Midwives: Bullying

Lord Markham Excerpts

Tuesday 16th April 2024 Lords Chamber

[Lord Hunt of Kings Heath]

To ask His Majesty’s Government what assessment they have made of the impact of bullying of students and newly qualified midwives in the NHS on (1) retention of staff, and (2) the treatment of pregnant women, as highlighted in the #Saynotobullyinginmidwifery report published on 12 November 2023.

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

This report makes difficult reading, highlighting unacceptable levels of bullying in midwifery. We know that culture and leadership have a significant impact on retention and staff experience. NHS organisations should have robust policies in place to tackle bullying and harassment. Through the NHS long-term workforce plan and the NHS equality, diversity and inclusion plan, we are seeking to expand the workforce and make the NHS a better place to work.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to the Minister. As he says, all NHS trusts have those robust policies. The problem is that they are not coming out into practice. This report describes the experience of midwives working in a toxic culture. One newly qualified midwife is quoted as saying that they were left

“burnt out by bullying and the terror of working on understaffed wards”.

Another said:

“I would return home crying most days and became suicidal from the fear and treatment at this trust”.


Does the Minister accept that much more fundamental change is required to deal with understaffed maternity units, NHS trusts preoccupied with reputation management over patient safety, and a reluctance to take whistleblowers seriously?

[Lord Markham (Con)]

I thank the noble Lord for his work in this whole area. That is genuine appreciation, because I know that he looks not just at bullying in this area. He is a very important conduit and I am personally grateful for the work he does on this and how much he cares. It is a combination of all the things that he mentioned. I had a meeting with the chief midwife on this subject this morning because of it being brought to my attention. I was actually quite reassured. Each trust now has what is called a quad leadership team, where the chief midwife, a neonatologist, an obstetrician and the general manager spend time together in a six-month process where they work together as a team on how they will address all these vital cultural issues.

[Baroness Burt of Solihull (LD)]

My Lords, among the very disturbing elements in this report is the way that midwives are bearing the brunt of the toxic culture and dangerously low staffing levels, which are causing over half of midwives to consider leaving their organisation. Despite what the Minister just said, the Ockenden report was over two years ago. Is he satisfied with this rate of progress? Should we not consider a statutory inquiry—a recommendation of this report—before more midwives leave and more babies die?

[Lord Markham (Con)]

We have the highest level of staffing ever in midwifery, 5% up on last year and 21% up on 2010, against a background of static births. I want to address that point on staffing; staffing levels are high. However, as the noble Baroness says, there are issues around culture. On the national inquiry, again, every one of those 150 trusts was visited by the CQC in the last year or so and action plans made on how to address this. We know what we need to do; we just need to get on and implement it.

[Lord Lucas (Con)]

My Lords, I am grateful to my noble friend for his replies. I am much more grateful to the many midwives who have helped my family over the years. They give an extraordinary service. If we are not to have an inquiry, will my noble friend make sure that his ears and doors continue to be open when things are not going as well as they should? The NHS has a habit of closing doors on things and making it difficult to interact with it. Bullying is not the only problem. There is a succession of problems which need bringing out into the air, such as overmedicalisation, the failure to implement the better births policy, and the regulatory culture overseen by the NMC. The Minister could help with that.

[Lord Markham (Con)]

I agree with my noble friend. Over the last 18 months, I have appreciated the power of this House and of these Questions. Each time I get one, it sets off a process. In this case, I undertook to meet the Chief Midwifery Officer to make sure that feet are being held to the fire. I know that Minister Caulfield is doing this. It is to the credit of the House that it has this scrutiny role.

[Lord Mackenzie of Framwellgate (Non-Afl)]

My Lords, my maiden speech in this House was on bullying in schools. Can the Minister tell me whether there is an anonymous hotline for whistleblowers to report unbecoming conduct in the health service? It is so important to have one.

[Lord Markham (Con)]

The noble Lord is absolutely correct. It is crucial. We have a whistleblowing system. It has had over 100,000 reported instances. We are trying to inculcate a culture where people feel able and free to stand up and point out an issue.

[Lord Allan of Hallam (LD)]

My Lords, workplace bullying is particularly toxic where managers are involved. This is where non-executive members of the NHS trust boards may come into their own if complaints involve executive members. What is being done to help non-executive members of trust boards be more responsive and able to deal with bullying complaints?

[Lord Markham (Con)]

The noble Lord is absolutely correct. This is the role of non-execs. Having done a bit of work on the Lucy Letby case, I understand that the non-execs should have said something. Obviously, the executives should have found out, but the non-execs clearly had a role. This is an excellent question. I have to be honest and say that I need to come back on it, if I may, so that I can give the noble Lord a full answer and make sure that this is happening.

[Baroness O’Grady of Upper Holloway (Lab)]

My Lords, does the Minister agree that we also need to tackle the conditions in which bullying can sometimes flourish? The Royal College of Midwives—the union representing midwives—published a report last week showing that over 100,000 hours of unpaid overtime are performed by midwives every week. Some 60% of midwives believe that staffing at their workplace is unsafe. Three-quarters of student midwives are expecting to graduate with £40,000 of debt. Surely it is time that we gave midwives the respect and the pay rise that they deserve.

[Lord Markham (Con)]

I agree. As ever with these things, there are a number of issues, of which pay is one. The introduction of the £5,000 a year support that we now give to all students is an important help with regard to debt. Work conditions are important, but key to it all is the culture. I have seen many examples where that has not been great. I was quite impressed by the Chief Midwifery Officer saying that every trust now has a midwife retention person whose job is to get into all these issues and make sure that they are addressed.

[Lord Boateng (Lab)]

My Lords, how many of the midwives recruited to deal with the current midwifery crisis in the NHS were trained and qualified in the United Kingdom? On a recent visit to Ghana, I visited a child oncology unit, which, in the past year, had lost a fifth of its clinical nursing staff, who were trained, qualified and paid for by the Ghanian taxpayer—to the benefit of the NHS. How is that ethical or right?

[Lord Markham (Con)]

I will come back to the noble Lord with the exact number, but he is correct: the long-term workforce plan is all about making sure that we have the right resources and infrastructure to train the required number of people. Behind that, we have funded an extra 150 spaces this year and we have a target to increase them by 1,000 by 2026. It is absolutely as the noble Lord maintains: we are putting training in place domestically, as well.

[Baroness Cumberlege (Con)]

My Lords, does my noble friend share my view about the evidence that, when midwives and other clinical staff understand the importance of continuity, it leads to safer care and better outcomes for both the mother and the baby? One of the midwives quoted in chapter 2 of the report that was sent to us—I thank my noble friend for that—says that working in a continuity team was the best, most rewarding time in their career. Continuity is absolutely critical; it comes up in a number of reports, some of which I have had a part in writing. We know that you need continuity if you are going to make a real impression on the midwifery service and that the women who are party to it must really understand what continuity does and can achieve.

[Lord Markham (Con)]

I thank my noble friend, who has been a tireless campaigner on continuity of care. I challenged the chief midwife on this just this morning, and the objective behind the long-term workforce plan is to make sure that we have the resources in place to maintain that, starting with ethnic minorities. We all know that there is a disparity of outcomes in terms of inequality, so the first priority for continuity of care is that setting, but the objective is to spread that across the whole system.

Immunisation: RSV

Lord Markham Excerpts

Tuesday 16th April 2024 Lords Chamber

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government when a decision on eligibility for a potential 2024 respiratory syncytial virus immunisation programme will be confirmed, and whether this will be aligned to the Joint Committee on Vaccination and Immunisation’s September 2023 advice.

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

The Government have made a policy decision on the eligibility of a potential RSV programme, which is in line with the JCVI’s September 2023 advice. We are working through the full business case, with costing and operational delivery, for final agreement in line with an autumn start.

[Baroness Ritchie of Downpatrick (Lab)]

I thank the Minister for his Answer, but what plans and resources, both staff and finance, are in place to enable the immediate implementation of any RSV immunisation programme for young infants and older adults, in line with the JCVI’s advice, once the ongoing market engagement and tender process is complete?

[Lord Markham (Con)]

That process is absolutely going on at the moment, as well as operational delivery aspects. For infants, it depends on whether we choose a vaccine that goes into the pregnant mother or the infant, as the delivery mechanisms are obviously different. We are looking at the effectiveness of not just one vaccination versus the other but the delivery mechanism. There is a different delivery mechanism for the group aged 75-plus. The full programme business case is considering exactly that to make sure that we can deliver in the autumn.

