Hospitals: Maintenance

Baroness Finlay of Llandaff Excerpts

Thursday 9th February 2023 Lords Chamber

[Lord Markham (Con)]

I can speak clearly on the subject of the new hospital programme, which I think the noble Lord will find is world-class. I will happily demonstrate that to him; indeed, people will see how ground-breaking this project actually is. We will see standardised designs with improved clinical standards, and more efficient productivity and costs as a result. It will be world-class, and we will export it around the world.

[Baroness Finlay of Llandaff (CB)]

My Lords, if the Government are saying that these are to be world-class hospitals, what is the comparison? Is it hospitals such as those in the Netherlands, which are extremely well designed and function very well, versus the many hospitals here which do not function well and have appalling design features? As soon as the staff move into them, they deteriorate rapidly.

Maternity Services

Baroness Finlay of Llandaff Excerpts

Thursday 9th February 2023 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is quite right to point out those figures, and they are something that none of us is happy with. That is exactly what the Maternity Disparities Taskforce was set up to deal with, so I am happy to make a commitment to talk through with the noble Baroness the progress of that.

[Baroness Finlay of Llandaff (CB)]

My Lords, running through the reports that my noble friend Lord Patel referred to are two strands: one is workforce, which relates to numbers and qualifications, but the other is dysfunctional teams and a failure of teamwork across the different disciplines, both within maternity services and relating to general medical services, for providing support to women, particularly those with multiple comorbidities who are then going through pregnancy and delivery. I wonder whether the Government are commissioning a specific piece of work to look at ways in which these teams can alter their behaviours internally and be supported to improve on this dysfunctional behaviour within them, which is having an adverse knock-on effect on the experience of mothers and on the clinical outcomes which, as has been said, are sometimes fatal.

[Lord Markham (Con)]

Yes, one of the Kirkup recommendations—recommendation 3, I believe—was about an improvement in teamwork, and that is what will be done under the guidance of national and regional maternity safety champions. I should say that while there is much improvement that we want to do, the overall context is a 19% decrease in stillbirth since 2010 and a 36% decrease in neonatal mortality over 24 weeks since 2010. So it is an improving picture, but it is something that we want to improve further.

Health and Social Care Information Centre (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023

Baroness Finlay of Llandaff Excerpts

Wednesday 25th January 2023 Lords Chamber

Finally, I return to the timing and the speed. This feels very much like a rerun of the closure of Public Health England and the creation of the UKHSA when a Covid surge was still going on; officials in the department and NHS staff were working at full tilt and had to change the way in which they worked in order to cope with the UKHSA as a new body. Can the Minister reassure us that that will not be the same when NHS Digital moves into NHS England? My fear is that the pressure on the NHS at the moment means that the situation could be similar to the pressure that the UKHSA has faced over the past year in trying to create a new organisation and new structures at a time of immense pressure.

[Baroness Finlay of Llandaff (CB)]

My Lords, I am grateful to the noble Lord, Lord Hunt of Kings Heath, for having put this amendment before us. I am not going to repeat the important points made by other noble Lords who have spoken but I have a few questions for the Minister. I should declare that I am a member of the BMA’s ethics committee and I am slightly concerned—if I heard the Minister right—that there has not been a comment back from the BMA, because there have been concerns about the potential monetisation of NHS data.

There were a lot of discussions within NHS Digital at the time of the passage of the legislation about pharma companies possibly having early access to some data and negotiating discounted prices as a result, particularly for expensive medication and early access. Can the Minister tell us how much discount has been achieved by some of those arrangements, whether those discounts have applied across the whole United Kingdom or whether they have been only of specific benefit within NHS England? As health is a devolved issue, we now have a problem particularly between Wales and England, where there is effectively a porous health border and many people are going from Wales to England for parts of their treatment cycles. That means that data moves across the border. So my next question is: what has happened in discussions with NHS Wales and what is being done to ensure compatibility for data transfer?

My next question relates to our experience last year when an NHS trust had its systems hacked and the whole system went down. How will the security of the new, larger holding of data be ensured? Obviously, if you have a lot of data held together, there are benefits but also risks. How are those risks being looked for and, as much as possible, mitigated against?

The other issue, again in relation to Wales, is somewhat historical but I have not been able to track down exactly what happened to some data. The Health and Social Care Information Centre merged with Connecting for Health in the 2012 Act. At that time, the data side was a UK-wide database. I wonder what happened to the data that was being held for Wales; whether NHS Digital still holds any data relevant to Wales; what discussions have been had with Wales over the transfer of relevant data; and what arrangements are being made for the future transfer of patient data—again, to allow the transfer of data while, importantly, preserving patient confidentiality. Of course, one of the problems when data is transferred between organisations is that there is a potential risk in terms of confidentiality and a possible leak.

My last question for the Minister is quite simple: why were these regulations not laid earlier? As I understand it, the processes are now well under way—indeed, they are almost complete in terms of the staff, the merger and so on. It would have been helpful for everyone to have been able to have sight of these regulations, as well as all the supporting documentation, earlier.

