Hospital Beds: Social Care

Lord Patel Excerpts

Monday 19th December 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness. We are all seeing different shapes and forms of describing how we need a local care system set up by the integrated care boards that can have an overview of all the needs in their area. That is exactly what we are doing, and exactly what the Patricia Hewitt review is reviewing. It will give advice on how best to do that by looking at the best needs of mental health care patients, or any other kind of patient, to make sure that the proper institutions and places are set up to give them the up-front support so that, as the noble Baroness said, they never need to go to hospital in the first place.

[Lord Patel (CB)]

My Lords, while recognising the current problems caused by bed blockages in NHS hospitals due to capacity and social care issues, does the Minister agree with the report from the Health Foundation, which, looking ahead, suggests that, because of changing demography and disease patterns in future, we will require between 25,000 and 40,000 more beds in the NHS if we are going to cope with the pressures on both the NHS and social care? What plans do the Government have to address that?

[Lord Markham (Con)]

We are absolutely aware that we need long-term plans and forecasts. That is also one of the things that the healthcare workforce plan will take into account: it will look at exactly where the capacity needs to be on a regional basis going forward so that we have the right number of hospital beds and social care places for an elderly and growing demographic in terms of age groups.

NHS Waiting Times

Lord Patel Excerpts

Tuesday 22nd November 2022 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend. Adult social care, as many have heard me say before in this House, is a crucial part of this, because it is all about the flow. That is why I was delighted that, in addition to the £500 million discharge fund for this year, we have secured up to £2.8 billion of funding for next year. That is in addition to the 7,000 extra beds and the tailored help for the 15 worst-performing hospitals with the ambulances, so we have a complete answer to all these areas.

[Lord Patel (CB)]

My Lords, patients with complex and long-term conditions are finding it increasingly difficult to access the care that they need, resulting, as the British Heart Foundation report indicated, in 10,000 excess deaths in people suffering from chronic cardiac conditions. The Minister referred recently to the system being a failure. Does he agree that we need a system that develops care for these patients, one that is accessible and timely, in community and primary care settings?

[Lord Markham (Con)]

I agree with the noble Lord that cardiovascular is one important area in which, over the last few years, patients have not received the number of check-ups that we want, so it is an area on which we want to focus—not just through checks in GP centres but in the community. We all know that it is very easy to take blood pressure and have blood pressure machines. As a team, we are looking at precisely those kinds of measures to make sure that we can get the preventive screening in up front, so we can identify these people before problems occur.

Ambulance Delays

Lord Patel Excerpts

Wednesday 9th November 2022 Lords Chamber

[Lord Markham (Con)]

The government pledge of 50 million additional appointments is across the country. It is the job of the ICBs to make sure that each area is well catered for; the idea is that this is felt in every area, including rural areas. I am glad to say that we are making good progress on our target to increase appointments by 50 million and, rest assured, I am working with the integrated care boards and their systems to ensure that they touch every part of England, including rural areas.

[Lord Patel (CB)]

My Lords, the Minister said that this is a systems failure. Who in the Government is responsible and when will the system be fixed?

[Lord Markham (Con)]

I think I said this is a systems issue. It is something on which we—including me and the Secretary of State—are very focused, because we need to address it across the piece. That is what the ABCD plan is all about. I am very confident that, over the coming weeks and months, we will start to see improvements from the investment we are making in 7,000 more beds and £500 million more into adult social care discharge.

British Heart Foundation: Tipping Point Report

Lord Patel Excerpts

Tuesday 8th November 2022 Lords Chamber

[Lord Markham (Con)]

I will check on that. I have been told that it is being done as part of that. It is available in a large number of pharmacies now and we have sent out hundreds of thousands of blood pressure monitors, so people can do it from home. It is fully understood that it is a vital part of early monitoring and we have a three-pronged strategy to make sure that we can measure people’s blood pressure at every point of contact.

[Lord Patel (CB)]

My Lords, the report identifies shortcomings in the delivery of primary and community care for patients with cardiac disease, which is a systems failure. I have no doubt that there will be similar findings for patients who suffer from other chronic diseases. Does the Minister agree that it is time to look at a systems change in the delivery of primary and community care, incorporating advances in technology and digital healthcare that would improve access for patients?