[Lord Allan of Hallam (LD)]

My Lords, will the Minister commit to making the vaccination records for new programmes such as RSV available through the NHS app from the outset? I ask this as a parent who has just had to verify his teenage children’s MMR status by hunting down the red books last seen a decade ago to find the tatty piece of paper that is the only record of it. I now have a digital copy through my camera phone, but it would be much more useful to have this kind of record in the NHS app.

[Lord Markham (Con)]

It will not surprise the noble Lord to learn that I totally agree. It is absolutely on the road map. I cannot promise it is there today; it is more there for adults. The child digital red book is another objective we are working on, but that is taking slightly longer. But in terms of direction of travel—yes, absolutely.

[Lord Patel (CB)]

My Lords, I congratulate the noble Baroness, Lady Ritchie of Downpatrick, on pursuing this even before we had vaccines available. Now we have succeeded in getting the vaccine, but why has 75 years been chosen for adult immunisation, when we know that the incidence and prevalence of RSV infections is much more common for over-65s?

[Lord Markham (Con)]

I too add my thanks; the noble Baroness is very good at holding our feet to the fire, and it is very important and appreciated. Regarding the age group, we are being guided by the scientific advice on what is most cost-effective.

[Baroness Merron (Lab)]

My Lords, earlier this year we discussed the busy pipeline of new vaccines, including those for RSV, which, coupled with the concerning decline in the uptake of immunisation, does point to the need for a fresh look at delivery mechanisms. What steps are being taken to move beyond traditional arrangements, and when can we hope to see an improvement plan in place, in readiness for the RSV immunisation programme?

[Lord Markham (Con)]

Of course, the communication needed for each one is different, and that is a vital consideration. As I said, we found that, often, it is easier to put RSV in the infant rather than the pregnant mother. It is a question of considering which is the most effective way to get the best outcome and the highest take-up rate. That is one of the key criteria we are looking at. Regarding general communication, the noble Baroness will be aware that, on MMR, we have challenges in both London and the West Midlands. That has shown that you need other communication routes to get to some ethnic minority groups, using technology such as the app. There is no one silver bullet —you need a series of measures in place.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, is the Minister confident that the implementation programme will take place before the 2024-25 winter period, as promised in previous iterations of this Question?

--- Later in debate ---

[Lord Markham (Con)]

The goal is absolutely to make sure that the JCVI advice is there for the key winter period the noble Baroness mentions. That is the programme we are working towards, and this is where the logistics come in. It is not just about the effectiveness of each vaccine but, in terms of the maternal versus infant vaccination to which I referred, being confident of getting it in people’s bodies in time.

Pandemic Preparedness

Lord Markham Excerpts

Monday 15th April 2024 Lords Chamber

[Baroness Deech]

To ask His Majesty’s Government what is their state of preparedness for the next pandemic.

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

The Government continue to plan and prepare for a range of pandemic and emerging infectious disease scenarios. These include respiratory diseases such as flu and diseases spread by contact, vector-borne or through oral transmission. This built on lessons learned through Covid-19. We are working with partners to strengthen our pandemic preparedness and to build a flexible and scalable response that can be adapted to any threat that the health and social care system faces.

[Baroness Deech (CB)]

My Lords, that is not very reassuring. With all due respect to my noble and learned friend Lady Hallett, the remit that she has been handed is too wide, too deep, too long and too expensive, not least due to the lawyers. It seems to be looking backwards rather than forwards. We do not need to know who said what to whom in the middle of the night a few years ago; we need to know whether we have innovative vaccine labs, ventilators, the right medical staff, preparedness with PPE, supply lines and so on. I suggest to the Minister that either my noble and learned friend’s remit be cut down or he set up a quick and short inquiry, looking forward to the next pandemic, which could be with us within months. Sweden managed its inquiry in two years. This one will take too long.

[Lord Markham (Con)]

I totally agree with the noble Baroness. What I am interested in as a Health Minister is what lessons we can learn so that we are better prepared next time round. My understanding is that stage 1 is going to be reported in early summer, and that should give us some of those findings. I completely agree that that is what really matters.

[Lord Browne of Ladyton (Lab)]

My Lords, an international pandemic treaty and government policies from 2021 are currently being negotiated by the World Health Assembly, aimed at preparing for the next global health emergency and preventing a repeat of what South Africa called vaccine apartheid, where countries had vastly unequal access to vaccines and drugs. Next month, World Health Organization member states are expected to vote on the final text. Where do we stand on the key issue of pathogen access and benefit sharing? Do we stand on the side of the group for equity or with those rich countries that have suggested that such an approach would undermine their sovereignty?

[Lord Markham (Con)]

I think our record in this speaks for itself. I am very proud of the action that we took as a Government to make sure that the AstraZeneca vaccine was prepared quickly, put in arms quickly and offered all around the world on a not-for-profit basis very quickly. Action speaks louder than words, and that is something that we are well-prepared on. I have been involved in some of the conversations about world pandemic preparedness. There is action that we think we can take collectively as a world, but what we are not prepared to see happen is our sovereignty—the management of our health services—being ceded to other countries.

[Lord Allan of Hallam (LD)]

My Lords, procurement during the pandemic has left a bitter taste in the country. While many good citizens stepped up in the public interest, there are legitimate concerns that others were profiteering at that difficult time. Can the Minister give a firm commitment there would be no VIP fast lane if there were another pandemic? Are the Government putting in place a much more transparent emergency procurement system as part of their preparedness planning?

--- Later in debate ---

[Lord Markham (Con)]

I think it is understood and accepted that the VIP fast lane was not a good way of going ahead; lessons have definitely been learned. At the same time, I refer to the fact that 97% of all procurement fit the bill and worked very well. Yes, 3% did not and lessons need to be worked on, but we should remember that, in those extraordinary times, 97% was pretty good.

[Lord Robathan (Con)]

My Lords, my noble friend the Minister has talked about lessons learned. Is not one lesson that was learned the terrible impact that the lockdowns had on our economy and society, children’s mental health, cancer rates and so on? In future, can we make absolutely certain, before taking any drastic step like a lockdown, that we weigh up the costs and benefits of such a policy?

[Lord Markham (Con)]

Absolutely. To respond to both this question and the earlier question from the noble Baroness, Lady Deech, the other things I would like to see the inquiry look at are the lockdown and comparisons with countries such as Sweden, what lessons can be learned across the whole health system, the impact on the mental health of our children and a lot of the other areas that my noble friend mentioned.

[Lord Patel (CB)]

My Lords, the WHO has identified Nipah virus as a priority candidate for the next pandemic. It belongs to the same group of viruses as the measles virus. Fortunately, Oxford University has developed a vaccine that went into human trial last week. The lesson therefore is that we should identify the organisms that are likely to cause pandemics and be prepared ahead of time with the vaccines; several other candidates have also been identified. For that to happen, we require a global conglomerate to focus on development of vaccines. Do the Government have any plans to establish one?

[Lord Markham (Con)]

We definitely look to work closely with our colleagues, and I have spoken to my Health Minister counterparts on this. One of the lessons from the pandemic was that you also need to have your own capability. The work we have done on the100-day mission, and the strategic relationship we have entered into with Moderna—which can develop vaccines in as little as four to six weeks to answer some of those unknowns—is very powerful.

[Baroness Wheeler (Lab)]

My Lords, it is now two years since the UK Health Security Agency replaced Public Health England. As we await the Science and Technology Committee’s report on the threat caused by zoonotic diseases such as Covid, avian flu and Ebola, can the Minister update the House on the progress the agency is making in building resilience in these areas? It reported last year on global work on developing pandemic-fighting tools but not on the nitty-gritty needed to tackle underlying problems still hampering us, such as tackling widespread health inequalities, building systems for vaccine resistance and raising public awareness of the threats we all face.

[Lord Markham (Con)]

I thank the noble Baroness. The UKHSA has been working and there are four main areas we want to be responding on. First, there is the vaccine, and the 100-day mission is all about making sure that we have the vaccines quickly. We have 100 million vaccines prepositioned for flu and 250 million for other diseases. Secondly, there is the manufacturing scale-up. We have a fund in place so that we have UK domestic production capability to produce vaccines quickly. Thirdly, there is the stock of PPE, and, fourthly, there is the diagnostic capability. That is how the UK Health Security Agency is making sure we have all the bases covered.

