Integration of Primary and Community Care (Committee Report)
Baroness Finlay of Llandaff Excerpts(6 months, 4 weeks ago)
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Baroness Finlay of Llandaff (CB)
My Lords, I declare and update my interests as listed in our report, as I now chair the Bevan Commission in Wales. It was a pleasure to be on this committee, so ably chaired by the noble Baroness, Lady Pitkeathley. She kept our focus on the topic at hand and worked extremely hard when there were changes of personnel in the clerical staff supporting our committee.
I came to this very important inquiry with experience of having set up hospice services from scratch, where nurses and care assistants needed upskilling and where bringing everybody together, including clerical and reception staff, for open education sessions resulted in them being able to outreach into community services. We established integrated working. Each person knew what the other one could do, and people worked to the top of their game.
As a committee, we were very keen to explore ways to transform the patient experience and decrease demand on health and social care services. We were acutely aware that we should not incur expenditure nor suggest major reorganisation but should reduce the waste from inefficient practices, and that much can be done by different attitudes and approaches.
We were acutely aware that patients want continuity of care. They often feel pushed from pillar to post, not sure whom to contact or even how to contact someone whom they have seen previously. If they get past an answerphone, they find that they are repeating their story time and again, uncertain about who does what and endlessly waiting for the next appointment along a whole chain that feels like a disjointed slow relay. Our suggestion to put health and social care providers together as much as possible, sharing ongoing training, sharing premises and with access to each other’s records, is really at the heart of patients’ experience of integration.
Yet the government response is deeply disappointing. Rather than welcoming our recommendations to provide additional strengths to their plans towards integration—which are outlined in their response—it reads as if the Government are saying, “We are doing it all already”. Yet, time and again, we heard from services about how disjointed they are. We heard about the changes that need to happen to bring health and social care together under one roof in premises fit for purpose, and we heard how disjointed IT systems are. The data held in the different record systems should be viewed as the patient data—it is about them—yet there seemed to be endless blocks to bringing staff and systems together.
We had hoped the Government would welcome our suggestions for patient data to be shared usefully and safely; for the multidisciplinary team to meet together and plan care; for joint education that would upskill social care to remove the risk-averse barriers to interventions that so often result in patients being put in an ambulance from home or a care home and sent to an already overcrowded emergency department for problems such as a blocked catheter or blocked feeding tube to be sorted out, when it could happen so much more easily if staff were upskilled and the patient would not then need to be moved. Many of the bureaucratic blocks could be overcome by honouring contracts that have all staff working together with common aims and contractual changes that reward work done and outcomes, with meaningless bureaucracy stripped out.
We repeatedly heard how patients cannot get the holistic care they need because staff are working in silos, often overseen by risk-averse attitudes from their managers; they do not feel able to do what needs to be done but revert repeatedly to a view of limited job responsibility. By staff working together under the same roof, as we suggested, for evolving general practices and primary care, integrating with local social care providers and the voluntary sector, the culture of care provision could be improved and better monitored to provide far better health outcomes in the longer term, particularly for frail and vulnerable people, for whom stability of place and of staff is especially important.
The Hewitt Review, published in 2023, found that culture, leadership and behaviours matter far more than structures. We wanted to break down the barriers in contracts and in behaviours, but the Government’s response seems to pull back from supporting our recommendations to focus on broad policies that were written recently, rather than address the need to build on them to create the crucial interpersonal relationships that determine good care. We felt disappointment in the Government’s response because it did not build on what they already are putting in place and encourage further integration, and it seemed almost to dismiss some of our suggestions by saying what they were doing but without welcoming our recommendations.
Immunisation: Children
Baroness Finlay of Llandaff Excerpts(7 months ago)
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Lord Markham (Con)
Or “none of the above”. The noble Lord is quite correct. Of course, data is vital in this whole area, and getting that sharing of data and understanding with people is vital. I will come back on the precise date, but I hope it will be soon.
Baroness Finlay of Llandaff (CB)
My Lords, there have been more than 1,000 cases of measles in the last six months. What action are the Government taking to make sure that mothers are given options, which maximise convenience, of places to go and times when they could take their children for vaccination, rather than tying them to appointments that may clash with the working day when they cannot get childcare for other children?
Lord Markham (Con)
That is an important point. We must try to make sure that vaccination clinics are widespread. We have used pop-up clinics successfully in many locations, particularly around London, and that has helped get 25,000 more jabs into unvaccinated people’s arms in the last few months.
