NHS England: Ovarian Cancer
Debate between Lord Patel and Lord Markham(7 months, 3 weeks ago)
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Lord Markham (Con)
Yes. To reiterate, I think that we should always use “man” or “woman” as the primary descriptor. For people with English as a second language, “woman” is very understandable. We can then be inclusive by saying a “person with ovaries”, so that we are absolutely clear. My remit here is health, so I want to make sure that most people, especially if English is their second language, understand who we are referring to when we say “woman”.
Lord Patel (CB)
My Lords, I am slightly reluctant to stand up and get involved, but I have done so previously, and I will continue to support the campaign led by the noble Baroness, Lady Hayter, to make sure that the words “woman” and “mother” are not removed from our language—I absolutely support that. I will muddy the waters a bit. There is, in medical terms, a syndrome called androgen insensitivity syndrome, which occurs in about two to five per 100,000 births. The person born is registered at birth as a female, because they have the phenotype of a female and external genitalia that resemble those of a female. They grow up as female, and the diagnosis is often not made until puberty, when they do not menstruate—but they develop breasts. They do not have ovaries. They often identify themselves as female for the rest of their lives, and they occasionally get married. I have looked after such a person myself. They are registered as female, they do not have ovaries and they sometimes have internal testes, which can become cancerous. So it is correct that only people with ovaries can develop ovarian diseases, including ovarian cancer. As I said, I have muddied the waters.
Lord Markham (Con)
I am not sure that there was a question there, so I might take the easy option of thanking the noble Lord for his comments—and for maybe muddying the waters—and moving on.
Covid-19 Vaccination: Coronary Disease
Debate between Lord Patel and Lord Markham(8 months ago)
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Lord Markham (Con)
The noble Lord is quite right. There were much wider effects and impacts in the lockdown, and alcohol intake was one of them; mental health, particularly of our children, was another. My sincere hope is that these are the kinds of issues that the Covid inquiry should really be investigating: the wider impacts on society caused by lockdown.
Lord Patel (CB)
My Lords, a recent study published in Vaccine of a cohort of 99 million people who were vaccinated with one of the vaccines—either vector or messenger RNA vaccines—showed an increased risk related to myocarditis and pericarditis. The incidence, particularly among the younger people, was about one in 10 in a 1 million population, as opposed to the non-vaccinated who got Covid. That should be the comparison, not the non-vaccinated who did not get Covid. In those cases, things such as Guillain-Barré syndrome, which is a long-term viral fatigue syndrome, occurred at a higher incidence in non-vaccinated people than in vaccinated people, particularly with the Oxford/AstraZeneca number 1 vaccine, which was withdrawn. Therefore, it is a balance of whether the disease or the vaccine will make you more sick. With any treatment in any branch of medicine, there is always a risk to the treatment. There has to be a balance.
Lord Markham (Con)
I am sure I speak for the whole House when thanking the noble Lord for his expert understanding and insights. As he said, the evidence is very clear that while no vaccine is risk-free, what it saves you from is much greater. The very firm advice is that you are much better off having the vaccine.
Immunisation: RSV
Debate between Lord Patel and Lord Markham(8 months, 1 week ago)
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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.
Pandemic Preparedness
Debate between Lord Patel and Lord Markham(8 months, 1 week ago)
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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.
Children’s Cancer Services
Debate between Lord Patel and Lord Markham(9 months ago)
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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.
Prioritising Early Childhood: Academy of Medical Sciences Report
Debate between Lord Patel and Lord Markham(9 months, 2 weeks ago)
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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.
Mental Health Patients: Discharge
Debate between Lord Patel and Lord Markham(9 months, 2 weeks ago)
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Lord Markham (Con)
Yes, in a word. We must try to make sure that each integrated care board has a mental health lead in place and that the services are rolled out. Much of the strength of the ICBs is that they can look after the needs of their area in ways that they know best. At the same time, where there is good practice, we must make sure that it is rolled out as well.
Lord Patel (CB)
My Lords, suicide is the second highest cause of maternal deaths in England. All such deaths are preventable, because mothers at risk can easily be recognised antenatally, and certainly postnatally. What actions will the Government take to prevent these deaths?
Lord Markham (Con)
Like many of us, I am sure, I have had very good personal experience of the midwifery service at community level. I know that there have been some challenges post Covid, but midwives are on the front line in understanding and recognising some issues. I should have mentioned earlier that there will be a round table with the Minister on mental health issues, following the one a few months ago, and this is one of the areas we should bring up with her.
Anaesthesia Associates and Physician Associates Order 2024
Debate between Lord Patel and Lord Markham(9 months, 4 weeks ago)
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Lord Markham (Con)
It is a protected title. The point I was trying to make about the general overhaul and understanding of the titles, however, is that there will be the scope to do this, as doctors and consultants are not protected titles today. I think we need to develop clarity on that, which is why the further reforms and SI changes will set out to protect other titles as well.
Lord Patel (CB)
Sorry about prolonging the debate, but is that the only protected title of all healthcare professionals?
Lord Markham (Con)
My understanding is that currently none of the titles is protected. These are the first set of titles that will be protected as a part of the secondary legislation that we are passing. The idea is to understand the hierarchy of titles and start to introduce the protections. I am happy to follow up in writing in more depth on all of this. I thank the noble Lord for his intervention.
Hopefully, this order will provide a standardised framework of governance and assurance for clinical practice and professional conduct for AAs and PAs. It will enhance patient safety and enable AAs and PAs to make a greater contribution to patient care. I beg to move.
NHS: Neurology Care
Debate between Lord Patel and Lord Markham(9 months, 4 weeks ago)
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Lord Markham (Con)
I thank the noble Baroness. Yes, the point about epilepsy nurses was made very clear to me just half an hour ago, and I quizzed both the national clinical director of neurology and Professor Stephen Powis on that subject this morning. I was assured that the next stage of the long-term workforce plan goes into that level of detail. I have made a commitment to the House to share some of that data, so we can make sure that it really is covered properly.
Lord Patel (CB)
My Lords, as human beings we are one biological system. A disease in one system often impacts another: for instance, chronic cardiac failure often results in cognitive dysfunction and people with neurological conditions often have associated cancers. While this Question is about funding for neurological diseases—and in the last two weeks, we have had Questions about funding for cardiovascular disease, cancers and others—what the whole thing shows is that we have one system failure in the health service. The only way that might be addressed is to get some out-of-the-box thinking. Does the Minister agree?