[Lord Hannay of Chiswick (CB)]

My Lords, will the Minister turn again to the answer he gave to the noble Lord, Lord Browne of Ladyton, about the international aspects of this? Does he not accept that throwing in the slightly abusive reference to the word sovereignty is simply a kind of “get out of jail” card to ensure that, next time round, again, equitable distribution across the world will not be achieved?

[Lord Markham (Con)]

Excuse me, but I think we will find that Britain was a world leader in developing a vaccine and making it available all round the world on a not-for-profit basis. If any noble Lord can come up with examples where countries have done more than we have in this space, I would be delighted to hear them. I, for one, am proud of what we did.

[The Lord Bishop of Leeds]

My Lords—

--- Later in debate ---

[The Lord Bishop of Leeds]

My Lords, do the Government have a preprepared communications plan for the eventuality of another pandemic—which could be next week, next year or whatever—so that it is not made up on the hoof? We remember that, in 2016, there was a big exercise in London which was forgotten about when we got to the actual pandemic. Are those provisions being put in now and preparations being made?

[Lord Markham (Con)]

That is all a part of what I referred to as having a toolkit for a flexible response. The problem always in these things is that you tend to fight the next war on what happened in the last one. We have to be careful in what we do and that we are not trying to fight the next pandemic on the last one, because inevitably it will be different. Having a flexible and scalable response, including communications, is vital.

[Baroness Chakrabarti (Lab)]

My Lords, the Minister says that we have a—

--- Later in debate ---

[Lord Turnberg (Lab)]

My Lords, some years ago, when I was chairman of the Public Health Laboratory Service, we had 31 public health laboratories dotted around the country. Their role was to track and trace the sources of infections. We lost those in a review of the Public Health Laboratory Service, and I resigned as a result of that. What a loss that has been. What efforts are being made now to replace those laboratories which can do the track and trace that we desperately need?

[Lord Markham (Con)]

As the noble Lord mentions, one of the key pillars is having diagnostic capability. The noble Lord will be aware that, for the sequencing of all the different Covid strands, it was the UK that they were sent to because our diagnostic and sequencing ability is second to none. I am assured that that capability still exists and, with that, our ability to scale up diagnostic testing very quickly.

Stroke Treatment

Lord Markham Excerpts

Wednesday 27th March 2024 Lords Chamber

[Baroness Wheeler]

To ask His Majesty’s Government what steps they are taking to improve treatment and care for those of working age who are affected by stroke.

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

The Government are taking three major steps to improve treatment and care for strokes: first, a whole series of prevention measures to help avoid a person having a stroke in the first place; secondly, an updated and evidence-based stroke care pathway using AI, the latest technology in stroke rehabilitation, to maximise the chances of recovery; and, thirdly, post-stroke rehabilitation care and support to maximise the chances of recovery.

[Baroness Wheeler (Lab)]

I thank the Minister. We know that one in four strokes happen to working-age people, and that it is also a leading cause of disability. Speech and physiotherapy support after stroke is therefore vital, because it helps recover key skills such as motor functions and cognitive ability, and it can be the difference between returning to work and not returning, or giving up altogether. With serious delays across the country in getting people to hospital and scanned, and in providing the speech and physiotherapy that is needed, and with chronic staff shortages across the country in hospital and community settings, good care is just not the reality for thousands of stroke sufferers. Some 40,000 people missed out last year on essential six-month, post-stroke reviews. When will the up and coming major conditions strategy be published? How will it specifically support effective stroke rehabilitation and recovery, and what timescales will be set for that?

[Lord Markham (Con)]

I thank the noble Baroness for her tireless work in this area. As she quite rightly points out, aftercare and rehabilitation is the vital third leg of the three-step process I spoke about. In the major conditions strategy we talk about how we are basing it on a national model for an integrated stroke care service, based around personalised, wraparound care, for as long as is needed, with reviews every six months. I have seen some fantastic examples when I have been out and about, such as in Royal Berkshire and Leighton. The proof of the pudding is in the results; we have seen the number of people who are achieving a full recovery increase from 16% to 48%. That is the target we are going after.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interests. The Minister mentioned the importance of prevention, which of course is not only primary but secondary prevention. In that regard, for both patients with atrial fibrillation at risk of a stroke and those who have had a stroke, it is vitally important that appropriate therapies, innovations in therapeutic intervention, and broader cardiovascular risk management are provided. Is the Minister content that we have a strategy that provides those opportunities, both for primary and secondary prevention of stroke?

[Lord Markham (Con)]

The noble Lord is quite right. Many noble Lords will have heard me echo Sir Chris Whitty’s words that his major concern about the whole Covid period was that people missed out on blood pressure and cardiovascular checks, which can be early-warning indicators. That is why we see prevention as a major leg of what we are trying to do, through having blood pressure checks and inviting everyone to have their health check every five years. What we are working on, and will be bringing out shortly, is greater use of digital for health checks, to do precisely what the noble Lord says.

[Baroness Browning (Con)]

My noble friend wrote to me in response to an Oral Question on the subject of strokes to explain how AI is enabling many hospitals now to be able to diagnose within the three-hour timeframe and give appropriate treatment, thus enhancing the recovery of stroke patients. I mentioned it to my local general hospital, and I am sorry to tell him that it does not have this AI technology. When does he think it will be rolled out nationally?

[Lord Markham (Con)]

This AI service, Brainomix, is one of the ground-breaking services that are part of the future of the NHS. It is part of the whole service, which will include video triaging. It is currently in 65% of hospitals, and I am sorry that it is not in my noble friend’s hospital. We have a target to increase that quite rapidly to 75%. I will look into the particular hospital that she mentions. It really is ground-breaking; overall, where we have got everything in place, full recovery has gone from 16% to 48%.

[Lord Allan of Hallam (LD)]

My Lords, to follow up on the issue of screening, atrial fibrillation is a well-known risk factor for stroke, but fortunately can now be checked for with some very cheap devices that connect to smartphones. What progress is being made on AF checks as part of screening programmes and routinely when high blood pressure is checked for? Can the Minister look particularly at the invites for the screening programme? I received one saying that I should come in for an AF check, not a stroke risk check or a cardiac risk check; they could be made much more user-friendly.

[Lord Markham (Con)]

The noble Lord is right to point that out, and I hope we are correcting it. I have seen the mobile app and digital being used to do all these things—I have even seen applications which can measure your blood pressure and pulse as you look at it. We need to check some of the accuracy around that, but it is all part of the programme. However, we need to make sure that it is in everyday English.

[Baroness Pitkeathley (Lab)]

My Lords, many family carers who provide care for stroke patients are also of working age. If they have to give up paid employment, it results often in the kind of debt that is currently in the news as a result of having to pay for care. What help can be given to those carers? I acknowledge that the Carer’s Leave Act was a welcome step forward, but that is only unpaid leave. What else can the Government provide for carers in these circumstances?

[Lord Markham (Con)]

The noble Baroness is right: carers are the hidden army who give so much support, not just in the area of strokes but across the board. As the noble Baroness said, we have put in place some steps, such as enabling leave and enabling people to claim benefits. I accept that that is not the whole enchilada, so to speak, but it is a step along the way.

[Baroness Meacher (CB)]

My Lords, I had a major stroke a year ago, and I am actually fine. I want to applaud the NHS. It has been truly remarkable, providing a machine beside my bed to monitor my heart every night. I also have atrial fibrillation. The NHS has monitored me incredibly carefully, with endless contact and the monitoring of my medication to ensure that it is exactly right—the GP was on to me this morning. The NHS has been completely wonderful, and it is worth saying that, as a patient.

[Lord Markham (Con)]

I am delighted to hear those good examples. As I say, we have had some very good results. The challenge is to ensure that everyone can have the sort of experience that the noble Baroness has had, which we are keen to do.

[Baroness Lawlor (Con)]

My Lords, does my noble friend agree that it might be worth looking further into post-stroke care, following what the noble Lord on the Cross Benches said? I have visited hospitals in France, where post-stroke patients, be they of working age or non-working age, are encouraged to get back to work and be fit for work. Sadly, in my own local hospital I have seen academics of working age discharged without provision for the speech therapy or physiotherapy which would allow them to continue working. This is something that we could learn from our French friends.