Covid-19 Vaccination: Coronary Disease
Baroness Finlay of Llandaff Excerpts(7 months, 2 weeks ago)
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Lord Markham (Con)
Deaths from heart disease among those under 75 are down by about 20% compared with 2010, which is a clear trend. Notwithstanding that, we are very aware—Sir Chris Whitty is concerned about this—that Covid meant that a lot of people did not get basic heart and blood pressure checks. That is why we have introduced the Midlife MoT, which is designed to give people a 10-year risk analysis; have put blood pressure devices in pharmacies and all sorts of other places to get 2 million checks; and have a workplace heart disease strategy check. All this is designed to get that prevention in place so that people are aware of and understand the risks.
Baroness Finlay of Llandaff (CB)
My Lords, does the Minister agree that, although we are talking about heart disease, we must also remember pulmonary embolism from clotting disorders, which can persist for up to six months after even a mild Covid infection? A massive pulmonary embolus is another cause of mortality in people who have Covid. One of the problems with the virus is its ability to mutate, but the evidence is that vaccination, even if it does not give you complete protection, moves you from obtaining serious Covid to having milder Covid. That risk of thromboembolism also needs to be monitored in the long term in relation to Covid infections, including for those who have had a mild infection and those who have long Covid.
Lord Markham (Con)
The noble Baroness is absolutely correct: a vaccine helped you avoid not just heart disease but all the other impacts of Covid that she mentioned, including long Covid and a whole list of other things. Again, the undeniable advice is that it is much better to have the Covid vaccine.
NHS: Long-term Sustainability
Baroness Finlay of Llandaff Excerpts(7 months, 2 weeks ago)
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Baroness Finlay of Llandaff (CB)
My Lords, I declare my interests as an NHS consultant and chair of the Bevan Commission. I congratulate the noble Baroness, Lady Ramsey of Wall Heath, on her very moving speech and on reminding us of the hardship of the pre-NHS days and why the NHS is so important to us. The contribution of the noble Lord, Lord Patel, in opening this important debate was characteristic of his great speeches.
I had the pleasure of being a member of the Times Health Commission, where we were given the task of suggesting reforms to improve the NHS. It was a very interesting experience, taking evidence from a wide range of people, including previous Ministers. At the end of our deliberations, we came up with a 10-point plan for health, which I will briefly outline now. For patients, it is clear that digital health accounts, such as patient passports accessed through the NHS app, are crucial for the future. Patients need to be able to co-ordinate their appointments, manage any medication and view their own records in full. We cannot expect people to take control of their own health if they do not have their test results, referral letters and vaccination and intervention records, or the ability to review, in their own time, the outcome from different consultations. Patients retain a small percentage of what they are told in a consultation, so it is very important that people can review things in their own time and with their families.
In Wales, we established Talk CPR to address the very important conversations around end of life and resuscitation procedures, which establish whether somebody wants ongoing treatment and intervention. We found that, by giving patients video books to take home, they were much more comfortable discussing issues than trying to have all that discussion in the context of a short consultation. In the Times Health Commission, we focused on the workforce—including the need to reform the GP contract and to write off student loans for people who continue to work in the NHS rather than leaving it—and the importance of no-blame compensation approach to errors, rather than the current blame culture that demoralises.
We addressed the need for mental health support and tackling obesity in particular. It is a precursor to so much disease, and the antecedents of illness can be decades before a patient presents. The importance of research and investing in it became more and more evident. Data collection is crucial for us to monitor and understand better the course of health in our own country, but also as a basis for inward investment from pharmaceutical and technological innovators. The NHS could be a major test bed, with integrated information and fast-track processes, to attract and retain researchers from around the world with inward investment, but unless we speed up the processes for investment we will never reach our goals.
One of our recommendations was to have a healthy lives committee to look at the impact of improved public health and a healthy life expectancy, addressing the antecedents of poor health. But whatever we do, bad things happen: people have accidents, severe illness hits out the blue and new infections emerge. Although palliative care is now in legislation as a core service, contracting is not the same as ensuring that patients have access, yet it is cost effective to involve palliative care services early. We need a national funding formula to support integrated care boards in establishing contracts with palliative care providers. Services must be rapidly responsive seven days a week; without that, the sad toll of inappropriate transfers to emergency departments out of hours will not decrease.
