Edenfield Centre: Treatment of Patients

Lord Markham Excerpts

Thursday 13th October 2022 Lords Chamber

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

My Lords, I shall now repeat in the form of a Statement the Answer given by my honourable friend in the other place.

“I am grateful to my honourable friend for this important question. Like him, I have been horrified by the treatment of vulnerable people at the Edenfield Centre, which has been brought to light by undercover reporting from the BBC. There is no doubt that these incidents are completely unacceptable. My ministerial colleague, the Parliamentary Under-Secretary of State for Health, has met with the Greater Manchester Mental Health NHS Foundation Trust, and a number of steps are being taken.

As a matter of first priority, my department is working with the trust to make sure all the affected patients are safe, and a multidisciplinary team has completed clinical reviews of all patients. Secondly, a significant number of staff have been suspended pending further investigation. Thirdly, the trust has agreed there will be an independent investigation into the services provided at the Edenfield Centre. Fourthly, Greater Manchester Police is investigating the material presented by BBC ‘Panorama’. For this reason, I will not be commenting on the specifics of the case. The trust will continue to work closely and collaborate with local and national partners including NHS England, the Care Quality Commission, the police and, of course, my department.

These are important first steps, but they are by no means the last. There are serious questions to be answered, especially in light of other recent scandals. I want to put on the record my thanks to the whistleblowers, the BBC and, above all, those patients and families who have been so grievously affected. Anyone receiving mental health treatment is entitled to dignity and respect. On that principle, there can be no compromise, and this Government will work with whoever it takes to do right by those affected.”

--- Later in debate ---

[Lord Markham (Con)]

My Lords, I completely agree with the question in making sure that this does not happen or is not happening elsewhere. We have been in touch with the CQC, as one would expect, which has made significant changes to protect people in specialist services, people with learning difficulties and autistic people in mental health patient settings. These include making it mandatory for all staff to undertake specialist training before inspecting these settings and introducing a new single assessment framework, which would allow more frequent inspections of the worst-performing providers. The CQC is doing a number of things around that framework, including six key evidence categories, which set out the type of evidence that will be collected. These categories are: people’s experiences; feedback from staff and leaders; observation of care; feedback from partners; processes; and outcome of care. The new assessment means that more targeted time can be spent on site, taking longer to talk to people using services and making every minute count.

Those are some of the standing replies. On a personal level, there clearly need to be questions about how the CQC can go in on an ad hoc basis because, when an investigation or inspection has been announced, a place has an opportunity to put things right. One area of my interest—and I do not claim to be an expert on this—is how we can pick up those ad hoc cases quickly. Clearly, we should not be expecting people such as “Panorama” to be doing that; we want to pick those up ourselves.

[Baroness Brinton (LD)]

My Lords, despite the Minister just commenting on the way it is possible for some organisations to game-play inspections, it is noticeable that the CQC inspection of 2019, published in 2020, was “Good”, despite the finding that,

“In acute wards … records did not show that supervision of staff in the service was effective”,


which was a “breach of regulation”. This is really concerning.

Reform of the Mental Health Act is long overdue. It was created over 40 years ago, and many noble Lords have been fighting for that to happen. It was good to hear in the Queen’s Speech that there will be a draft mental health Bill, but there are real concerns that it is about to be shelved. My honourable friend Munira Wilson MP asked the Minister responding to this Urgent Question whether it was going to come forward. She did not get a straight answer. I ask the Minister whether Parliament, and this House in particular, will see the mental health Bill this Session.

[Lord Markham (Con)]

My Lords, like the noble Baroness, I am aware that the White Paper is in draft, but I have not seen its latest status. I know it will address some of the issues that we all agree are not to our satisfaction. At the moment, I can undertake only to understand the position of the White Paper and come back to her, if I may.

[Baroness Chisholm of Owlpen (Con)]

My Lords, first, I congratulate the Minister on his position. It is a baptism of fire, but I know he is up to the role. Would it be better if we engaged with the CQC better, so that these issues did not arise, rather than leaving it to undercover reporters? Thinking outside the box a little, what about body cameras? The police have them, after all, and they can protect not only workers but those the carers are looking after.

[Lord Markham (Con)]

My noble friend is correct that these are the sorts of things that we need to think about in this situation. It is a complex situation because, of course, as well as the advantages of body cameras being able to pick up things like this, these are first and foremost patients in need of care and there are all sorts of privacy issues to take into account in such a situation. I think that what this shows is that more intensive dialogue and thought on this whole area is required. I do not believe that there is an easy solution such as body cameras; that might be one approach, but first and foremost I want to feel that these are places where patients feel that their privacy is respected.

What I would violently agree on is the need for further conversations with the CQC, so that it is aware of the need to do a review on this. We need to be looking at exactly these types of things to see if a more intrusive type of system is what is required to stop these sorts of things happening again.

[Baroness Browning (Con)]

My Lords, I declare my interest, which is in the register, as a vice-president of the National Autistic Society. I welcome my noble friend, and I hope that he and I will have an opportunity in the very near future to discuss autism and learning disability. He mentioned more recent cases. I quite take his point, but these are not just recent cases. These have gone back over decades. I have listened, in both Houses, to Minister after Minister say that there is going to be change, and it does not come. In the vast majority of cases, it is totally inappropriate—in fact, I think it is criminal—for people with autistic spectrum disorders and learning disabilities to be placed in mental health institutions. It is not the place for them. There are proven records, over and over again, that it is not the right course of treatment, any more than you would think of putting someone with a coronary heart condition into such a place. So I say to my noble friend that this needs urgent attention from the Government.

