Paediatric Care: Wating Times

Lord Winston Excerpts

Monday 16th October 2023 Lords Chamber

[Lord Markham (Con)]

I am aware from personal experience that, when you have a child with neurodiversity or developmental needs, it is a long journey. We are seeing this manifest itself much more in recent years; I was talking to Minister Caulfield about this just this morning. One-to-one is always preferable but, where capacity is constrained, group education and help can sometimes lend themselves to this space. It is a long-term condition, and clearly it will not be solved by treatment over a few months but needs many years.

[Lord Winston (Lab)]

The Minister quite rightly referred to the brain development of a child being very rapid and resulting from experience, and to various experiences having a profound effect on children’s development. However, he did not mention the place of primary care and, particularly, general practitioners in this. Does he feel that general practitioners are getting enough resources to be able to assess children on a more routine basis? The app will certainly be useful, but it does not get them clearly involved with medical practice; we need some standard way of doing this. Can he give us some information about the role of the GP?

[Lord Markham (Con)]

The role of the GP is clearly vital. That is what I was trying to get behind in the Start for Life initiative and clear early warning indicators. Clearly, that needs to go right through the development of a child at different key stages along the way. On digital treatments, I was at Boston children’s hospital last week, and it has early indicators for dyslexia—for example, looking at pattern recognition via an app, as it is not until children are older that they can see letters. Similarly, early signs of neurodiversity can be seen in the way that children play online on certain apps. I think we can add some of these digital support tools, but clearly the GP has a primary role.

Cancer Referral Targets

Lord Winston Excerpts

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend is correct that there were knock-on implications of lockdown, cancer detection rates being one of them. Noble Lords have heard me speak of Chris Whitty’s concern about heart disease because those check-ups were missed, and mental health is another area. Clearly, these are some of the things we are hoping to learn from the Covid inquiry, so that we know the impact of lockdowns, not just on restricting Covid but more widely, on the population as a whole.

[Lord Winston (Lab)]

My Lords, have the Government made an assessment of the cost of false positive tests in this kind of screening and the cost to patients?

[Lord Markham (Con)]

When the noble Lord says this kind of screening, I am not quite sure which type of screening he is referring to.

[Lord Winston (Lab)]

For cancer.

[Lord Markham (Con)]

I did not know whether the noble Lord was referring to GRAIL and the comment from the noble Lord, Lord Patel, about false positives. This question probably deserves a detailed reply but, as with any test, it is not about just specificity but sensitivity, which is key, so that the number of false positives is minimised. I will provide a detailed reply.

Pharmacies: Medicines at Home

Lord Winston Excerpts

Wednesday 17th May 2023 Lords Chamber

[Lord Markham (Con)]

Absolutely. That is one of the major reasons why blister packs are not always the right solution, because there are many cases of wastage in exactly the way that the noble Baroness has mentioned. Wastage is one of the many reasons why both NICE and the Royal Pharmaceutical Society have come out against the blanket use of blister packs.

[Lord Winston (Lab)]

My noble friend on the Front Bench is absolutely right. As somebody who is currently taking hourly medication, I can tell the Minister that it is extremely difficult to keep that up. Does he not recognise that we need to have set blood levels for many drugs, and that it is really important that those are not delayed if we are to have proper pharmaceutical action in the blood stream?

[Lord Markham (Con)]

Yes. There are occasions when it is absolutely appropriate that medicines are packaged in that way; I am sure we all have plenty examples of friends and relatives for whom that is very useful. The whole point is that the blanket application of blister packs is not the right approach.

Life Expectancy: Pensions, Health and Insurance

Lord Winston Excerpts

Wednesday 26th April 2023 Lords Chamber

[Lord Markham (Con)]

I know that my health brief is broad but including pensions and insurance in it is quite a challenge. Like other noble Lords, I am very aware of the impact of inflation on the final salary scheme and on lifestyles, and of the fact that not many employers can afford the schemes any more—apart from, dare I say it, government. That has an impact. However, I am happy to meet my noble friend to go through this in further detail.

[Lord Winston (Lab)]

My Lords, the Government have made a pledge that they know perfectly well they cannot keep. There is no way that this massive morbidity will be reduced: obesity is not the answer. If he looks carefully, he will see what the Science and Technology Committee—chaired by the noble Lord, Lord Patel, who may want to comment—showed: that it is clearly due to deprivation in poorer parts of the country, which leads to a much shorter life. The Government need to deal with this holistically; it is not the problem of the Department of Health and Social Care but a much wider issue.