In recovery from a serious accident or devastating illness, early rehabilitation becomes crucial to improve outcomes and decrease costs. Next Monday, I am hosting a drop-in on rehabilitation with the full range of professionals involved. Rehabilitation is cost effective for the NHS, yet, like palliative care and hospice services, it is very patchy in provision. As such, we allow distress and ongoing, avoidable morbidity to accumulate and jeopardise long-term outcomes, in both the patient and the bereaved. Fair access to help in response to need is essential; we must never forget the patient.
Cass Review
Baroness Finlay of Llandaff Excerpts(7 months, 3 weeks ago)
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Lord Markham (Con)
I remember that it was the noble Lord who, in the round table that we had on this, made very clearly the same point I was making earlier about puberty and age. It is only when you are right the way through it that you really are in a position where you start to know your own mind and your own body. I agree with the noble Lord that it can be as late as 25, and that is why that is definitely the intention behind the eight clinics that are being set up—that they can provide that continuity right up to the age of 25, given that there is such a state of flux in a young person’s life.
Baroness Finlay of Llandaff (CB)
My Lords, I thank the Government for giving us this opportunity. Dr Cass’s report is incredibly important. She has taken a scientific, as well as a kind, humane and humanitarian, approach to the children affected and to the way the report is written. In the recommendations, as well as the discussion over puberty blockers there is the importance of ongoing research, research capacity and data. One finding that emerged for her was that there was a lack of consistent collection of data, which means that for many of these children, the people who were looking after them were, in effect, flying blind. That cannot be allowed to continue in future.
Her recommendation 17 is that:
“A core national data set should be defined for both specialist and designated local specialist services”.
Recommendation 18 is that:
“The national infrastructure should be put in place to manage data collection and audit and this should be used … to drive continuous quality improvement and research in an active learning environment”.
My question to the Government is whether, among the organisations listed, there are also discussions with the Royal College of Surgeons, because there is also surgical intervention undertaken in some of the processes. Without a database of the numbers that undergo a surgical intervention, the type of intervention and the complication rates, and monitoring the effect of that surgery on quality of life, we risk carrying on flying blind with clinical treatments that are literally life changing.
Lord Markham (Con)
I thank the noble Baroness. She is absolutely right: it is only in that lack of data environment that, dare I say it, ideology can fill in the vacuum and start to drive the sorts of behaviours that we see. Data is always the best way to cut through and provide light when there is a lot of heat in an argument. She makes an excellent point about the Royal College of Surgeons. I am sure that it has been contacted along with all the other bodies, but we need to make sure that is covered off. As ever, I will come back in detail in writing to all noble Lords who have raised points. I will make sure that point is addressed as well.
Sodium Valproate and Pelvic Mesh
Baroness Finlay of Llandaff Excerpts(8 months, 2 weeks ago)
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Lord Markham (Con)
I thank the noble Baroness. I will provide the precise figures, but the incidence has gone down by 34% in terms of the amount that has been prescribed. At the same time—and this is particularly fitting, as tomorrow is National Epilepsy Awareness Day—for some people, this is the only treatment for epilepsy that will work for them. It is therefore important to make sure that protocols are in place for prospective mothers and prospective fathers to make sure that, in those cases, they are not being prescribed sodium valproate, because in other cases it is often the only medicine that works.
Baroness Finlay of Llandaff (CB)
My Lords, given that, sadly, errors and problems repeatedly occur in the NHS, how are the Government working with the devolved Administrations to ensure that a redress scheme is designed to be fit for the future as well as fit for the recognition of harm that has occurred? What will they do to ensure that trust in the NHS is maintained by an approach that encapsulates prospective monitoring and listening to patients and relatives for early detection of adverse events and avoids cumulative errors?
Lord Markham (Con)
I thank the noble Baroness. I was actually speaking to Minister Caulfield about this just this morning, because she is in regular touch with the affected patient groups. They were talking precisely about some of the things around the Scotland NHS scheme in place in terms of redress. It is fair to say that there are some concerns in patient groups on some aspects of this, but underlying what the noble Baroness says is making sure that, whatever we do, we are trying to do it consistently across the UK because there should be one consistent approach. Likewise, we are learning lessons from these things as well.