[Lord Markham (Con)]

That is what these SQuIRe centres are about—trying to roll out best practice. As I mentioned, I have seen fantastic examples, including simple things such as at Leighton Hospital, which gets every patient, not just stroke patients, to exercise for a couple of hours each day. That makes a difference to their length of stay and their ability to go back into the community and into the workplace.

[Lord Hunt of Kings Heath (Lab)]

My Lords, to follow on from the encouraging intervention of the noble Baroness, Lady Meacher, the Minister will know that, in 2010, London centralised hyperacute services into a small number of expert units. What progress are we making throughout the rest of the country, because in some parts it has been disappointingly slow?

[Lord Markham (Con)]

The stroke quality improvement for rehabilitation—SQuIRe—services are where we are trying to take best practice from London, France and around the world and roll it out. The good news is that we have the model; it is based on a national model for an integrated community stroke service. We have got that in 65% of locations, with the goal of making it 75%.

[Lord McColl of Dulwich (Con)]

My Lords, as there are 40 million people at risk of stroke because they are obese or overweight, would it be a good idea for the Government to recommend, as I have done for some time, that people have one fewer meal a day? That would reduce their weight and their expenditure.

[Lord Markham (Con)]

My noble friend is correct that weight and obesity is a major factor in all sorts of conditions, including strokes. Encouraging people to eat correctly, in a healthy manner, is absolutely the right way to go.

As this is the last time that I will see your Lordships, I wish all noble Lords a happy Easter. I for one am looking forward to the break.

Sodium Valproate and Pelvic Mesh

Lord Markham Excerpts

Monday 25th March 2024 Lords Chamber

[Baroness Cumberlege]

To ask His Majesty’s Government what are the timescales for, and what progress has been made on, a response to the Patient Safety Commissioner’s report on options for redress for those harmed by sodium valproate and pelvic mesh, published on 7 February.

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

The Government commissioned the Patient Safety Commissioner to produce a report on redress for those affected by sodium valproate and pelvic mesh. We are grateful to the commissioner and her team for completing this report and our sympathies remain with those affected by sodium valproate and pelvic mesh. The Government are now carefully considering the PSC’s recommendations and will respond substantively, hopefully in the coming months.

[Baroness Cumberlege (Con)]

My Lords, I thank my noble friend for that reassuring reply. However, as it has been five months since the Government received the advice from the Patient Safety Commissioner in October 2023, how much more time do patients and families need to wait for the redress that they so desperately need?

[Lord Markham (Con)]

My Lords, I thank my noble friend for her tireless work in this area. It is something which, in the Chancellor’s very own words—because it was the Chancellor who, as Health Secretary, first commissioned the report—remains a top priority to both him and the Government. That remains the case. I spoke to Minister Caulfield about it just this morning, and it is a complicated area, but it is something that we are very keen to redress in the next few months.

[Baroness Uddin (Non-Afl)]

My Lords, I am really grateful to the noble Baroness, Lady Cumberlege, for raising this issue. On previous occasions, I have raised my ongoing concerns about the use of sodium valproate, especially for patients with mental health issues incarcerated in hospital. Do the Government collect information on how many people have been prescribed this terrible medication in some cases, and whether it is being disproportionally applied, particularly to young men from minority communities in the mental health institutions?

[Lord Markham (Con)]

I thank the noble Baroness. I will provide the precise figures, but the incidence has gone down by 34% in terms of the amount that has been prescribed. At the same time—and this is particularly fitting, as tomorrow is National Epilepsy Awareness Day—for some people, this is the only treatment for epilepsy that will work for them. It is therefore important to make sure that protocols are in place for prospective mothers and prospective fathers to make sure that, in those cases, they are not being prescribed sodium valproate, because in other cases it is often the only medicine that works.

[Baroness Finlay of Llandaff (CB)]

My Lords, given that, sadly, errors and problems repeatedly occur in the NHS, how are the Government working with the devolved Administrations to ensure that a redress scheme is designed to be fit for the future as well as fit for the recognition of harm that has occurred? What will they do to ensure that trust in the NHS is maintained by an approach that encapsulates prospective monitoring and listening to patients and relatives for early detection of adverse events and avoids cumulative errors?

[Lord Markham (Con)]

I thank the noble Baroness. I was actually speaking to Minister Caulfield about this just this morning, because she is in regular touch with the affected patient groups. They were talking precisely about some of the things around the Scotland NHS scheme in place in terms of redress. It is fair to say that there are some concerns in patient groups on some aspects of this, but underlying what the noble Baroness says is making sure that, whatever we do, we are trying to do it consistently across the UK because there should be one consistent approach. Likewise, we are learning lessons from these things as well.

[Baroness Burt of Solihull (LD)]

My Lords, an ex-constituent of mine, after years of excruciating pain, the onset of returning cancer and no care plan, finally borrowed $47,000 to have the failed mesh implant removed in America. She now has her life back but is in deep debt. However, we learn that the Government will consider redress only in 2025. Can the Minister hazard a guess as to how many more mesh-induced deaths will have occurred by the time a single penny is paid out in compensation at this rate?

--- Later in debate ---

[Lord Markham (Con)]

The 2025 date is the timetable that the Patient Safety Commissioner recommended in terms of financial redress. The point that the noble Baroness makes, quite rightly, is about the non-financial aspect: if you are suffering pain from it all, you want to be treated as quickly as possible. That is why we have set up these nine specialist centres to allow exactly that sort of redress to occur.

[Lord Hunt of Kings Heath (Lab)]

My Lords, can I remind the noble Lord that, of course, it was not a matter of months since this first recommendation came? The noble Baroness, Lady Cumberlege, recommended a redress scheme some years ago. Why was it rejected in the first place, and why are we waiting many more months, as the Minister said, when, as the Patient Safety Commissioner has said, the intention is

“an initial, fixed sum in recognition of the avoidable harm they have suffered as a result of system-wide healthcare and regulatory failures”?

Why are the Government being so slow to respond?

[Lord Markham (Con)]

That is precisely what I put to Minister Caulfield this morning. She commissioned the review because her feeling was that the period from when my noble friend’s initial report came in until when Maria Caulfield was in post was too long. So it was absolutely she who commissioned it last year, and it is absolutely she who very much said that she is determined that there should be a substantive reply from us in the next few months.

[Baroness Bennett of Manor Castle (GP)]

My Lords, at the launch of the Patient Safety Commissioner’s report the victims of the Primodos scandal expressed great distress as they felt that they had been airbrushed out. Of course, the noble Baroness, Lady Cumberlege, recommended that they should receive redress, and they were treated the same way in the report as the sodium valproate and vaginal mesh victims. Can the Minister tell me what will be done to provide redress and ensure that there is appropriate treatment for the victims of Primodos?

[Lord Markham (Con)]

Again, these are difficult areas. My understanding is that we are working from the conclusions of the expert working group in 2017, and its review of all the evidence was that it could not find a causal link between Primodos and the impact it had during pregnancy. This was again reviewed by the MHRA when more information was brought up in the last year. So I am afraid that, as we stand today, the evidence is not there that suggests that causal link.

[Baroness Wheeler (Lab)]

My Lords, the Patient Safety Commissioner’s report is all the more valuable because it is drawn from patients’ experiences, including physical, psychological and emotional impacts and their daily struggle with accessing health and other key services such as social security benefits and special educational needs support for the valproate-harmed children they are raising. What is being done to support mothers and families as they cope with the indecision and delay over the Government’s response to the commissioner and await the vital support they need?

[Lord Markham (Con)]

We have completed four of the initial recommendations in the report of my noble friend Lady Cumberlege, and another three are in process. The most important of those, to answer the noble Baroness’s question, is the setting up of these nine specialist centres which can provide the support needed, not just in terms of redress surgically or treatment-wise but in terms of the support that people need to help them cope with the issues.

[Baroness Blackwood of North Oxford (Con)]

My Lords, as important as this report and these findings are, this is part of a wider problem. Some 4,000 babies die due to pregnancy-specific conditions in the UK every year, but 73% of drugs given to pregnant women have no safety information. That is clearly unacceptable. The Minister knows that I have raised this issue with him before; please can he give an update on progress towards putting this right?

[Lord Markham (Con)]

My noble friend is correct on this. Probably the best way to do that is to come back in detail in writing, because it is vitally important.

