Breast Screening

Baroness Finlay of Llandaff Excerpts

Tuesday 14th December 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for raising the importance of co-ordination and sharing information across the devolved Administrations. I have meetings scheduled with health Ministers from the devolved Administrations, and I will make sure that my office puts this on the agenda.

[Baroness Finlay of Llandaff (CB)]

My Lords, following on from the question of the noble Baroness, Lady Ritchie, will the Minister tell us how the stage of presentation of breast cancer has altered over the past two years? How many women presenting with stage 3 and stage 4 cancers had never been screened?

[Lord Kamall (Con)]

I thank the noble Baroness for giving me advance notice of the question, and so giving me the chance to get some information. Data on cancer stages is currently published only annually, and NHS Digital is publishing the data from 2019 on Thursday 16 December. The latest data from 2018 shows that nearly 86% of breast cancers were diagnosed at stages 1 and 2, meaning that about 15% were diagnosed at stages 3 and 4, but this was pre-pandemic. I will make sure that I get the updated data as soon as possible.

Medical Schools: Training Places

Baroness Finlay of Llandaff Excerpts

Monday 13th December 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Lord raises an important question, but the fact is that we are training more doctors, and we are recruiting internationally where it is ethical to do so. On retirements, we are looking at a scheme that lasts until 2024 to allow doctors to come back without it affecting their pension.

[Baroness Finlay of Llandaff (CB)]

My Lords, I should declare that I am a fellow of the Royal College of Physicians. Do the Government accept the report from that body, Double or Quits, which has shown that we need 15,000 medical school places annually? Doubling the number of medical school places to that number would cost £1.85 billion, which is only one-third of what hospitals currently spend on agency and bank staff. Therefore, an increase is an investment to save.

[Lord Kamall (Con)]

I thank the noble Baroness for that question and for the advice and expertise that she has passed on to me in my short time in this place. As part of the expansion, we have opened five new medical schools across England, in Sunderland, Lancashire, Chelmsford, Lincoln and Canterbury. Sometimes we have the training, but it is difficult to find doctors in certain locations. We have tried to move training as close to those locations as possible.

NHS: Elective and Cancer Care Backlog

Baroness Finlay of Llandaff Excerpts

Tuesday 7th December 2021 Lords Chamber

[Lord Kamall (Con)]

The Government have announced the NHS long-term plan. We have had a budget increase. We are focusing on a number of different issues. One of the challenges over recent years has been the ageing population. That should be a positive thing and we want to make sure that we look at the new health challenges that we face for the future.

[Baroness Finlay of Llandaff (CB)]

My Lords, do the Government recognise that one-fifth of patients with cancer are diagnosed in emergency departments across the country? When patients are diagnosed late, the nature of cancer and its progressive metastasising behaviour means that, by the time they are diagnosed, the treatment burden is greater and the cost to the NHS goes up. Early diagnosis becomes the only way to tackle the overall problem.

[Lord Kamall (Con)]

The noble Baroness makes a very important point—as did the noble and gallant Lord—about how we reconfigure our healthcare system to make sure that we catch these diseases much earlier in the system rather than waiting for secondary referral. This is not only in primary care but lots more self-diagnosis with more technology now in the home and elsewhere.

Health and Care Bill

Baroness Finlay of Llandaff Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my interests in medicine and physiotherapy and as a Bevan Commissioner. Like others, I welcome the noble Lord, Lord Stevens of Birmingham, who clearly brings a veritable wealth of experience.

In the debates during the previous health and social care Bill, there were two references to the Titanic, and it felt as if we were commissioning different lifeboats. The lifeboats never arrived. We have two separate systems, health and social care, both of which are creaking under current pressures and severe workforce shortages. Integration is essential and complex. Integrated care boards need comprehensive membership, with a broad overview for patients and children.

Specialist palliative care services, like maternity services, must be commissioned as core. Would you depend on fundraising events for a woman to be able to have a caesarean section in obstructed labour? No. So why do we allow distress in severely ill people to go unaddressed because there is no specialist palliative care service commissioned? I do not mean after-care, as was suggested in the other place. Good specialist palliative care must be commissioned to be integrated across the trajectory of a person’s serious illness, to deal with problems in a timely way when the prognosis is unknown, not just when people are actively dying.