Cancer: Staffing
Baroness Finlay of Llandaff Excerpts(8 months, 3 weeks ago)
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Lord Markham (Con)
I totally agree that it is a range of things. I completely agree with the noble Lord that a good employer should be looking to make sure that employees have good working conditions and feel valued, and that there is an understanding culture in the workplace as well as decent pay. I say all this in the context that the workforce in the cancer space has actually increased by 56% since 2010, so it is not as if there have not been massive increases here. The actual number of treatments and diagnoses has gone up by more than 20% from pre-pandemic levels. So we are doing a lot in this space, but I agree with the noble Lord’s basic premise that we need to ensure that staff feel valued so they will want to carry on working.
Baroness Finlay of Llandaff (CB)
My Lords, I declare my interest as being employed in part by the Velindre Cancer Centre in Cardiff. Do the Government recognise that continuity of care is absolutely essential for patients to be able to spot when things are changing and to allow sensitive conversations to occur? Will he therefore undertake to have urgent discussions with the Royal Colleges and with Health Education England to look at the training rotas for doctors who are working in oncology, allowing them to provide better continuity of care with less disruption to their own lifestyles, and better support? Will he also look at recommending that they might draw on the Welsh experience of Talk CPR, which allows early conversations about very difficult topics, providing video books and so on that patients can take home and then come back to see the same person again some time afterwards, providing continuity of care and better communication?
Lord Markham (Con)
First off, I completely agree about continuity of care—in any treatment, to be honest. I was just saying, in answer to a maternity question the other day, that continuity of care in the midwifery space is another vital example. On the question of learning lessons from what the noble Baroness mentioned, we have some meetings set up, so I look forward to discussing it further then.
Anaesthesia Associates and Physician Associates Order 2024
Baroness Finlay of Llandaff Excerpts(9 months, 1 week ago)
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Baroness Finlay of Llandaff (CB)
My Lords, I declare that I am a doctor registered with the General Medical Council, a member of the BMA and a fellow of the Royal College of General Practitioners and the Royal College of Physicians.
We have physician associates and anaesthesia associates seeing patients, examining them and advising them, who are as yet unregulated. All responsibility for their behaviour rests with the doctor who is their supervisor from whom they have delegated responsibility. The professional scope of practice for these associates can vary widely across the country. It is determined at a local level and patients have no idea about the variation.
There is a golden thread in clinical care that the most experienced person delegates down. They delegate down tasks that they know the relevant team member has the skills to undertake. A key skill in medicine, gained with extensive experience, is the integration of all the relevant information, evaluation of risk and prioritisation. Currently a problem in the whole of the NHS is that we expect staff to refer upwards and the boundaries are unclear.
A case of non-accidental injury in a child has been brought to my notice where the expert evidence was provided by a physician associate whose relevant experience is unclear at best. This blurring is misleading to non-medical professionals, including the police, judiciary and legal professionals. Supervision must be mandatory and stipulated in the GMC’s Good Medical Practice.
The junior doctors’ discontent, which we have heard about already from the noble Baroness, Lady Bennett, is boiling over. After training, medical graduates emerge with huge student debts to work a 40-hour week for just over £32,300, only to find that after a two-year postgraduate programme a physician associate typically earns between £3,000 and £11,000 more, for only 37.5 hours a week. All this has inflamed tensions—although I would say that direct verbal attacks on physician associates and anaesthesia associates, who have trained in good faith and with good intent, are not appropriate and I would not condone them.
Doctors are the only healthcare professionals who must undergo extensive, nationally stipulated postgraduate training before being appointed to a permanent senior role. Without long-term job security, these juniors rotate through departments, sometimes commuting many miles. They find that they do not belong and do not feel part of the team or valued, while patients miss out on continuity of care.
Very importantly, patients seen by a physician associate sometimes think that they have seen a doctor. The term “physician associate” gets muddled with the specialty and associate specialist doctor, who often has years of experience. Can the Minister clarify whether the term “physician associate”, which is so misleading, will become a protected title after this order passes? How can the name then be changed to revert to the more accurate “physicians’ assistant”? Currently, no medical titles are protected: “doctor” is not and grades up to and including consultant are not, which is another source of confusion. How is that going to be cleared up?
The cost-efficacy basis for these posts has been questioned in a recent paper, showing how the cost of one consultant anaesthetist supervising two operating theatres with an anaesthesia associate in each—that is, three staff—is more expensive than having two consultants doing one list each. The risk is higher if a problem arises in both theatres, especially in an anaesthetic emergency, when deterioration and brain damage can happen in minutes.