[Baroness Brinton (LD)]

My Lords, in response to the noble Lord, Lord Hunt, the Minister said that Minister Caulfield had commissioned this report, but he misses out at least three years of work earlier. There was the report of the noble Baroness, Lady Cumberlege, and there was a long debate during the passage of the Health and Care Act when Nadine Dorries said she would look at commissioning something and then refused to do so. This is not recent history. Will the Minister please give this House a date on which the Government will come back to Parliament with a response?

[Lord Markham (Con)]

The point I was making was that Minister Caulfield absolutely agreed with the point the noble Baroness makes that the delay had been too long, and so it was she who came forward and said that she wanted to commission the Patient Safety Commissioner to report exactly in this area. So that was her being proactive on all this. In the same way, she says that she is determined to get a response back in the next few months. I cannot give a specific date yet, because it is a complicated area which involves industry, many government departments and the devolved authorities. However, as the Chancellor said, this remains a top priority area for both the Chancellor personally and the Government.

Foetal Sentience Committee Bill [HL]

Lord Markham Excerpts

2nd reading
Friday 22nd March 2024 Lords Chamber

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

I thank my noble friend Lord Moylan for introducing this Private Member’s Bill. I am grateful for the contributions by all noble Lords to the debate, which has proven more than ever that there are some deeply held personal views. That is because the Bill itself raises issues of profound sensitivity on a topic on which, as we see, there is a wide range of views.

As the noble Lord said, the main purpose of the Bill is for the Secretary of State to

“establish and thereafter maintain a committee called the Foetal Sentience Committee”

to provide

“evidence-based, scientific expertise on the sentience of the human foetus in the light of developments in scientific and medical knowledge”.

The Government have expressed reservations over the Bill as we do not believe that legislation is needed. The aims of the Bill can be achieved through alternative routes, thereby rendering legislation unnecessary. The Government must uphold the duty of care not to legislate where other reasonable processes are available. Also, the House can decide, if it wishes, whether it wants to set up a such a committee to scrutinise the matter. I fear that, if the Government were to set up such a committee, we would immediately get into issues of who should be on it, its composition and whether it goes one way or the other. That would inevitably lead to the politicisation of it all, and I think we all agree that that would be a regrettable step.

Before I turn to the points raised in the debate, let me first remind noble Lords of the history of abortion legislation in Great Britain and the Government’s long-standing position on matters of abortion policy. Abortion in Great Britain is governed by the Abortion Act 1967, which clearly defines grounds under which an abortion may be carried out. With the exception of emergencies where it is necessary to perform an abortion to save the life of the woman, two doctors must certify that, in their opinion, which must be formed in good faith, a request for an abortion meets at least one ground set out in the Act, and they should be in agreement about which ground this is.

The current gestational limits of abortion in this country are based on the gestation at which a foetus is considered viable, not on foetal awareness. Foetal viability is the ability of a foetus to survive outside the womb. The link between viability and the gestational limit for abortion was made in the 1990 amendments to the Abortion Act, when the gestational time limit for most abortions was changed from 28 to 24 weeks following a change in widespread medical consensus.

An important feature of abortion legislation is that Parliament decides the circumstances under which abortion can be legally undertaken, not the Government. The Government take a neutral stance on changing existing law relating to abortion. Any change to the law in this area is rightly a matter of conscience for individual parliamentarians, rather than for the Government.

Over the last 50 years, the Abortion Act has contributed to a significant reduction in maternal mortality and enabled lawful access to abortion, which is an important area of women’s healthcare. The department remains committed to ensuring that women have access to safe, legal abortions on the NHS, including taking abortion pills at home where eligible, in accordance with the Act.

According to our most recent data, most abortions take place in the early stages of pregnancy, with 93% up to and including 12 weeks’ gestation. Abortions at 20 weeks and beyond are very infrequent. The percentage performed at 20 weeks and over was 1% in 2020 and 2021, and 41% of these were under ground E of the Abortion Act, which states that, if the child were born, there would be

“a substantial risk … it would suffer from such physical or mental abnormalities as to be seriously handicapped”.

The decision to proceed with an abortion due to foetal abnormality is very difficult for parents. In 1990, when the grounds for abortion were last amended, Parliament decided that doctors are best placed to make these decisions with the women and their families.

A few noble Lords raised issues using the example of the Animal Welfare (Sentience) Act, which legislates for the creation of animal sentience committees. This legislation reflects that the Department for Environment, Food and Rural Affairs sought independent advice specifically on animal welfare, as it is a topic on which it sets policy. The Government do not set policy on foetal awareness. When we consider matters as sensitive as that of foetal awareness, it is right that clinical policy is reached through medical consensus among the professional bodies that set clinical guidelines.

We must recognise that the prevention and relief of unnecessary pain is a primary concern in clinical practice. There is no doubt that there have been medical advances over recent decades in in utero surgery and in the study of pain perception. Clinicians who are experts in this field have undertaken a balanced study of the evidence. It was on this basis that, recently, the Royal College of Obstetricians and Gynaecologists undertook a comprehensive review and published its foetal awareness evidence review in December 2022.

This review concluded that evidence to date indicated that the possibility of pain perception before 28 weeks of gestation was unlikely. As an independent organisation responsible for producing clinical guidelines and setting standards for high-quality women’s healthcare, the RCOG’s clinical expertise on this matter is recognised by the Government. In response to questions raised, my understanding is that analgesia is used more to immobilise the foetus for its safety when operations are taking place.

In conclusion, the Government have expressed reservations about this Private Member’s Bill, as a number of non-legislative routes exist through which a committee could be created to consider this matter. I recognise the sensitivity of this topic, as well as the diverse and deeply held views across the House. I thank all those for taking the time to attend and participate in this important and sensitive debate.

Children’s Cancer Services

Lord Markham Excerpts

Wednesday 20th March 2024 Lords Chamber

[Baroness Bloomfield of Hinton Waldrist]

To ask His Majesty’s Government whether a fully funded delivery plan has been agreed in relation to NHS England’s proposal to relocate children’s cancer services away from The Royal Marsden NHS Foundation Trust to other providers across London.

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

NHS England has decided that Evelina London should be the future location of the principal treatment centre, following extensive engagement with a wide range of stakeholders across the south London/south-east region. A delivery plan has been assessed as affordable by NHS England, with capital funding in place, and remains subject to robust financial scrutiny. Ministers are considering next steps.

[Baroness Bloomfield of Hinton Waldrist (Con)]

I thank my noble friend the Minister for his Answer and draw attention to my entry in the register of interests. This is an extraordinary act of self-harm. NHS England, in a decision delegated to the London region, announced that it will be closing the world-leading paediatric cancer services of the Royal Marsden Hospital in Sutton and transferring these to the Evelina Hospital in central London. The Royal Marsden is the largest centre for clinical trials for new drugs for children with cancer in Europe. Its unique co-location with the ICR and the team developing new adult cancer drugs and researching how these can be used to help support childhood cancers means risking the loss of many of these trials and breakthroughs by breaking this bond. Will my noble friend undertake to ask the Secretary of State to call in this decision, as legislation allows her to?

[Lord Markham (Con)]

First, I thank my noble friend for the tireless work she does on behalf of the Royal Marsden, and convey the views of probably all noble Lords on the fantastic work the Royal Marsden does. The current situation, as I think noble Lords know, is that the NHS has reached a decision. The Secretary of State does have the power to call in exceptional cases, and as a result of that, Minister Stephenson is undertaking a fact-finding mission. I have set up a meeting with him to discuss this, and my noble friend is very welcome to join me at that meeting.

[Earl Russell (LD)]

My Lords, structural healthcare decisions are among the most challenging, and my worry is that there are greater risks now the Evelina has been chosen. It will be the only principal treatment centre in the UK where neurosurgery is not carried out on-site. St George’s has over 25 years’ experience in caring for children with cancer and a dedicated staff team of over 430 people, only four of whom will be moving to the Evelina. What actions will the Government be taking to monitor and ensure a continuing standard of cancer care for children?

[Lord Markham (Con)]

Ministers are on a fact-finding mission. I understand the points the noble Earl makes; the NHS made the point that it wants cancer treatment to be co-located alongside an intensive care unit. Following Professor Sir Mike Richards’ review, it believes that it is best to have those services co-located, which is why it has chosen the Evelina. There are pros and cons to every decision, and that is why Ministers are doing further fact-finding.