[Lord Markham (Con)]

I agree with the points that my noble friend makes. I have some personal experience of people with learning difficulties, and I completely agree that the right setting for them should actually be in the community. I know that is the direction of travel of this Government, and I know that there is an objective to make sure that that is the major place where they are cared for. I have some further details on that, which I would be happy to share, and to meet with my noble friend.

[Baroness Blackwood of North Oxford (Con)]

My Lords, I have been in the Minister’s place, answering on similar scandals, and I think that the whole House shares the dismay of my noble friend that we are in this place once again. I hope that the Minister will take back the condemnation of this House that such a thing should happen in this country. We want to say that it will never happen again, but I think that we feel as though we will be back here once more.

If I could raise one single point, it is that the CQC, the police, the Government and all those involved in the investigations that go forward should take particular care with the patients and families as they go forward, to have the utmost respect and transparency in the way in which they communicate. Too often in these cases, information is leaked to the media or there are failures in communication, which leads to even more distress over and above what has already happened. Please can that not happen in this case, and can those who have already been so grievously affected be protected going forward?

[Lord Markham (Con)]

I am grateful for my noble friend’s comments. She is absolutely correct that, although we are grateful to the likes of the BBC for highlighting these issues—and I speak here as a former director of ITV—and for the undercover work they do, I believe that there is a responsibility there as well, when they have found these sorts of cases, to allow the patients and the people affected some sort of early indication, because the impact on them is central to all of this. I do not know what the BBC did in terms of an early warning on this, to make sure that there were no surprises. I think it is a very good point. We need to make sure that, although independent journalists are correctly doing their job and highlighting important issues, for which we are grateful, we first and foremost need to make sure that when this happens, patients and their family are made aware first and that their concerns are foremost in any action that is taken.

Pharmaceutical Research and Development Spending

Lord Markham Excerpts

Thursday 13th October 2022 Grand Committee

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

My Lords, I thank the noble Lord, Lord Hunt, and the noble Baroness, Lady Wheeler, for arranging the debate on this vitally important topic. Despite this being the fifth time that I have spoken in the last four days, this is technically my maiden speech. I believe it is customary to start with a few personal remarks, and if that means that I go slightly over time, I beg the indulgence of being given time to make sure that I answer the points properly as well.

First, I thank Black Rod, the staff and the police for my fantastic introduction. I thank my noble friend Lord Nash for his encouragement for me to join the Lords, my noble friend Lord Courtown for his last-minute introduction of me when he had to step in, and my noble friend Lord Kamall, whom I have known since university in 1988. I thank all noble Lords for the kindness that they have shown me, and their welcomes. I especially thank the doorkeepers, who were fantastic to my family on the day of the introduction and have been fantastic at preventing me getting too lost in the myriad corridors.

On a personal note, I am the product of a very loving family. My grandparents and mum were nurses. My dads—I had two dads, for reasons I will tell noble Lords at some later stage—were a policeman and an advertising executive. My wife is a dentist. I went to the local comprehensive school and spent much of my life in and out of A&E—and continue to do so because I still, perhaps unwisely, play rugby. As a result, I like to think that I am very much the product of the public sector and the public system.

I have three children, whom I want to mention so that they are in Hansard: Ben, Sam and Xavi, who are surprised and bemused to now be known as “Honourables”. I have had a very varied career, and I hope to use that experience to add value to a lot of these debates. I have been a CEO, a CFO, an HR director, a strategy director and a chair in lots of different industries, including consulting, retail, media, health and construction. More recently, I have been an entrepreneur in many different fields. At the same time, I have had public sector experience: I was deputy leader of Westminster Council and have been the lead NED on MHCLG and DfT, and worked with the Department for Work and Pensions. I could be seen as a veritable jack of all trades—and if I could master one, it would probably be capturing the language of the House as quickly as possible. I ask noble Lords to forgive me while I learn.

Most of all, I want to talk about the type of Minister that I would like to be. I love learning about new industries, sharing ideas and using critical and constructive challenge to make better decisions. I like to say, “Two plus two equals five”. Noble Lords will find me wanting to share my thoughts and ideas and to hear and discuss theirs, ideally sitting around a table. I must admit that I find this a bit weird. There are a lot of good comments here about how we all want to grow the industry, and I would usually do this around a round table with a cup of coffee, where we are having a good discussion. Maybe that is something we can do as a follow-up to this.

I like to hear and share ideas. I know that sharing my thoughts at an early stage may sometimes get me into trouble—I like to brainstorm—and create many opportunities for people to make political hay, but I want to take that risk because, in our hearts, I think we are all here because we care about our country and want to make it a better place. I put my trust in your Lordships to share some of those thoughts at an early stage so that you can, hopefully, build on some of the good thoughts and politely help me discard the poor ones—I promise there will be many of those—and not to make too much political hay along the way, except maybe on some of the ideas that may be more naive.

Most of all, I would like to be known as a thoughtful Minister, someone who thought, listened and got things done. Part of the reason I am delighted is that I realise I will be here, hopefully, for many years and will make many friends along the way from all sides of the House. I was given this tie by the noble Lord, Lord Alli, 20 years ago on my birthday when I used to work with him at ITV. I still consider him a friend and hope to make many more here.