This crisis has been 20 years coming because we failed to expand medical school places or to register these new healthcare roles and define their scope of practice. What is the solution?
I fear this order will not solve all the problems. Yes, physician associates and anaesthesia associates must be regulated. It seems an outrage that people with such responsibility have been around for 20 years, unregulated, and a decade after that was recommended. The General Medical Council, in taking responsibility for regulation, must keep the register completely and clearly separate from that of medically qualified doctors. Can the Minister confirm that this clarity will be a legal requirement?
I tabled my regret amendment because it must be clearly on the record that the concerns exist, that some current regulation around the Medical Act needs updating urgently and that the GMC must be held accountable to Parliament, as has been explained by the Minister. Regulation is essential, but it is not the end of the issue; it is only the beginning.
The GMC must tackle the inappropriate way that some courses are advertised, which state that they train PAs
“to work as a safe and competent medically trained healthcare professional”
or to
“be a medically trained, generalist healthcare professional”
—which sounds awfully like a GP to me. Some courses describe working under a senior physician, but others say nothing about supervision. The anaesthesia associate courses differ slightly. They make it clear that, at present in the UK, only doctors who have specialist training in anaesthesia can administer anaesthetics and that the anaesthesia associate works as part of the anaesthetic team.
Next, the scope of practice must be clearly defined and agreed at national level, so that any employer is aware of what the associates should be doing and how the senior doctors must supervise them on site. Employers must also ensure that all patients know the qualification level of the person seeing them. Seven-day services are essential for patients.
Medical postgraduate training itself is in crisis. The royal medical colleges, the Academy of Royal Medical Colleges and the GMC must get together urgently to address postgraduate training. Perhaps it could be shortened, with post consultant-level fellowships to develop highly specialised skills and bring innovation to healthcare. Lifelong learning is essential; it is the essence of growing a good medical workforce in the long term. Medical schools, as they welcome the increased numbers, must look at how those who might wish to convert to a medical degree can be credited with their prior learning and experience, and tackle regulatory blocks in funding and timing.
Importantly, the title must be reviewed. The terms “physician assistant” and “anaesthesia assistant”, in use until 2014, clearly denoted the role as having delegated responsibilities from a supervisor. If “physician associate” and “anaesthesia associate” are to be protected terms, then we need a designation of medicine that clearly identifies a medical degree—similar to the American MD designation, for example. Patients must know who has seen them.
To summarise: patients must know the level of training of the person whom they have seen. Physician associates and anaesthesia associates must be regulated with appraisal and ongoing learning, including revalidation. The scope of practice of this new workstream must be defined to ensure that they have clear boundaries and supervision must be defined as being closely supervised on site to ensure patient safety. People must not be misled into believing that they are completely independent practitioners.
Baroness Brinton (LD)
My Lords, I am grateful to follow both the noble Baronesses, Lady Bennett and Lady Finlay of Llandaff, and I have been crossing out large chunks of what I was going to say, which I hope will be helpful to Members of your Lordships’ House.
As both of the other noble Lords have, I want to start by saying that this is not an attempt to discredit the many PAs and AAs who do an extremely good job. We need to understand that, and we need to understand that our health system must change and modernise. The issue is what is happening in our NHS and how the role of PAs and AAs is impacting not just on patients—I will come to the detail of that in a minute—but on the working of supervising doctors and junior doctors. All of those groups are in crisis, and this just seems to be adding further problems.
I echo the points made by, I think, the noble Baroness, Lady Bennett, about the Secondary Legislation Scrutiny Committee, which the Minister referred to in his introduction. In the committee’s report to us, it says three times that the Explanatory Memorandum assumed understanding and that it was not good enough. I ask the Minister if he will work with his officials to ensure that any more Explanatory Memorandums that come forward, not just on this issue but on others, are very clear and do not assume prior knowledge.
All of us have said that PAs and AAs—I am not going to keep saying physician associate and anaesthesia associate because it takes too much time—are not a replacement for doctors, though not one of us believes that that is the case. I am going to start with the title. The Royal College of Physicians and the Faculty of Physician Associates, which sits within the RCP, has guidance on the associate title and introduction guidance for PAs, supervisors, employers and organisations. What it says is in complete contradiction to what is happening on the ground:
“It is our view that, when a PA introduces themselves to a patient or staff member, they must make it clear at the start of the interaction that they are a physician associate, as well as explain the use of the term ‘PA’ … PAs must correct patients and staff if they refer to them as a … doctor, nurse or other professionally protected role title. This includes verbal, written and other forms of communication”.