[Lord Markham (Con)]

Yes, we all agree that prevention is better than cure. One of the few benefits of Covid was that millions of people downloaded the NHS app. People are using that for self-diagnosis now, in exactly the way that has been mentioned. In October alone, 500,000 people used the app for self-diagnosis, the healthy heart blood pressure MoT and diabetes checking. That is part of this and it is all part of our five-year healthier life plan, which, as mentioned, is very much focused on MoTs from age 40 onwards, so that we can diagnose these problems early. Our focus should absolutely be on prevention rather than cure.

NHS: Nurses

Lord Patel Excerpts

Tuesday 1st November 2022 Lords Chamber

[Lord Patel (CB)]

My Lords, shortages of NHS staff, whether they be nurses, physiotherapists, doctors, dentists or community nurses, results in poor service. What plans do the Government have to make primary and community care more sustainable in the long term?

[Lord Markham (Con)]

The plans are very much those that we are doing, which I believe are successful. As mentioned before, it is not just that the number of nurses has gone up by 29,000; we have seen significant increases in doctors and the other medical professions as well. We should remember that we have 200,000 more people working now within the profession than in 2010. That is not to say that we will rest on our laurels; I completely agree that we need to carry on expanding supply to ensure that we properly meet the demand.

Maternity and Neonatal Services

Lord Patel Excerpts

Tuesday 25th October 2022 Lords Chamber

[Lord Markham (Con)]

Yes. Resourcing the special measures programme—for want of a better name—is vital to all of us. I am pleased to see in the case of East Kent that, of the 67 special measures recommended, it has now passed 65 and the two remaining ones will be completed by the end of November.

[Lord Patel (CB)]

My Lords, this is the most recent of several reports identifying failures of maternity units in England. The CQC identified 40 maternity units that had failing safety standards. Bill Kirkup has not only produced a brilliant report but identified the way forward, by developing a matrix of standards of safety and outcomes that would apply to all maternity units to make them all high calibre, high standard and safe. Will the Minister agree that, by meeting Bill Kirkup, Ministers could ask him to identify the areas to draw up these standards? Because time is short, if the Minister agrees I will be happy to meet him to enlarge further.

[Lord Markham (Con)]

I agree about wanting to implement the recommendations. My colleague Dr Johnson, the Minister in the other House, already met with Dr Kirkup this week. We also undertook to come back in the next four to six months with where we are on each of the recommendations. I will bring that back to the House then.

Menopause

Lord Patel Excerpts

Tuesday 18th October 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness. I agree that it is fitting that we should be having this debate today, World Menopause Day. I completely agree with the importance of this subject for employers, productivity and the economy as a whole, as well as for women’s health.

As I am sure the noble Baroness is aware, 10% of people end up leaving their job during menopause. That is a real loss to business and those individuals. That is why, through our strategy, we are appointing an employee champion in this area. Their job will be to reach out to employers and work with them to make sure that this subject is very high up on their agenda. As an employer myself, in my personal entrepreneurial life, I agree that it is an area of utmost importance.

[Lord Patel (CB)]

My Lords, women with post-menopausal symptoms are disadvantaged by not getting the treatment they need due to restrictions put on the treatments by local formularies. Does the Minister agree that we need a national formulary where all hormone replacement therapy treatments are available to women who need them, and that that national formulary should be made mandatory? If he does not agree, why not?

[Lord Markham (Con)]

I agree that we want to make sure that there is national access. I understand that, whereas we had 30% take-up as long ago as the 1990s, with the incorrect scare around some of the causes since then, that rate is only about 15% today. There is clearly a need to increase awareness and the ability for people to receive treatment.

I am aware of the issue around formularies; I have heard that they believe that it can be resolved. I will take it away and write to the noble Lord to make sure that it is properly dealt with.

Pharmaceutical Research and Development Spending

Lord Patel Excerpts

Thursday 13th October 2022 Grand Committee

[Lord Patel (CB)]

My Lords, I might end up repeating some things that have already been said, but that will just reinforce the important aspects of this debate. I thank the noble Lord, Lord Hunt, for initiating it, and the noble Baroness, Lady Wheeler, for introducing it.