Turning to the subject at hand, I thank the noble Lord, Lord Hunt, and the noble Baroness, Lady Wheeler. I firmly believe that to achieve—dare I say it?— growth, growth, growth you have to pick sectors where the UK has an advantage and leverage them. I have some familiarity with the media sector. After the financial crash, there was a real push to say that it should be one of the sectors we did more about. We did very good things to leverage the key assets, the BBC and ITV. We built an ecosystem. We had critical mass around setting up the BBC in Manchester, alongside Granada, where we could attract the best people and companies. I see a lot of similarities in how we are talking about trying to create ecosystems here, which I will come to later. The BBC has BBC Worldwide, which was set up to leverage that fantastic institution; I feel there are parallels with many of the comments I have heard today about how we can use the NHS and clinical research to better effect.

Life sciences is a high-profile sector, as the noble Baroness, Lady Wheeler, mentioned, and it makes a major economic and scientific contribution to the UK. We have a long and rich heritage in this sector, from Edward Jenner’s development of the world’s first vaccine to our fantastic development of the Covid-19 vaccine. As previously mentioned, it is also responsible for £4.5 billion of R&D investment per year, which I believe is about 20% of the whole economy. It has led to such things as the £1 billion investment by Merck in the MSD UK Discovery Centre and the construction around King’s Cross of AstraZeneca’s £1 billion global R&D centre. Importantly, unlike many other tech sectors much of this wealth is spread across the UK and is not London-centric.

However, as noble Lords have rightly mentioned, we cannot rest on our laurels. There are many places where we should and want to do better. I would like to help us do so. That is why, as my noble friend Lord Goodlad mentioned, the Government published our Life Sciences Vision. I am happy to write later to say how we are following up on that and making sure we implement it. The vision reflects the sentiment of many noble Lords’ speeches that, to grow our proportion of global pharmaceutical investment, we must improve every aspect of the life science ecosystem.

I will address that by looking at four areas. First, as was mentioned, in terms of investing in R&D, in the spending review we have committed £5 billion for the sector by 2024-25. This is the largest uplift in public R&D spending we have ever seen. It includes a major uplift for the National Institute for Health and Care Research. The Government also committed to raise R&D spending to its highest level ever—£22 billion by 2026-27.

As part of this investment in R&D, the Government are particularly focused on investing in areas of global strength such as these. This includes £341 million for Genomics England, so ably chaired by my noble friend Lady Blackwood. We are determined to maintain our international leadership in this important field. Fitting in with a lot of the comments on the importance of big data in this field, we are also investing £200 million in a major new data for R&D programme.

Secondly, as acknowledged by noble Lords, we need to do more to make sure the NHS plays its full role. Amanda Pritchard, the chief executive of NHS England, has been unambiguous in stressing the criticality of research, even at times of great service pressure. I am sure we are all aware of initiatives such as the GRAIL blood test and the work being done on it. At the same time, I have had personal experience of the fact that in clinical trials we are not as effective as we should be. I think we all recognise this, and points were ably brought up by the noble Baronesses, Lady Wheeler and Lady Walmsley, and the noble Lords, Lord Patel and Lord Kakkar. I go back to my analogy of BBC Worldwide. Is there something we should be doing to leverage off the NHS more? It is something I would like to pick up further. Maybe we can have a discussion, perhaps around a round table, at some later point and share ideas on how to make the best of that.

Big data was another point brought up by the noble Baronesses, Lady Wheeler and Lady Brinton. We all know that there are fantastic opportunities in big data that we are not fully utilising. We all understand that there are lots of thorny issues around that, such as protecting patients’ anonymity, but at the same time there is a huge opportunity that we are not making the most of.

Thirdly, as the noble Baroness, Lady Walmsley, quite rightly pointed out, we need to make sure that the business environment and the whole ecosystem are as hospitable to inward investment as possible. I highlight the work to improve life sciences’ access to finance and to give a strong pipeline to SMEs. I do not mean just things such as the £500 million committed by the Chancellor to the long-term investment fund but initiatives such as the EIS, which I am sure many of us are familiar with, and the R&D tax credits so that we can get investment in at that vital stage. On attracting and developing the right ecosystem for all this, I would like to understand further whether there is scope to use our investment zones so that they can benefit this area.

My noble friend Lord Goodlad and the noble Baroness, Lady Walmsley, talked quite rightly about dementia and the potential of the dementia moonshot and asked whether we are really following up on that. I undertake to write to give noble Lords a full picture of where we are backing that. I was very interested in the insight of the noble Baroness, Lady Brinton, about new market venture capital and how we get this capital into this sector. It is vital. Again, these are all points that I would like to pick up around a table.

As far as I am aware, we are aware of the potential impact of the VPAS. I have been a CFO, and I understand that suddenly hearing that your sales line might go down by 15%, 20% or 30% is pretty important knowledge; I get it. I know that we are undertaking a consultation to understand how to make sure that this system works going forward. I think we all agree that there are a lot of good aspects and agree with the intent of what we are trying to do.

Fourthly, inspired by the Vaccine Taskforce, we are delivering a series of healthcare missions focused on the leading causes of death and disease. These missions will fuse private sector ingenuity with the UK’s scientific excellence, drawing in significant private investment in areas such as dementia, cancer and mental health, which were mentioned by many speakers.

I particularly thank the noble Baroness, Lady Bennett, for a lot of her thoughtful comments and for writing some of them beforehand. I realise that I am about to run out of time, so I probably cannot answer them specifically. I will be pleased to write to her. As an ex-economics student, I was interested in how she talked about understanding the externalities of a lot of the investment in drugs and their impact. I would like to turn my thoughts further to that when I get my feet further under the table.

The Government are confident that through Life Sciences Vision we will develop the end-to-end improvements required to attract an ever-growing proportion of pharmaceutical investment to the UK. At the same time, I hope noble Lords see that I, for one, am not resting on any laurels here. There is a lot more we can do and a lot that I want to learn from the wisdom and comments made in this Room. We will be relentless in picking up these opportunities.

