Stroke Care

Baroness Manzoor Excerpts

Monday 24th July 2023 Lords Chamber

[Lord Markham (Con)]

First, I thank the noble Baroness for the work that she does in this area; I know that it is very close to her heart. I have set up a meeting with the NHS COO David Sloman and with Sarah-Jane Marsh, and would be delighted if the noble Baroness would like to join me. The benefit of these sessions is always the shining of a light on areas.

It is vital that people are seen within the first hour; currently 59% of people are, which is an improvement on the last couple of years when the figure was 55%. However, we would all agree that we want that number to be as high as possible. The SQuIRe managers’ job is to make sure that all the different integrated care boards are delivering best practice in each area.

[Baroness Manzoor (Con)]

My Lords, what role will NHS England play in first collecting information, monitoring it, evaluating it and disseminating it across the UK to ensure best practice, and how often does it undertake to do this?

[Lord Markham (Con)]

I thank my noble friend. The NHS delivery plan set out in January 2023 was trying to set out the best practice in this area. It is then the job of the SQuIRe managers to make sure that that is implemented in each area. One example is that they are trialling having videos in ambulances in certain areas so that paramedics can speak to stroke experts. We all know that getting patients to the right place quickly is vital, so I hope that that is another example of best practice that we can roll out.

MMR Vaccine

Baroness Manzoor Excerpts

Thursday 20th July 2023 Lords Chamber

[Lord Markham (Con)]

Yes. This whole campaign is looking particularly at hard-to-reach communities. The concern is particularly in London. Whereas we have about 85% take-up across England as a whole, in London it is around 75%, so that is where the particular outreach is. That also involves looking at children who are not able to go to school or who are home-schooled.

[Baroness Manzoor (Con)]

My Lords, I welcome the catch-up campaigns that the Government are running. They are very welcome. I particularly note the campaign in London. As the Minister will know, there is variation across the country. The WHO stipulates that 95% is the target reach, yet we are at 89%. So how are those hard-to-reach communities, particularly the ethnic-minority communities, being targeted? The uptake is slightly lower in those particular areas.

[Lord Markham (Con)]

There are two main approaches. If a child is under 11, we would prefer to have a parent present, for obvious reasons—because it involves a vaccination—so that is normally done through the primary care system, through nurses. Post 11, because you do not need the parent there, that is where schools really come into effect. In particular, there is a school-age assisted immunisation providers programme that goes into every school in a particular area, targets it and speaks to every child to see whether they have had their vaccination—and they can give it on the spot if they have not.

Ultra-processed Food

Baroness Manzoor Excerpts

Tuesday 18th July 2023 Lords Chamber

[Lord Markham (Con)]

First, I thank the noble Baroness for the work she does and has done in this space for a number of years. The problem is the definition of “ultra-processed food”. It includes things such as wholemeal bread, baked beans and cereal. It is not a helpful definition. There are certain ultra-processed foods which are high in fat, salt and sugar. We completely agree that those things are bad for us and that we should do everything we can to discourage people from eating them. The label “ultra-processed food” is not helpful.

[Baroness Manzoor (Con)]

My noble friend will know that one-third of baby and infant foods contain ultra-processed food which, in effect, is leading to obesity, and he will know that obesity can lead to cardiac problems and hypertension in later life, which costs the NHS significant sums of money. There is evidence in recent research that firms’ marketing is providing misleading information. What are the Government doing to ensure that this aspect, particularly with baby and infant food, is better regulated?

[Lord Markham (Con)]

I thank my noble friend. We are focused on the sugar, salt and saturated fat content. It is not the fact that food is called ultra-processed, per se. We would not discourage people from eating whole- meal bread, but wholemeal bread is considered to be a processed food. The action we are taking is for a reduction in sugar, salt and saturated fat.

Community Health Services: Waiting Lists

Baroness Manzoor Excerpts

Wednesday 12th July 2023 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is correct about the urgency for young people; I have personal experience of this as well. We are taking steps by piloting nine early language and support services for all children focused on exactly what the noble Baroness mentioned. There is £70 million behind that pilot, with the intention being that we learn lessons from that and roll it out quickly.

