Pharmacies: Medicines at Home

Baroness McIntosh of Hudnall Excerpts

Wednesday 17th May 2023 Lords Chamber

[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.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, I cannot claim any expertise in this matter; I have just been listening to the conversation that has been going on. My noble friend’s original Question referred to the burden on carers. I have not heard the Minister say much about that, particularly when the negotiation over what is the right way of dispensing certain kinds of medicine presumably has to go on between a patient, a pharmacist and, presumably, a doctor somewhere in it, or somebody representing the patient who would, in many cases, be the carer. In what way are carers being helped to engage in that negotiation, with all the knowledge and expertise that they bring about what actually works in the circumstances?

Autism: Diagnosis Targets

Baroness McIntosh of Hudnall Excerpts

Tuesday 16th May 2023 Lords Chamber

[Lord Markham (Con)]

We are working closely with the Department for Education. The Bradford pilot scheme I mentioned takes the early years foundation stage profile scores of children. It knows that if you have a low score, you are far more likely to have autism. That triggers a multidisciplinary team to come in and inspect. That is a way that we can use that as an early warning indicator and then follow it up with volume. I hope that working very closely with the DfE in this space will be a real way forward.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister has already anticipated receiving this question—I would not want to disappoint him. He is clearly aware that there is some question over the reliability of some diagnoses that are being offered, particularly in the private sector, for ADHD, which is another neurodevelopmental disorder. Is he confident that, in trying to scale up the availability of diagnosis, which is obviously an admirable aspiration, the quality of those diagnoses will be maintained? Are the NICE guidelines sufficiently robust to ensure that?

[Lord Markham (Con)]

As we all know, it is a complex area, and there is no black and white diagnosis of autism. The noble Baroness’s point is absolutely correct: we need to make sure that the quality is there. The Bradford pilot has now been running in 100 locations. Every child has to get an early years profile score. If we can show the linkages and follow that up with the screening programme, that will be very promising; but, absolutely, we have to make sure that the right assessment is made.

Childbirth: Black Women

Baroness McIntosh of Hudnall Excerpts

Wednesday 3rd May 2023 Lords Chamber

[Lord Markham (Con)]

The point I was trying to make is that I think all noble Lords would agree that the NHS does a fantastic job in addressing and reaching people of all ethnic minorities. That is something we can all support.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister omitted to answer the first question put to him by my noble friend Lord Hunt of Kings Heath about the frequency with which the task force met and the gap between its last meeting and the moment at which its report was put forward, if I understood the question correctly. Can he answer that now?

[Lord Markham (Con)]

My understanding is that since the task force was set up, which was little more than a year ago, it has had as many as four or five meetings. If that is incorrect, I will correct it. The latest meeting was on 18 April. Again, if noble Lords look at the actions that have come out of it, they will all agree that it is actions that count the most. The task force has been very thorough, and Minister Caulfield is very committed.

Adult Social Care: Challenge Procedures

Baroness McIntosh of Hudnall Excerpts

Wednesday 19th April 2023 Lords Chamber

[Lord Markham (Con)]

Yes, we are taking them very seriously. The House has heard me talk many times about the 13% of beds that are blocked. This is a key issue for the whole flow of the system, which is backed up right the way through. That is why we introduced the discharge fund. Again, Minister Whately is very focused on this issue.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, further to the question asked by the noble Lord, Lord Laming, in response to my noble friend Lady Pitkeathley, the Minister referred to an 89% satisfaction rate among people in receipt of social care. However, as the noble Lord, Lord Laming, has just pointed out, the issue is not the people in receipt of social care but those who are not, of whom there are far too many. That is exactly what is causing some of the problems the noble Lord referred to. Does the Minister agree?

[Lord Markham (Con)]

Again, this goes to the point about the massive increase we have put in place of £7.5 billion. I have not heard of but would be pleased to hear about any plans on the other side of the House to increase that funding, since £7.5 billion is a very large figure—a 20% increase. Clearly, we will continue to review whether more is needed; we have put in increases each year. The importance of ensuring social care provision is completely understood.

