Paediatric Care: Wating Times

Lord Markham Excerpts

Monday 16th October 2023 Lords Chamber

[Baroness Wheeler]

To ask His Majesty’s Government what recent assessment they have made of the impact of the length of waiting times for paediatric care on children’s developmental outcomes.

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

Cutting waiting lists is one of the PM’s top five priorities, and we are aware that waiting times impact more developmentally on a younger person’s life. Given this, we are committed to ensuring that babies, children and young people are prioritised in integrated care systems, and that the reforms in the Health and Care Act 2022 to improve child health and well-being outcomes are delivered on the ground.

[Baroness Wheeler (Lab)]

My Lords, the Academy of Medical Royal Colleges has described sick children as the

“forgotten casualties of the NHS’s waiting list crisis”

across hospital and community health. NHS data shows that over 220,000 are waiting for children’s and young people’s services, including paediatrics, autism spectrum disorder diagnosis, health visiting, and speech and language therapy. Even worse, almost 20,000 have been waiting over a year—that is 8% up on the previous month. What action are the Government taking specifically to address this appalling situation, and what cross-government measures are in place to try to mitigate the huge knock-on impact on children’s education, health and well-being, and on their families?

[Lord Markham (Con)]

I thank the noble Baroness for bringing this question up; this is an important area, and we all know that a year in the life of a child aged 10 is a lot more impactful than it is to a 60 or 70 year-old. It is a question very well put. Since receiving this Question, I have been working on it with the department and talking to the relevant Ministers about what we can do specifically. We are expanding capacity generally through the CDCs and the 95 surgical hubs designed around this space, but we are putting in measures with ICSs and tiering to make sure we are specifically addressing children’s wait times as well.

[Lord Allan of Hallam (LD)]

My Lords, it is naturally very stressful for any parent when they face a long wait for their child’s paediatric referral. That stress is often compounded by the fact that it is left to the parents themselves to chase things up through confusing referral systems and systems that are still far too manual and depend on paper letters that get lost. Will the Minister make a priority of improving the information flow to parents about a child’s referral, so that they can quickly and easily see what is happening and know what to expect?

[Lord Markham (Con)]

That is a point very well made. as the noble Lord knows, that is one of my priorities and what we are trying to do with the app. There will be a number of launches, but already we are seeing hundreds of thousands of messages going out via the app to make sure that people are getting them on time. That has become the backbone of our communication system and will expand across the piece to try to cover exactly the points the noble Lord raises.

[Lord Hunt of Kings Heath (Lab)]

My Lords, in addition to the list raised by my noble friend, I would also mention hearing assessments for children who do not initially get the newborn hearing assessment. Does the Minister consider that one of the problems is that, around the table at the ICBs and integrated care systems, no one really has the responsibility of representing the interests of young people and children, and that this is reflected in the discussions they have on prioritisation? If he would agree to look at this, does he not think we need a way of ensuring that, around that table, experts in issues relating to children, infants and young people are brought to the fore?

[Lord Markham (Con)]

It is now the legal responsibility of the ICBs to appoint an executive lead in this area, but I think the point generally is a good one. As I said, as a result of this Question I have managed to spend some time looking into this and we clearly need to make sure it is a priority. One of the other things I have been talking about with the executive team of the NHS is how we can introduce this to the tiering measures so that hospitals are given special help in making sure that children’s wait time is one of the key priority areas, and we can put more resources and support towards that and more support where hospitals are not performing well in that area. I agree with the noble Lord.

[Lord Laming (CB)]

My Lords, does the Minister agree that all staff in the front line of these services need to be aware of the dangers of child abuse or child neglect, because the developmental needs of very young children can also be indicators of serious neglect in the home?

[Lord Markham (Con)]

Yes. That is where our colleagues in the Department for Education have a key part to play. Start for Life is a joint initiative with DfE which is trying to look at early diagnosis. At the same time, often some of those issues can manifest themselves in anxieties and mental health issues. That is why we have done a lot of work to expand the number of mental health-aware teachers and assessors in schools, so that we can have early detection.

[Lord McLoughlin (Con)]

Have the Government made any assessment of the impact of strikes on waiting times?

[Lord Markham (Con)]

Unfortunately, industrial action is impacting on waiting times; we estimate that about a million appointments have been lost to date. Clearly, that is a matter of regret and not good news for anyone.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, I take the Minister back to the question from the noble Lord, Lord Allan, who referred to the necessity for parents to do a lot of running around and following up for themselves. Does he agree that this is a particular problem with the management of long-term conditions in young people—for example, ADHD and other things relating to autism—where the challenge is not just to get the diagnosis but to then get a consistent level of treatment over the long term? Can he comment on what steps have been taken to improve that? Can he also comment on the reported limited availability of appropriate drugs for treating young people with ADHD?

[Lord Markham (Con)]

I am aware from personal experience that, when you have a child with neurodiversity or developmental needs, it is a long journey. We are seeing this manifest itself much more in recent years; I was talking to Minister Caulfield about this just this morning. One-to-one is always preferable but, where capacity is constrained, group education and help can sometimes lend themselves to this space. It is a long-term condition, and clearly it will not be solved by treatment over a few months but needs many years.

[Lord Winston (Lab)]

The Minister quite rightly referred to the brain development of a child being very rapid and resulting from experience, and to various experiences having a profound effect on children’s development. However, he did not mention the place of primary care and, particularly, general practitioners in this. Does he feel that general practitioners are getting enough resources to be able to assess children on a more routine basis? The app will certainly be useful, but it does not get them clearly involved with medical practice; we need some standard way of doing this. Can he give us some information about the role of the GP?

[Lord Markham (Con)]

The role of the GP is clearly vital. That is what I was trying to get behind in the Start for Life initiative and clear early warning indicators. Clearly, that needs to go right through the development of a child at different key stages along the way. On digital treatments, I was at Boston children’s hospital last week, and it has early indicators for dyslexia—for example, looking at pattern recognition via an app, as it is not until children are older that they can see letters. Similarly, early signs of neurodiversity can be seen in the way that children play online on certain apps. I think we can add some of these digital support tools, but clearly the GP has a primary role.

[Lord Addington (LD)]

My Lords, following on from his last comment, can the Minister give us some idea of what contact there has been on this with the Department for Education? We are supposed to talk to each other, but it becomes increasingly apparent that we do not do so.

[Lord Markham (Con)]

I like to think that we have good contact on this, centred around, as I said, Start for Life, which is a £300 million joint programme between ourselves and the Department for Education. There are also other things; for example, noble Lords might remember me mentioning the Bradford pilot previously, where we are looking at children’s scores in test environments and using those where there may be early indicators of ADHD or other neurodiverse needs. There is quite a bit of work going on in this space. No doubt we could always work more closely, but there is some promising work being done.

[Lord Kamall (Con)]

My Lords, looking at the waiting lists, there is clearly an issue of different needs and levels of seriousness in the conditions that people are suffering. Can my noble friend the Minister tell us what sort of prioritisation process has been put in place to make sure that those who need care immediately are prioritised over those who could possibly wait a little longer?

[Lord Markham (Con)]

Probably the best example of that is in the whole area of cancer, which we all agree has to be the absolute priority. We have set up children’s cancer networks precisely around that. They are also set up so we can do whole genome sequencing for all children with cancer and start to introduce specific point-of-care medicines especially for them. These are examples of where we are saying that this really is the priority and that it is what we will devote all our resources to.