NHS England, and has designed a research project to see whether AI can be safely used to read mammograms in the breast screening programme, and whether that is acceptable both to women and to clinicians. That work will continue.

[Lord Patel (CB)]

My Lords, I join others in commending the work that Breast Cancer Now has done in improving outcomes for women through breast screening and improving breast cancer outcomes. However, the problem remains when it comes to wider issues about care of patients with cancers. We know that early diagnosis achieves the best results for all cancers, yet we are woefully low in the percentage of people who are picked up with early cancers. There is another more serious issue, which is unwarranted variations in the care of all cancer patients. Unwarranted variation is when care that is clearly demonstrated to be effective in reducing death rates is not given to cancer patients. That has to be absolutely unacceptable. Eliminating unwarranted variation in cancer care ought to be one of the performance measures that integrated care boards are measured on—I hope that the noble Lord, Lord Darzi, is listening.

Smoking: Public Places

Lord Patel Excerpts

Tuesday 3rd September 2024 Lords Chamber

[Baroness Merron (Lab)]

I am glad that the noble Baroness welcomes the direction of travel. As regards the specifics that she seeks, those will be forthcoming in the very near future. However, it is important to remind ourselves that the tobacco industry, for example, was very vociferous in its opposition to indoor smoke-free legislation and argued that it would be disastrous for hospitality, but, as I mentioned, it had almost no impact, and in some sectors it had a positive impact. As my noble friend said earlier, the response of the public, the way they approach this matter and their understanding are also crucial.

[Lord Patel (CB)]

My Lords, the noble Lord, Lord Geddes, tempted me to get up. In wishing him a happy birthday, I suggest that his longevity might not be related to his cigar and cigarette smoking. The statistics are quite clear: smoking causes immense harm to those who indulge in it, with not only 10,000 lung cancers a year but tens of thousands of chronic lung diseases. It is right that we have a policy that eliminates cigarette smoking altogether.

[Baroness Merron (Lab)]

I am glad that the noble Lord welcomes the Bill, and I hope that he will bring his expertise and support when it is before the House. This will be a matter of great debate but also one of consultation.

NHS Blood and Transplant Service: Blood Stocks

Lord Patel Excerpts

Tuesday 30th July 2024 Lords Chamber

[Baroness Merron (Lab)]

The noble Baroness is right in her observations. What I can say is that, while there has been a dramatic and somewhat sustained increase in the need for O-group blood, that is now improving. There has not been a negative effect on elective surgery; I think that is an important reassurance. In the future, obviously cyberattacks are going to be something that we are going to have to always be mindful of. That is why the service, at my request, is working to come up with plans for greater resilience, and such work is already ongoing within the department and across government.

[Lord Patel (CB)]

My Lords, does the Minister agree that, as a country, we should be pleased that, throughout the four nations of the United Kingdom, we are self-sufficient now in blood and all blood products and do not have to import, as we used to in the past? Furthermore, the problem that occurred was because, apparently, demands became suddenly high and the stocks were there for about only 1.4 days; normally, they are there for about four days. For a person being transfused, it is better if they are transfused with freshly donated blood, rather than blood that has been on the shelf, because it will last in their bodies for longer. The problem, particularly for recipients and donors of O-group blood, was, I hope, temporary and will be addressed.

[Baroness Merron (Lab)]

I assure the noble Lord that it is indeed a temporary problem. However, it is likely the alert will go on for a little while yet, not least because, as I mentioned, we can benefit from keeping it in place. I absolutely associate myself with the assessment that it is so much better to be self-sufficient within the United Kingdom, and that will be of great benefit. It is important to realise that this is a situation that we must live with but not be at the mercy of. I also assure the noble Lord and the House that this is because of external factors and not internal factors to do with the service, as was the case in 2022.

Coronavirus: UK Deaths

Lord Patel Excerpts

Monday 29th July 2024 Lords Chamber

[Baroness Merron (Lab)]

I thank the noble Lord for his kind welcome and I hear his disappointment that it is not my noble friend Lord Vallance—who will be extremely flattered—answering. On the matter of lockdowns, I start by paying tribute to the British public; it was they who rallied to ensure that lockdowns could save lives. Before Oral Questions, I met with the Chief Medical Officer to discuss the very point that the noble Lord has raised. I say to the House that, when looking at other countries, it is very important to consider the complexity of comparison; it is just not possible to draw direct comparisons. But what I can say is that we are of course waiting for the Covid inquiry, which will shine a light on a number of the matters that the noble Lord has raised.