Mental Health Act Reform

Baroness McIntosh of Hudnall Excerpts

Thursday 26th January 2023 Lords Chamber

[Lord Markham (Con)]

Yes, and understanding starts in schools. Again, I am very aware of that, and of the fact that training in schools is vital. We have increased the proportion of schools with trained mental health assessors from 25% last year; it will shortly be about 35%. The target is 50% next year. It is not 100%—we need to do more—but it is rapid progress.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, like other noble Lords who have spoken, I was a member of the scrutiny Joint Committee. I should say in parentheses that I entirely support the legislation being brought forward, but one of the things that came through very strongly from all the evidence we took was quite serious anxiety about resourcing for the kinds of reforms that are required. That is about not just money but, to go to the point made by the noble Baroness, Lady Barker, the recruitment of appropriate people to deliver the services that are needed, and the retention and training of those people. Can the Minister tell the House whether the Government will review the resource allocation for the proposed changes to the Mental Health Act, to ensure that these workforce issues are addressed?

Health: Pancreatic Cancer

Baroness McIntosh of Hudnall Excerpts

Monday 21st November 2022 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend. Key to this is the Help Us to Help You campaign, which reaches out to lots of different communities, including a number of minority communities. At the same time, we have rolled out the early cancer diagnosis service to GPs, where they are looking out for some of those warning signs, even when people are there for a regular appointment. Clearly, as has been said by other speakers today, a lot more needs to be done; it is a journey, but awareness is the vital first part of that journey. On that point, I thank the Pancreatic Cancer UK charity, which has been excellent in this field.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister has just referred to awareness, to which he has referred many times in the course of this Question. Would he accept that, for some people, it is difficult to understand what you need to be aware of—particularly with a disease which is, as far as I am hearing today, largely asymptomatic for a good part of its early progression? Can he tell the House where people, who perhaps need to be aware, should look for the things that they need to be aware of?

[Lord Markham (Con)]

The noble Baroness is correct: the problem about the so-called invisible diseases—of which cervical cancer is another example—is that you do not know quite what you should be looking for. That is why I mentioned earlier the non-specific symptoms pathways, which are exactly designed for those sorts of things, whereby general checks are included in the area so that, although people do not even go along with a specific symptom, they are starting to be screened. That needs to be rolled out further. As I mentioned before, this would cover 75% of the population by March 2023; clearly, we need to be at 100%, with the target of March 2024 for that.

Abuse and Deaths in Secure Mental Health Units

Baroness McIntosh of Hudnall Excerpts

Wednesday 9th November 2022 Lords Chamber

[Lord Markham (Con)]

We are investing, and I understand and agree with the point that training is key to this. We have committed to spend £2.3 billion more in 2023-24 in the mental health arena, exactly around this space. It is something that we are working on, and we understand that we need to ensure that the mental health of all our citizens, whatever their race or colour, is well served and looked after.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, as a member of the committee that the noble Baroness, Lady Buscombe, chairs, may I ask the Minister to especially note what she said about the importance of acting quickly on whatever recommendations come forward? Will he also acknowledge that mental health services, not just in secure institutions but across the country, are under very severe strain and that it is when people get into crisis that they are then put into secure units, often because they have not had the help they need before that crisis arrives? Will he please accept that there is a very serious shortage of mental health provision across the country? It would be interesting to know what real impact the numbers he has been able to tell us about today will have on that.

[Lord Markham (Con)]

As previously mentioned, we are investing to increase the provision—I believe it is £2.3 billion in 2023-24, which is a significant sum. We have increased the workforce by 7,000 in this last year alone, and there are plans to increase it further. Clearly, we need to keep that under review. I agree with the premise that prevention is always better than cure in these instances, and we need to make sure that mental health services, training and support are given at the point of need.

Mental Health: Advertising and Body Image

Baroness McIntosh of Hudnall Excerpts

Thursday 30th June 2022 Lords Chamber

[Lord Kamall (Con)]

My noble friend has asked me a very concise question, which will require a less concise answer. Clearly, there is a link between obesity and type 2 diabetes, for example, but one of the difficult things in this area, as with much in healthcare, is getting the right balance. The more emphasis we put on tackling obesity, the more unintended consequences there will be for people with eating disorders. There is now calorie labelling in restaurants and other out-of-home places, but some charities working with people with eating disorders are concerned that this may have a negative impact on them. It is always a difficult balance, but we must try to achieve it.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister and other noble Lords have raised the issue of social media. What assessment has he made—or is he aware of—of the influence of social influencers, particularly in cases where they are supported by commercial deals that pay them in part to promote certain kinds of advertising?