Like other noble Lords, I have been inundated with letters from doctors and patients saying that they have been misled—not in the deliberate sense, but that PAs have not been correcting the record when someone has called them a doctor. The BMA, in its very helpful briefing, said that:
“To patients, PAs and AAs and doctors may look the same and appear to be doing a similar job”.
The problem, as the noble Baroness, Lady Finlay, said, is that the title is confusing. “Physician associate” perhaps implies that they have the same level of expertise as doctors. Unfortunately, as the noble Baroness, Lady Bennett, said, this has already led to a tragedy. Emily Chesterton died, aged 30, after two appointments with a PA who she believed was a GP, where mistakes were made.
A further difficulty, particularly in GP practices, is that GPs are beginning to worry that they are going to spend their entire time supervising PAs, as well as seeing patients with chronic diseases, and will not see ordinary people at all. Trainee GPs are worried about how they are going to be supervised. How is the Minister going to ensure that the issues of supervising and training, which are very serious, will be dealt with after the passage of this SI—because I do not think any of us are planning to call a vote today?
We have heard that, across acute trusts and GP surgeries, doctors have reported 70 instances of avoidable patient harm and near misses caused by PAs. That includes fatalities, missed diagnoses resulting in terminal diseases, missed DVTs, sepsis, heart attacks and haemorrhages. Missed cancer diagnoses in primary care has therefore emerged as a significant issue. In England, 74 acute trusts have replaced doctors with PAs on the doctors’ rota. Even if those PAs are supervised, that means that doctors who should be seeing patients are supervising more and more people. It is not a zero-sum game. One trust—I think it was Leeds, from memory—had a paper on how much more beneficial PAs were on the rota because they were much cheaper than doctors.
Doctors at 24 trusts reported witnessing PAs illegally prescribing medications, including controlled drugs. That is a particular worry because they are not permitted, under their current training and qualifications, to prescribe any drugs. That must be done by the doctor. The PA can recommend to the doctor what they think, but it should be signed off by a doctor. In addition, 42 acute trusts in England have witnessed PAs introducing themselves as doctor or failing to correct errors.
We have heard about a number of issues. I conclude by saying that, earlier on today, on the Victims and Prisoners Bill, we were talking about the duty of candour, which the NHS introduced nearly a decade ago. One issue related to this is that every regulated member of staff must report whenever they believe that something has happened that either possibly will cause damage or has caused damage. One of the good things about regulation for PAs and AAs is that they will come under the duty of candour. However, in all the cases that we have been told about where things have gone wrong, there is no evidence that there were reports to the CQC by the supervising doctors about things going wrong. Therefore, yet again I say to the Minister that my real concern is about current practice inside our extremely pressed and busy NHS, to make it safe. Just providing regulation for PAs and AAs will not in itself do that. I hope that he can help your Lordships’ House to understand.
Lord Markham (Con)
That is something I will pick up on. On the point raised by the noble Baroness, Lady Fox, I say that the GMC, with the CQC, should be able to give the ongoing quality assurance.
The noble Lord, Lord Hunt, said very well that the discussion on mistakes has not been useful. We are all aware that, regrettably, mistakes happen in all areas, and we need to make sure that we understand and learn from them, rather than using them to point fingers. Moving into the regulated space, where there is duty of candour, is useful.
I do not think anyone could be failed to be moved by the passion with which the noble Lord, Lord Winston, spoke about his experience. It was a very telling story. As reassurance I cite the noble Lord, Lord Patel, on the scope of the practice: it is one anaesthetist to two AAs, and the role of the AA is very much to maintain, as he explained well. In a similar way, the PAs really do need to work under GP supervision. The numbers are set out in the long-term workforce plan. We have a foot on the throttle for those training places, particularly in regulating them. We will make sure that things are properly managed so they cannot get out of control.
I absolutely agree with the points made by the noble Baronesses, Lady Watkins, Lady Harding and Lady Bloomfield, that this is a people management issue, and a lot of the heat from this debate is a feeling from junior doctors and others that they are unloved and uncared for. I freely admit that there is a wider issue that we need to look at, concerning things like hot meals; clearly, it is something trusts need to look at it as well.