Children and young people need to be considered in all parts of the system, with integrated services and early mediation for disputes between clinicians and loving parents. Abuse, alcohol and drug addictions, the promotion of cosmetic procedures, dental caries and nutritional problems are all part of the public health emergency for children and young people we now face. Underpinning all of this for children is data. There is a desperate need for a unique identifier for a child that goes across health and social care. Some 46 years ago, I admitted a child who had been dipped in boiling water. The case went to the Old Bailey. This week, we heard of a child being brutally assaulted and killed. Has nothing changed? We cannot continue to have social care data kept separate from healthcare and not linkable to education and police records. To improve life chances, we must have relevant information rapidly available. Across the UK, transferable and comparable data is also imperative for decisions in devolved Administrations to be made in the best interests of the patient. This Bill needs to show that.

Seven years after Framework 15, workforce projections remain uncertain. Some 48% of advertised consultant posts went unfulfilled across the UK last year, and there are long-term vacancies on top of that. Unless workforce planning, education and training improve, underpinned by research initiatives and findings, care provision will not improve.

We also need to recognise the appalling work environments, where staff do not feel looked after or valued. Social care will only have the status that it deserves if there is an integrated career path with the NHS, with staff travel time paid for and staff able to access support and advice if they are concerned about someone—with their opinion being valued—without having to go through multiple hoops.

Cancer outcomes at one year are falling behind that of our European colleagues, yet our research is ground-breaking. Sticking with process targets is not good enough. We must not water down the amendments so ably introduced in the other place and accepted by the Government.

Disease does not respect the clock or the calendar. The Bill fails to address the overwhelming number of problems that arise during the three-quarters of the week that is out of hours. The Bill also fails to address the large number of people being treated in inadequate premises because overcrowded emergency units are unable to move sick patients through to wards because there are no beds. Currently, one cannot expect ambulances to offload in a timely way or expect staff to give each patient safe care. Discharging into the community to assess needs in people’s homes makes sense, but where is the workforce to do it? Physiotherapy and occupational therapy are essential in every team to avoid deterioration as well as to restore well-being.

Until health and social care are integrated, we will not solve any of the problems that we face. I believe that the budgetary systems need to be combined. Clause 140 feels like trying to apply an enormous sticking plaster to tackle the underlying chasm: the gap between the current rationing of social care by means-testing versus an NHS free at the point of delivery. The success of the integrated vision in the Bill rests on social care being an equal partner to the NHS, but significant work is required if parity is to be achieved. We have much to do.

Health and Social Care

Baroness Finlay of Llandaff Excerpts

Monday 6th December 2021 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I should declare my interest in relation to medicine, the BMA and the Royal College of Emergency Medicine, and I would like to ask about emergency medicine. The winter flow data from the Royal College of Emergency Medicine has data from 40 sites across the UK. They are reporting that, in November, there were 275,596 attendances. Their long hospital stays had increased by 13% to more than 48,000 patients. Their 12-hour stays in emergency departments were twice as high as they had been in the previous year, and that was equivalent to 7.3% of all attendees. Their four-hour performance is incredibly low, at 62%. I know from one department that was built for 28 patients that, on a Monday in November, it had 108 patients in. This becomes unsustainable, and the overcrowding is a danger in terms of Covid and infection. It is also a danger to the welfare of staff because, in this particular department, even the staff toilets were not flushing, so the staff had to leave the department just to excuse themselves.

The estate takes time to rebuild and be repaired. What is being done with projects now to create additional space for emergency departments to manage this overcrowding? Is there targeted money going to make sure that the departments are in a good condition of maintenance for the staff? Separate, but related, to that, is the pension block, which has stopped doctors from returning from retirement and has pushed some doctors into early retirement, being addressed in the long term? It is important that doctors who have retired because their pension pot has reached its limit can be incentivised to come back to take pressure off in GP surgeries and in hospital departments, particularly out-patient departments, by seeing patients where their long-term experience and wisdom can contribute to the clinical services.

[Lord Kamall (Con)]

I thank the noble Baroness for the points she makes. We are doing what we can to support the dedicated NHS staff in healthcare services. This year alone, we have invested over £15 billion on top of the existing NHS annual budget, and that includes funding to help get patients out of hospital, freeing up beds and supporting hospitals to manage Covid-19. In addition, we are looking at how we can tackle capacity issues on NHS 111 and A&E. We are giving NHS 111 £98 million to boost capacity, help people avoid unnecessary ambulance trips to A&E and take pressure off hospitals. We realise that NHS 111 is often the first port of call to provide urgent medical advice quickly and book time slots for people at their local A&E or appointments at alternative services. We are also delivering the largest ever seasonal flu vaccination programme, so we hope to tackle it on that basis. A number of CCGs and others are having conversations about how we can tackle the pressures on A&E.