[Lord Markham (Con)]

As ever, there are multiple factors at play. That is what the Office for Health Improvement and Disparities is all about: making sure that we are tackling this in exactly the holistic way the noble Lord mentioned, going back to all the major conditions that are causes of death and tackling each one by one. The 10 million cancer screenings save 10,000 lives a year, and our breast cancer screenings save 1,300 lives. There is a lot to do but a lot that we are doing already.

Gender Identity Services: Children and Young People

Lord Winston Excerpts

Wednesday 19th April 2023 Lords Chamber

[Lord Markham (Con)]

Again, my understanding—and I freely admit that the benefit of having these questions is that you then delve into them, which I very much support in terms of how this process works very well —is that these people who have been through these services need to be looked after and catered for, so that is something we are very much on.

[Lord Winston (Lab)]

My Lords, leaving aside the issue of the serious psychological problems some of these children undoubtedly display, can the Government clarify one issue? Do they regard so-called gender dysphoria, which is a very broad term, as a pathological condition or simply a medical one? Is it a pure choice of the individual? Therefore, the question is: at what stage should the National Health Service be intervening in these cases?

[Lord Markham (Con)]

I feel I am probably outgunned to some degree by the noble Lord. I would like to make sure that I answer that in the proper way and give him a detailed written response. I am happy to follow up, because I want to make sure that I am answering in completely the right way.

NHS: Access to Treatments

Lord Winston Excerpts

Wednesday 7th September 2022 Lords Chamber

[Lord Kamall (Con)]

My noble friend raises a very important point. It is not just in my department; across government a number of different departments are looking at the impact of the cost of living crisis and higher energy bills. Clearly the NHS, but also individual practitioners and centres within the NHS, will be affected by rising costs. Discussions are going on at the moment. One of the things that my right honourable friend the incoming Secretary of State has said is that she is very clear on the priorities—ABCDD: ambulances, backlog, care, dentists and doctors—but also understands the energy crisis.

[Lord Winston (Lab)]

My Lords, the Minister’s Answer to the noble Lord, Lord Hunt, does not seem to address the question. What we are seeing, of course, is a reduction in the number of doctors, whether from retirement and not being replaced or for whatever reason, or from a lack of training. Are the Government intending to reduce the number of doctors, as they have been doing, and how do they intend to substitute for proper medical care by a doctor, which is what patients want to see?

[Lord Kamall (Con)]

The noble Lord raised a number of different points, which I will try to respond to. One issue is that, although we are recruiting more doctors, at the same time clearly there are doctors who are looking to leave. There is a demographic of people reaching a certain age, and one of the issues is pensions and whether they hit the limit. Those discussions are going on. There are also lots of discussions going on about how we can improve retention of those staff who feel overworked and have had enough.

In addition, at certain levels, for example primary care, it does not always have to be a doctor that the patient sees. It could be a practice nurse or a physiotherapist. There is also more emphasis on the Pharmacy First programme, whereby people can get advice from pharmacies, unless they actually need to see a doctor.

General Practitioners: Shortage

Lord Winston Excerpts

Tuesday 12th July 2022 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Lord for that question, but I should explain to him that I have been warned for exceeding my powers, as it were, in the past. I think setting up a Select Committee is a bit beyond my powers. The noble Lord and I, and many noble Lords across the House, including previous Health Ministers of all parties, have had this conversation, and we know that the old-fashioned model of a five to 10-minute appointment with your GP, only to be referred elsewhere and into secondary care, is broken in many ways. We need a much more modern model. We have seen primary care take on some of the functions of secondary care, but we have also seen, at the GP level, that the GP does not have to do everything, and that there are other workers such as nurses, physio- therapists and pharmacists who can do more of what the GP has done in the past.

[Lord Winston (Lab)]

My Lords, the figures show that more than half of GPs are considering retirement or are retiring before the age of 60. As the noble Lord has pointed out, there are lots of reasons for this, but he has not told us what he is doing about them. What is he doing constructively to change the attitudes and experience of GPs, which lead to this disillusionment among men who are at the highest point of their career, when they are the most useful to patients in primary care?

[Lord Kamall (Con)]

I assure the noble Lord that the Government are doing lots of things. Not only are we listening but we are looking at potential solutions and discussing them with the relevant bodies. For example, one of the pressures mentioned was the impact of the number of phone calls. There has been investment in handling them and getting them redirected appropriately, and GP practices have been offered money for that. The other issue is pensions: some GPs are worried about taking a hit on their pension if they come back to service. There are discussions about whether they are really worse off and how we can retain staff. Also, having other staff at the GP level who can take on some of those functions that GPs do not necessarily need to do could ease their workload. The administrative burden has added to this, but the digitisation of services should solve a lot of those problems.