With that, I once again pay tribute to the noble Lord, Lord Hunt, for securing this important debate and, in his absence, to the noble Baroness, Lady Wheeler. I reiterate my commitment to serving the House and Government faithfully in my role as Minister for as long as I have the honour to do so.

NHS: Winter Challenges

Lord Markham Excerpts

Monday 10th October 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I beg leave to ask the Question standing in my name on the Order Paper and, before the Minister responds, warmly welcome him to your Lordships’ House and to his ministerial role. I wish him well.

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

I thank the noble Baroness. If I may respond personally first, I am delighted, honoured and privileged to be taking on this role. I look forward to working with all noble Lords and learning from the vast experience and expertise around the Chamber. The Government are aware of the pressures facing the NHS this winter due to potential surges in Covid-19, the return of respiratory conditions and impacts arising from cost of living challenges. The Government are taking a range of actions, including increasing NHS capacity this winter by the equivalent of 7,000 beds and allocating £500 million of funds to speed up the safe discharge of patients from hospital. We will keep the House updated as we progress.

[Baroness Merron (Lab)]

My Lords, NHS Providers reports that 72% of trusts are extremely concerned about the cost of living impacting on their ability to manage winter pressures, tackle care backlogs and meet targets. Can the Minister tell your Lordships’ House what assessment has been made of the impact on health services of the ever-widening gap between the Government’s original assumption of inflation and the spiralling increase and, to protect patients, what will be done about it?

[Lord Markham (Con)]

As I am sure the noble Baroness is aware, we are investing an unprecedented amount of money into the NHS and have recruited more doctors and nurses. We are setting up 7,000 new beds to cope with it all. At the same time, I accept that we are in a period of unprecedented challenge from not just the cost of living crisis but the effects of Covid and the likely impact of flu this year. That is why I very much see our role as making sure that that record level of investment is used to the best effect and that we drive performance across the NHS. I am sure we all have lots of examples of brilliant services and examples of where more needs to be done, candidly. My role in this, as someone with a background of business experience, is to try to take those areas of best practice that I have seen in some of the hospitals I have already visited and make sure they are allocated across the whole NHS.

[Baroness McIntosh of Pickering (Con)]

My Lords, I congratulate my noble friend and welcome him to this place. I remind the House of my interests with the Dispensing Doctors’ Association. I commend the Government’s vaccination programme for this winter, but in rural areas there is a very difficult and dangerous situation where vaccines for the over-65s are not currently available in many rural practices but they cannot vaccinate the under-65s until they have vaccinated the over-65s. Will my noble friend personally take an interest in this matter and ensure that vaccines for the over-65s are rolled out to rural practices as soon as practically possible?

[Lord Markham (Con)]

I think we are all aware of the importance of the vaccine programme, and I know that, to date, we are following the medical advice as to who the priority groups should be. If I may, I will follow up with a written response so I can give my noble friend the detail required on her question.

[Lord Laming (CB)]

My Lords, the Minister, who we welcome to his post, will know that the efficient use of NHS resources, particularly during the winter, depends in many ways on the availability of social care services. As time is rushing on toward the winter, could the Minister say what action is being taken now to improve the availability of effective social care services during this coming winter?

[Lord Markham (Con)]

The noble Lord is correct that care is at the centre of all of this. The flow of patients through hospitals is vital, and we are all aware that 13% of all hospital beds are held up by people who should be discharged into care. The £500 million investment is all about freeing up those beds. That will ease the flow right the way through the system—right the way into A&E, so that people can be discharged straight into hospitals, and right back to ambulances being able to discharge into A&E. I completely agree with the noble Lord; that is the focus of what we are doing.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Lord has talked about £500 million going in, but he knows that the efficiency savings target annualised is £12 billion. He also knows that unfunded inflationary pressures are estimated by NHS England to be £6 billion to £7 billion on top of this—and the Treasury is demanding further cuts in order to shore up its disastrous mini-Budget. Given that, how are the Government going to meet winter pressures, cut the Covid backlog and balance the books?

[Lord Markham (Con)]

We are facing unprecedented challenges, as the noble Lord states. We also have unprecedented investment, a plan for patients which is focused on the key elements that will make a difference—ambulances, the backlog, care, and doctors and dentists—and a group of Ministers who are focused on making a difference where it really counts. We have record investment, and a record number of doctors, nurses and people ready to face those challenges.

[Baroness Brinton (LD)]

My Lords, the plan for patients refers to the expansion of virtual wards in hospitals this winter. My local hospital, Watford General, pioneered this in 2020, but it put considerable pressure on GPs, community nurses and social care. Will there be extra funding for those areas that have virtual hospitals this winter to make that work?

[Lord Markham (Con)]

I had the pleasure of visiting Watford General just a week ago, and I saw the virtual wards first hand, so I agree on the excellence we saw there. To give the House a sense of that, the wards have reduced 90-day readmission rates from around 45% to 7%. When I talk about performance improvements, those are precisely the sorts of areas in which I wish to see investment made, so that we can roll that out across the NHS. It is in those areas that we can make a real difference.

[Lord Balfe (Con)]

My Lords, we are now on our 10th Secretary of State in 20 years and we have had slightly more Lords Ministers. In that time, spending on the NHS has more than doubled, yet the answer always seems to be to look for more money. Does the Minister consider that we need to take a more fundamental look at the National Health Service to see whether priorities can be moved so that the money we are presently spending will be spent more wisely and we will not, every single year, have the same headlines, the same problems and the same inability to solve them?