Lord Markham (Con)
I hope the noble Lord knows me well enough to know that I am always up for some out-of-the-box thinking. We are putting a lot of resources into this space. When we talk about dementia, which is captured in this, the commitment I gave last week was to bring in the expert panel, so that we can start to really understand this because early diagnosis is absolutely key. There is some out-of-the-box thinking there. Again, just now I was caught by the spinal muscular atrophy people; they were saying that if we could add that to the baby pinprick test, for instance, we could make sure that babies never suffer those symptoms later in their life, in many cases. I am absolutely up for that out-of-the-box thinking.
NHS: Dementia Commission Report
Debate between Lord Patel and Lord Markham(10 months ago)
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Lord Markham (Con)
Yes, that is a very good point. For me, as I have looked into this, the reason for assembling the panel that we can all interrogate is that we have the value of different noble Lords in this House who can add those points to it. What the noble Lord said sounds sensible. The honest answer is that I do not know whether there is such a person today, but let us use this as an opportunity to find out, because I think there should be.
Lord Patel (CB)
My Lords, there are several important points in development that should allow us to better manage people with dementia. The first is early diagnosis, as has been mentioned, but we need greater input into research in developing biomarkers that detect early development of the disease. Having done so, we then need drugs that will be effective in early phases of the disease—so-called disease-modifying treatments. Some of those have recently been given accelerated approval in the United States and Japan, but they are very expensive drugs. As we discussed last week, one of the drugs for small-cell lung cancer failed at the final endpoint, so we have to be guarded. For instance, the drug lecanemab, which has been approved, would use up half the pharmaceutical costs of all the 27 countries of Europe. These two things are important, and I hope that the forum that is developing will address those issues of research.
Lord Markham (Con)
As ever, my colleague the noble Lord is correct. The blood biomarkers are central to this. We have set up the NIHR biomarker challenge to try to understand those, and my understanding is that a Swedish blood test is quite promising. NICE is bound to approve the two early-stage drugs that the noble Lord mentioned over the summer, in July and September, but then we need to look at scale-up issues. Often, we are talking about having to deliver them through drips, which means a whole workforce scale-up. So there are a lot of issues around this that the noble Lord rightly brings up, and I hope the panel can discuss them further.
Premature Deaths: Heart and Circulatory Conditions
Debate between Lord Patel and Lord Markham(10 months, 2 weeks ago)
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Lord Markham (Con)
I thank the noble Baroness and draw attention to my register of interests: I am a shareholder in a small health company that does high-end heart tests for the private sector.
It is fitting that February is Heart Month. The concern that the noble Baroness raises is exactly the one that noble Lords will have heard me speak about. This is precisely the concern that Chris Whitty, our Chief Medical Officer, was worried about during Covid, with missed appointments because people stopped going to see their doctor meaning that we missed things such as high blood pressure and high cholesterol. To tackle the problem urgently, as the noble Baroness suggests, we have put 7,500 blood pressure checkers in pharmacies. They have done 2 million checks to date. We have sent 270,000 blood pressure monitors to houses and have instigated mid-life NHS health checks to look specifically at early heart indicators so that we can try to tackle the problem that the pandemic caused.
Lord Patel (CB)
My Lords, we have had lots of plans and initiatives for reducing deaths from heart disease. Despite that, variation in both preventive care and outcomes have persisted for years now. They are exaggerated by deprivation and ethnicity.
Let me give two examples. First, 40% of people with high blood pressure have failed to be diagnosed— I know that the Government have an initiative for pharmacies checking blood pressure—and, even when they are diagnosed, 10% of them do not get the appropriate medication. Secondly, there are examples of people suffering from atrial fibrillation not getting the appropriate anti-coagulation treatment; we then find that 60% of the strokes that occur in these patients are because they have not been properly medicated.
It is these variations in care and prevention that we need to tackle. It is disappointing to see that some of the ICB plans do not take on the need to reduce this variation, particularly in deprived areas.
NHS: Fracture Liaison Services
Debate between Lord Patel and Lord Markham(10 months, 2 weeks ago)
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Lord Markham (Con)
I thank the noble Lord. His interventions around the communications side are always welcome, because we recognise that it is one thing having a service and another thing making sure that the world knows about it. I will go and find out more and write to the noble Lord.
Lord Patel (CB)
My Lords, the fracture liaison service originally started in Glasgow, with the particular intention of identifying mostly women who had a higher risk of fractures from osteoporosis. In England and Wales, a fracture liaison service audit has been established now for several years. How do the Government receive the learning from those audits and how do they implement the learning that they receive?
Lord Markham (Con)
The noble Lord is correct; there has been some good evidence gained. As I mentioned previously, it shows that the probability of suffering from a fracture if you have been in a clinic is 10%—some studies have shown as much as 30% to 40%. It also shows, as my noble friend Lord Black was saying, that there is actually a good cost saving: it is thought that £65 million per annum will give a return of more than £100 million. There are some very good statistics around this, and I assure noble Lords that we are making a strong case for their expansion.
Smoking
Debate between Lord Patel and Lord Markham(11 months ago)
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Baroness Blackstone (Lab)
My Lords, I refer to my interests as set out in the register. Would the Minister agree that smoking in pregnancy has enormously damaging effects, leading to much poorer birth outcomes than for mothers who do not smoke? Would he also agree that incentives to pregnant women not to smoke have been very effective? In the light of this, could he give a guarantee that the existing scheme, which comes to an end this year, will be continued with adequate resources, so that it is not in any way disrupted?
Lord Markham (Con)
I totally agree with the noble Baroness on the importance of stopping smoking—always, but especially during pregnancy. In fact, we have a maternity debate coming straight after this, where this will be one of the things that we discuss. I hope, from showing that we are putting all this spend in place, that we are backing everything that works. As long as the anti-smoking in pregnancy measure continues to work, that will be one of the major features to make sure that we are continuing to stop all activity, but especially in pregnant ladies.
Lord Patel (CB)
My Lords, in the light of the last question, I will change my question. What assessment have the Government made of the long-term harm that vaping will cause, particularly to young people?
Lord Markham (Con)
The honest answer is that we do not know yet, and that is a problem. As we know, a number of these things take time to play through. That is why we want to make sure we take a precautionary approach. In this legislation, we aim to really stop anything that is targeted at young people in terms of vaping. We see vaping as an important tool to help people quit smoking, but we are equally sure that we never want anyone to start vaping. That is why we will also look at banning anything that targets young people, such as flavouring and packaging. We want to stop anything targeted at youth vaping.