I was going to try to focus on two things. One was clinical trials and the other was potential research into dementia. We know that clinical trials are an important part of domestic R&D, an important source of revenue for the NHS and a critical way of delivering early access to promising treatments for patients. As has already been mentioned, in the 2018-19 financial year, in addition to the revenue generated, there were £30 million of pharmaceutical product cost savings from trials supported by the NIHR clinical trials network. Numerous studies have also shown that research-active NHS facilities deliver better patient outcomes.

It has already been said that the UK has slipped down the global rankings and our reputation as a reliable destination to locate clinical trials is taking a hit. The National Institute for Health and Care Research found that there were about 28,000 participants recruited into clinical trials in 2021-22, compared with over 50,000 in 2017-18, and patients in different parts of the country, as the noble Baroness, Lady Walmsley, has already mentioned, have wildly varying experiences of being able to participate in research. The noble Baroness gave the particular example of cancer research. As she said, cancer patients in west London are 71% more likely to be asked to take part compared with those in some other areas. That is quite shocking, because cancer research trials were one area where we excelled.

The pandemic obviously had an impact on this decline. R&D leaders in the NHS estimate—again, as the noble Baroness, Lady Walmsley, mentioned—that we lost something of the order of £0.5 billion. But it cannot be ignored that the UK was beginning to decline pre Covid, and our post-pandemic recovery is lagging behind that of other countries. Even Spain has now overtaken us in the world ranking of clinical trials. We are now number 8, whereas some years ago we were number 2.

There are ways that we can tackle this, including by streamlining the slow set-up of recruitment to studies. So can I ask the Minister what the Government are doing to prioritise the recovery of industry clinical trials in the UK and ensure that research is embedded as part of routine NHS care across the whole of the UK? I think he has a golden opportunity as a new Minister to get some people into his office and demand that we change this declining position. Clinical trials should be a key part of our NHS research agenda.

I will now return to some aspects of dementia research that the noble Lord, Lord Goodlad, mentioned. It is the ambition in the life sciences vision of the Government to escalate novel treatments for dementia. As has already been mentioned, Alzheimer’s Research UK is concerned that the government commitment to research into Alzheimer’s is now slowing—to put it mildly. We know that dementia is the world’s biggest health challenge, with almost 1 million people in the United Kingdom alone suffering, and we know the heartbreak it causes not just to individuals but to their families.

Traditionally, this area has been risky for investment, but the commitment of dementia researchers over many years has led to some recent scientific breakthroughs and a growing pipeline of new treatments in clinical trials from which we in the United Kingdom are not benefiting. In recent news, a treatment called Lecanemab has shown in initial phase 3 clinical trials that it can slow down patients’ decline in memory and thinking. It is very promising. Taking these together, this means that dementia research is at a tipping point of progress. Continued life science investment is crucial to delivering the safe and effective treatments that people with dementia desperately need.

Over the past five years, we have seen an overall decline in the number of dementia trials being initiated in the UK and the number of participants in each trial. The noble Baroness, Lady Walmsley, mentioned how Germany, France and other countries have outstripped us in initiating dementia clinical trials, which is sad to have to admit. One of the reasons is that as a country we identify the problem at a later stage of the disease. We currently diagnose people with dementia too late, so their condition has progressed beyond the point where they are eligible to take part in clinical research. There is therefore a need for the NHS to address the diagnostics of dementia. Again, the point has already been made about government investment, which declined from 2018-19 to 2019-20. So the plea for the Government to have a plan to focus attention on dementia research is well made and I hope the Minister will say whether the Government have a plan to take forward research in dementia as identified in the Life Sciences Vision report of July 2021.

Skills for Care Report

Lord Patel Excerpts

Thursday 13th October 2022 Lords Chamber

[Lord Markham (Con)]

My Lords, my noble friend is correct that this is also a labour supply issue. Part of the benefit of living in an economy with full employment is, of course, that there is little unemployment. Part of the downside of that is the competition for jobs. My noble friend rightly points out the need to recruit more in this sector; that is why I am pleased that she mentioned the work we are doing to add this sector to the essential workers list so that we can recruit people from overseas and get essential workers in.

[Lord Patel (CB)]

My Lords, I welcome the Minister to his post. I look forward to working with him. In that spirit, I ask him this: where might I find the data relating to the long-term planning for the NHS and social care workforce? If such data does not exist, will he agree that such planning data should be made available as a matter of urgency?