PPE Expenditure

Baroness Finlay of Llandaff Excerpts

Wednesday 25th January 2023 Lords Chamber

[Lord Markham (Con)]

Right now, less than 1% of stock is held in China—to answer that question directly. In terms of cost, we are currently paying about £700,000 per day, which is why we are writing off the stock and effectively disposing of it. We have tried to donate as much of it as possible to people who want it, but we have to bite the bullet on the rest and say, “You know what? It’s no longer required so we are disposing of it as rapidly as possible.” We are bringing down those costs; we will be saving £200 million a year through that rapid disposal.

[Baroness Finlay of Llandaff (CB)]

How many health and social care staff are now off long-term sick with long Covid? What correlation has there been between long Covid and their perception that they did not have adequate PPE for the job to be done?

[Lord Markham (Con)]

I will write to the noble Baroness with the statistics. I can be clear that the endeavours undertaken to buy the PPE were to make sure that we did not run out. Again, there is quite a bit of hindsight going on in saying, “Ah, we bought too much of it”, when at the time everyone was scrambling to say, “You need to buy more.” That was the result of the situation, and to try to apply hindsight now is quite wrong. They did a pretty good job regarding the amount that they bought; they got 97% of it right, which I think we would agree is a pretty good result.

Social Care: Integrated Care Systems

Baroness Finlay of Llandaff Excerpts

Wednesday 11th January 2023 Lords Chamber

[Lord Markham (Con)]

Clearly, it is early days. These were set up last summer and we must ensure that they bed in properly and learn. I am confident that that is the right approach, but, as the noble Lord mentioned, we must make sure that regulators in this space ensure that that is the case. It is probably a question for a few months’ time, when we can be sure.

[Baroness Finlay of Llandaff (CB)]

My Lords, according to Hospice UK, of which I am a vice-president, up to half a million people last year had a palliative care phase before they died. In many of those cases, a failure of social care resulted in a breakdown of care in the community and hospital admission. Following on from the question asked by the noble Lord, Lord Touhig, when these patients are seriously ill or disabled children, they need access to respite care during their illness, as well as at the end, with rapidly responsive care. How are the Government monitoring whether the needs of these people are being met and that the timeframe to put in place the social care that they need does not just slip to the point of becoming a meaningless exercise?

[Lord Markham (Con)]

Those monitoring processes are in place, but to give sufficient detail, it is best that I write.

Streptococcus A: Antibiotics

Baroness Finlay of Llandaff Excerpts

Thursday 15th December 2022 Lords Chamber

[Lord Markham (Con)]

My general thinking—this is a personal view—is that the market is normally very well placed to supply these things. There was the excellent example of the vaccines, whereby it acted incredibly quickly and got Covid vaccines out as necessary. I think we are always better placed using the strength of the whole market and looking to international suppliers as well. They are always going to be able to provide the necessary medicine to a quicker timescale than our own company would.

[Baroness Finlay of Llandaff (CB)]

My Lords, since the risk of invasive group A streptococcal infection is increased in the presence of other viral infections—any of them; it could even be chickenpox in children—what guidance are the Government giving to all schools on public health measures to decrease cross-infection between children and ensure parents are encouraged to keep those who might be unwell away from school, rather than sending them to school, as is the tendency, because of attendance registers?

[Lord Markham (Con)]

The noble Baroness is correct; it is the coincidence of more than one condition, particularly respiratory conditions, which causes the more extreme cases. The advice is definitely to keep children away from school if there is any question on that at all, especially as we are about to enter a period of school holidays. It is very much the view of the experts that the school holidays should flatten the curve of infections. I should also say at this point that while we are all quite correctly concerned about this, and doing everything we can regarding supply, the current levels are still lower than those we saw in 2017-18, when March and April had the normal peaks of around 2,000 a week. We are currently at around 1,200 cases a week and, as I say, we expect that to flatten out a bit with the firebreak, so to speak, of the Christmas holidays.

Bereavement Support

Baroness Finlay of Llandaff Excerpts

Wednesday 9th November 2022 Lords Chamber

[Lord Markham (Con)]

I am afraid that I do not have any knowledge of the case in point. As I said before, I welcome the role of the right reverend Prelate the Bishop of London in producing this report, which I know all the bishops and all the Church, of whatever faith, will take directly to heart. Again, I can only repeat the title of the report: Bereavement is Everyone’s Business. The Church has a key role to play in that, as it fully understands.

[Baroness Finlay of Llandaff (CB)]

My Lords, will the Government ensure that groups who are undertaking good bereavement support of children, particularly in schools, are actively engaged in cross-departmental working, given that a large number of children who are acutely bereaved do not get any support at all and often do not have the language with which to express their feelings? Will the Government also ensure that, through the Ministry of Justice, the Prison Service is actively involved? It has been estimated that about four out of five remand prisoners have had a seriously traumatic bereavement experience with no support at all, which has culminated in progressive anger resulting in criminal activity.

[Lord Markham (Con)]

I was very struck when I read the report by the breadth: for every death, five to nine people are bereaved, and often they are young people or people in prison. The truth, as we know, is that it is people across the board. That is why I particularly welcome the new policy team, which has members from the DfE and, I think, the Ministry of Justice; however, I will check, because the point the noble Baroness has made is a good one. The whole point of the policy team is that it is cross-functional, to try to ensure that we really can touch every single point where there are institutions which can help the bereaved.