Adult Social Care: Staffing
Debate between Lord Patel and Lord Markham(1 year ago)
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Lord Markham (Con)
Charging reform is still part of the Government’s commitment. At the same time, I think we all recognise that, largely as a result of the pandemic, we had to stabilise the social care situation first. That is what the £8.1 billion in funding has been all about and what the investment and recruitment have been for—so that we can stabilise first. I am glad to say that we are reaching a more stable footing. For the first time, staffing went up over last year and, likewise, the number of people in social care went up. We have to stabilise before we move on to the reform. I think we would all agree that the speed of reform needs to be a bit quicker, but it is sensible that we stabilise the situation first.
Lord Patel (CB)
My Lords, in the Government’s search for long-term sustainable funding for adult social care, what assessment have they made of the successful models that operate in Germany and Japan, for instance?
Lord Markham (Con)
The shorthand for the German system is the “double doughnut”, which tries to give wraparound care. We can learn many things from that system, which is why a part 2 reform needs to happen here. I accept that we are clearly not there yet.
Cancer Research UK Report
Debate between Lord Patel and Lord Markham(1 year ago)
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Lord Markham (Con)
Yes, we are taking extensive action on the obesity front. As well as being a major cause of cancer, it is the cause of a lot of ill health. We have taken a lot of action against 96% of the reasons given in obesity research on calorific intake, with regard to what people buy in supermarkets. Also, the soft drinks industry levy—the sugar tax—has decreased sugar in drinks by at least 14%.
Lord Patel (CB)
My Lords, I congratulate CRUK on producing this magnificent report and manifesto. Continuing with the theme of research, the report identifies the necessity of further closing the funding gap in research of about £1 billion in the next decade. This research is in key areas where our scientists are leaders in the world, such as the early detection of cancer using cell-free DNA and technologies such as messenger RNA for vaccine production, using genomes and early protein expressions for early diagnosis. The Minister mentioned the key area of reducing lung cancer using known technology, but it is in discovery science where we need to increase funding, especially when government funding falls far behind charity funding, particularly from CRUK.
Lord Markham (Con)
I agree that research funding is key. That is why I mentioned the £100 million that we spent in 2021-22. The Medical Research Council is also spending £125 million per annum on cancer research. That is allowing us to introduce vital things such as the point-of-care cancer treatments that our regulators that have brought in ahead of anyone else in Europe, showing the key flexibility that our regulators now have, meaning that people can have individualised cancer care. I agree that we need to invest in these sorts of activities.
Children’s Hospices: Funding
Debate between Lord Patel and Lord Markham(1 year, 1 month ago)
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Lord Markham (Con)
First, I absolutely recognise the noble Lord’s point that 80% of hospices’ funding comes through charities, so they represent an excellent resource for us. That is why we are pleased to confirm the £25 million for next year. The debate, which I am sure we will get into more later, is about making it a direct grant. We generally think that ICBs are best placed to take control of health services in their area, and it is about trying to get the right balance between making direct grants for the provision of places and saying that ICBs know what is best for their area and should cater for them in that way. I would be happy to talk further about that balance with the noble Lord.
Lord Patel (CB)
My Lords, should we not be ashamed that care for children at the end of their short lives is funded by village fetes, cake shops and elderly marathon runners instead of by central government? The total cost of 34 children’s hospices is £130 million and the totality of it should be funded centrally, not as unguaranteed £25 million grants every year. We should be ashamed of this.
Lord Markham (Con)
To put this into context again, only about 6% of children’s deaths occur in hospices, so 94% happen in other settings. I want to get that right for the context of all this. There are many parts to this; hospices are quite close to my heart and I want to donate to them charitably. There are many parts of society where we think there is a role for charities to add value and enhance the system, rather than their being crowded out by government-funded sources all the time.
Domestic Violence and Brain Injury
Debate between Lord Patel and Lord Markham(1 year, 2 months ago)
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Lord Markham (Con)
The noble Baroness is correct. We need to make sure that all our front-line services are trained to identify potential brain injuries—that is A&E, GP surgeries, the police and schools. There is already a programme in schools for children affected by domestic violence. We have also made sure that every ICB has to appoint a domestic violence and sexual abuse lead, so that they can identify these sorts of issues.
Lord Patel (CB)
My Lords, data collection and research is very good news. However, under normal circumstances, any person who suffers a head injury, for whatever reason, would be subjected to immediate testing for a brain injury. Why would that not be the case for someone who suffers a head injury from domestic violence?
Lord Markham (Con)
It is a very good point. As all noble Lords are aware, often the challenge is getting people to come forward when they have suffered domestic violence. Some of this research shows that there are tools, such as a spit test, to understand whether someone has suffered from a traumatic brain injury. Bringing some of those things into play, so that people are identified and encouraged to come forward, is vital.
General Medical Council: Internal Guidance
Debate between Lord Patel and Lord Markham(1 year, 2 months ago)
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Lord Markham (Con)
I am very willing to hazard a guess that it is zero, but I will happily follow that up in writing with the exact number.
Lord Patel (CB)
My Lords, I do not intend to be frivolous. I have looked after thousands of mothers during their pregnancies; it has been a great privilege to do so. Terms like “mother” and “women” should not be removed from any guidance, GMC or not. I have spoken to the GMC and expressed my discomfort at its removal of the words “mother” and “women”. Of course, I recognise the transgender issues. I also recognise therefore that those who may not consider themselves women could have children, but that does not remove the importance of motherhood. Being a mother is more than that; it is about motherhood and the responsibilities and what mothers contribute to children. I regret that the GMC has decided to remove these words.
Lord Markham (Con)
I think the noble Lord makes the point very well. I do not think I have anything to add, apart from basic agreement.
NHS: Staff Numbers
Debate between Lord Patel and Lord Markham(1 year, 3 months ago)
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Lord Markham (Con)
I believe that the whole point of the workforce plan is that every couple of years there is a review of our progress against it and how it needs to be adapted, since it is a moving feast. So, absolutely, it is vital and something we are working on. Overall, the things that we said that we would do we are on course for. We said that we would increase the number of nurses by 50,000 over the course of this Parliament. It is currently 47,000. We said that we would increase doctors’ appointments by 50 million. That is currently on track. So a lot of good work has already happened. A lot of targets have been hit. Yes, there is more to be done and we are happy to track it.
