NHS Blood and Transplant Service: Blood Stocks
Lord Patel Excerpts(3 weeks, 5 days ago)
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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(3 weeks, 6 days ago)
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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(3 months, 3 weeks ago)
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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(4 months ago)
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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.
NHS: Long-term Sustainability
Lord Patel Excerpts(4 months, 1 week ago)
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Lord Patel
That this House takes note of the long-term sustainability of the NHS to be able to deliver comprehensive, timely and affordable health and social care for all, including options for systems of care and funding.
Lord Patel (CB)
I see noble Lords leaving. The debate will not be that bad. It has certainly emptied the House.
I am grateful to the noble Lords who are taking part in the debate. I look forward to their speeches, particularly the maiden speech of the noble Baroness, Lady Ramsey of Wall Heath; I wish her well. Several noble Lords—the noble Lords, Lord Stevens of Birmingham and Lord Darzi, the noble Baronesses, Lady Harding and Lady Watkins, and the noble and gallant Lord, Lord Stirrup—would have joined us, but other commitments do not allow them to do so.
I declare my interests. I am a fellow of several medical royal colleges and faculties. Importantly, I worked for 39 years in the NHS in its glory days. My comments will be based on comparing the current state of our healthcare system with 26 other systems that I have looked at. They all have some problems but, compared with more developed systems of universal care in Europe and the Far East, ours is severely strained.
On 26 April 2018, 6 years ago, we debated this exact Motion. There were 50 speakers and the debate lasted nearly seven hours, interrupted by a Statement on artificial intelligence, which mentioned how AI will transform healthcare. Today’s debate may well mirror that debate in 2018. What has happened since then? We have daily media reports of the demise of the NHS as we know it, and lots of suggestions for how to improve things. Public satisfaction with the NHS is at its lowest point; waiting lists are at their highest level; waits at A&E are long and harming patents; and there are huge inequalities in health and poor outcomes—I could go on.
After several reorganisations and reforms, including a seismic one in 2012, the NHS has not found the equilibrium that it needs. But the NHS is still capable of delivering superb primary, community and hospital care. Thousands of hard-working, resourceful and committed front-line professionals are prepared to go the extra mile, despite feeling undervalued. They need to be better supported and valued before they too give up. It is access to care that has become a major problem.
The current state of NHS is not because of some inevitable built-in decay; it is a system failure. It is the result of decades of political short-termism, a lack of long-term planning and an underinvestment in capital infrastructure and technology. The system lacks capacity, with fewer beds and equipment such as CT, MRI and PET scanners, and with a huge workforce shortage compared with other countries. We now have a workforce plan stretching to 2035, with no longer-term funding. We need it to work. I congratulate the Minister for getting 50,000 nurses in place, as the Government hoped to.
A lack of planning means that disease is diagnosed at a later stage, leading to poor outcomes. Modelling suggests that, by 2040, one in five people will be living with a major illness, which is upwards of 9 million people. Nearly 3 million people of working age will not be in work due to ill health. Not investing in health means greater pressure on the budgets of other departments. Anxiety, depression and chronic pain will be the main causes of ill health, which has implications for primary and community care.
Unfortunately, there is no silver bullet to reduce the growth in people living with major illness in the short to medium term. Diseases that affect millions, such as diabetes, cardiovascular disease, stroke, some cancers and chronic lung disease, are all amenable to either prevention or early detection. The focus needs to change to prevention and health, not just healthcare. We need to move from: “I am ill; I need to get better” to “I don’t want to be unwell”. Countries that have recognised this are seeing the benefits of higher life expectancy, people living more years in good health and being more economically productive. The system needs to change to make primary and community care a central part of our care system.
The current funding of primary care is at 8.4% of the total NHS budget of £192 billion, which is the lowest in eight years, and it employs only 154,000 of the total 1.3 million workforce. This proportion will need a significant increase to at least 20% or more if we are to see improved access to primary care. The traditional system of a single portal of access to healthcare also needs to change. To enable patients to have greater choice of access, community care will need to be staffed by a multidisciplinary team of professionals, including general practitioners.
An explosion in data, generated by patients and the health system, will drive healthcare through screening services’ early detection of markers of disease, such as blood pressure monitoring and hypercholesterolemia, to mention but two. Population and risk-based genomic screening, liquid biopsies, individual health data monitoring and so on will lead to early risk identification and detection of disease. Healthcare will be digitally driven, technologically enabled, personalised and patient-centred. Patients will be involved in planning and managing their own health. The best health systems in the world have strong community care, with a focus on helping people stay well.
From birth to death, health, healthcare and long-term care in old age is a continuum. If any part of it is not functioning, it affects the rest. The lack of a properly funded and organised social care system is having a huge effect on the NHS. We have had 28 years of kicking the can down the road. After seven policy papers, six consultations and four independent reviews, we have a social care system that is means-tested, needs-assessed and underfunded.
There is a lack of a workforce plan for a service that needs 1.5 million staff, with 2 million people still needing care—one-third of whom get no support. With a rise of 20% in working-age adults needing social care, this needs urgent attention. Capacity is getting worse, and public satisfaction with social care is as low as 13%.