[Baroness Manzoor (Con)]

My Lords, my noble friend will know that a number of surveys have identified that over half a million adults are waiting for adult care assessments. The normal waiting time is 28 days, but for some it is, sadly, significantly longer, which has a disproportionate effect on some of the most vulnerable. What action are the Government taking to reduce it?

[Lord Markham (Con)]

We are starting to see a blue- print which is beginning to work. The highest waiting list for adults is related to musculoskeletal issues. Since we put an improvement framework in place, 91% of people are now being seen within 12 weeks—a big improvement. We are moving to self-referral also, and digital therapeutics beyond that. There is a road map in place that we need to apply across other areas.

Dementia Palliative Care Teams

Baroness Manzoor Excerpts

Thursday 15th June 2023 Lords Chamber

[Lord Markham (Con)]

First, we were very upfront about it; part of the Health and Care Act 2022 is that the ICBs commission palliative care. Secondly, it is part of the six major conditions strategy. It is a major cause of death; about 11.4% of all deaths are caused by dementia. It is fundamentally the responsibility of the ICBs but we at the centre are making sure that the ICBs are commissioning in the way they need to.

[Baroness Manzoor (Con)]

My Lords, I very much welcome the work that is being done in Derbyshire and, quite rightly, we want to see it commissioned elsewhere across the country. My question follows on from that of the noble Lord regarding the NHS board. What is it doing to evaluate where these kinds of proposals are being developed elsewhere? Unless it does this, and can demonstrate that it is doing this and providing guidance, we will not get the excellent service that residents in Derbyshire are receiving in more deprived areas, such as places in West Yorkshire and so forth.

[Lord Markham (Con)]

We have developed the dementia palliative care toolkit, which we are spreading around all the ICBs. Health Education England has developed an end-of-life care training programme, which is being taken up. Derbyshire has been a key part of the efforts as well, with its own programmes. It is very much our responsibility to make sure that the ICBs, which by law have to provide these services, are providing them to a high standard.

NHS GP Surgeries: Purchase by US Companies

Baroness Manzoor Excerpts

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

What the centre is most interested in is quality of the service; that is exactly what we do. As for Operose, which the noble Lord mentioned, 97% of its surgeries are rated by CQC as good or excellent. In the case of the one where there was a concern, CQC did a deep dive of the surgery and looked at the staff mixing, and that practice is now considered good. The key thing, I think all noble Lords will agree, is the quality of service, not ownership.

[Baroness Manzoor (Con)]

My Lords, as my noble friend said about ensuring the quality of services for users, since the inception of the NHS, GPs have been private practitioners and have invested money from their own pockets to improve their surgeries. What are the Government doing to ensure that there is equity and accessibility of good GP services to those who live in inner-city and deprived areas, and in rural areas?

[Lord Markham (Con)]

My noble friend is correct, of course. GPs have always been independent businesses, and that is the backbone of the service. We have managed to increase the number of GPs by 2000 since 2019, but we all accept that more needs to be done to attract them, especially to the key areas that my noble friend mentions. We have a £20,000 bonus in place to recruit GPs to those difficult areas and, most importantly, we have a record 4,000 GPs in training.

NHS National Health Inequalities Improvement Programme

Baroness Manzoor Excerpts

Thursday 25th May 2023 Lords Chamber

[Lord Markham (Con)]

First, I thank the noble Lord for the work that he does in this space; I know it is something very close to his heart. It is the school foods standards that set and define the formulation in the food and drinks provided by schools. That is all through the school day: breakfast, lunch and afterwards. They were due to be reviewed around the time of Covid in 2019; clearly, that did not happen then, so we are looking again at whether we should be reviewing those. Precisely in that, we shall be looking at levels of calorific intake.