Lord Patel (CB)
My Lords, it is currently predicted that there will be a shortage of about 4,000 fully trained anaesthetists by 2025. The Government’s plan to expand anaesthesia associate training will also need anaesthetists to supervise the trainees in the workplace. However, currently there is a bottleneck at a certain level of the training of anaesthetists. That bottleneck can be resolved by increasing the number of training slots. Why do we not do that?
Lord Markham (Con)
In every area, anaesthetists being a very good example, we need to be looking at where the bottlenecks are and moving to free up those situations. I think we would all agree that with practitioners such as anaesthetists and in other areas, it is a very sensible approach to make sure that the most highly skilled are focused on the most highly skilled jobs and that they can have people underneath them who can be trained to work within that. So hearing that there is a certain amount of opposition from certain colleges and the BMA to those sorts of roles is quite disappointing. I hope they would accept that this is a key way of addressing the issue.
Community Health Services: Waiting Lists
Debate between Lord Patel and Lord Markham(1 year, 5 months ago)
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Lord Markham (Con)
The noble Lord is correct, and my understanding is that we are looking to use the independent sector more and more. I will check and verify this, as it was from the briefing probably about three or four months ago, but my belief is that about 51% of the physiotherapy that we use is from the private sector. I absolutely agree with the noble Lord that we need to use the independent sector more and more in these situations—something pioneered by the noble Lord, Lord Reid, over there.
Lord Patel (CB)
My Lords, every day, about seven children will develop cancer; eight out of 10 will survive more than five years with modern care, but these children who survive require long-term community care, both for their families and themselves. Would the Minister agree that the integrated care pathways developed by integrated care systems should improve community care for cancer-surviving children?
Lord Markham (Con)
Yes; our whole direction of travel, as noble Lords are aware, is putting more and more power in the hands of the local integrated care boards. Going into the detail of it, the whole workforce plan moves a lot of the emphasis away from treatment in hospitals into care in the community—primary and prevention. This is a direction of travel that I think we all agree on, which is why we are putting more resources behind it, albeit that these things take time.
Mental Health Services: Huntington’s Disease
Debate between Lord Patel and Lord Markham(1 year, 6 months ago)
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Lord Markham (Con)
Our commitment is very much that mental health should be treated just as seriously as physical health conditions. I was delighted to announce today that on the NHS app we are launching mental health digital therapeutics, which are available for everyone to use. I recommend everyone tries them. The idea behind it all is that it is accessible to everyone at any time in their life.
Lord Patel (CB)
My Lords, part of the problem of patients with Huntington’s chorea not being given proper treatment is that it is regarded as a neurodegenerative organic disease rather than what it is: it presents first with mental health symptoms. Guidelines are required, maybe from NICE, that clearly outline the patient journey of care for people with Huntington’s disease.
Lord Markham (Con)
I have learned in the process of researching this that it is absolutely vital that commissioners understand what the patient pathway needs to be in each area. That is why we have tasked the NHS with a neuroscience transformation programme to set out those care pathways.
NHS GP Surgeries: Purchase by US Companies
Debate between Lord Patel and Lord Markham(1 year, 6 months ago)
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Lord Markham (Con)
This is absolutely the work that the Treasury is doing at the moment. Noble Lords have asked, many a time, when it is coming out. I think people will understand that part of the delay is making sure that, when the plan does come out, it really does work.
Lord Patel (CB)
My Lords, what does the Minister think is the main reason that general practitioners might be leaving the NHS to work in the private sector?
Lord Markham (Con)
My understanding is that it is a range of issues, clearly including workload, pay and conditions. We are trying to address those; I think the change in the pensions rule has been generally welcomed in terms of encouraging more doctors to stay on in place. But it is a range of those measures—again, all things we are hopefully addressing through the new training and skills programmes, and the long-term workforce plan.
Sodium Valproate
Debate between Lord Patel and Lord Markham(1 year, 6 months ago)
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Lord Markham (Con)
The noble Baroness is correct. In terms of data, it is vital: first, that we have a register of all the people who are taking valproate so that we can be sure that the information is there; secondly, that we then keep a record of where patients have signed the annual acceptance; and, thirdly, that we are gaining data on testing. The latest suggestion is that we should also be looking at males taking valproate because there is evidence that it can, through their sperm, cause difficulties in pregnancies. On all those factors, data is central and we should make sure we collect it.
Lord Patel (CB)
My Lords, we have known for decades that sodium valproate, particularly when given in early pregnancy, causes 1% of babies to be born with deformity and as many as 10% to be born with learning disabilities. Despite the guidance issued two years ago, last year 250 babies were born to mothers taking high doses of sodium valproate. Does the Minister agree that we need to make the guidance much stricter, particularly about the appropriate contraception to use, and that when advising women who might be planning a pregnancy, sodium valproate should stop being prescribed for them?
Lord Markham (Con)
The noble Lord is absolutely correct. Everyone taking sodium valproate who is of childbearing age should be on a pregnancy prevention programme to make sure that those sorts of incidents do not happen. It is vital, when it is necessary for people to take it, that they really understand the risks and do everything to avoid pregnancy.
Pharmacies: Medicines at Home
Debate between Lord Patel and Lord Markham(1 year, 7 months ago)
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Lord Markham (Con)
As noble Lords are aware, I hold the technology brief, so, if there are automated ways, I am absolutely all for them. As I learned while researching this Question, this is a complicated area, given the number of permutations of pills that can be there in each circumstance. I have not seen those solutions, but I will look into them.
Lord Patel (CB)
My Lords, medicines reconciliation —the right drug to the right dose at the right time—is an important part of managing diseases, particularly for patients who are on multiple medications. Blister packs were seen as one of the solutions to reduce risks, as 10% to 15% of older people on multiple medications end up in acute medical wards. If blister packs are not the solution, what solution does the Minister propose to reduce issues with medicines reconciliation?
Lord Markham (Con)
I am sorry: I will try to be clear to make sure that I am fully understood. There are many, many people for whom a blister pack is absolutely the right solution. Basically, what has been put in place here is a structured medicine review, so that, in each case, it will be the responsibility of the pharmacist to make sure that they have the right solution for the patient. What I am saying equally is that blister packs are not a blanket solution, and it needs to be done on a case-by-case basis.
Life Expectancy: Pensions, Health and Insurance
Debate between Lord Patel and Lord Markham(1 year, 7 months ago)
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Lord Markham (Con)
As ever, there are multiple factors at play. That is what the Office for Health Improvement and Disparities is all about: making sure that we are tackling this in exactly the holistic way the noble Lord mentioned, going back to all the major conditions that are causes of death and tackling each one by one. The 10 million cancer screenings save 10,000 lives a year, and our breast cancer screenings save 1,300 lives. There is a lot to do but a lot that we are doing already.