[Lord Markham (Con)]

My Lords, my understanding is that there is a 10-year plan as part of a workforce plan, which rightly looks at the issues raised by the noble Lord. As I mentioned in my answer to the previous question, the workforce is key to this sector. We employ 1.5 million people; I think that they account for about 5% of our whole workforce. So making sure that this is an area that people want to come and work in, that people enjoy and that people see as a vocation is vital and will be part of the plan. I will look up the data requested and reply in writing.

Primary and Community Care: Improving Patient Outcomes

Lord Patel Excerpts

Thursday 8th September 2022 Lords Chamber

Moved by

[Lord Patel]

To move that this House takes note of (1) the role of primary and community care in improving patient outcomes, and (2) the need for reform.

[Lord Patel (CB)]

My Lords, I am pleased to open the debate today. I thank the Minister and all noble Lords who have their names down to speak and look forward very much to their contributions. This debate takes place at a time when the whole NHS is under immense pressure, with media headlines such as “NHS in crisis”, “End of general practice as we know it” and “Will we have an NHS in the future?”, to quote a few. The focus of today’s debate is primary and community care—the backbone of our health service—how its performance affects patient outcomes, and whether there is a need to reform the primary care service.

Primary care has been the bedrock of the NHS since its inception in 1948. It has been revered by patients and has delivered huge health improvements. When Nigel Lawson—now the noble Lord, Lord Lawson of Blaby—said that the NHS was a national religion, it was because of patients’ love of its primary care services. The two professional groups worshipped by the people were the general practitioners and nurses in primary and community care, not the brilliant obstetricians, colorectal surgeons, palliative care doctors and—I say on behalf of the noble Baroness, Lady Murphy, who had to withdraw because of cataract surgery yesterday—not even the psychiatrists. Primary care is now in a different place. It is still the bedrock of the service, but the foundations are shaky, even crumbling. Unless fixed, the whole system will collapse.

What is primary and community care? It is the first point of contact for healthcare and is provided mainly by GPs, but also increasingly by nurses, dentists, optometrists, pharmacists and many other allied health and care providers, including physiotherapists, mental health nurses, care co-ordinators and, in the community, health visitors, specialist nurses, midwives and end-of-life carers. The system is about caring for people rather than treating specific diseases. A system designed to work as an integrated team, with the patient as its centre and focus, has now been broken through incoherent policies, being starved of resources, and a lack of attention to the need in primary care to develop a technologically driven healthcare system and the infrastructure and professionals needed for an efficient and effective system to run.

Primary care is the setting for 90% of patient contacts, involving some 26 million patients a month. Huge increases in demand are putting pressure on the whole system and leading to long waits in general practice, emergency care and planned care. These pressures have created the biggest single fall in public satisfaction with the NHS in decades. A recent survey suggests 68% of patients do not feel they will receive timely treatment if they fall ill, 50% think it is harder to get a GP appointment and 40% think the service has deteriorated. With general practice under immense pressure, recent data from the GP Patient Survey and the British Social Attitudes survey suggest two-thirds of people are dissatisfied with service provision, with the quality of care received perceived to be an issue.

If the problems in general practice and its performance are not resolved, it will lead to the demise of general practice as we know it and, in turn, the collapse of the whole system of primary care and the wider healthcare system. We will see a repeat in general practice of what has happened in dentistry, where 90% of NHS dentists are not accepting any new adult patients.

Putting aside the rhetoric, GP numbers are declining, despite higher numbers in training. Recruitment and retention are poor. More GPs are retiring early, with pressures of work, bureaucracy and pension rules cited as reasons. Reports of nearly 57% of GPs working three days a week or less and increasing numbers doing only private work—approximately 1,500 at the most recent count—are a worry. The service may become more privately driven.

Contracts and the independent status of general practitioners dominate all discussions related to primary care. The small-business model of GP contracts is still favoured by professional organisations, but a House of Lords report suggested that model is not fit for purpose. A recent Policy Exchange report, At Your Service, advocates a universal shift to a fully salaried model over time as part of wider reforms in primary care. More and more younger general practitioners are choosing to be salaried.