[Lord Markham (Con)]

My noble friend is correct that we have to make sure that the record investment is put to good use. We have 200,000 more people working in the health service than in 2010. It is correct that we have more resources invested in this area than ever before and also that we have to make sure that those are used to best effect. Noble Lords can rest assured that that is very much in my remit.

[Baroness Finlay of Llandaff (CB)]

My Lords, will the Government now ask NHSE to publish the 12-hour length of stay times for emergency departments in order to be able to evaluate the efficacy of the proposed 7,000 beds and financial investment? Data shows that, at the moment, 52% of all emergency medicine trainees are already burned out. On top of that, there is the flight of nurses from emergency departments because of stress. The emergency departments are already in crisis, yet the key data on 12-hour waits there is not being collected.

[Lord Markham (Con)]

I do not have the detail on the 12-hour wait-list at this moment, but I will come back to the noble Baroness with a detailed written response.

[Lord Reid of Cardowan (Lab)]

My Lords, I welcome the Minister. I am delighted that he has his position but I have to say that I do not envy him. Some months ago, I pointed out to his predecessor—who, very fortunately, is sitting next to him—that the number of people on waiting lists had increased over the past 20 years from 0.5 million, which the last Labour Government still regarded as far too high, to 4 million before Covid and 6 million when I asked the question. I asked the then Minister what the Government were doing about it. He kindly explained what they would do, but since that time the number on waiting lists has moved from 6 million to 6.8 million. Since that means that 6.8 million people are waiting in pain, trepidation and fear, will the Minister make it his highest priority to bring what business acumen he can to make sure that choice is extended to patients? It is choice for patients that will bring down the waiting lists, whether they wish to go to another NHS hospital or to a hospital in the private sector provided free at the point of need.

[Lord Markham (Con)]

I agree with those excellent points. As someone who is also responsible for the new hospital build programme, which can give that choice and make sure we have the most effective system, that is top of my agenda.

Health and Social Care Update

Lord Markham Excerpts

Monday 10th October 2022 Lords Chamber

[Baroness Brinton (LD)]

My Lords, I echo the comments of the noble Baroness, Lady Merron, about the nature of the plan. It is full of warm words and aspiration, light on detail, especially on funding, and seems to disregard the reality on the ground at the moment. I also echo her concern about the rumours of the White Paper on inequalities being shelved. That is really important. Many of us spent a lot of time in your Lordships’ House during Covid hearing about the problems of people with Covid, particularly those from ethnic minorities and deprived backgrounds. There is a lot of data to say that those people have really struggled.

The workforce plan is something else that from these Benches we asked for consistently long before work started on the Health and Care Act, but absolutely consistently since then. Turning to the plan itself, on ambulances, the announcement in July was welcome but three months on—and this was an emergency announcement—it feels as if nothing has changed. The number of delayed discharges remains stubbornly high, and we know that there is a new wave of Covid rising: the ZOE study figures today suggest around 230,000 new daily cases and 2.2 million active cases. That is going to continue to rise: all the medical experts in this area say we are now definitely at the beginning of this wave.

B stands for backlogs, and I am afraid that that is not really improving either. Although it is good to see that the two-year waiting list is reducing, the under-two year list continues to grow: 6.8 million at the end of last month. The plan talks about patients being redirected from hospitals, but our primary care system—GPs, community nurses, physios, speech and language therapists in the community, and especially social care—is already at breaking point. It is good to be offering Covid boosters, but why are under-12s excluded unless they are immunocompromised? Children at schools without proper ventilation were drivers of the last two waves of Covid, and it just seems ridiculous that they have not been included, because that would be an easy win.

In my question earlier today, I asked the Minister about care and particularly about virtual hospitals. It is good that the plan is picking up on some excellence in the NHS, and I am very proud of my local hospital for doing it, but the Minister did not actually answer my question, which was: given that this work of virtual hospitals creates more work for GPs, community nurses, physiotherapists in the community that in the past would have been done in hospitals, will there be extra resources for primary care? Without it, primary care is already at breaking point; they cannot just magic extra time and energy to do it.

The section about GPs is admirable in spirit, but doctors have repeatedly said that their main problem is a lack of doctors. We also know from the BMA survey back in the spring that GPs’ workload has increased by 30% on clinical administration alone. It is not Covid; it is mainly to do with digitisation and complex systems. It is all very well talking about getting administrators in to do it, but these are administrative tasks that doctors have to do themselves. Unfortunately, it is causing a problem, and I do not see any solution in the plan.

Whenever Ministers talk about doctors, they talk about the highest number ever—indeed, the Minister did so earlier—but there are two problems with that. There are more patients than ever, and that is never reflected in any comments by Ministers. Government funding for doctor training has not been sustained. This year, far too many—hundreds, just under 1,000—newly qualified doctors, fresh out of university, could not get training places because there was no funding for hospitals to be able to do it. The exodus of NHS staff was reported in the Times just last Saturday. The net change is not positive now; it is negative.

On dentists, it is very good news about the simplification of government rules regarding overseas dentists qualifying to work, and we look forward to seeing the regulation shortly, but the main problem is the drastic need to overhaul the government contract. While the Statement says first steps are being taken, I ask the Minister when the major work funding for it will be concluded. Will he also tell your Lordships’ House what provision there will be for the 3 million people who are either immunosuppressed or immunocompromised—for example, because of blood cancer or because of strong medication which has to suppress their immune systems? The government advice on the web page still says that people in this group should not mix with people who are not fully vaccinated or may possibly be brewing Covid, but a year ago all support to this group was ended. Along with other people in this group, because I am one of them, I am about to have my sixth Covid jab, but I have no idea how long I am going to be protected for—that is why I wear a mask a lot of the time in the Chamber. Half a million of the most severely immunocompromised people cannot make any antibodies in response to the vaccine. They were promised antiviral medication or Evusheld. Five million doses of antivirals were ordered, but only 50,000 were handed out, and the Government have just refused to allow Evusheld to be used. What will the Minister do to ensure that this group of people will be protected?