Lord Patel (CB)
My Lords, in his introductory remarks, the Minister quoted the Government’s ambition to extend healthy life expectancy by five years by 2035. Can he put some numbers to it? What age are we talking about?
Lord Markham (Con)
My understanding is that people are predicted to live a healthy life until around age 63. It is about looking at that aspect as well; it is not just about the length of life but how well we live it.
Long Covid
Debate between Lord Patel and Lord Markham(1 year, 8 months ago)
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Lord Patel (CB)
My Lords, two things are important in the long-term management of patients with long Covid. The first is epidemiological studies, and I am glad that the Government are backing with £50 million the NIHR to do such studies. The second is finding cures. Interestingly, the molecular studies carried out by Oxford show that there might be mitochondrial dysfunction, which leads to a loss of energy production and therefore fatigue. A drug that has entered its phase 2 trial sounds promising, so we must also support molecular science to find a cure for this condition.
Lord Markham (Con)
I thank the noble Lord and applaud the research work that has been done. As I said, we have invested £50 million on top of the £118 million for Covid research. Just as we were one of the front-runners in developing the Covid vaccine, with AstraZeneca, it is very much our ambition to be a front-runner in developing cures for long Covid.
Stroke Rehabilitation and Community Services
Debate between Lord Patel and Lord Markham(1 year, 9 months ago)
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Lord Markham (Con)
My Lords, that is a very important point. Two things have really struck me. When people are in hospital, they lose 10% of their muscle mass per week, which is clearly key in their ability to have an active lifestyle and look after themselves outside. At the same time, they need constant support and reminders to keep up that active lifestyle. It is very much at the front of our mind.
Lord Patel (CB)
My Lords, we know that rehabilitation at the appropriate level is key to the best outcome for stroke patients: some 10% will not have any residual disability, 25% will have a minor disability and 40% will have a moderate disability, but without rehabilitation, 80% will have a major disability. Would it be a good idea to carry out a country-wide audit of what services for the rehabilitation of stroke patients are currently like?
Lord Markham (Con)
I thank the noble Lord. I believe that this is what the national integrated community stroke service is all about. It is the responsibility of each ICS to make sure that there is sufficient capacity in their area. At the same time, it is always good to make sure that that is happening, so I will follow up with the NHS to see what plans are in place to make sure that we really are getting that uniformity of service.
Patient Deaths: Ambulance Waiting Times
Debate between Lord Patel and Lord Markham(1 year, 9 months ago)
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Lord Markham (Con)
My noble friend is absolutely correct: with responsibility for these things comes accountability, and it is the job of us all to hold people to account where performance is not where it should be. I know each Minister has their own set of ICBs— I have a particularly close relationship with seven; other Ministers have the same—so that we can bear down on exactly these sorts of differences and hold people to account.
Lord Patel (CB)
My Lords, does the Minister agree that the junior doctors’ representative at the BMA and the Department of Health should get round the table and negotiate the end of the doctors strike before more harm is done to the patients? To express a personal view, as a doctor, I would never withdraw my services from patients.
Lord Markham (Con)
I thank the noble Lord for his contribution, as ever. Yes, absolutely; these things always have to be resolved around the table. As I say, I am pleased that we are making good progress with nurses and ambulance workers, and I hope we can get around the table and make more good progress with GPs as well.
Physiotherapy: Rehabilitation Services
Debate between Lord Patel and Lord Markham(1 year, 10 months ago)
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Lord Markham (Con)
I agree with the noble Lord’s point; our estimate is that over half of all physiotherapy takes place outside the hospital environment. Clearly, all sorts of settings, including swimming pools and gyms, are vital for that. The work we have done with the Energy Bill and the caps has been a vital help to those leisure centres, and, thankfully, we are now starting to see bills come done and so these places are on a better financial footing.
Lord Patel (CB)
My Lords, I was previously a trustee of the Stroke Association and the chair of Chest Heart & Stroke Scotland. Every five minutes, a person suffers a stroke. Their outcome depends on two crucial factors: first, the so-called golden hour during which they should receive treatment—if they do not, their outcome is poor—and, secondly, the rehabilitation they get over the next three to six months, including training on speech, mobility and dealing with daily life. Sending these patients to care homes or their own homes without that kind of support decreases their outcomes considerably. Currently, 10% of these patients end up in nursing homes for ever; if these services are not available, that number rises to 30% to 40%. So, despite the positive response from the Minister, there is a degree of urgency for integrated care boards to address the issue of rehabilitation for stroke patients.
Maternity Services
Debate between Lord Patel and Lord Markham(1 year, 10 months ago)
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Lord Patel
To ask His Majesty’s Government what steps they intend to take in response to the Care Quality Commission’s Maternity Survey 2022, published on 11 January.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
My Lords, we are committed to continuing our work to ensure that all maternity services provide safe and compassionate care. We will continue to closely monitor progress in improving the standard of maternity care across the country. We have made significant investment into maternity and neonatal services, with £127 million announced in 2022 to go into the maternity system to help to increase the NHS maternity workforce and improve neonatal care.
Lord Patel (CB)
My Lords, I thank the Minister for his Answer. The Ockenden report on Shrewsbury and Telford, the Kirkup reports on East Kent and Morecambe Bay, the current report of the CQC, the fact that the CQC fined a Nottingham hospital the maximum amount—£800,000—for a baby death, and the fact that we are now paying out in maternity litigation costs over £1 billion per year all point to one thing: a question of safety in our maternity units. Mothers and babies should not die in our maternity units without care and compassion, but that is what is happening. I am glad that the Minister, the honourable Maria Caulfield, met Dr Kirkup last week, which is a great improvement and progress. I hope the Government will now take seriously the need for zero tolerance of mothers dying in our maternity units and zero tolerance of normally formed babies dying or being damaged in childbirth. I shall keep pursuing this until we get that.
Lord Markham (Con)
I welcome the noble Lord’s pursuit because that is absolutely the right thing to do. I think we all agree with that, and we would all say that what happened in East Kent and the other examples from the Ockenden report are clearly not something that we are happy with or that we should put up with. The Kirkup and Ockenden reports gave us a north star, a way forward. I am pleased to see that we are making progress on that, but I expect the noble Lord to hold us fully to account because I am holding the department to account on this.
