Neurological Conditions

Lord Kamall Excerpts

Thursday 9th June 2022 Grand Committee

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)]

My Lords, I thank all noble Lords who took part in this debate, especially the noble Lord, Lord Dubs, for raising this issue. I also thank him and the noble Lord, Lord Monks, for sharing their personal experiences. As the noble Baroness, Lady Wheeler, rightly said, hearing people’s personal experiences, rather than simply reading words on a page, really does bring it home. I also thank the noble Baroness, Lady Murphy, for sharing her experience from the other side, as it were; that was a very valuable contribution for us all.

I should start by talking about the overall plan. I will then focus on some of the conditions discussed today. We have to acknowledge that the pandemic affected health and care services, which is why we must have a recovery service. The priority of that recovery is to address the pressures caused by the pandemic. Noble Lords will be aware of the Delivery Plan for Tackling the COVID-19 Backlog of Elective Care, published in February 2022, which sets out a long-term plan to look at bringing that down. It also looks at creating extra capacity, including through partnerships with the independent sector and in the NHS, to undertake more complex work, such as neurosurgery, with improvements for the most clinically urgent patients.

To support the ambitions in the delivery plan, the department has committed more than £8 billion over the next three years, from 2022 to 2025. This investment is in addition to the £2 billion elective recovery fund and the £700 million targeted investment fund already made available to the health and care system to push the recovery forward.

We know that there can be significant variation in the services provided for people with neurological conditions. I can confirm that NHS England is currently recruiting for a national clinical director for neurology to tackle this variation and provide national leadership and specialist clinical advice. This will complement existing work to improve neurology services—particularly the work of the neuroscience transformation programme, which will support services to deliver the right service at the right time for neurology patients closer to home. The noble Baroness, Lady Brinton, and others made this point.

NHS England also continues to work closely with the National Neurosciences Advisory Group to ensure continued service improvement and support neurosurgery networks with transformation and implementing changes that could have the highest impact. The National Neurosciences Advisory Group has developed a series of best practice optimal pathways for neurosurgery and neurology. They are being used to inform the proposed changes to the neurology service model, which will in turn be used to revise the service specification for neurology. This work is anticipated to be completed during this financial year.

We also know we cannot increase health service capacity and access to treatment without expanding our workforce capacity. As was made clear in many debates during the passage of the Health and Care Act, the Government commissioned Health Education England to come up with a strategy. The Act mandates the Government to publish a workforce strategy and plan every five years, on not only a national level but a bottom-up local level. We want to avoid Soviet Union-style planning which does not understand local communities, local trusts and areas. Bottom-up planning will happen at primary and secondary care level, trust level and ICS level. I will make some more comments about that.

We have made some progress so far with nearly 29,000 more hospital and community health service staff in March 2022 compared to the previous year, which includes nearly 11,000 more nurses and 4,300 more doctors. Working with the NHS, we will continue to identify and address these gaps across key types of staff. To support long-term planning, as I said, we have commissioned Health Education England.

On the social care workforce specifically, we know that many people living with neurological conditions rely on support from care workers. We recognise the challenges the sector faces in recruiting and retaining staff. Noble Lords will be aware that we launched the national register. It was voluntary at first, as some concerns were raised in the initial consultation about people not wanting to register. We want to build that confidence so we can understand the existing landscape and the myriad qualifications. How can we ensure we rationalise it so that it is a more professional service which people will feel attracted to, and what issues will we have to address so that we recruit more? To support local authorities and providers to address workforce pressures, there is the health and care visa and shortage occupation list, alongside work with DWP. We hope to boost recruitment in these areas.

Let me go into some more specific issues. It might be handy for me to discuss how the NHS generally, and the department, look at neurological conditions. When I was being briefed on this, I asked if I could be sent a list of all the neurological conditions. I now realise that was a naive question; apparently there are over 600 types. That shows that awareness is one of the big issues and barriers. If you want change, you have to realise what the issue is. If you think of how we as a society have developed, things that we now consider neurological conditions are things where, in the old days, people were told to pull themselves together. There were quite offensive names for some conditions that people had. We are now far more aware of them, which is really important. They can be broadly categorised into sudden onset conditions, intermittent and unpredictable conditions, progressive conditions and stable neurological conditions.

The noble Lord, Lord Dubs, and the noble Baroness, Lady Wheeler, rightly raised the issue of unpaid carers. During the debate there was consensus on the work that unpaid carers do, often with little reward, and what support should be available. As a result of the pressure rightfully put by noble Lords on the Government, the department and NHS have been interacting with Carers UK. I also put on record our thanks to the noble Baroness, Lady Pitkeathley, for all her work in this area and for pushing the Government to make sure that we first understand what support is needed. Sometimes it can be as simple as respite; at other times, far more support is needed. It is also about awareness and training, and we have the reform funding programme. We want to make sure that we not only recruit more motivated carers, giving them a proper career path, but do not forget the unpaid carers—recognising who is an unpaid carer and what support can be available, working from national government level and at local level.

