National Health Service: Major Conditions Strategy

Lord Markham Excerpts

Monday 18th September 2023 Lords Chamber

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

My Lords, the Government are providing additional funding of £3.3 billion in 2023-24 and £3.3 billion in 2024-25 to support the NHS in England. The Government have not committed further additional funding specific to the major conditions strategy. However, as part of the strategy, we will be identifying innovative actions to help alleviate pressure on the NHS and support improvement within the current settlement, such as maximising the use of new technology to screen individuals for conditions.

[Baroness Wheeler (Lab)]

My Lords, the major conditions strategy has been well received in both approach and content, particularly the focus on primary and secondary prevention as part of a life-course approach, and bringing together a strategic framework for the six major conditions that drive over 60% of morbidity in England, including cancer, heart disease and stroke. However, key stakeholders have warned that, without adequate resources, NHS trusts and other bodies will struggle to deliver, especially given their current and future focus on trying to cope with ever-escalating waiting lists. Do the Government acknowledge this and how will January’s future strategy address it?

[Lord Markham (Con)]

We are investing about 11% of the economy—£160 billion—in the NHS, and the conditions in the major conditions strategy account for 60% of all the causes of death and long-term illness. What we are really talking about is prioritising spend around prevention and personalised care, as the noble Baroness said, and channelling the money we are already investing towards those aims, on which I think the whole House agrees.

[Lord Allan of Hallam (LD)]

My Lords, in June, the Government announced a ring-fenced AI diagnostic fund of £21 million to support the major conditions strategy. Will the Minister update the House on progress with the rollout of that fund? What other steps are the Government taking to ensure that NHS patients in all parts of the country can benefit from the latest developments in artificial intelligence?

[Lord Markham (Con)]

AI is a key point. Take stroke, which is one of these conditions. I saw a very good example in the Royal Berkshire the other day of what we all know as the golden hour, and the results from it. The Royal Berkshire has AI scans that go straight to the responsible physician, who can say straightaway whether a thrombectomy, for instance, is needed, the timing of which is critical. That is now being used in that cluster of hospitals and will be one of the six key technologies, the roll out of which we will encourage across the board to others.

[Lord Black of Brentwood (Con)]

My Lords, osteoporosis must surely be included in the major conditions strategy, as fractures are the fourth-worst cause of premature death and disability in the UK, with as many people dying of fracture-related causes as lung cancer and diabetes. Does my noble friend agree that the inclusion of osteoporosis in the strategy would need to be backed up by investment in fracture liaison services to make it effective? Would not a two-year transformation budget of just £54 million to pump-prime universal coverage of FLS in England, which would quickly pay for itself, be a game-changer for patients, the NHS and the taxpayer?

[Lord Markham (Con)]

I thank my noble friend. I think that is covered by musculoskeletal conditions, which is one of the six major conditions we are looking at. Key to pathways is moving treatment away from individual silos to patient-based treatment that looks across the board. We know that 55 year-olds have, on average, at least one condition, and that 80% of those over 85 will have one, two or three of these conditions. We need to ensure that we look at this across the board, rather than in silos.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I understand the rationale for identifying these areas, but how will the Government ensure that integrated care boards do not deprioritise services for other clinical conditions, such as eye health or kidney disease, for which there is huge demand in the NHS, involving many patients?

[Lord Markham (Con)]

The strategy tries to provide a road map for how we want to do this. It starts with prevention, which I think we are all agreed on, then early diagnosis, quality treatment and then living or dying well with that condition. It is a philosophy: the idea is that we get it right in these six major areas with 60% morbidity, and then we roll it out across the board in all other areas. It is a way of treatment, really—a way of looking at the whole problem, centred around whole patient needs, that we will roll out to other conditions as well.

[Baroness Barker (LD)]

My Lords, if this is to become a reality rather than an aspiration it will require a huge increase in the number of community nurses. How do the Government think that will happen when the main incentives and career development for nurses lie within the acute sector?