Maternity and Neonatal Services

Baroness Finlay of Llandaff Excerpts

Tuesday 25th October 2022 Lords Chamber

[Lord Markham (Con)]

We all acknowledge a duty of candour. That should be fundamental to the leadership and to everyone in every trust. In this case, I was pleased to see the trust completely accept the findings and its failings and apologise unreservedly. That is something we need to make sure that all trusts do. We have the framework in place to do that but, if we do not, we will not hesitate to act further to ensure that it is.

[Baroness Finlay of Llandaff (CB)]

My Lords, this alarmingly clear report flags up flawed teamworking as a major failing throughout. That also reflects previous reports. It also points out the unintended adverse consequences of using the phrase “normal births”, which should perhaps be replaced by “safe births”. Will the Government consider the problem of teamworking? Although there already is a joint group between the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists, there also needs to be commissioning guidance to make sure that services are commissioned only when there is joint education and training, audit, and co-production of guidance with parents who have experience of the unit.

[Lord Markham (Con)]

Again, we agree with Dr Kirkup’s third recommendation that teamwork is vital in all this. Some £26 million has been invested in maternity teamwork training, and a core curriculum has been set up for professionals in this area. Strong leadership has been established, with two national maternity safety champions and a number of regional and local maternity safety champions. We believe that we have the framework in place for these independent working groups but, as we review these recommendations, if we find they are inadequate we will not hesitate to act further. We will bring this back to you in the four-to-six-month timeframe when we report on the recommendations.

NHS: Winter Challenges

Baroness Finlay of Llandaff Excerpts

Monday 10th October 2022 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, will the Government now ask NHSE to publish the 12-hour length of stay times for emergency departments in order to be able to evaluate the efficacy of the proposed 7,000 beds and financial investment? Data shows that, at the moment, 52% of all emergency medicine trainees are already burned out. On top of that, there is the flight of nurses from emergency departments because of stress. The emergency departments are already in crisis, yet the key data on 12-hour waits there is not being collected.

[Lord Markham (Con)]

I do not have the detail on the 12-hour wait-list at this moment, but I will come back to the noble Baroness with a detailed written response.

Health and Social Care Update

Baroness Finlay of Llandaff Excerpts

Monday 10th October 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Viscount for his good luck wishes. I do not understand completely the economics of the doctor’s surgery yet. I want to get my head around that, because I understand that a surgery needs to be set up so that it can be a successful business for them and can have the proper infrastructure. I am very interested in the dentistry field as well; as I said, I have an interest in terms of my wife. But I realise that in a lot of these situations, you are asking doctors and dentists, who are trained to be excellent medics, to effectively set up their own business. That is a quite different thing and demands quite different skill sets. I believe that we need to have a package of support to help them in this respect. As part of that, we need to understand exactly what funding can be used and whether it gives them the headroom—for want of a better word—to allow them to do those elements and have the support staff in the numbers they need. Understanding further this area is on my to-do list, and I would like to get back to the noble Viscount as soon as I can.

[Baroness Finlay of Llandaff (CB)]

I also welcome the Minister to his post, which I think is probably one of the trickiest ministerial posts in government. I declare that I am a registered medical practitioner and remain on the clinical register. I would like to briefly return to the question of workforce. We have spoken about doctors, dentists and nurses; in addition, there are allied health professionals. I should state here that I am president of the Chartered Society of Physiotherapy.

I have come across a lot of professionals who have had time working abroad, for one reason or another, and who have remained clinically up to date but find it extremely difficult to get back on to the register. I have also had conversations with retired professionals who have been allowed to be reregistered under the Covid regulations but find that, because they do not have a responsible officer, it is extremely expensive for them to undertake the processes to come back on the register.

In addition, I have also had conversations with refugees. We have a lot of refugee doctors, dentists, nurses and allied health professionals who currently are completely unable to work because they have not gone through the different exam processes—yet all the time they are not working, they are losing some of their clinical skills. Will the Minister meet with me, because I think there are some ways, in conjunction with the registration bodies, that we could possibly create a provisional registration category to allow these people’s skills to be used rapidly for the good of the NHS, rather than waiting the several years it would take them to get through the different hurdles laid before them?

As part of that, these clinicians—particularly doctors and nurses—could then have input into 111, where we know that currently only 40% of calls have a clinical input. The Royal College of Emergency Medicine has calculated that this figure needs to be 65% of all calls in order to decrease the demand on A&E departments from calls to 111. Will the Minister meet with me fairly urgently? It seems a waste to have people who want to get back on the register but, for many reasons, cannot.

[Lord Markham (Con)]

I thank the noble Baroness, Lady Finlay, for those excellent points. I have to declare a further interest: my wife is not only a dentist, she is a dentist originally from the Dominican Republic who practised in Spain for 20 years before coming here. So many of the excellent points the noble Baroness made are well recognised here. I am in the market for good ideas, so I will meet with the noble Baroness with pleasure to understand and discuss some of the ideas she spoke about.