I echo the points made by the noble Lord, Lord Hunt, that passing this order is the best way to ensure the safety of patients. As we develop, there is perhaps scope to be more ambitious, but let us try to do this step by step, to make sure we really are happy and that the scope of practice works. As ever in a debate as long as this—it has been a very thorough one—I will write to fill in any details that I have not managed to cover. At this point, I hope and trust I have provided sufficient answers to the questions, and have demonstrated—
Baroness Finlay of Llandaff (CB)
I hesitate to rise because the House clearly wants to end the debate, but I am not sure whether the Minister, in summing up, said whether the titles of physician associate and anaesthesia associate will be protected titles when the order goes through. Are they negotiable? I ask that question specifically because I had a lot of discussions with different people involved in this, particularly the GMC, and I have been concerned that if those are the only protected titles of all the grades registered by the General Medical Council, we may be storing up further problems for the future. If this is to be a protected title, can the Minister provide assurance that further statutory instruments could be brought forward if, in the light of the consultation advised by the noble Lord, Lord Allan, a different title is suggested? Could it then be changed?
Lord Markham (Con)
It is a protected title. The point I was trying to make about the general overhaul and understanding of the titles, however, is that there will be the scope to do this, as doctors and consultants are not protected titles today. I think we need to develop clarity on that, which is why the further reforms and SI changes will set out to protect other titles as well.
Baroness Finlay of Llandaff
At end to insert “but regrets that the draft Order refers to “associates” rather than “assistants”, which would more properly reflect the role, scope and responsibilities of such staff and reduce patient confusion.”
NHS: Neurology Care
Baroness Finlay of Llandaff Excerpts(9 months, 1 week ago)
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Lord Markham (Con)
I thank my noble friend, and I proudly wear the Epilepsy Action badge from the meeting I was just at. As my noble friend says, it is all about trying to get that early diagnosis. If you can get that and help people get the right treatments, that is exactly the right direction of travel because it can make a huge difference to outcomes. The progressive neurological condition toolkit I mentioned earlier sets out that pathway and the model of integrated care for all the ICBs, which they will all then be held to account on to make sure patients with all these conditions—and there are 600 of them including epilepsy—are getting the right treatment in their neighbourhood.
Baroness Finlay of Llandaff (CB)
My Lords, I declare my interests in palliative care. Do the Government recognise that many of the patients with neurological disease are living with palliative care symptoms such as pain, breathlessness, worry and fatigue, which could be managed in the community with good integration between palliative care services and neurological services? Therefore, have the Government given specific commissioning guidance to integrated care boards to ensure that they look to see how the integration is developing in their own areas to enable these patients to improve their quality of life and their ability to live actively for as long as possible?
Lord Markham (Con)
Yes, that is precisely what I was referring to: the progressive neurological condition toolkit is all about the pathways for that integrated approach to it all. Again, there are 15 million people affected—I think this statistic was mentioned earlier—and one in five deaths come from related conditions, so making sure we have that integration with palliative care as well as the other services is key.
NHS Dentistry
Baroness Finlay of Llandaff Excerpts(9 months, 2 weeks ago)
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Lord Markham (Con)
There will be a schedule of when the mobile vehicles will visit each area, with the ability to pre-book so, if someone calls up with an issue, they will know that a truck will come to their area in a week or two’s time. That is the idea, or people can queue to receive those services as well. I hope this will be successful. It has worked quite well in some areas already. The case will prove itself and the 14 will be just the start. We can do much more from that, because we all agree that we need to expand supply.
Baroness Finlay of Llandaff (CB)
Given that over 8,800 new oral cancers were diagnosed last year, and a fifth of those were in people under the age of 65, do the Government recognise that it is a false economy not to increase dentistry provision, dental hygienist screening for oral cancers and advice on prevention, such as by cutting down on smoking and so on? The cost of treating this, and of early morbidity to the country, is huge.
Lord Markham (Con)
Yes, absolutely. That goes back to my noble friend’s point about outcomes. I know that a lot of places, if they are fortunate enough to have an NHS dentist, give you check-ups every six months as a matter of course. In fact, NICE says that if you are in good oral health you will need that only every 24 months, with the idea being that you can create more space for other people to come in, because prevention and screening are vital in all this as well.