The noble Lord, Lord Dubs, and my noble friend Lady Fraser also raised the issue of mental health. In addition to managing neurological conditions, we recognise that patients quite often do not get enough mental health support. We are committed to expanding mental health services. We also have the long-term physical health pathway. We are integrating improving access to psychological therapies—IAPT services—and have launched a public call for evidence in developing a new cross-government 10-year plan for mental health. I hope I can encourage all noble Lords to highlight that.

The noble Lords, Lord Dubs and Lord Monks, rightly raised the issue of multiple sclerosis and spoke about their own experiences of it. NICE has updated its guidance on management, diagnosis, treatment, care and support of people with MS. Following diagnosis, and with a management strategy in place, we aim for most people with MS to be cared for through routine access to primary and secondary care. NHS England has commissioned the specialised elements of MS care through the 25 specialised neurological treatment centres across England. The various parts of the NHS systems have also started to implement the guidance set out in the progressive neurological conditions RightCare toolkit, which includes a specific section on MS and was developed in collaboration with key stakeholders, such as the MS Trust and the MS Society. The RightCare toolkit provides the opportunity to assess and benchmark current systems to find out how we can improve. But it also has to be a continuous learning system, not just one set of guidelines that are followed for ages until someone tells you they are out of date.

Another important aspect of this is the research, as my noble friend Lady Fraser rightly raised. The Department of Health and Social Care funds research into neurological conditions through the National Institute for Health and Care Research. In 2019-20 the NIHR spent about £54 million on research through the Medical Research Council and is open to more bids, but it does not assign for particular conditions. Quite often, why NIHR does not assign a pot for certain conditions comes up in debates. It is open to research bids in all areas, including neurological conditions and so far it has given £54 million, but it welcomes more applications. Other areas are really important as well, such as motor neurone disease and others. That is why we urge the research community to come forward.

We also want to make sure that there is more awareness throughout the workforce, as noble Lords rightly said. As a speciality, neurology is popular and generally sees a 100% fill rate for training places. There has been an expansion in neurology posts across England and postgraduate trainees will start in August 2022. The National School of Healthcare Science is recruiting more trainee scientists to its three-year, work-based training programme, which leads to a master’s degree in neurosensory sciences. But the point is taken that it is not only these specialists we need; we also need to make sure that staff across the system are aware of these conditions and how we deal with them.

The noble Lord, Lord Dubs, raised the issue of cannabis. In November 2018 the UK Government legalised cannabis for medical use but imposed strict criteria. Specialist doctors are allowed to prescribe medicinal cannabis but there are still concerns about this not being enough people. I take the point that the noble Lord, Lord Dubs, made: if the patients feel that it benefits them, then it benefits them. That is important. I can offer to write to the noble Lord, Lord Dubs, or to have a further discussion.

We have seen increases in the number of full-time doctors working in this specialty, in neurology, including consultants, but as I have said, it is important that they are not just specialists.

Turning to strategies, there are two at the moment, one for dementia and the other for acquired brain injury. Once again, I am open to suggestions and happy to listen if people want to raise issues about this.

I should just touch on the neurosciences transformation programme. The NSTP itself came up with a new definition for specialised neurology and a model for new neurology services. The clinical pathways and the optimal pathways have been developed and indicators are being designed in partnership with stakeholders to support services delivering the right service at the right time for all neurology patients and, critically, closer to home or in the home. What we hope to see is that this approach will be built in as part of the integrated pathways, through the ICSs being set up.

On some questions that I am unable to give specific answers to—for example, on housing and a number of other issues—I offer to write to noble Lords. I think the noble Lord, Lord Dubs, asked whether I am prepared to have a meeting. Usually I say yes—I am sure noble Lords recognise that I met frequently during the passage of the Health and Care Act—but I just want to make sure I am the relevant Minister. If the relevant Minister is not available, I am very happy to meet, or to meet with the relevant Minister. I would really like to learn more and, either on my own or in partnership with the relevant Minister, to meet with the noble Lord, Lord Dubs—

[Lord Dubs (Lab)]

The task force.

[Lord Kamall (Con)]

The task force, yes—I thank the noble Lord for the prompt.

That is all I will say for now. I apologise if I have not covered all the questions; I will endeavour to write. I will diligently read Hansard and offer to write to noble Lords on those questions I have not answered. I thank the noble Lord, Lord Dubs, for raising this issue and all noble Lords for taking part in the debate and for their questions. It means I have to go back to the department and not only learn more myself but make sure we have some meaningful answers to the questions that noble Lords asked.

Committee adjourned at 4.56 pm.