Bread and Flour Regulations 1988
Debate between Lord Patel and Lord Markham(1 year, 10 months ago)
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Lord Markham (Con)
Yes, I am very happy to do so. It has been quite a process, as my noble friend says, but we are getting there. As I said, the good news is that the industry is seeing the direction of travel and is responding as well. That is always better when done voluntarily. We are seeing more foods with levels of fortification. We will get there in terms of it being mandated as well.
Lord Patel (CB)
My Lords, there has to be some progress. I think the noble Lord, Lord Markham, is the seventh or eighth Minister to answer this Question, the first being the noble Earl, Lord Howe. To get the scientific facts right, the advice given by the Royal College of Obstetricians and Gynaecologists of 1 milligram is based on the surmise that higher doses do not cause any harm. It is wrong science, for which there is no proof, to say that doses as high as 1 milligram mask B12 deficiency. It is completely false and we must not use that. The chief scientific officer of the Department of Health confirmed that at our last meeting, which the noble Lord, Lord Rooker, may well remember.
Lord Markham (Con)
To be clear, I was referring to scientific advice I received today about the potential risk of masking, as I said. It is a concern but, as ever, one of the wonders of this House is the expertise available on tap. I will go back to consult on that and write to the noble Lord.
PPE Expenditure
Debate between Lord Patel and Lord Markham(1 year, 11 months ago)
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Lord Markham (Con)
Absolutely. I remember well, as I am sure do others, watching the news about planes being diverted to other countries and it being asked how come they were not coming to the UK and what the department was doing to get on top of it. I am sure there was criticism from this House—it was before my time—asking what we were doing as a Government to get a grip of it. Well, we did get a grip of it; we did buy the PPE and it did not run out. Yes, we ended up buying too much of it because, thankfully, the pandemic did not turn out to be as bad as we thought it would. I think we did a sensible thing at the time, and now we are going after all those people who did not keep to their supply agreements, and we are recovering the funds. By and large, with the benefit of hindsight, I think we did a fairly decent job—not perfect but pretty good.
Lord Patel (CB)
How long will we continue paying £700,000 a day to the Chinese?
Lord Markham (Con)
As I said, less than 1% of the stock is being held by the Chinese. Most of the money being spent on storage costs is in the UK. Notwithstanding that, we clearly want to get rid of it as quickly as possible. As soon as I came in, I said, “Let’s bite the bullet, write it off, get on with it and dispose of it.” That is absolutely what we are doing. We are accelerating that to the maximum extent. Those accelerations have already saved £200 million this year.
Times Health Commission
Debate between Lord Patel and Lord Markham(1 year, 11 months ago)
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Lord Patel (CB)
My Lords, the Minister mentioned different reports and said that the Government will be willing to implement good advice. The House of Lords Select Committee on the Long-term Sustainability of the NHS also published a report, with clear recommendations. Will the Government implement some of those recommendations, even now?
Lord Markham (Con)
As I mentioned, we are working on and taking good ideas from there. I know that it is one of the inputs being considered in all this.
Respiratory Syncytial Virus
Debate between Lord Patel and Lord Markham(1 year, 11 months ago)
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Lord Markham (Con)
I thank the noble Baroness for her question. I am pleased to say that there are promising new vaccinations. The current vaccination unfortunately requires monthly injections, which is why it is not very effective, and costs £2,000, so it is not an effective way ahead. A new injection, nirsevimab, has just been licensed which is showing in tests to be 75% to 80% effective and immunises people for six months, so we are hopeful that it is the way ahead. The JCVI is currently conducting a study on it, and we are hoping its recommendations will suggest a good way forward.
Lord Patel (CB)
My Lords, two days ago Moderna from the United States announced that it had used messenger RNA technology to develop a vaccine for RSV. The report was of a late-stage trial and the vaccine has an efficacy of 84% for adults. There are similar results from both GSK and Pfizer, with an efficacy of 66%, but we already have antibody prevention treatment developed by AstraZeneca and Sanofi for prevention of RSV in children and young infants. That has been approved by the European Medicines Agency, and the Moderna vaccine is seeking FDA approval. Why does none of these have market authorisation in the United Kingdom?
Lord Markham (Con)
I can report best on nirsevimab, which has just been licensed, is shown to be 75% to 80% effective in the trials and has the approach of immunising people for six months. I am aware of Pfizer developing a maternal vaccination for whooping cough, which will give the baby immunisation through the mother. The House will also be aware of the recent announcement we made with Moderna on the investment in new R&D facilities here, so that we are at the forefront. I hope the noble Lord can see that we are looking at all these new innovations and will roll them out.
United Kingdom: Future Pandemics
Debate between Lord Patel and Lord Markham(1 year, 11 months ago)
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Lord Patel (CB)
My Lords, the Minister is absolutely right that we led the world in sequencing the genomes of Covid-19, particularly identifying the variants worldwide. But since we have now closed down many of our sequencing facilities, how can we surveil internationally, particularly for emerging variants? For example, XBB1.5 is now emerging as the variant causing most of the infection, probably including in England. What is our surveillance mechanism for sequencing?
Lord Markham (Con)
Given the detailed nature of the question on sequencing, it probably deserves a detailed response. I will happily write on that. The 100 Days Mission—to deploy effective diagnostics, therapeutics and vaccines within 100 days—is all about having UKHSA ensure that we have a preserved capability to act when we need to.
NHS Winter Pressures
Debate between Lord Patel and Lord Markham(1 year, 11 months ago)
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Lord Patel (CB)
The Minister may not agree, but the NHS is in crisis. He may say that the situation is “challenging”, but it could not be more challenging. Although infection rates related to Covid, flu and other infections may have exacerbated the situation, the genesis of the crisis is not of today’s making. It has been in the making for years. It is related to lack of capacity. Does he agree that the emergency measures now being put in place are not likely to work? If they are not likely to work, what is plan B? Importantly, what is the long-term plan to ensure that this does not continue into the spring, summer or next winter?
Lord Markham (Con)
I absolutely think these measures will improve the situation; I would not be putting them forward if I did not believe that. At the same time, just as we put out plans in October and are amending them now, I will continue to amend our plans. I think that is a flexible, responsible approach: you have a plan, you adapt that plan, you invest and you continue to improve. That is what we will continue to see and do; we will see those improvements go through this year and into the next.
National Health Service (NHS Payment Scheme—Consultation) (No. 2) Regulations 2022
Debate between Lord Patel and Lord Markham(1 year, 11 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
My Lords, I start by wishing everyone a happy new year and welcoming the noble Lord, Lord Allan of Hallam, to his position. It gives me great pleasure to speak in this debate and I welcome the opportunity to discuss these draft regulations.