Cannabis: Medicinal Use

Lord Winston Excerpts

Tuesday 12th July 2022 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for his question and note his concerns. However, I think we should look at this in two ways: there is medicinal cannabis and there is recreational cannabis, and we must be quite clear on that. Some people clearly want to liberalise both. I cannot comment on my own particular views because I am conflicted on this, but what is really important here is that we take a cautious approach and look at the particular issue of medicinal cannabis. The MHRA is ready to regulate medicinal cannabis; it just needs companies to come forward and spend money on the trials.

[Lord Winston (Lab)]

My Lords, the Science and Technology Select Committee, which I had the honour to chair some 15 or 18 years ago, looked at the medicinal uses of cannabis. One of the things we clearly showed was that the statement we just heard is not true; in fact, there was no evidence then that the medicinal use of cannabis led to addiction in patients. Indeed, patients who were having medicinal cannabis were trying very hard not to become high and trying to use the doses in very limited amounts so that they could cure their symptoms.

[Lord Kamall (Con)]

The noble Lord makes a very important point: whatever our personal views, we must distinguish between recreational and medicinal uses of cannabis. We know from observations and many stories that many people believe that they benefit from medicinal cannabis. We know that there is a barrier because companies have not come forward to have it regulated or go through the clinical trials, but we are trying to work with those companies and encourage them to come forward. In fact, we have also found some NIHR research money available to help with those trials. My request to the industry is: “You make a lot of money out of this—please come forward and go through those trials with the MHRA”.

Coronavirus: New Cases

Lord Winston Excerpts

Monday 11th July 2022 Lords Chamber

[Lord Kamall (Con)]

One of the things we do in the Department of Health and Social Care is to have regular meetings with our counterparts in the devolved Administrations—all the Ministers do. The noble Lord, Lord Foulkes, shakes his head, but I can tell him that we regularly have meetings with the devolved Administrations. I commit to go back to the department and see who is next due to have a meeting with their devolved counterparts, and ask whether we can put Covid on the agenda.

[Lord Winston (Lab)]

Does the Minister agree that his dismissal of hindsight is one of the most useless ways of looking at this? Surely with continuing infection like this, hindsight is really important, and we should be looking all the time to see how we can change our practice.

[Lord Kamall (Con)]

I was making the point that there is the benefit of hindsight but also the fallacy of hindsight. The benefit is that we learn from mistakes we made in the past. We learn from previous actions what worked and did not work, particularly in a local context. Some of my friends in other countries tell me that what we did in England may not necessarily have worked in their country, and vice versa. There is also the fallacy of hindsight, when people say that in the same situation, 18 months or two years ago, they would have done something completely different with the information we had then. That is what is known in social sciences as the fallacy of hindsight.

Paramedic Services

Lord Winston Excerpts

Monday 4th July 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness will be aware that there are a number of things going on with the 10-point plan. Maybe I will go through some of the points now. We are supporting 999 and 111 services, making sure that the appropriate person answers the call; supporting primary care and community health services to manage those services; making more use of urgent treatment centres; and providing more support for children and young people. Sometimes people ring 999 but do not need emergency treatment and they can be redirected to another clinician, who can speak to them and that takes pressure off. We are recruiting more staff and looking at more prevention and looking at different rules which prevent the appropriate workflow through the system.

[Lord Winston (Lab)]

My Lords, some months ago, as my wife lay dying in my arms, I phoned the 999 service. The man answering the call asked me a litany of questions and asked me to count her number of heartbeats per minute. That waste of time is critical; with a cardiac arrest you have only a few seconds. I had to interrupt the cardiac massage that I was giving my wife until the emergency services arrived, but of course they had not been called yet. When eventually the man backed down, it was obvious that he had not been trained to ask the right questions. Can the Minister assure the House that there is proper training for people who answer these calls at these critical times, when they are dealing with someone who may recognise that their close relative is dying, and that the latter can hear what they are saying on the telephone? It is highly dangerous and that makes it very difficult. The last thing we hear as we die is usually the voice of someone who is with us.

[Lord Kamall (Con)]

I thank the noble Lord for sharing that very personal story. Clearly, there are too many incidents of this kind. One of the issues that we have to be very careful about as we look to recruit more numbers is to look at the system and at how to divert the less urgent calls. Probably in that case the person was trained to ask particular questions to ascertain how serious or urgent it was but, clearly, that was inappropriate. I will take that case back to the department and see whether I can get some answers.