The noble Baroness makes the point about staff who, during Covid, went way beyond the call of duty, and we managed temporarily to address those concerns. We are very grateful to staff who had retired and returned, and we are looking at whether that can be a long-term solution. We need to make sure that no one who is willing to come back is disincentivised. I do not have the details at the moment but I commit to write to her.

NHS: Primary Care Surgeries

Baroness Finlay of Llandaff Excerpts

Wednesday 24th November 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for that important question. International engagement remains crucial to tackling the pandemic and ensuring future resilience. In my first few weeks in the job, I have had a number of meetings, at bilateral, G7 and other levels, to make sure that we are fostering international health partnerships. “It is also really important that we understand the contribution the private sector can make towards making the NHS better for all of us.” Those are the words of Alan Milburn, also a former Labour politician.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare that I am a fellow of the Royal College of General Practitioners. Do the Government recognise that, with an increasing number of GPs working salaried and part-time, it is essential that they have security in their contracts? There is a tension when commercial providers need to provide profits to their shareholders, which can work in the opposite direction to the needs of the community, as the medical staff should be working as a co-operative to improve services locally.

[Lord Kamall (Con)]

I am sure that we all want to pay tribute to the work of GPs, who are at the front line and, quite often, are the gateway to many services across the NHS and the wider healthcare system. It is important that we recognise some of the pressures they are under, but also work out how to help them and, indeed, patients. As I have said in the past, I will be a champion of patients and it is important that patients have access to their GPs, as a gateway to further services.

Covid-19

Baroness Finlay of Llandaff Excerpts

Monday 15th November 2021 Lords Chamber

[Lord Kamall (Con)]

I apologise if I have misled the House: I have booked my booster jab but I have not had it yet. I was able to book it in advance but I cannot have it until—perhaps I should not make this public, but they have given it to me one day before the six months is up. This will be all over the front pages tomorrow, it will be a huge scandal and noble Lords will be calling for my head. I understand that.

On the serious point, I share the frustration of all noble Lords who have brought this issue up. I was hoping to be able to announce a date today, but it was scratched at the last minute. I think there was some technical reason, but we hope to have good news soon. I know that will be as frustrating to many noble Lords as it is to me. Believe me, I would rather have good news than to be seen to be avoiding answering the question.

[Baroness Finlay of Llandaff (CB)]

I shall follow up on the question asked by the noble Baroness, Lady Tyler, in relation to pregnant women in particular. There were maternal deaths early on. It would be most helpful if we could have the data on the number of such women, the pattern of vaccination and the pattern of maternal deaths from Covid and severe infection. Women are still worried and hesitant because there was a failure to vaccinate early on, because the data on safety was not there. Having data on the drop in the number of deaths will help to persuade women of childbearing age to pursue being vaccinated, whether they are already pregnant or not.

[Lord Kamall (Con)]

The noble Baroness raises a very important point and I apologise for not spotting it and answering it earlier. Many noble Lords will be aware of the very sad story of a young lady who died because she felt that the vaccine was not safe; her mother is encouraging other pregnant women to have the vaccine. For that reason, we want clearly to communicate that the vaccine is safe and will not affect fertility, so getting the vaccine is the best way to protect yourself. Pregnant women are more likely to get seriously ill from Covid-19, and we know that vaccines are safe for them and make a huge difference. In fact, no pregnant woman who has had two jabs has needed hospitalisation with Covid-19. We need to make that clearer, and I will take this back to the department and the Government to make sure that we communicate more clearly. We all share the same will to share that message more widely.

Alcohol Duties

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Tuesday 2nd November 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Lord makes an important point in looking at the various factors that have to be balanced up. Clearly, we want to encourage consumers or drinkers to move towards low-alcohol and no-alcohol products, while balancing that against the wider economic climate and the hard two years that the hospitality sector has faced, which is why we announced the freeze to some alcohol duties. On encouraging people to go out and drink alcohol, I am afraid I am the wrong person, because I am teetotal.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my interest, having chaired the Commission on Alcohol Harm. Our report published last year cited the data, then 10 years old, which showed that the cost from alcohol to the NHS was £3.5 billion a year, while the Home Office’s own estimates were that the cost to society was £21 billion a year. In the decade since then, the number of alcohol-related hospital admissions has risen by 19%, and there has been a rise, too, in alcohol-related hospital admissions and deaths, which increased by 20% last year alone. Given the rising cost to the NHS, what contingency plans have the Government made should this drop in duty fail to decrease alcohol harms, and what other methods do the Government plan to use to decrease alcohol consumption?