Finally, the Health Service Journal has said that two out of three integrated care systems have fallen off track on their financial plans because of the impact of inflation, Covid cases not being funded this financial year and higher spending on agency staff. This plan will not work if the new integrated care systems cannot work. It is vital that the Minister tells us what plans there are to make sure that ICSs will be supported properly.

The plan for patients has many warm words for delivery. I know this is something the Minister cares greatly for, and we will support him, but the words on their own will not do it. Our NHS and care sector are on their knees already. The Nuffield Trust report says that data shows that even without the pandemic, the backlog would have been well over 5 million. It says the NHS was already stretched. I look forward to hearing the Minister explain how the NHS and care sector will be able to deliver on this plan in their current state.

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

I thank noble Lords again for the warm welcome they have all given me today. I feel like an old hand already—I wish. Before I begin, I draw attention to my declaration of interests in the register as a new boy here, so to speak.

I am grateful to noble Lords for the interest they have shown in our plan for patients and will try to address the questions raised. As my right honourable friend the Secretary of State said in the other place, these measures across a number of important areas are the start, not the end, of our ambitions for health and care. They will help us to manage the pressures that health and care will face this winter and next, and they will improve these vital services for the long term.

First, I want to set down that there is record investment going into this area. In fact, we are spending about 12% of our GDP, which is the highest level ever. To answer the noble Baroness’s question directly, the 200,000 figure I gave was for FTEs since 2010. That means 200,000 more full-time equivalent employees in the health services than in 2010, so the investment is there, and we have a plan, set out in the plan for patients, to increase supply by 30% in terms of electives. I have seen some excellent examples of that already in Chase Farm Hospital, one of the new hospitals.

As I think I mentioned earlier, the new hospital build programme is one of the areas for which I am responsible; a £10 billion investment per year will go into capital programmes such as this and other initiatives. It is all about increasing supply by 30%, because we will be able to get on top of these issues only if we increase supply.

At the same time, as has been drawn out, I appreciate that we face an unprecedented challenge in the levels of Covid we are seeing and in flu respiratory issues; we have had less warning about that than ever before, because normally we can see what happens in Australia and use that as a warning. I am aware that we are likely to face more challenges there than ever. At the same time, we are putting forward the beginnings of a long-term plan to tackle this. I will talk about that and, I hope, answer the questions raised—my own ABCD, if I may.

I will start with care, because not only is it important in its own right to make sure that people are cared for in the correct place—it is much better and more cost effective for people to be in a care home than in a hospital—but freeing that up will free up the whole system. We all know the problem is often that A&E is full because it cannot put patients into hospital beds and therefore the ambulances cannot release their patients into A&E, backing up all the way through the system. That is why one of my priorities is the care side.

I will need to get back to the noble Baroness, Lady Brinton, on virtual wards in terms of support for GPs. I have seen the excellence at first hand, and the incredible reduction in figures that it can make, so to my mind we should focus on that and make sure that GPs and their surgeries have the right focus and support to help them. I will follow up with the noble Baroness with more detail on that, if I may.

I see this as key to care and the £500 million spend—again, I will give the noble Baroness, Lady Merron, details of how that is being used, because we want to make sure that we work with the integrated care boards, as she said, to ensure that it works to best effect. With that, I think we will start to see improvements come in for A&E and ambulances. As I mentioned before, we have seen a 10% increase in staff there versus 2019-20; that is what the 7,000 new beds are all about.

However, in terms of performance, we have seen great disparities. I am sure noble Lords have heard before the statistic that 15 of the hospital trusts account for 45% of all waits. I want to understand why that is. It is fair enough to trot out that statistic—I expect noble Lords to challenge me in a couple of months’ time to ask what was happening in those 15 trusts and what I have done to put it right and make sure they are performing well. My task is very much to put them under the spotlight and try to understand how we can perform much better in some areas and take those learnings to help them in others. I am under no illusions that it is tough out there. My wife is a dentist, so I have some knowledge of this; also, my mother was a practice nurse, so I understand how important and tough the role is.

Working through the backlogs and getting on top of the waiting lists will be key. There is an £8 billion programme, as we are all aware, to increase supply by 30%. I have seen fantastic examples at Chase Farm, as I have mentioned, and Watford of robotic surgery—I had the pleasure of playing with it myself, though not on a real patient—that I am sure will be revolutionary and transformative. It is about doctors, dentists and all care workers—all of them. As I say, I have a particular interest in the nursing profession.

It is all about releasing the 50 million more appointments, which I am glad to say we are making progress on. A lot of that is about making sure that you see the person best suited to meet your needs. We must make sure that we use GPs where they will best meet those needs. They are our most skilled specialist resource, so I want to make sure that they are focused on the cases that are best for them. As I say, I have experience through my mother’s role as a practice nurse of how much she could do and how much we can use them to meet a lot of the appointments targets—and make it a better job for them, because they have the skills and can be very valuable. The same is true of community pharmacies. Funnily enough, I worked at one in my first job—many years ago—so I have a little experience of that. It is all about trying to expand capacity.