Of course, no change in service delivery can occur without general practitioners being part of it and, importantly, playing a leading role. General practice can and should provide that leadership, but at the same time recognise that strong leaders remain strong and gain respect by at times letting go of some strongly held values, such as their gatekeeper role or even their responsibility for minor contractual issues. I am sure GP professional organisations are aware of this: my conversations with them suggest that they are not averse to change, but wish to be involved in any policy developments. The workforce issues are not confined to general practitioners. Similar problems exist with nursing, health visitors and community care professionals, all of whom are a crucial part of an effective system of primary care.

Of course, there have been efforts to try to improve the system and deliver patient care. The establishment of primary care networks, starting in 2019, is one key example. While the majority of general practices belong to them, not all do. Success at delivering service at scale in primary care—that is the important point—by PCNs has been variable, and now the BMA is threatening to withdraw its support, with lack of resources and contractual issues given as the reasons for doing so. Some other measures undertaken to improve service are the recently established diagnostic hubs and the recent involvement of pharmacists in blood pressure monitoring.

I was impressed that the voluminous briefings we have all received all cry out for a need for change in primary care that delivers three things: workforce, infrastructure and technology, including IT. Various recent reports have come up with suggestions for improving the primary care system: the report Fit for the Future: A Vision for General Practice, produced by the Royal College of General Practitioners; the At Your Service report I mentioned from Policy Exchange; and the Fuller Stocktake report by Dr Claire Fuller, an eminent general practitioner, which was commissioned by NHS England. All of these reports have suggestions for an integrated system that delivers primary care at scale. In commenting on some of the reports, the King’s Fund has suggested that tinkering with “more of the same” will not produce results. Reforms need to be driven from the bottom up, by the people who do the work.

Undoubtably, we need a primary care service that delivers at scale, is fully integrated with other parts of the health and care system and, above all, is responsive to patient needs and delivers better patient outcomes and health improvement. So what is the way forward? My personal view, which I hope noble Lords would support, is that first and foremost we need political recognition that an effective primary care system is a prerequisite to a sustainable NHS. To this end, proposals for change to make future primary care fit for purpose have to be led by the Secretary of State for Health and Social Care. The words from the Prime Minister and the Secretary of State hitherto are encouraging and I hope they will be followed by some actions.

On the other hand, this House has an opportunity to play an important role by setting up a special Select Committee to report on the future of primary and community care, identifying possible barriers and solutions that could make important contributions to making primary and community care fit for purpose and fit for the future. I hope this gets support from noble Lords.

As for questions for the Minister, I have only one: is there a recognition by the Government that primary care is now in intensive care? None of the piecemeal reforms, mostly of process, will work. Strong, bold leadership is needed to bring about the system change it needs. Otherwise, it will die, and with it the NHS. I beg to move.

--- Later in debate ---

[Lord Patel (CB)]

My Lords, at the outset, I respectfully associate myself with the Minister’s comments and wish Her Majesty the Queen well.

I thank all noble Lords who spoke, and the Minister in particular for taking the debate and answering at length. Your Lordships spoke not just with passion but with real research behind it in finding out what the problems are with primary and community care. I hope the Minister got the information he needed, as was highlighted by everybody.

It was striking that in this debate, unlike others, no speaker tried to get at the government policies. There were no combative speeches; they all tried to help resolve the problem we now face in primary and community care, which must urgently be fixed. There is one message I suggest the Minister takes back to his ministerial colleagues—by the way, it is a good idea that they and their advisers all get a copy of today’s debate. In his meetings with his colleagues, the Minister should highlight the important issues that were raised today. I still say that primary and community care are in intensive care; if we do not rescue them soon, they will die. The problem will not be worse any more, because it will not be there.

I could summarise every speech, but I will not do that. They all made very important points. I say to the noble Viscount, Lord Eccles, please keep coming back; as the noble Baroness, Lady Hodgson, said, you are not past your sell-by date.

I ask the Minister to take this matter seriously. We hope the new Secretary of State recognises that primary and community care need fixing. I appreciate all the support I had for my proposal for a special Select Committee and hope the Liaison Committee listened very carefully. I thank noble Lords for today’s debate and for contributing; I appreciate it very much.

Motion agreed.