[Lord Patel (CB)]

My Lords, this decision is daft on many counts, some of which have already been expressed by the noble Baroness, Lady Bloomfield. I declare an interest in that I am an occasional contributor to the Royal Marsden Cancer Charity. As has already been mentioned, the Royal Marsden is a world-renowned centre for cancer research, including in children.

Going back to the decision, even if the Royal Marsden was closed down and all the children’s cancer services were shifted to the Evelina, it does not and will not have all the facilities to deliver medical oncology services to children. Compromised children with cancers will then have to be transferred out of the Evelina to other places where radiotherapy is available. Why shut down a centre which last year transferred to intensive care only three children out of 700—all of whom survived —and instead use another centre which does not have major radiotherapy facilities?

[Lord Markham (Con)]

The noble Lord makes some very good points. Following the NHS review and the evidence put forward, specific cancer treatments will take place at University College Hospital London, which has two particular benefits for patients: radiotherapy and proton beam technology. Ministers want to understand and make the points the noble Lord has made, and to see whether this is a decision we are comfortable with. As I said earlier, since January 2024 we have had the power to call in a decision in exceptional circumstances.

[Baroness Chisholm of Owlpen (Non-Afl)]

My Lords, we have heard a lot in this House about joined-up thinking, but this is not joined-up thinking. Instead, we are thinking of fragmenting a service which works very well. Co-location is important, in order to enable experts to talk, research and take decisions together. Can the Minister do everything he can to change the decision?

[Lord Markham (Con)]

I am happy to go through the facts. I hope noble Lords know me well enough to know that I like to look at all the evidence, and, clearly, we are at that stage. I saw an excellent example just the other day in Cambridge, where we are building a new centre to put research and treatment under one roof. That, of course, is what the Royal Marsden has for children’s cancer, so I am aware of the benefits and they will be at the front of my mind.

[Lord Winston (Lab)]

My Lords, I am sure the Minister understands that cancer cannot be seen as an isolated disease. One aspect of that is how you provide for children in their entirety during the treatment, which does not always involve just cancer but other organs and other parts of the child.

[Lord Markham (Con)]

Yes, and the Royal Marsden has a very good track record on that. As was explained to me on the Cambridge visit, having all those services together under one roof is a definite advantage. When the pros and cons are weighed up, that will definitely be a pro.

[Lord Reid of Cardowan (Lab)]

My Lords, the Minister will be aware by now that there is considerable doubt, controversy and concern around this decision. He has said—and we all take it in good faith—that the Secretary of State is calling this in at this stage for fact finding. When does he anticipate that such a review of the facts might be finished?

[Lord Markham (Con)]

It is only now that the facts are starting to come to us. On something as important as this, we definitely do not want to be hurried into it. Normally, I would be saying at this Dispatch Box that I want to “go, go, go”, but on something as profound as this I want to make sure that we are not hurrying into it. All noble Lords will agree that we have a very good service in operation. For instance, I looked at the Royal Marsden’s stats on speed of treatment and diagnosis, and they are excellent. I am afraid I cannot give a timetable because, quite deliberately, I want to make sure that we do not rush into any decision until we know all the facts.

[Lord Fox (LD)]

My Lords, there seem to be two issues here. One is the seemingly inexplicable nature of the decision, but also the process by which it was made. Can the Minister please talk to his colleague, not only on a fact-finding mission about this decision, but about how decisions such as this are taken within the NHS, what issues are being considered, and which are considered more important than others? It seems to me that there is an imbalance in the decision-making process. Perhaps that is also an issue that needs to be addressed.

[Lord Markham (Con)]

I want to be fair to the NHS here. It has done an extensive study, with a lot of professionals rating extensive criteria, and they really did believe that in certain areas, the Evelina scored higher than St. George’s and the Marsden. It is a balanced decision; all I can do is absolutely promise noble Lords that we will take all those factors into account.

[Baroness Merron (Lab)]

My Lords, I appreciate that the Minister is looking at all of this, but given the difficulties of achieving the number of clinical trials in the UK, what effect is anticipated on research because of the proposed relocation of paediatric cancer services? Is there an intention to factor into the final decision the need to expand research capacity for childhood and adult cancers?

[Lord Markham (Con)]

Among the criteria the NHS has taken into account are clinical services, the patient care experience and research, and it scored the Evelina higher on research. I want to understand that, because many noble Lords will be surprised by that finding. I assure the noble Baroness that research and the ability to do clinical trials, which is a vital component of our life sciences industry, is an important factor in this decision.

Sexual and Reproductive Healthcare

Lord Markham Excerpts

Tuesday 19th March 2024 Lords Chamber

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

I start by adding my thanks to the noble Baroness, Lady Barker, for securing this debate and for all the work that she does in this important area. I was grateful for all the contributions, but I admit that it made me smile when the noble Lord, Lord Allan, asked whether the solution to the sexual health debate should be one of a bigger bed. I thought that was a very topical answer to it all, but I will come back to his bigger bed question on the long-term workforce plan later on.

I admit to a bit of surprise when hearing some words used in the debate: the noble Baroness, Lady Barker, used “crisis” and the noble Baroness, Lady Bennett, mentioned “broken Britain”. I can answer the question of the noble Baroness, Lady Merron, about the quality and availability of services for sexual health because, thanks to our very own House of Lords Library briefing, as I am sure all noble Lords saw, some very interesting and extensive research was produced by the European Parliamentary Forum for Sexual and Reproductive Rights in October 2023. It looked at 46 European countries on a whole range of subjects and, for instance, in the area of access to abortion services the UK came third out of 46. On contraception, we came first and on HPV prevention, we came third. On gender-based violence in education, we came first. If we add all those up, what was our overall ranking? First.

I am somewhat surprised because this is a reasoned and balanced place, and this came from the House of Lords Library. In the whole conversation we have had in this debate—in all the things mentioned—I was somewhat surprised that it was not mentioned anywhere that this body had done extensive research on it all and it put us first. It commended us time and again in that.

I was also surprised when HIV was mentioned a couple of times. The UN target is called 95-95-95, which is wanting 95% of cases to be diagnosed, wanting 95% to be treated and wanting to make sure that 95% of people with HIV have an undetectable viral load. The UK, and I think we are alone in this, hit the 95% level on diagnosis. On treatment, we hit 98% and on detectable viral loads, we hit 98%. I will check whether we are alone but we are definitely beating those UN targets.

The action taken by the Government—which was recently applauded during Elton John’s visit, as noble Lords will remember—includes standard things such as opt-out HIV testing in every circumstance where people are going into A&E. This has already detected 1,000 people with HIV who were previously undetected. That is absolutely ground-breaking in the world. We were also applauded for the action taken on HIV through PrEP. Call me old-fashioned, but I would rather look at the results we are achieving than at how much we are spending, and I hope noble Lords would join me in that. On the results, according to this independent source and against the UN HIV target, we undeniably come out very highly.

However, I do not want to appear complacent. Clearly, far fewer people are using condoms—often for very good reasons, because there is not the same fear of sexual disease and HIV. So there are societal changes, but that brings some challenges regarding sexually transmitted diseases—that is understood. We are trying to make our funds go as far as possible, not just in services today but in introducing contraception and those services to pharmacies. Pharmacy First is making this very accessible—we are already seeing good take-up, and we expect about 30% of people to get their contraception through Pharmacy First. That is a real example of how we are massively expanding access to the workforce.

The long-term workforce plan is absolutely a bigger bed strategy, and I take the point of the noble Lord, Lord Allan, that we clearly need to make sure that that provides the individual specialisms that are needed. The Government and I accept that work will need to be done to make sure that those specialisms result from that. But I think all noble Lords will agree that the bigger bed strategy is right, and improvements will come through across the board.

The noble Lord, Lord Hunt, referred to Sexwise. The steps we are trying to take are sensible, and the Government did this well when they consolidated a lot of their different websites into a single source. We want the primary source of information we are pointing people towards to be the NHS websites, and particularly the NHS app, which I think all noble Lords would agree is completely appropriate for younger people. At the same time, I absolutely take the sensible point the noble Lord made about a group being willing take over Sexwise. Funnily enough, I said exactly that: “Why can’t we give it a contract for £1 if it is difficult to give it away? Why can’t we do something pragmatic along those lines?” That is the challenge I have set: if it is a good service and someone is willing to do that, why would we not want to support that? But I hope noble Lords see that, in general, it is a sensible strategy in the digital age to consolidate your assets around the overall NHS umbrella and the NHS app.