Various options have been considered, including free personal care, the Dilnot cap and universal care. The best performing comprehensive system of social care is provided in countries with a long-term care insurance, or which is tax funded, based on the principle of social solidarity. People above a certain salary range pay throughout their lives. Without a solution to the funding of social care, the NHS cannot survive.
I now turn to the key issue of funding the NHS. Funding of the NHS has always been a rollercoaster, despite its link to the performance of the NHS. The planned budget for 2024-25 is £192 billion, an increase in real terms of 0.6% from the 2023-24 settlement but a reduction from 2022-23. According to NHS England, it will provide a spending increase of 0.25%. Over the parliamentary term 2019-20 to 2024-25 the increase has been 3% per year, but from 2010 to 2019 it was 1.4% on average.
Following the famous “expensive breakfast” in 2000—when Prime Minister Tony Blair announced on breakfast television an uncosted commitment that he would bring NHS spending up to the EU average—and the Wanless report, there was a multiyear increase in funding leading to better NHS performance. Waiting lists came down dramatically and health inequalities began to improve.
If the EU average had been maintained in the years that followed, the budget would now be £40 billion higher per year. Lack of capital funding—an average of £2.5 billion per year from 2010 to 2019—has led to poor infrastructure and a lack of equipment; it has not increased. Rising costs have led to calls for funding reform. Social insurance, some element of self-pay and hypothecation have all been suggested. Each has its own problem. Analysis suggests that a single-payer system is most effective in costs and complexity. The public seem to prefer a tax-funded system. What is important is that there is properly costed long-term funding that tracks GDP growth. Also important to note is that while measures of prevention and healthy living may make people live longer in good health, they will not cut costs. If cutting costs is a priority, a different model of care will be needed—but people may not live longer.
In conclusion, a sustainable future for both NHS and social care is possible, and with it a healthier population that leads to increased life expectancy and decreased health inequalities. It needs a long-term funding commitment, including in capital funding, and strong primary and community care with a focus on prevention and health. It needs to be digitally driven, connected and tech enabled, and to have a clear plan with timelines for its introduction. An overcentralised, bureaucratic system will not address the fundamentals of effective healthcare. This may well be the last opportunity for the NHS as we know it and as we want. If not, the public may well seek an alternative that could lead only to a two-tier system of care.
My question, in this election year, is to the Minister and the noble Baroness on the Opposition Front Bench: what plans does each party have to make the NHS sustainable in the long term? What support will the Liberal Democrat Front Bench give to make amends for the part it played in the reforms of the coalition years? I beg to move.
Lord Patel (CB)
My Lords, the new rules do not allow me to speak at length, so I am constrained. I truly am constrained, because I would have loved to dissect some of the speeches made by some of my friends. I wish that the hospital, wherever it was, had treated the noble Baroness, Lady Murphy, better, because her speech might have been different. When I put in a bid for this debate, I did not imagine that I would get the talent pool we got today, or the brilliant speeches that have been made. Top of the list, of course, is the maiden speech by the noble Baroness, Lady Ramsey of Wall Heath; we look forward to hearing her over and over again.
I had intended that this would not dissolve into a political debate, and I am glad that it did not. I am glad that my challenge to all three Benches paid off. By the way, I say to the noble Lord, Lord Allan, that it was this House that won the vote to put mental health at equal esteem; it was not the other House, although the Minister, Norman Lamb, did help. It was an amendment by the noble Baroness, Lady Hollins, that won, although I had to call it because the noble Baroness was not here at the time.
I thank all noble Lords again; I am grateful that they all joined in this debate. It contained lots of ideas, but the key thing that came out was the need to make community and primary care stronger. The second thing was the solution to social care: it is funding, whichever way we go. The other thing was data. By the way, as the noble Lord, Lord Allan, was speaking, I asked ChatGPT: “How can data help healthcare?” It produced immediately a 700-word, six-point response; I might send it to the noble Lord.
Immunisation: RSV
Lord Patel Excerpts(4 months, 1 week ago)
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Lord Markham (Con)
It will not surprise the noble Lord to learn that I totally agree. It is absolutely on the road map. I cannot promise it is there today; it is more there for adults. The child digital red book is another objective we are working on, but that is taking slightly longer. But in terms of direction of travel—yes, absolutely.
Lord Patel (CB)
My Lords, I congratulate the noble Baroness, Lady Ritchie of Downpatrick, on pursuing this even before we had vaccines available. Now we have succeeded in getting the vaccine, but why has 75 years been chosen for adult immunisation, when we know that the incidence and prevalence of RSV infections is much more common for over-65s?
Lord Markham (Con)
I too add my thanks; the noble Baroness is very good at holding our feet to the fire, and it is very important and appreciated. Regarding the age group, we are being guided by the scientific advice on what is most cost-effective.