[Lord Patel (CB)]

My Lords, on a previous occasion when the noble Lord asked the same Question and cited the Swedish mortality rates, I cited a study carried out in Scandinavia comparing the Swedish model with Scandinavian countries that implemented lockdowns. It clearly showed that the death rates were lower in those Scandinavian countries that implemented lockdowns. To satisfy the noble Lord today, I asked ChatGPT to compile all the evidence. It said:

“In summary, while lockdowns during COVID-19 were effective in reducing death rates from the virus itself, they also had complex and varied impacts on overall public health. The net effect on mortality rates includes both the direct benefits of reduced transmission and the indirect consequences of restricted mobility and access to healthcare”.


Will the Minister agree that there is now some evidence that lockdowns were effective in reducing mortality?

[Baroness Merron (Lab)]

I thank the noble Lord for his informed observations. It is true to say that every Government were making decisions based on balance and that, with that, as the noble Lord said, not locking down would have meant that more lives would have been lost. It is important to put on record that the clear majority of professional opinion in this country was that lockdowns absolutely had their place. Even though there was a balance in terms of difficulties with mental health, access to services and the impact on the economy, in Opposition we supported the then Government, as we would in any national emergency.

NHS England: Ovarian Cancer

Lord Patel Excerpts

Thursday 2nd May 2024 Lords Chamber

[Lord Markham (Con)]

Yes. To reiterate, I think that we should always use “man” or “woman” as the primary descriptor. For people with English as a second language, “woman” is very understandable. We can then be inclusive by saying a “person with ovaries”, so that we are absolutely clear. My remit here is health, so I want to make sure that most people, especially if English is their second language, understand who we are referring to when we say “woman”.

[Lord Patel (CB)]

My Lords, I am slightly reluctant to stand up and get involved, but I have done so previously, and I will continue to support the campaign led by the noble Baroness, Lady Hayter, to make sure that the words “woman” and “mother” are not removed from our language—I absolutely support that. I will muddy the waters a bit. There is, in medical terms, a syndrome called androgen insensitivity syndrome, which occurs in about two to five per 100,000 births. The person born is registered at birth as a female, because they have the phenotype of a female and external genitalia that resemble those of a female. They grow up as female, and the diagnosis is often not made until puberty, when they do not menstruate—but they develop breasts. They do not have ovaries. They often identify themselves as female for the rest of their lives, and they occasionally get married. I have looked after such a person myself. They are registered as female, they do not have ovaries and they sometimes have internal testes, which can become cancerous. So it is correct that only people with ovaries can develop ovarian diseases, including ovarian cancer. As I said, I have muddied the waters.

[Lord Markham (Con)]

I am not sure that there was a question there, so I might take the easy option of thanking the noble Lord for his comments—and for maybe muddying the waters—and moving on.

Covid-19 Vaccination: Coronary Disease

Lord Patel Excerpts

Tuesday 23rd April 2024 Lords Chamber

[Lord Markham (Con)]

The noble Lord is quite right. There were much wider effects and impacts in the lockdown, and alcohol intake was one of them; mental health, particularly of our children, was another. My sincere hope is that these are the kinds of issues that the Covid inquiry should really be investigating: the wider impacts on society caused by lockdown.

[Lord Patel (CB)]

My Lords, a recent study published in Vaccine of a cohort of 99 million people who were vaccinated with one of the vaccines—either vector or messenger RNA vaccines—showed an increased risk related to myocarditis and pericarditis. The incidence, particularly among the younger people, was about one in 10 in a 1 million population, as opposed to the non-vaccinated who got Covid. That should be the comparison, not the non-vaccinated who did not get Covid. In those cases, things such as Guillain-Barré syndrome, which is a long-term viral fatigue syndrome, occurred at a higher incidence in non-vaccinated people than in vaccinated people, particularly with the Oxford/AstraZeneca number 1 vaccine, which was withdrawn. Therefore, it is a balance of whether the disease or the vaccine will make you more sick. With any treatment in any branch of medicine, there is always a risk to the treatment. There has to be a balance.

[Lord Markham (Con)]

I am sure I speak for the whole House when thanking the noble Lord for his expert understanding and insights. As he said, the evidence is very clear that while no vaccine is risk-free, what it saves you from is much greater. The very firm advice is that you are much better off having the vaccine.