Children’s Cancer Services

Debate between Baroness Chisholm of Owlpen and Lord Markham

Wednesday 20th March 2024 Lords Chamber

[Lord Markham (Con)]

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

[Baroness Chisholm of Owlpen (Non-Afl)]

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

[Lord Markham (Con)]

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

Social Care: Integrated Care Systems

Debate between Baroness Chisholm of Owlpen and Lord Markham

Wednesday 11th January 2023 Lords Chamber

[Lord Markham (Con)]

First, I think we can all agree on the necessity of making sure that these are integrated and the vital role that social care plays in all this. I must say, my experience from the places I have visited is that they are well integrated, but I will take that point back and would be pleased to look at any particular examples of where we feel that is not the case because, as I think the whole House will agree, it is vital that they are completely integrated.

[Baroness Chisholm of Owlpen (Non-Afl)]

My Lords, I believe that six integrated care boards have been selected as national front-runners on innovations that will help move patients from hospital to their home. Can my noble friend the Minister confirm that these are going ahead, give examples and reassure us that they will be properly monitored, with data being collected? I have just realised that I called the Minister “my noble friend” but, due to my new role, all noble Lords are now my noble friends.

[Lord Markham (Con)]

Replying on behalf of all noble friends, let me say that I am particularly pleased to see this scheme go ahead. Just yesterday, Members of the House were talking about whether we should have full-time contracted dom care people because they know their patients best. That is exactly what these front-runner pilots are designed to do: to try out these new ways of working and heavily invest in areas, which you probably cannot justify on a national level until you know that it really works. Leeds, for instance, is developing a transfer of care hub, while the Northern Care Alliance is focusing on dementia. This is all about seeing what works and then, when we know what works, scaling it up very quickly.

NHS Waiting Times

Debate between Baroness Chisholm of Owlpen and Lord Markham

Tuesday 22nd November 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness. With reference to past performance, that is what the spending increases were all about. They were an acceptance that we need to do more in this space, and we are doing more. The pandemic clearly brought unprecedented circumstances and that is why we have announced more funding to get on top of that in the next few years, tackling all the areas that the noble Baroness mentioned in terms of A&E wait times, GPs and all the rest.

[Baroness Chisholm of Owlpen (Con)]

My Lords, we know that part of the problem is that ambulances are going to A&E departments but are not able to deposit their patients in A&E. We know that there is a blockage at the other end in social care, with people not being able to be discharged fast enough back into the community or into care homes. Until that is sorted out, I cannot see how we are ever going to sort out the waiting lists. Can my noble friend the Minister tell me what might happen that will perhaps make those problems better?

[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.

Ambulance Delays

Debate between Baroness Chisholm of Owlpen and Lord Markham

Wednesday 9th November 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness. I have been made aware of the TV series and it is on my watch list. I am looking forward to going out overnight on an ambulance control shortly to learn at first hand. Tomorrow, I am visiting ambulance response teams and leaders in the field in the Maidstone and Tunbridge Wells area. Ambulances are of key importance; they are the “A” in the ABCD plan, and that plan very much features in everything we are doing. We are active on that and will rightly report, as we are here, on a continuing basis, and, as the noble Baroness knows, regularly report the statistics to ensure that we are on top of the problem.

[Baroness Chisholm of Owlpen (Con)]

My Lords, the delayed response to category 1 incidents by ambulances is really due to a systems failure, whereby those who should be treated in the community are unable to be, and those who are in hospital blocking beds are unable to go back into the community, where they should be treated. I ask my noble friend the Minister what plans there are to improve social care. I also congratulate him on answering four Questions today. As a nurse, I prescribe a strong drink at the end of the afternoon.

[Lord Markham (Con)]

I thank my noble friend for probably the best advice and question I have received in my marathon series. I could answer her question at great length, because I agree that this is a whole-system issue and we need a whole-system response. I would happily talk about every aspect of that but I will pick up just a couple of the specific points that she made. Social care is clearly vital to this. That is what the £500 million discharge fund is for. We are all aware—noble Lords have probably heard me say it enough times—that 13% of our beds are occupied in this way. As my noble friend states, an ambulance will visit a home and 50% of the time will not end up conveying someone into hospital. Is having an ambulance there, with three people in it, the best use of our resources when perhaps a paramedic on a bike could solve it just as well? In a similar vein, my understanding is that roughly 50% of all A&E attendances are people who do not really need emergency treatment. Again, that goes to the point about making sure that they have opportunities to receive primary care appointments, which is what the pledge to increase appointments by 50 million is all about. This is a whole-system problem and something that we are working on with a whole-system approach.

NHS: Nurses

Debate between Baroness Chisholm of Owlpen and Lord Markham

Tuesday 1st November 2022 Lords Chamber

[Lord Markham (Con)]

With respect, the numbers I quoted are up to date. They take into account the overall increase. We saw 36,000 leavers and 45,000 starters in the last year, so that is an overall growth of 9,000, which shows that the work we are doing to encourage people into the profession is working.

[Baroness Chisholm of Owlpen (Con)]

My Lords, I know how much I, the noble Baroness, Lady Watkins, and the right reverend Prelate the Bishop of London enjoyed our nursing careers; we all trained at the same place. Is there not some way in which we can encourage students to come forward to this fantastic profession so that we can make sure we have a sustainable domestic workforce here in this country?

[Lord Markham (Con)]

I totally agree. I am proud to say that we have 72,000 nurses and 9,000 midwives in training at the moment. There is no cap on the number of people who can join the programme, so that is very much the spirit of what we are trying to do. Key to that was a £5,000 grant each year for nurses to attract them into the profession. It is working.

Edenfield Centre: Treatment of Patients

Debate between Baroness Chisholm of Owlpen and Lord Markham

Thursday 13th October 2022 Lords Chamber

[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.