[Lord Markham (Con)]

My Lords, the noble Baroness is absolutely correct. That is set out in the long-term workforce plan: a move much more upstream to prevention and primary care, of which community nurses will be a key part. The recruitment is in place for it all. Yes, a lot of people might see the action as being in the acute sector, but a lot of people really enjoy working in the community as part of their lifestyle. The hope and expectation is that it will appeal to a lot of people in those areas as well.

[Lord Aberdare (CB)]

My Lords, less survivable cancers such as pancreatic cancer are often characterised by vague, non-specific symptoms, making them hard to diagnose. Will the major conditions plan include making funds available for symptoms awareness campaigns to ensure that these signs of deadly cancers are not missed? Will it also cover increased funding for research aimed at increasing survival rates for pancreatic cancer, which is the deadliest common cancer? Survival rates have hardly changed in the past 50 years, whereas for leukaemia there has been a surge in survival rates following an increase in funding for research.

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[Lord Markham (Con)]

This is all about prevention—letting people understand when there is something not right within themselves and trusting them to know that. That is why the self-referral part of this is so important, rather than always having a GP as a kind of gateway to it all. Most people know their bodies better than anyone else does. If we can arm them with awareness and give them the ability to self-refer to these centres, we can get them diagnosed that much quicker.

[Viscount Stansgate (Lab)]

Does the Minister agree that in the broadest sense, this strategy would be aided by the Powers of Attorney Bill that passed in this House last week and will shortly reach the statute book? With the indulgence of the House, I pay tribute to my friend and colleague Stephen Metcalfe, the Member for South Basildon and East Thurrock, who steered the Bill through the other place, my noble friend Lord Ponsonby of Shulbrede and the noble and learned Lord, Lord Bellamy, both of whom are in their places, for getting government and opposition support. I thank the officials at the Ministry of Justice who worked for years to make it possible. Does the Minister agree that lasting powers of attorney as applied to health will make a difference to the better?

[Lord Markham (Con)]

Absolutely. The Government, and in particular my noble and learned friend Lord Bellamy on behalf of the whole MoJ team, fully support the noble Viscount’s remarks on the Powers of Attorney Bill and warmly thank him, Stephen Metcalfe MP and all the others for their efforts on the Bill.

[Baroness Fraser of Craigmaddie (Con)]

My Lords, I congratulate the Minister on concentrating on the importance of person-centred care, particularly for people with long-term conditions. I declare an interest as chief executive of Cerebral Palsy Scotland. Cerebral palsy is a good example of this, because we actually have very good NICE guidelines for the treatment of adults with CP but there seems to be nothing we can do to ensure that integrated care boards around the country follow those guidelines. Can the Minister explain why?

[Lord Markham (Con)]

My noble friend is absolutely correct, in that we are setting out the whole emphasis of what we are trying to do here. It is really ingrained in those pathways. It is about culture and behaviour as a whole, rather than a silo-based scheme, looking at the whole patient. Once we have got those pathways set up properly, it is Ministers’ job—I have mentioned before that we each look after six or seven ICBs—to hold them to account and make sure they are following those pathways.

[Baroness Bennett of Manor Castle (GP)]

My Lords, on that whole- patient approach, in 2021 when the Office for Health Improvement and Disparities was launched, the then Secretary of State said that the Department of Health would be co-ordinating activity across government, looking at the wider drivers of good health—employment, housing, education and environment—lack of which often drives many major conditions. Can the Minister tell me how that co-ordination is going?

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[Lord Markham (Con)]

As mentioned, this is about looking at the whole patient, and that is why the ICB role in this, working with local authorities, is key. The environment in which people live is also key, as is tailoring our part of the jigsaw puzzle—health—towards this. One of the major elements that noble Lords have heard me talk about before is mobile lung cancer screening, which goes into neighbourhoods where it is known to be a problem, often the old mining communities or places where there are high levels of smoking and deprivation. That mobile screening technology has meant that instead of reaching only 60% of people by stage four of cancer, we are capturing 75% at stages one and two. This is about working with local authorities on whole health needs to ensure that our efforts are targeted in the right places.