Type 2 Diabetes: Continuous Glucose Monitors

Lord Bishop of London Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Merron (Lab)]

It is probably important to say at the outset that type 1 diabetes, as the noble Lord knows, is not related to lifestyle issues, and at this point cannot be prevented, so it is a case of management. The technology that is available now is quite remarkable— not just the CGMs that the noble Lord, Lord Rennard, inquired about, but also hybrid closed loop systems, where the CGM is paired with an insulin pump, so it is administered automatically without the person having to calculate. I think that is incredibly helpful. It is only available to those eligible, with type 1 diabetes, but the rollout began in April 2024. The noble Lord makes a good point, as did the noble Lord, Lord Rennard, about access and inequality in access. That is something we continue to work on, ensuring that everybody can fairly access these wonderful technology advancements.

[The Lord Bishop of London]

My Lords, women with type 2 diabetes face a higher risk of miscarriage, stillbirth, neonatal deaths and birth defects. As we have heard, women who live in areas of high deprivation as well as women who come from black and minority ethnic groups are more likely to be impacted by type 2 diabetes. This compounds the existing inequalities in the maternal mortality rate. What steps are the Government taking to support integrated care boards to build relationships with these women who are most likely to experience these impacts, to ensure that they have the best maternity care and diabetic care, including ensuring they have access to continuous glucose monitoring where necessary?

[Baroness Merron (Lab)]

The right reverend Prelate is quite right in what she says, including that responsibility for CGM implementation rests with integrated care boards. It is their responsibility to ensure that the technologies we are talking about can be accessed by all eligible patients regardless of their ethnicity or their indices of multiple deprivation. I assure the right reverend Prelate that achieving that equality of access in all diabetes technology is an absolute priority. We will continue to monitor progress and encourage ICBs to do that by the NDA quarterly dashboard in 2025-26. In other words, we will give ICBs the tools to do the job they need to do.

Hospices: Funding

Lord Bishop of London Excerpts

Thursday 24th October 2024 Lords Chamber

[The Lord Bishop of London]

My Lords, I too thank the noble Lord, Lord Farmer, for introducing this debate. I declare my interests as outlined in register, particularly that I am patron of Hospiscare in Exeter.

I suspect there has never been a more important moment in time to discuss the funding of the hospice sector, which is facing extreme challenges. It is also important to remember that hospices deliver excellent care to a significant number of people who are dying well. However, according to Hospice UK, the sector is facing the worst financial crisis in more than 20 years.

The state provides on average only a third of hospice funding. A large proportion is found by fundraising. Those who live in affluent areas are more likely to financially support their hospices than those in deprived areas. That will have a direct impact on not only access but quality of care to those in the deprived areas.

It also entrenches the worsening inequalities in health, as highlighted by the noble Lord, Lord Farmer, not just between regions but also within them. In addition, the funding given to ICBs for palliative and end-of-life care is highly variable, and sometimes disproportionate for the demographics of their population. In the absence of any long-term plan, I echo the request of the noble Lord, Lord Farmer, and ask the Minister what support the Government are giving to ICBs as they make their commissioning decisions in this area.

As already indicated by the contributions made, noble Lords are aware of the introduction of the Private Member’s Bill in the other place which seeks to change the law for those who are terminally ill. How can we consider this if we do not give enough funding to hospices, palliative care and palliative care research, so that people dying receive the best care—the care that they need to make life worth living and, in the words of Dame Cicely Saunders, to live life until they die?

I hope that we are not prioritising the care of those who need it based on their contribution to our economy. This is contrary to how God values each one of us, contrary to the principles on which the NHS is founded, and contrary to human dignity. How the Government choose to prioritise palliative care matters very much. I look forward to hearing from the Minister about the Government’s plan to secure a sustainable future for hospices, palliative care and palliative care research.

Palliative and End-of-life Care: Funding

Lord Bishop of London Excerpts

Wednesday 4th September 2024 Lords Chamber

Asked by

[The Lord Bishop of London]

To ask His Majesty’s Government what assessment they have made of the adequacy of funding arrangements for accessible and equitable palliative and end of life care.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, we want a society where every person receives high-quality, compassionate care, including at the end of their life. Integrated care boards are responsible for the commissioning of palliative and end-of-life care services to meet the needs of their local populations. This is to promote a more consistent national approach and supports commissioners in prioritising palliative and end-of-life care. We will be considering the next steps, including funding, more widely in the coming months.

[The Lord Bishop of London]

I thank the Minister for her reply. We know that the hospice sector depends on charitable giving because of the low level of statutory funding at present. This means that the wealth and resilience of a community define the level of hospice services. This entrenches inequalities of place and means that access to hospice services is extremely unequal. Can the Minister outline what the Government are doing to look at the funding settlement, and particularly the wider hospice funding model, to ensure that this is not just another service that has poorer access for those in more deprived areas?