The Health and Care Act 2022 marks an important step in the Government’s ambitious health and care agenda. Noble Lords will be fully aware of how wide-ranging a piece of legislation it is. I think we can all agree with its overall objectives; making it easier for health and care organisations to provide joined-up care is vital.
With the introduction of integrated care systems came the opportunity to review how the financial frameworks in the NHS worked and tailor them to make them consistent with the new integrated approach. The Health and Care Act replaces the NHS national tariff payment system with the NHS payment scheme by inserting new Sections 114A to 114F into the Health and Social Care Act 2012. As with the tariff, the NHS payment scheme will set rules around how commissioners establish the amount to pay providers for healthcare for the NHS. It does not set the amount of money available but intends to make sure that available resources are used as effectively and efficiently as possible.
Before a new payment scheme can be published, NHS England has a duty under the Health and Social Care Act 2012 to consult on the proposals for the new scheme, as it did with the tariff. NHS England is required to consult each integrated care board, each relevant provider and other such persons it considers appropriate. It opened the consultation on the proposals for the 2023 to 2025 payment scheme on 23 December 2022, which is scheduled to close on Friday 27 January 2023.
This brings me to the purpose of these regulations, which is relevant to how those consulted respond and what this means for NHS England. The purpose of this SI is to set these objection percentage thresholds at 66%, which will be reached if the requisite percentage of either integrated care boards or providers object. I believe this is a proportionate level to ensure that a qualified majority can require NHS England to reconsider its proposals, while minor objections cannot stop them. I also consider laying these regulations to be a relatively administrative process. The objection percentages are not changing compared to previous consultations on the tariff; we are maintaining the status quo with 66%. I commend these regulations to the Committee.
Lord Patel (CB)
My Lords, I thank the Minister for his comments. I too wish everybody a happy new year. My question is quite simple, and it reflects the discussions we had during the debate on the Act that we passed: is 66%, which is two-thirds, too high a level for the objections? It is a higher order to achieve than, let us say, 60%.
While we await the tariff, I reiterate, so that it is on record, that the important bit is not the level at which the trusts and ICSs can object but how the tariff will vary according to the needs of the population. When we had the debate, we focused on existing inequalities in health and how to minimise and reduce them. One way of doing that is to address the needs of the population who have greater need in healthcare, and therefore the tariff needs to be different. It is a high order to require 66% of ICSs, trusts or providers to object.
I would like the Minister to confirm that the tariffs will reflect the need for the levelling-up agenda to improve healthcare, particularly in more deprived populations, and to comment on why 66%, which is two-thirds, was chosen.
Plastics: Health Research
Debate between Lord Patel and Lord Markham(2 years ago)
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Lord Markham (Con)
The phrase I used was that there is “limited evidence” in this space. I reiterate that if a good research proposal is put forward, funds are available there. The only point of difference on this is that I do not believe we should ring-fence a definite amount each year when the evidence does not yet exist that it is a health risk.
Lord Patel (CB)
My Lords, the Minister suggested that his scientific advisors told him that there was no evidence. Finding “no evidence” does not scientifically prove that there is no evidence. It has been said several times that if a scientific proposal was put forward, it would be looked at. Accepting that plastic pollution is a problem, should the NIHR not put out tenders inviting research proposals?
Lord Markham (Con)
Again, my wording was “limited evidence”. There are many demands. It feels as though every day I am up here being asked to spend money on something else. As a responsible Minister, I must prioritise spend in areas where it is needed. At the moment, I am being guided by the science, which tells me that there is very limited evidence in this space. If a good proposal is put forward, we will welcome it and look into it. Until then, this is not good use of public money.
Hospital Beds: Social Care
Debate between Lord Patel and Lord Markham(2 years ago)
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Lord Markham (Con)
I thank the noble Baroness. We are all seeing different shapes and forms of describing how we need a local care system set up by the integrated care boards that can have an overview of all the needs in their area. That is exactly what we are doing, and exactly what the Patricia Hewitt review is reviewing. It will give advice on how best to do that by looking at the best needs of mental health care patients, or any other kind of patient, to make sure that the proper institutions and places are set up to give them the up-front support so that, as the noble Baroness said, they never need to go to hospital in the first place.
Lord Patel (CB)
My Lords, while recognising the current problems caused by bed blockages in NHS hospitals due to capacity and social care issues, does the Minister agree with the report from the Health Foundation, which, looking ahead, suggests that, because of changing demography and disease patterns in future, we will require between 25,000 and 40,000 more beds in the NHS if we are going to cope with the pressures on both the NHS and social care? What plans do the Government have to address that?
Lord Markham (Con)
We are absolutely aware that we need long-term plans and forecasts. That is also one of the things that the healthcare workforce plan will take into account: it will look at exactly where the capacity needs to be on a regional basis going forward so that we have the right number of hospital beds and social care places for an elderly and growing demographic in terms of age groups.
NHS Waiting Times
Debate between Lord Patel and Lord Markham(2 years, 1 month ago)
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Lord Markham (Con)
I thank my noble friend. Adult social care, as many have heard me say before in this House, is a crucial part of this, because it is all about the flow. That is why I was delighted that, in addition to the £500 million discharge fund for this year, we have secured up to £2.8 billion of funding for next year. That is in addition to the 7,000 extra beds and the tailored help for the 15 worst-performing hospitals with the ambulances, so we have a complete answer to all these areas.
Lord Patel (CB)
My Lords, patients with complex and long-term conditions are finding it increasingly difficult to access the care that they need, resulting, as the British Heart Foundation report indicated, in 10,000 excess deaths in people suffering from chronic cardiac conditions. The Minister referred recently to the system being a failure. Does he agree that we need a system that develops care for these patients, one that is accessible and timely, in community and primary care settings?
Lord Markham (Con)
I agree with the noble Lord that cardiovascular is one important area in which, over the last few years, patients have not received the number of check-ups that we want, so it is an area on which we want to focus—not just through checks in GP centres but in the community. We all know that it is very easy to take blood pressure and have blood pressure machines. As a team, we are looking at precisely those kinds of measures to make sure that we can get the preventive screening in up front, so we can identify these people before problems occur.