[Baroness Manzoor (Con)]

My Lords, as my noble friend will know, in the short term a poor diet can lead to stress, inability to concentrate and tiredness. In the longer term it can lead to obesity, diabetes, high blood pressure and indeed heart disease. Of course, my noble friend will be aware that there are great inequalities within ethnic minorities. Can he say what the Government are doing to reduce the inequalities and ensure that micronutrients play an important part in the promotion of the food strategy?

[Lord Markham (Con)]

First, I wish my noble friend a happy birthday. I totally support her question. The most important thing with regard to inequalities—funnily enough, this was the answer to an earlier question—is the use of free school meals. I think we can all welcome the fact that 37.5% of children now receive free school meals and therefore a nutritious start to life. Clearly, that is the best way to make sure that children, particularly those with potential inequalities, are getting a healthy start in life, as well as the under-fours clubs to make sure that they get healthy food.

Pharmacies: Medicines at Home

Baroness Manzoor Excerpts

Wednesday 17th May 2023 Lords Chamber

[Lord Markham (Con)]

NICE and the Royal Pharmaceutical Society are clear that they do not recommend widespread adoption but prefer a case-by-case basis. There are many examples of where blister packs are not appropriate: some pills cannot be stored next to each other, some pills need to be stored in their original packaging and some blister packs cannot have more than four pills. So it is clear that you need a case-by-case review to make sure of what is right for the patient.

[Baroness Manzoor (Con)]

My Lords, the Government have the excellent Pharmacy First initiative. Can my noble friend the Minister say what the Government are doing to support community pharmacists with technology, and to advise those with chronic diseases, such as diabetes and heart disease, what their roles and responsibilities could be in relation to the technology that may be available to them?

NHS: Allocation of Financial Resources

Baroness Manzoor Excerpts

Thursday 11th May 2023 Lords Chamber

[Lord Markham (Con)]

The budgets are in the allocations for each ICB and each hospital, and within them there are specific allocations to make sure that these fundings are rooted in the place where they have the most effect. As for making sure that really does happen, it is the responsibility of each ICB to make sure it is doing that. Ministers hold them to account by each having seven ICBs to take care of and make sure that they are hitting those targets.

[Baroness Manzoor (Con)]

My Lords—

[Lord Stirrup (CB)]

My Lords—

--- Later in debate ---

[Baroness Williams of Trafford (Con)]

My Lords, we will hear from the Conservative Benches and then the Cross Benches.

[Baroness Manzoor (Con)]

My Lords, I very much welcome the significant sums of money that have been put into the NHS to date by the Government. It is not just increases in beds that we need in hospitals. We live in an age where we have made significant inroads and innovation in technology, diagnostics and so forth, including artificial intelligence. Will my noble friend the Minister say how new technologies are being used to ensure that patients are not needing the extra beds in hospitals and creating the old mistakes we know of?

[Lord Markham (Con)]

I shall answer quickly. As I said, there is already a 13% lower cost in a hospital which is digitally mature. We have virtual wards going in to make sure that we can treat as many as 50,000 patients every month to improve the flow and improve services.

Childbirth: Black Women

Baroness Manzoor Excerpts

Wednesday 3rd May 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness; there were a number of questions there. I accept that there is a disparity, which is why the Maternity Disparities Taskforce was set up. I was speaking to Minister Caulfield just this morning, and I assure noble Lords that this is very high on her agenda. That is why, in providing continuity of maternity care, the focus is on making sure that people from ethnic minorities, particularly black women, get priority.

[Baroness Manzoor (Con)]

My Lords, this is not a new issue. I am pleased to hear that the disparities task force has been set up, but can it look not just at the issues of workforce planning—there is a shortage of midwives—but at the additional antenatal care that black and ethnic-minority women need because of underlying causes, and at the care they receive during labour?

[Lord Markham (Con)]

My noble friend is right. I was speaking to Minister Caulfield about this very subject this morning. She pointed out that a lot of the reasons for the differences are underlying health conditions and factors such as smoking, weight and alcohol consumption, as well as diabetes. Education is a key part of this, as is continuity of care, and making sure that there is prenatal and postnatal care is absolutely a focus.