I apologise, I cannot answer the noble Baroness, Lady Brinton, right now on the 3 million immunosuppressed so I will need to get back to her on that.

As the noble Baroness, Lady Merron, said, it is about trying to raise performance across all areas. The brilliant thing is that we have seen very good areas—I am sure we have all seen them when we visit hospitals—which have excellent performance, but my feeling, coming in as a bit of an outsider from business, is that it is patchy. There is an opportunity to spread that performance, really understand what good looks like and do more work to make sure that it is spread across the system. Part of my remit will very much be the performance agenda and working with the NHS executive team to make sure we see those improvements across the board.

I hope that gives noble Lords a flavour of how I hope to address what we see as our plan for patients. It is our commitment to what our patients can expect. I hope we can see that it is proactive, not prescriptive; ambitious but also achievable. We hope that, by empowering patients, they can start to challenge and drive performance as part of that, as a first step. Through that, we will be able to help, as part of the long-term plan, both the NHS and health and social care deliver for them. As such, I commend this Statement to your Lordships’ House.

[Baroness Watkins of Tavistock (CB)]

My Lords, I welcome the new Minister and declare my interests, in particular that I share his interest in the nursing profession. I have two questions. One is about the 15 units where particular problems have been identified. Does he think that is to do with demography, particularly older populations, and that we have got the funding calculation right in those areas? Secondly, is he prepared to meet me to talk about retaining people who are currently qualifying who, if they do overtime, are being hit with the 9% repayment for their student loans? This means there is very little incentive for the younger generation to do overtime, despite their being the fittest and probably most able to do so.

[Lord Markham (Con)]

On the 15 trust areas, I will need to get back to the noble Baroness on whether it is down to demographic factors. I wish to dig into it more and will look at a number of things. I have been told anecdotally that the day of the week makes a big difference to performance and wait time, so that is another area I want to get underneath. In terms of retaining people, as an entrepreneur who has started up many businesses, I know the importance of motivating a workforce. Clearly, if work does not pay—for want of a better word—there is not much motivation to put in the extra hours we require. I will come back to the noble Baroness with more information on that.

[Baroness Tyler of Enfield (LD)]

My Lords, I welcome the Minister to his new role and declare an interest as a non-executive director of the Royal Free London group of hospitals, which includes Chase Farm. I would like to pursue the points made by both the noble Baroness, Lady Merron, and my noble friend Lady Brinton about health inequalities. With an almost 20-year gap in healthy life expectancy between the most and least deprived areas in London, could the Minister say if and when the Government are planning to publish the health disparities White Paper?

[Lord Markham (Con)]

I thank the noble Baroness for reminding me that I failed to reply to that point earlier and for giving me the opportunity to do so, but I will need to investigate further. As I say, I do not have immediate knowledge of this issue, but I undertake to come back to the noble Baroness with a reply.

[Viscount Stansgate (Lab)]

My Lords, I welcome the Minister to the Dispatch Box. I am sorry I missed his first outing earlier today; in fact, I had a medical appointment. Whatever the definition of “challenge”, it must include the position of a Minister representing the Department of Health on the Front Bench of this House—so good luck. The Statement makes the bold claim that up to a million GP appointments can be freed by

“changing funding rules to give freedoms to GPs to boost the number of staff to support their practice.”—[Official Report, Commons, 22/9/22; col. 832.]

Can the Minister explain exactly what that means?

[Lord Markham (Con)]

I thank the noble Viscount for his good luck wishes. I do not understand completely the economics of the doctor’s surgery yet. I want to get my head around that, because I understand that a surgery needs to be set up so that it can be a successful business for them and can have the proper infrastructure. I am very interested in the dentistry field as well; as I said, I have an interest in terms of my wife. But I realise that in a lot of these situations, you are asking doctors and dentists, who are trained to be excellent medics, to effectively set up their own business. That is a quite different thing and demands quite different skill sets. I believe that we need to have a package of support to help them in this respect. As part of that, we need to understand exactly what funding can be used and whether it gives them the headroom—for want of a better word—to allow them to do those elements and have the support staff in the numbers they need. Understanding further this area is on my to-do list, and I would like to get back to the noble Viscount as soon as I can.

[Baroness Finlay of Llandaff (CB)]

I also welcome the Minister to his post, which I think is probably one of the trickiest ministerial posts in government. I declare that I am a registered medical practitioner and remain on the clinical register. I would like to briefly return to the question of workforce. We have spoken about doctors, dentists and nurses; in addition, there are allied health professionals. I should state here that I am president of the Chartered Society of Physiotherapy.

I have come across a lot of professionals who have had time working abroad, for one reason or another, and who have remained clinically up to date but find it extremely difficult to get back on to the register. I have also had conversations with retired professionals who have been allowed to be reregistered under the Covid regulations but find that, because they do not have a responsible officer, it is extremely expensive for them to undertake the processes to come back on the register.

In addition, I have also had conversations with refugees. We have a lot of refugee doctors, dentists, nurses and allied health professionals who currently are completely unable to work because they have not gone through the different exam processes—yet all the time they are not working, they are losing some of their clinical skills. Will the Minister meet with me, because I think there are some ways, in conjunction with the registration bodies, that we could possibly create a provisional registration category to allow these people’s skills to be used rapidly for the good of the NHS, rather than waiting the several years it would take them to get through the different hurdles laid before them?

As part of that, these clinicians—particularly doctors and nurses—could then have input into 111, where we know that currently only 40% of calls have a clinical input. The Royal College of Emergency Medicine has calculated that this figure needs to be 65% of all calls in order to decrease the demand on A&E departments from calls to 111. Will the Minister meet with me fairly urgently? It seems a waste to have people who want to get back on the register but, for many reasons, cannot.