In response to the noble Baroness, Lady Barker, we definitely want to build on the women’s health hubs. STI and HIV screenings are part of their specifications. In response to the noble Baroness, Lady Bennett, we have hepatitis B, HIV and syphilis as standard parts of the screening of pregnant women. That is seen as very important. I also absolutely agree about the importance of home testing in all this. As noble Lords will see, we are trying to use the NHS app as a vehicle for people to get home testing as they require.

The noble Baroness, Lady Bennett, asked about the advice behind focusing chlamydia screening on women rather than men. That is based on the scientific advice and evidence we have received that that is the best use of resources in this case.

I will write to the noble Lord, Lord Allan, on his very reasonable question about where young people get their information from in a letter detailing what we know. I accept that, if we do not have that information, we should find it out. Hopefully, we can come back on that. Likewise, I will need to come back further on what evidence we have to date on ICBs and the benefits of joint working. As ever, I will follow up on the detail in writing.

I am grateful for the opportunity for us to debate these things. This is one of those occasions where I can stand here in all honesty and say that, objectively, by a number of measures—looking at the results coming in, not at the funding—including from none other than the European Parliamentary Forum for Sexual & Reproductive Rights, Britain comes out at No. 1. That is something that we can all feel proud of.

Cancer: Staffing

Lord Markham Excerpts

Thursday 14th March 2024 Lords Chamber

[Baroness Merron]

To ask His Majesty’s Government, in the light of warnings by the Parliamentary and Health Service Ombudsman, what assessment they have made of the risk to cancer patients in England presented by the staffing levels, workloads and working conditions of healthcare professionals.

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

I express my regret about the cases referenced by the ombudsman. The department is taking steps to reduce cancer diagnosis and treatment waiting times across England and to improve survival rates across all cancer types. Through announcing the first ever NHS long-term workforce plan, we are taking meaningful steps to build the NHS workforce for the future. The Government are backing the plan, with over £2.4 billion of funding for additional education and training places.

[Baroness Merron (Lab)]

My Lords, the Minister will know that numerous complaints relating to patients with cancer that were investigated by the Parliamentary and Health Service Ombudsman included misdiagnosis, treatment delays, the mismanagement of conditions, poor communication and unsuitable end-of-life care. As the NHS is grappling with over 110,000 staff shortages, how is patient safety being compromised by the Government’s long delay in bringing forward the workforce plan? What immediate action will the Government take to deal with the continuing risk to cancer patients posed by a workforce that the ombudsman describes as “understaffed, under pressure and exhausted”?

[Lord Markham (Con)]

As the noble Baroness says, we see increasing the workforce as a core component here. I was speaking to the president of the Royal College of Radiologists about this the other day, and we obviously need to make sure that the workforce can be as effective as possible at what it does. We are doing a lot of new diagnosis, and 80% of all the medical AI technologies are in the radiography space, which is making a huge difference to diagnosis and productivity. It is clearly fundamental that we get the treatment to these people as quickly as possible.

[Baroness Meacher (CB)]

My Lords, does the Minister accept that there has been underfunding of the NHS for more than a decade now and that our cancer recovery rates do not compare with those of our competitors in Europe? Will he agree to have an urgent uplift in the funding of cancer services in particular over the next period, in order to try to lift our recovery rates up to those of Europe?

[Lord Markham (Con)]

Noble Lords have heard me say many times that we are investing roughly 10% of the economy into the health space, which is much more than ever before and comparable to nations around the world—apart from America, which stands significantly above. I am sure noble Lords saw the headline in the Times today that survival rates are at their best level ever, and there has been a 35% reduction in mortality rates for men and women over the last 10 or 15 years. So there is a lot of progress in this space, but I accept that we need to invest more—that is what the new CDCs, and the 7 million extra tests they are performing, are all about.

[Baroness McIntosh of Pickering (Con)]

My Lords, I remind the House of my interest with the Dispensing Doctors’ Association. Does my noble friend share my concern about the number of GPs, particularly those under 55, who are considering retirement in the next five years? How do the Government plan to fill the vacancies that will be created, to ensure that, particularly in rural areas, a fast track will exist for patients who are suffering from cancer for the earliest possible referral to hospital? I refer to the letter I wrote to our noble friend Lord Evans on this.

[Lord Markham (Con)]

I thank my noble friend and totally agree that GPs are the front line of our medical services. We are trying to do everything we can to make sure that they feel valued and are retained. The recent change to the pension law was all about addressing that very point, answering GPs’ number 1 concern in order to keep them. Their hard work has seen a 25% increase in the cancer referral rate: we treated 3 million people, up 600,000, over the last year, thanks to their work and the expansion in the diagnostic centres we have set up.

[Baroness Barker (LD)]

My Lords, does the Minister agree with us on these Benches that there should be a statutory two-month period between diagnosis and access to appropriate treatment for any cancer patient? In order to achieve that, there needs to be further investment in radiography training and an equitable distribution of trainee radiographers and qualified radiographers across the country. How will the Government ensure that that happens?

[Lord Markham (Con)]

As I mentioned, that was very much the big feature of the discussion that I had with the president of the Royal College of Radiologists just the other day. We have been growing the number of radiographers by about 3% every year, which is a good rate, and we look to increase that even further. The CDCs are about that. However, the actual demand is increasing by about 5% every year. Clearly, as well as recruitment, we need to make sure that we have effective diagnosis, and this is where the field of AI is very exciting. The radiographers are 100% behind it, because they really see the revolutionary effect it is bringing.

[Lord Turnberg (Lab)]

My Lords, we are certainly shortly of staff, and the problem is not increasing recruitment but enhancing retention. Staff are leaving because they are disillusioned and disaffected, and we do not treat them well enough. Any large business knows that, if you have a happy workforce, it will be productive. We certainly do not have that in the NHS. We certainly need to stop this dismissive attitude and enhance the conditions of their service, and it is not simply about pay. Does he agree?

[Lord Markham (Con)]

I totally agree that it is a range of things. I completely agree with the noble Lord that a good employer should be looking to make sure that employees have good working conditions and feel valued, and that there is an understanding culture in the workplace as well as decent pay. I say all this in the context that the workforce in the cancer space has actually increased by 56% since 2010, so it is not as if there have not been massive increases here. The actual number of treatments and diagnoses has gone up by more than 20% from pre-pandemic levels. So we are doing a lot in this space, but I agree with the noble Lord’s basic premise that we need to ensure that staff feel valued so they will want to carry on working.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my interest as being employed in part by the Velindre Cancer Centre in Cardiff. Do the Government recognise that continuity of care is absolutely essential for patients to be able to spot when things are changing and to allow sensitive conversations to occur? Will he therefore undertake to have urgent discussions with the Royal Colleges and with Health Education England to look at the training rotas for doctors who are working in oncology, allowing them to provide better continuity of care with less disruption to their own lifestyles, and better support? Will he also look at recommending that they might draw on the Welsh experience of Talk CPR, which allows early conversations about very difficult topics, providing video books and so on that patients can take home and then come back to see the same person again some time afterwards, providing continuity of care and better communication?

[Lord Markham (Con)]

First off, I completely agree about continuity of care—in any treatment, to be honest. I was just saying, in answer to a maternity question the other day, that continuity of care in the midwifery space is another vital example. On the question of learning lessons from what the noble Baroness mentioned, we have some meetings set up, so I look forward to discussing it further then.

[Lord Kakkar (CB)]

My Lords, I draw noble Lords’ attention to my registered interests. The Minister rightly identified an improvement in survival rates for those between their late 30s and 69 over the last 30 years. He also accepted the fact that those delivering cancer services are under a huge amount of pressure to ensure timely provision of that care. It is also essential to achieving long-term improvement in outcomes that we continue to innovate and that clinicians are provided the opportunity to participate in clinical research, which validates innovation and allows its adoption at scale and pace. Is the Minister content that we are doing enough to protect time for clinical research and participation by all healthcare professionals in those protocols to drive those advances in innovation?