Smoking Cessation: Prescription of E-cigarettes

Baroness Finlay of Llandaff Excerpts

Tuesday 2nd November 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for pointing that out, and I will investigate. Not being a user of e-cigarettes or cigarettes, or of any sort of narcotics or alcohol, I am afraid that I am not really an expert myself. I will look into that and write to my noble friend.

[Baroness Finlay of Llandaff (CB)]

Can the Minister confirm that the nicotine levels will be looked at, given that the nicotine level in some e-cigarette products is very high and that nicotine is the addictive substance both in cigarettes and in the continued use of e-cigarettes? The commercial incentive for tobacco producers to produce flavoured, palatable and highly addictive products should not be pandered to.

[Lord Kamall (Con)]

The noble Baroness raises an important point about nicotine itself being a very addictive substance. I am sure that the MHRA will be looking at the guidance, but if the noble Baroness would like to write to me, I can confirm that.

Social Care in England

Baroness Finlay of Llandaff Excerpts

Thursday 14th October 2021 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I congratulate the noble Baroness, Lady Pitkeathley, on obtaining this debate, her important opening speech and her constructive suggestions. I welcome the Minister to his crucial role in the future well-being of the nation. I must declare that I chair the National Mental Capacity Forum and am vice-president of Marie Curie, which provides a great deal of care to people in the community as they are approaching the end of life.

Looking forward, we must fix social care properly. I have worked for decades with social carers in an integrated way through the hospice movement, where it is evident that those providing social care are an essential support to people with severe and life-limiting illness, and to their families. Without input from social care, families would break. Where there is a young parent who is ill, their children need to know the person who is coming to provide support to their parent—a person to whom they often look for emotional support also. Where a child or young person has learning difficulties compounded by physical problems, their social care is literally a lifeline for all in the family. Let us not forget the underage carers in so many families.

No one should think that social care is simply about washing, dressing and eating. It plays a vital role to enable the carers of people at home to cope with their own lives, go to work, go to school and study, and manage all aspects of the home. For the person, social care can make all the difference between feeling a burden, worried that one’s family is being worn down, and being able to function still in one’s role within the family and society. Where good social care is in place, people with profound disabilities are often still able to work with the support of different aids and adaptations, and I have been struck over the years by the number who have run businesses, written papers and even books. It is their carers who they praise as the person enabling them to do this.

Sadly, Marie Curie found that, during the pandemic, 61% of carers said that the person who had died had not had all the help that they needed with personal care before dying at home. More than three-quarters of carers said they did not receive all the care and support that they needed. It is the carers who spot when somebody is less well and when things are deteriorating, and is often the person who triggers the call to the GP or district nurse to come in and diagnose what has changed, alter medication and review the way in which an illness is managed. No one should think that these carers are unskilled or low skilled; they are not. They are very skilled and often have a wealth of experience.

When I was medical director of the hospice in Cardiff, I often looked to the care assistants just as much as the trained staff for important information on patients and families. They spotted whether families were behaving oddly. They would alert me to changes in a person’s condition because, when they took them to the bathroom or helped them with the meal, they spotted changes early. Patients talk to carers because they are not part of the power differential between professionals and patients. Patients often tell doctors and nurses what they think they want to hear, but will be much more open and frank with carers about worries and concerns that they may feel are too trivial to trouble trained staff with but are crucial.

Social care is essential to free up places in hospital. Carers should be there when somebody comes home; that transition from hospital to home is a vulnerable time both physically and psychologically, particularly for those who live alone. If hospital discharges do not happen, the backlog right through the system to the ambulance at the front door of A&E only worsens. It has been estimated that NHS bed days lost to delayed hospital discharges rose by 50% between 2015 and 2017—before the pandemic—when the number of beds available was decreasing in the hospital sector. This, of course, produced greater pressure.

Social care work is hard work. There is a workforce turnover of more than 30% and we must be able to retain skilled and experienced care workers by making sure that this is an important, high-status job, and that the travelling time between clients’ homes is recognised. For those who are unpaid family carers, we should consider carers’ leave, particularly when they are caring for someone who is dying at home.

As we move forwards, the reforms set out in the Health and Care Bill should ensure that every part of England is covered in an integrated care system, with close collaboration between the NHS, local government and other partners. However, it is deeply concerning for people living with terminal illness that there is no requirement on integrated care systems to ensure that they commission palliative care services. I therefore give notice that I will be bringing forward an amendment to the relevant Bill and I hope that the Minister will be able to assure me that the Government will consider carefully amending the Health and Care Bill to include a requirement for every integrated care system to arrange for the provision of specialist palliative care services to meet the needs of the population. Everything must be integrated for the benefit of all.