[Lord Markham (Con)]

I thank the noble Baroness, Lady Finlay, for those excellent points. I have to declare a further interest: my wife is not only a dentist, she is a dentist originally from the Dominican Republic who practised in Spain for 20 years before coming here. So many of the excellent points the noble Baroness made are well recognised here. I am in the market for good ideas, so I will meet with the noble Baroness with pleasure to understand and discuss some of the ideas she spoke about.

[Baroness Walmsley (LD)]

My Lords, the health service is suffering from inflation in the same way as the rest of us. Julian Kelly, NHS England’s chief finance officer, told the board recently that it will have to find £20 billion in efficiency savings over the next three years because of the increased cost of goods and services that it buys. He said that

“clearly you have to completely revisit investment in cancer and mental health, primary care … diagnostic capacity and you would have to look at what it meant in total for what the NHS could deliver.”

With that situation, could the Minister say how on earth we are going to deliver the plan for patients?

[Lord Markham (Con)]

As I mentioned earlier, yes, there are inflationary pressures, but as a percentage of our national wealth—our GDP—we are investing more than ever before, at around 12%. That level is very high compared with most other OECD countries. So, the investment and the staffing are there. I think the correct challenge, which I have heard from a number of Members today, is whether we are getting the best performance out of that money and investment. Again, that is very much where I have been brought in—to make sure that we are taking those areas that are performing well and disseminating that good practice. That is where I would like to focus my attention, to make sure that we really are getting the maximum output possible from this record level of investment.

[Lord Walney (CB)]

I add my welcome to the Minister, and I ask him about the issue of unmet need in the care sector from local authorities. His predecessor gave a Written Answer to my noble friend Lord Stevens earlier this year which made it clear that the Government do not currently record the scale of the unmet need from care packages that cannot be offered by local authorities. The Minister brings a considerable amount of expertise to this; does he recognise that that is a shortcoming, an issue, and is it something he would like to see his department address?

[Lord Markham (Con)]

I thank the noble Lord, Lord Walney. Another part of my many and varied background is as a previous deputy leader of Westminster Council, so I realise the importance of local authorities in this role. I will not confess to being familiar with that scale of unmet need at the moment, but I thank the noble Lord for raising that issue. I will make sure I go and find out more on it and, if I may, come back with a written response.

[Lord Scriven (LD)]

My Lords, I also welcome the Minister to his role and wish him well, because of the crisis that the NHS and social care face. In asking my question, I also declare my interest as a non-executive director of Chesterfield Royal Hospital’s NHS trust and as a vice-president of the Local Government Association. The Conservative cabinet member for adult social care in Devon said in the last couple of weeks:

“We are … in crisis mode … It is very difficult because you can stack shelves in supermarkets and earn more money than you can in social care. We need to see national government”


respond to this urgently. If all the £500 million given to social care—assuming that this money, because it is short term, is to last for six months—was to be equally distributed between the salaries of the 1.5 million people in social care, it equates to just 31p per hour more, which would still be below the market rate for some supermarket shelf stackers. So what is going to happen to make sure that enough resources go towards dealing with the crisis in social care, so that need can be met and staff can be retained?

[Lord Markham (Con)]

We live in a time of a very competitive jobs market and such a competitive market brings challenges with it, as the noble Lord says. We need to make sure that people feel that these jobs not only are recognised as important but make sense economically for them as well. We are investing £15 million in expanding our recruitment and resourcing to attract more people into the industry. We also need to look overseas and I think many are aware of our plans to do that. It is not lost on the team over here that we need to make sure that this is an attractive job and career for people to move into.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I join others in welcoming the Minister to his new place. I acknowledge that he has stepped in very late in the piece to pick up this Statement, but we are right to ask questions on it. Unlike the noble Baronesses on the Front Benches, I want to address the issue of the number and supply of doctors, particularly GPs. There are some strong statements here about “setting the expectation” of getting an appointment within two weeks, “opening up time” for 1 million more appointments and helping practices “improve performance”. Think about what GP practices have done in improving performance: there were 4.9 million more appointments in December 2021 than there had been two years previously—a 20% rise. A BMA survey found that nine out of 10 doctors reported that their workload was excessive and dangerous. This Statement says that there will be more and more GP appointments, but where will the doctors needed to provide this service in a healthy and safe manner come from?

[Lord Markham (Con)]

As I mentioned, we have 3,500 more doctors, but the 50 million more appointments target, which we are well on the way to delivering, is from not just GPs but across the piece. It is also from nurses and community pharmacies. I think we would all agree that doctors are our most precious resource. Given the comments on not wishing to overburden them and the stresses of that, we need to make sure that their limited time is focused on the patients that most essentially need that time. We are expanding supply and spreading it among nurses—as I mentioned, from my experience with my mother, they are very capable and willing to pick up a lot—and among pharmacies as well.

[Baroness Merron (Lab)]

My Lords, I appreciate the answers that the Minister has given your Lordships’ House, but would he be good enough to write to address a number of the more detailed questions raised and give the information requested?

--- Later in debate ---

[Lord Markham (Con)]

I thank the noble Baroness for giving me that opportunity. I wish to be part of this House as someone who is open and collaborative, so I will take the opportunity and fulfil it to the best of my ability, to make sure I can give complete and thorough answers. I will also aim to make myself available, because these things are often best carried out through a conversation. I have tried to answer as well as I can today, but I will gladly follow up with more detail.