[Baroness Merron (Lab)]

I certainly take on board the point that the right reverend Prelate makes. It is the case that the amount of funding that charitable hospices receive varies by ICB area. That, in part, is dependent on the breadth of a range of palliative and end-of-life care provision within the ICB area. I can assure your Lordships’ House that my colleague, Minister Kinnock, the Minister of State for Care, has recently met with NHS England, and discussions have started on how to reduce inequalities and variation in access to services and their quality.

Covid-19 Inquiry

Lord Bishop of London Excerpts

Tuesday 3rd September 2024 Lords Chamber

[The Lord Bishop of London]

My Lords, I declare my interest as set out in the register. It is good to have this opportunity to speak in this debate and to acknowledge the important recommendations of this first report from the Covid inquiry. The pandemic was a seismic event for us all, and a great tragedy for many. My thoughts and prayers go to those who have lost individuals because of the pandemic. My thanks and gratitude go to those who stepped up and beyond to care for and protect us.

I want to highlight a couple of points from the report. The first is that the clearest flaw identified in the risk assessment was the underlying health of the UK population prior to 2020, as mentioned by the noble Baroness, Lady Tyler. We are all aware of the entrenching and exposing effect that the pandemic had on health inequalities. We are all aware of the impact that non-clinical factors such as housing have on our health. We are all aware of the vast difference in healthy life expectancy depending on where we live. We are all aware that those living in more deprived areas are more clinically vulnerable on average, but spend much more time in front-line jobs.

We are an interconnected people whose health and well-being are bound up in one another’s. It is the weighty responsibility of all of us, especially in this place, to take on such an injustice with priority and focus. In the section on data, the inquiry recommends that:

“The UK government should … commission a wider range of research projects ready to commence in the event of a future pandemic,”


including to

“identify which groups of vulnerable people are hardest hit by the pandemic and why”.

The Covid-19 Bereaved Families for Justice spokesman responded to the publication of this report by saying that we must

“challenge, address and improve inequalities”

and not just understand

“the effects of these failures”.

In fact, I wonder whether we have really and completely understood the impact. We were all affected, but we were not equally affected. At the height of the virus, the Bangladeshi population had a death rate around five times higher than the white British population. The rate in the Pakistani population was around three times higher and in the black African population it was twice as high. But even these statistics do not communicate the extent of the damage that the virus caused to specific communities. Between March 2020 and February 2021, the Church End area in Brent lost 48 people. The damage done to individual communities was, in some cases, very severe. What action are the Government taking to address the widening health inequalities in our communities, not just for future pandemics but for now?

There are questions I believe we need to ask about how these devastating events have impacted the trust that those communities have in the health service, local government services and the Government. In 2021, I did a piece of work examining the role that faith communities played during the pandemic and heard their stories and experiences. Many shared stories of loss and resourcefulness, but they also shared stories of culturally incompetent care. This included the story of a Sikh man in Southall, who had had a stroke and was unable to speak, who had his moustache and beard cut without obtaining the permission or seeking the consent of his family. This was deeply offensive and after investigation it was found there was no medical reason for it to have occurred. We heard stories of distrust of the health service and a lack of understanding from statutory bodies of the provision for their communities that faith groups had held for generations. They said:

“There was a lack of cultural knowledge about how a burial for the Muslim community happens so we did it ourselves. We raised money so people could die with dignity”.


During the pandemic, faith leaders were rightly identified as important partners, and there are fantastic accounts of successful vaccination rollouts and health campaigns supported by them. However, that engagement has not been sustained. Forming relationships in a moment of crisis is not the way that resilient and interconnected communities are built. I have said many times in this place that, if we are to make a serious and sustained effort to tackle health inequalities, faith groups must be involved. I was encouraged to hear the words of the noble Lord, Lord Evans, about including diverse views, which I would see as also including faith groups.

Areas of high deprivation often have a higher level of faith observance. A person’s faith is also significant to their healthcare needs. Because of these things, systematic engagement with faith communities at a local, regional and strategic level is vital. This both ensures that the PLUS target populations are prioritised and makes sure that appropriate healthcare is offered to those with faith-based requirements. In addition, the extraordinary effort that faith groups gave to supporting their communities during the pandemic and continue to give should be recognised for the benefit not just to their communities but to us all. What progress are the Government making to engage with faith groups not just in the moment of crisis but over the long term?

This report should inform not just the earmarked actions that we take to prepare for the next pandemic but our approach to other areas of life and health. Our collective health will be undermined if these entrenched inequalities persist and will make us all the more vulnerable to future health threats. I urge the Government to consider carefully how they respond to this report to improve the health of those communities which bore the brunt of the Covid-19 pandemic and to undertake a serious reform of social care. This has never been more urgent.