Pandemic Preparedness
Lord Patel Excerpts(4 months, 1 week ago)
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Lord Markham (Con)
Absolutely. To respond to both this question and the earlier question from the noble Baroness, Lady Deech, the other things I would like to see the inquiry look at are the lockdown and comparisons with countries such as Sweden, what lessons can be learned across the whole health system, the impact on the mental health of our children and a lot of the other areas that my noble friend mentioned.
Lord Patel (CB)
My Lords, the WHO has identified Nipah virus as a priority candidate for the next pandemic. It belongs to the same group of viruses as the measles virus. Fortunately, Oxford University has developed a vaccine that went into human trial last week. The lesson therefore is that we should identify the organisms that are likely to cause pandemics and be prepared ahead of time with the vaccines; several other candidates have also been identified. For that to happen, we require a global conglomerate to focus on development of vaccines. Do the Government have any plans to establish one?
Lord Markham (Con)
We definitely look to work closely with our colleagues, and I have spoken to my Health Minister counterparts on this. One of the lessons from the pandemic was that you also need to have your own capability. The work we have done on the100-day mission, and the strategic relationship we have entered into with Moderna—which can develop vaccines in as little as four to six weeks to answer some of those unknowns—is very powerful.
Children’s Cancer Services
Lord Patel Excerpts(5 months, 1 week ago)
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Lord Markham (Con)
Ministers are on a fact-finding mission. I understand the points the noble Earl makes; the NHS made the point that it wants cancer treatment to be co-located alongside an intensive care unit. Following Professor Sir Mike Richards’ review, it believes that it is best to have those services co-located, which is why it has chosen the Evelina. There are pros and cons to every decision, and that is why Ministers are doing further fact-finding.
Lord Patel (CB)
My Lords, this decision is daft on many counts, some of which have already been expressed by the noble Baroness, Lady Bloomfield. I declare an interest in that I am an occasional contributor to the Royal Marsden Cancer Charity. As has already been mentioned, the Royal Marsden is a world-renowned centre for cancer research, including in children.
Going back to the decision, even if the Royal Marsden was closed down and all the children’s cancer services were shifted to the Evelina, it does not and will not have all the facilities to deliver medical oncology services to children. Compromised children with cancers will then have to be transferred out of the Evelina to other places where radiotherapy is available. Why shut down a centre which last year transferred to intensive care only three children out of 700—all of whom survived —and instead use another centre which does not have major radiotherapy facilities?
Lord Markham (Con)
The noble Lord makes some very good points. Following the NHS review and the evidence put forward, specific cancer treatments will take place at University College Hospital London, which has two particular benefits for patients: radiotherapy and proton beam technology. Ministers want to understand and make the points the noble Lord has made, and to see whether this is a decision we are comfortable with. As I said earlier, since January 2024 we have had the power to call in a decision in exceptional circumstances.
Prioritising Early Childhood: Academy of Medical Sciences Report
Lord Patel Excerpts(5 months, 2 weeks ago)
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Lord Markham (Con)
I totally agree. Funnily enough, I was talking to Minister Leadsom about this subject just this morning. It is complex, because all parents need proxy access so that they can get those digital records for their children automatically. It is something we are working towards. The Pharmacy First initiative, whereby you can write data from a pharmacist immediately into GP records, will help because it will give a road map to do that for children and babies from hospital. It is something we are working on, and I will give details of the timeline in writing.
Lord Patel (CB)
My Lords, I declare an interest. I am a fellow of the Academy of Medical Sciences, which produced this seminal report addressing issues related to child health. I will pick up two points that the Minister might comment on. Although he is implementing what we already know from research works in improving children’s health, we have no strategy for the implementation of good practice. My second point is about research into the early years. Diseases that people may develop later in life can occur as a result of epigenetic influences during the early years that alter the genome, yet research into childhood accounts for 5% of total government research funding.
Lord Markham (Con)
I totally agree about the importance of research and data. We have spent about £580 million on research in the children and young persons’ space since 2020. As per the earlier question, data is vital to this. I saw a fascinating example just a couple of weeks ago in the Cambridge Research Centre concerning young children. It is using data to construct what it calls “virtual children”, to look at rare diseases, how they progress and different treatments that can be tried. It is truly revolutionary and something I totally support.
Mental Health Patients: Discharge
Lord Patel Excerpts(5 months, 3 weeks ago)
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Lord Markham (Con)
Yes, in a word. We must try to make sure that each integrated care board has a mental health lead in place and that the services are rolled out. Much of the strength of the ICBs is that they can look after the needs of their area in ways that they know best. At the same time, where there is good practice, we must make sure that it is rolled out as well.
Lord Patel (CB)
My Lords, suicide is the second highest cause of maternal deaths in England. All such deaths are preventable, because mothers at risk can easily be recognised antenatally, and certainly postnatally. What actions will the Government take to prevent these deaths?
Lord Markham (Con)
Like many of us, I am sure, I have had very good personal experience of the midwifery service at community level. I know that there have been some challenges post Covid, but midwives are on the front line in understanding and recognising some issues. I should have mentioned earlier that there will be a round table with the Minister on mental health issues, following the one a few months ago, and this is one of the areas we should bring up with her.