[Lord Kamall (Con)]

The noble Baroness makes a really important point about a contributing factor to people having poor body image. We know that there are influencers who promote certain products, and that they often alter their own image so that it is almost an idealistic image—whatever that means. Young people then feel inadequate when looking at those images. We also must recognise that this issue affects not just young people but a range of people—even older people. For them, it might be as a gentle a thing as a comb-over, but if that makes them feel better, great. We must look at this issue in its entirety, and it has been looked at as part of the online advertising programme.

Draft Mental Health Bill

Baroness McIntosh of Hudnall Excerpts

Tuesday 28th June 2022 Lords Chamber

[Lord Kamall (Con)]

I am sure the noble Lord is aware that one of the things we found when looking at the shortage of doctors—even though we have more doctors than ever before—was that some people are likely to stay close to where they were trained. That is why, for example, we have opened the new medical schools, and we are bringing more doctors into the system. Clearly, that will not happen overnight, since training to be a doctor takes a very long time.

We are also looking at what else needs to be done at that level. There are other pathways, such as nurses becoming doctors after a certain amount of time. Clearly, international recruitment plays an important role there. Our aim is to have an additional 27,000 mental health professionals in the NHS workforce by 2023-24. We are investing money to achieve that, but again, it is a question of how long it takes for the money to get through. At the same time, we must ensure that by having this additional workforce in the NHS, we are not squeezing out the voluntary sector but ensuring that we are working in partnership with it.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, I am sure the Minister will agree that if we get to point of having to apply the Mental Health Act to a particular individual, the system has failed because that person is, by definition, in crisis. I entirely accept that this Bill is necessary because the current legislation is no longer fit for purpose—Simon Wessely’s review is a very salutary read in that respect—but it is none the less the case that what we really need is to better equip our preventive services to deal with incipient mental health problems as they emerge, trying to prevent them becoming critical. That has been alluded to, in various ways, during this discussion.

Can the Minister tell the House where the £900 million —I think that is what he said—that is being committed immediately to the improvement of mental health services is to be spent? The real crisis is in the availability of human resource to deliver the service. There simply is not enough of it, as many people in this House, and certainly beyond, know from personal experience.

[Lord Kamall (Con)]

As noble Lords discussed during the Health and Care Bill, prevention is crucial. One thing I became aware of when I became a Minister was, when talking to the NHS and others, how they want to move away from purely curing to prevention. In response to the noble Baroness’s specific question, I commit to write to her on the exact allocation of that, but there is one area that plays an incredibly important role. We know, for example, looking back on the crisis, that when we did not know how long it would last, that created a lot of uncertainty. Uncertainty is very unbalancing for people, and it is a huge factor in them having mental health issues. Clearly, one of the issues that came up during the Bill was the use of civil society organisations, social prescribing, music and art therapy, but also conversations—people being able to talk to someone about the issue they are facing and feeling they are not alone. Clearly, that is something we have looked at, in terms of prevention, but in response to the specific question I commit to write to the noble Baroness.

Long Covid

Baroness McIntosh of Hudnall Excerpts

Monday 23rd May 2022 Lords Chamber

[Lord Kamall (Con)]

My noble friend is absolutely right that we must take this seriously. This is why, first, we have tried to map it to the three medical conditions I mentioned earlier: acute Covid-19, ongoing symptomatic Covid-19 and post-Covid-19 syndrome. We are also looking at the WHO definition, which defines post-Covid-19 condition as the condition that

“occurs in people who have a history of probable or confirmed SARS-CoV-2 infection; usually within three months from the onset of COVID-19, with symptoms … that last for at least two months”

and which

“cannot be explained by an alternative diagnosis.”

In my meetings with other Health Ministers from across the world, they want to learn from us what we are doing on long Covid and how we can co-operate better.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister has stressed the fact that the diagnosis of long Covid is quite tricky and variable, according to the period of time over which people have suffered from it. Can he tell the House what support the NHS is able to provide for GPs to understand how to look at people who are presenting with an unspecified collection of symptoms which might be long Covid? Can he also say what is being done to help employers to understand this?

[Lord Kamall (Con)]

The noble Baroness makes an important point because there have been some reports that patients feel that GPs have not taken their concerns seriously. In response, NHS England has worked with the Royal College of General Practitioners to provide advice for GPs on the identification and management of long Covid. They have also worked with Health Education England to produce e-learning modules on Covid-19 recovery and rehabilitation. Rather than take up too much time, I commit to writing to the noble Baroness on her second question.