Ambulance Delays
Debate between Lord Patel and Lord Markham(2 years, 1 month ago)
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Lord Markham (Con)
The government pledge of 50 million additional appointments is across the country. It is the job of the ICBs to make sure that each area is well catered for; the idea is that this is felt in every area, including rural areas. I am glad to say that we are making good progress on our target to increase appointments by 50 million and, rest assured, I am working with the integrated care boards and their systems to ensure that they touch every part of England, including rural areas.
Lord Patel (CB)
My Lords, the Minister said that this is a systems failure. Who in the Government is responsible and when will the system be fixed?
Lord Markham (Con)
I think I said this is a systems issue. It is something on which we—including me and the Secretary of State—are very focused, because we need to address it across the piece. That is what the ABCD plan is all about. I am very confident that, over the coming weeks and months, we will start to see improvements from the investment we are making in 7,000 more beds and £500 million more into adult social care discharge.
British Heart Foundation: Tipping Point Report
Debate between Lord Patel and Lord Markham(2 years, 1 month ago)
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Lord Markham (Con)
I will check on that. I have been told that it is being done as part of that. It is available in a large number of pharmacies now and we have sent out hundreds of thousands of blood pressure monitors, so people can do it from home. It is fully understood that it is a vital part of early monitoring and we have a three-pronged strategy to make sure that we can measure people’s blood pressure at every point of contact.
Lord Patel (CB)
My Lords, the report identifies shortcomings in the delivery of primary and community care for patients with cardiac disease, which is a systems failure. I have no doubt that there will be similar findings for patients who suffer from other chronic diseases. Does the Minister agree that it is time to look at a systems change in the delivery of primary and community care, incorporating advances in technology and digital healthcare that would improve access for patients?
Lord Markham (Con)
Yes, we all agree that prevention is better than cure. One of the few benefits of Covid was that millions of people downloaded the NHS app. People are using that for self-diagnosis now, in exactly the way that has been mentioned. In October alone, 500,000 people used the app for self-diagnosis, the healthy heart blood pressure MoT and diabetes checking. That is part of this and it is all part of our five-year healthier life plan, which, as mentioned, is very much focused on MoTs from age 40 onwards, so that we can diagnose these problems early. Our focus should absolutely be on prevention rather than cure.
NHS: Nurses
Debate between Lord Patel and Lord Markham(2 years, 1 month ago)
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Lord Patel (CB)
My Lords, shortages of NHS staff, whether they be nurses, physiotherapists, doctors, dentists or community nurses, results in poor service. What plans do the Government have to make primary and community care more sustainable in the long term?
Lord Markham (Con)
The plans are very much those that we are doing, which I believe are successful. As mentioned before, it is not just that the number of nurses has gone up by 29,000; we have seen significant increases in doctors and the other medical professions as well. We should remember that we have 200,000 more people working now within the profession than in 2010. That is not to say that we will rest on our laurels; I completely agree that we need to carry on expanding supply to ensure that we properly meet the demand.
Maternity and Neonatal Services
Debate between Lord Patel and Lord Markham(2 years, 2 months ago)
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Lord Markham (Con)
Yes. Resourcing the special measures programme—for want of a better name—is vital to all of us. I am pleased to see in the case of East Kent that, of the 67 special measures recommended, it has now passed 65 and the two remaining ones will be completed by the end of November.
Lord Patel (CB)
My Lords, this is the most recent of several reports identifying failures of maternity units in England. The CQC identified 40 maternity units that had failing safety standards. Bill Kirkup has not only produced a brilliant report but identified the way forward, by developing a matrix of standards of safety and outcomes that would apply to all maternity units to make them all high calibre, high standard and safe. Will the Minister agree that, by meeting Bill Kirkup, Ministers could ask him to identify the areas to draw up these standards? Because time is short, if the Minister agrees I will be happy to meet him to enlarge further.
Lord Markham (Con)
I agree about wanting to implement the recommendations. My colleague Dr Johnson, the Minister in the other House, already met with Dr Kirkup this week. We also undertook to come back in the next four to six months with where we are on each of the recommendations. I will bring that back to the House then.
Menopause
Debate between Lord Patel and Lord Markham(2 years, 2 months ago)
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Lord Markham (Con)
I thank the noble Baroness. I agree that it is fitting that we should be having this debate today, World Menopause Day. I completely agree with the importance of this subject for employers, productivity and the economy as a whole, as well as for women’s health.
As I am sure the noble Baroness is aware, 10% of people end up leaving their job during menopause. That is a real loss to business and those individuals. That is why, through our strategy, we are appointing an employee champion in this area. Their job will be to reach out to employers and work with them to make sure that this subject is very high up on their agenda. As an employer myself, in my personal entrepreneurial life, I agree that it is an area of utmost importance.
Lord Patel (CB)
My Lords, women with post-menopausal symptoms are disadvantaged by not getting the treatment they need due to restrictions put on the treatments by local formularies. Does the Minister agree that we need a national formulary where all hormone replacement therapy treatments are available to women who need them, and that that national formulary should be made mandatory? If he does not agree, why not?
Lord Markham (Con)
I agree that we want to make sure that there is national access. I understand that, whereas we had 30% take-up as long ago as the 1990s, with the incorrect scare around some of the causes since then, that rate is only about 15% today. There is clearly a need to increase awareness and the ability for people to receive treatment.
I am aware of the issue around formularies; I have heard that they believe that it can be resolved. I will take it away and write to the noble Lord to make sure that it is properly dealt with.
Skills for Care Report
Debate between Lord Patel and Lord Markham(2 years, 2 months ago)
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Lord Markham (Con)
My Lords, my noble friend is correct that this is also a labour supply issue. Part of the benefit of living in an economy with full employment is, of course, that there is little unemployment. Part of the downside of that is the competition for jobs. My noble friend rightly points out the need to recruit more in this sector; that is why I am pleased that she mentioned the work we are doing to add this sector to the essential workers list so that we can recruit people from overseas and get essential workers in.
Lord Patel (CB)
My Lords, I welcome the Minister to his post. I look forward to working with him. In that spirit, I ask him this: where might I find the data relating to the long-term planning for the NHS and social care workforce? If such data does not exist, will he agree that such planning data should be made available as a matter of urgency?
Lord Markham (Con)
My Lords, my understanding is that there is a 10-year plan as part of a workforce plan, which rightly looks at the issues raised by the noble Lord. As I mentioned in my answer to the previous question, the workforce is key to this sector. We employ 1.5 million people; I think that they account for about 5% of our whole workforce. So making sure that this is an area that people want to come and work in, that people enjoy and that people see as a vocation is vital and will be part of the plan. I will look up the data requested and reply in writing.