[Lord Markham (Con)]

First, I completely agree on the need for and the vital importance of clinical research in all this. Providing clinicians with time does two things: it means that they get their incredibly valuable time, resources and brains on it; it also addresses the question asked earlier about retention. Of course, this is why a lot of clinicians want to be in this space, so they have time to do research as well. There are very good personal and medical reasons why they should be allowed to do that.

[Lord Dubs (Lab)]

My Lords, I should declare an interest in that my wife is receiving treatment from the Royal Marsden. Is it possible that the national statistics mask a great variation between hospitals such as the Marsden, which is absolutely top of the range, and some others? Is it worth looking at the differences and what we can learn from them?

[Lord Markham (Con)]

Yes. Funnily enough, I was having a similar conversation just yesterday about how we can use data to really understand some of the differences in performance because, as the noble Lord said, we have all heard of some brilliant examples in our NHS hospitals and we have all heard of some other examples which, as pointed out by the ombudsman, were unfortunately not so good. Understanding those centres of excellence and those that need more help is vital.

Prioritising Early Childhood: Academy of Medical Sciences Report

Lord Markham Excerpts

Monday 11th March 2024 Lords Chamber

[Lord Hunt of Kings Heath]

To ask His Majesty’s Government what assessment they have made of the report of the Academy of Medical Sciences Prioritising early childhood to promote the nation’s health, wellbeing and prosperity, published on 5 February, particularly regarding children under 5.

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

The Government welcome the report. We have taken significant action to improve children’s health in the early years. This includes reducing sugar in children’s food, supporting healthy diets for families from lower-income households through schemes such as Healthy Start, and investing record amounts into children’s and young people’s mental health services and around £300 million in the family hubs and Start for Life programmes. We are also improving children’s oral health through our dentistry recovery plan.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I pay tribute to my noble friend Lord McAvoy, who was an incredible parliamentary servant in both Houses over many years.

I thank the Minister, but he will be aware that we have a frightening number of people of working age who are not able to work because of long-term illness. The implication of the academy report is that we are storing up huge problems for the future. As one example, 20% of under-fives are obese or overweight. If the Government are so keen to take action, why have they postponed the implementation of their obesity strategy, which would start to take action against unhealthy food and encourage young people towards more exercise and a healthier lifestyle?

[Lord Markham (Con)]

First, I add condolences from myself and this side of the House for Lord McAvoy.

Secondly, I am grateful for the direction of the report. I think that we all agree that early investment in childhood, and in young people, is vital. That is what our vision for the first 1,001 critical days is all about. A lot of the things in the report are helpful. I must admit that I did not recognise that particular stat, because rather than it being one in five children suffering from obesity at age five, the latest report—and it is an extensive study—shows that it is less than one in 10. It is the lowest number since 2006-07. So, in the area of obesity, we can show that our plans are working. I say again: we have the lowest level of obesity among reception age children since 2006-07.

[Baroness Jenkin of Kennington (Con)]

My Lords, the Food, Diet and Obesity Select Committee, which is one of the new ad hoc committees, took evidence last week from specialists in childhood, early years, and school food. The situation is grave, as the noble Lord, Lord Hunt, said. Some 80% of the food that children eat is ultra-processed—we have no idea what the long-term consequences will be. May I encourage the Minister to look again at the figures and the ultra-processed foods that we are feeding children—the health consequences of which are not yet understood?

[Lord Markham (Con)]

I assure my noble friend that the numbers are correct; they are the lowest since 2006-07. I can also assure her that free school meals are at their highest level ever, at 33%. The whole idea behind those programmes, as well as the Healthy Start in school and the five-a-day, is to give children healthy diets early on, exactly as my noble friend says.

[Lord Allan of Hallam (LD)]

My Lords, I echo the condolences to Lord McAvoy’s family from these Benches. I always enjoyed working with him in another place.

On the Question before us, the Government have rightly been bigging up the digital revolution in the NHS, but many of the basic building blocks are still not there. Does the Minister agree that it would be helpful for the health of infants for there to be a digital red book, rather than relying on parents carrying around a physical one? Can he give a timescale for when we will move on from endless pilots and aspirational announcements to this being widely available?

--- Later in debate ---

[Lord Markham (Con)]

I totally agree. Funnily enough, I was talking to Minister Leadsom about this subject just this morning. It is complex, because all parents need proxy access so that they can get those digital records for their children automatically. It is something we are working towards. The Pharmacy First initiative, whereby you can write data from a pharmacist immediately into GP records, will help because it will give a road map to do that for children and babies from hospital. It is something we are working on, and I will give details of the timeline in writing.

[Lord Patel (CB)]

My Lords, I declare an interest. I am a fellow of the Academy of Medical Sciences, which produced this seminal report addressing issues related to child health. I will pick up two points that the Minister might comment on. Although he is implementing what we already know from research works in improving children’s health, we have no strategy for the implementation of good practice. My second point is about research into the early years. Diseases that people may develop later in life can occur as a result of epigenetic influences during the early years that alter the genome, yet research into childhood accounts for 5% of total government research funding.

[Lord Markham (Con)]

I totally agree about the importance of research and data. We have spent about £580 million on research in the children and young persons’ space since 2020. As per the earlier question, data is vital to this. I saw a fascinating example just a couple of weeks ago in the Cambridge Research Centre concerning young children. It is using data to construct what it calls “virtual children”, to look at rare diseases, how they progress and different treatments that can be tried. It is truly revolutionary and something I totally support.

[Lord Rooker (Lab)]

My Lords, I distinctly heard my noble friend Lord Hunt describe these children as obese and overweight. The Minister has addressed only obesity. You can be overweight without being obese, but it means you are on the way to obesity. That is the serious problem.

[Lord Markham (Con)]

I think we all agree that it is a very serious problem, so I do not want to diminish that. I was trying to demonstrate that the steps we are taking—there is a lot to do in this space—are having an effect. Noble Lords have heard me say before that our reformulation efforts mean that everything from Mars Bars and Snickers to all sorts of other foods are having the sugar content taken out, so we can make sure they are healthier for people to enjoy.

[Lord Bird (CB)]

My Lords, have the Government looked at the idea of bringing back something like Sure Start? I was involved in Sure Start, and I saw people breaking down poverty in their lives because of children coming in and mixing with other healthy children. It was wonderful. Can we look again at Sure Start?

--- Later in debate ---

[Lord Markham (Con)]

One of the recommendations of the report is a cross-cutting approach of the kind the noble Lord mentioned to avoid silos. The family hubs we are investing in alongside the Department for Education are trying to do exactly that sort of thing to make sure the healthy start for life exists.

[Baroness Merron (Lab)]

My Lords, these Benches will greatly miss my noble friend Lord McAvoy. I had the pleasure and education of serving with him as a Whip in the other place. May his memory be for a blessing.

The Academy of Medical Sciences report highlights the importance of continuity of maternity care, which can reduce the likelihood of pre-term birth by 24%. Given that premature babies are more likely to have complications that affect vision, hearing, movement, learning and behaviour, which will all impact later life, what steps are the Government taking to increase the number of women receiving dedicated midwifery support throughout their pregnancies?

[Lord Markham (Con)]

I agree with the noble Baroness and my noble friend Lady Cumberlege about the importance of continuity of care in the maternity space. We are investing resources as part of the long-term workforce plan to increase the number of people trained in maternity and in this area generally. To give another example, we are investing in family nurses by increasing the number of training places by 74%, because it is understood that we need the workforce to provide all these services in an ever more complex world.

[Lord Sterling of Plaistow (Con)]

My Lords, is not one of the problems that children today do not get anything like the exercise we used to do in the old days?

[Lord Markham (Con)]

Wearing the tie I was awarded for being man of the match in the rugby against the Irish parliament this weekend, which we won, I totally agree about the importance of exercise in all walks of life. Social prescribing is vital. We are expanding the number of PE services available for children, because exercise is vital.

[The Lord Bishop of Leicester]

My Lords, there is strong evidence that in the early 2000s increases in child benefits led to an increase in the amount parents spent on fruit and vegetables and books and toys for their children. What assessment have the Government made of the impact of the two-child limit on benefits and, in particular, on the health and well-being of the 1.5 million children affected?

[Lord Markham (Con)]

We recognise very much, as said in the report, the importance of poverty in all this. We have seen the number children in absolute poverty decrease by 400,000 since 2010, which is a significant reduction. The Chancellor’s announcement last week showed the importance we place on child benefit in getting money to people to help. It is a very important area.