Stroke Treatment
Baroness Meacher Excerpts(1 month ago)
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Lord Markham (Con)
The noble Baroness is right: carers are the hidden army who give so much support, not just in the area of strokes but across the board. As the noble Baroness said, we have put in place some steps, such as enabling leave and enabling people to claim benefits. I accept that that is not the whole enchilada, so to speak, but it is a step along the way.
Baroness Meacher (CB)
My Lords, I had a major stroke a year ago, and I am actually fine. I want to applaud the NHS. It has been truly remarkable, providing a machine beside my bed to monitor my heart every night. I also have atrial fibrillation. The NHS has monitored me incredibly carefully, with endless contact and the monitoring of my medication to ensure that it is exactly right—the GP was on to me this morning. The NHS has been completely wonderful, and it is worth saying that, as a patient.
Lord Markham (Con)
I am delighted to hear those good examples. As I say, we have had some very good results. The challenge is to ensure that everyone can have the sort of experience that the noble Baroness has had, which we are keen to do.
Cancer: Staffing
Baroness Meacher Excerpts(1 month, 1 week ago)
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Lord Markham (Con)
As the noble Baroness says, we see increasing the workforce as a core component here. I was speaking to the president of the Royal College of Radiologists about this the other day, and we obviously need to make sure that the workforce can be as effective as possible at what it does. We are doing a lot of new diagnosis, and 80% of all the medical AI technologies are in the radiography space, which is making a huge difference to diagnosis and productivity. It is clearly fundamental that we get the treatment to these people as quickly as possible.
Baroness Meacher (CB)
My Lords, does the Minister accept that there has been underfunding of the NHS for more than a decade now and that our cancer recovery rates do not compare with those of our competitors in Europe? Will he agree to have an urgent uplift in the funding of cancer services in particular over the next period, in order to try to lift our recovery rates up to those of Europe?
Lord Markham (Con)
Noble Lords have heard me say many times that we are investing roughly 10% of the economy into the health space, which is much more than ever before and comparable to nations around the world—apart from America, which stands significantly above. I am sure noble Lords saw the headline in the Times today that survival rates are at their best level ever, and there has been a 35% reduction in mortality rates for men and women over the last 10 or 15 years. So there is a lot of progress in this space, but I accept that we need to invest more—that is what the new CDCs, and the 7 million extra tests they are performing, are all about.
Allied Health Professionals: Prescribing Responsibilities
Baroness Meacher Excerpts(2 months, 2 weeks ago)
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Lord Markham (Con)
Yes, I will happily undertake to do that. There are a couple of mechanisms we can use. We can give them an independent prescribing ability, or we can give patient group directions on a certain number of items. That is what we are doing with Pharmacy First, for instance, in respect of the seven conditions. Clearly, we could look at doing that with the relevant autism drugs.
Baroness Meacher (CB)
My Lords, the steps so far taken by the Government to delegate prescribing to pharmacists seem pretty sensible. However, can the Minister assure the House that, bearing in mind that correct prescribing requires correct diagnosis, the Government will be extremely reluctant to delegate out the roles of doctors to healthcare professionals who do not have the benefit of a doctor’s training?
Lord Markham (Con)
I suspect that we are starting to get on to the debate we will have shortly on physician and anaesthetist associates. In both cases there is definitely a role for them, because we want to support doctors in the surgery and allow them to train and teach at the top of their profession. Clearly, however, we need to be sure of what such people can do and where they need extra supervision, and that is what we are setting out.
Autism: In-patient Care in Mental Health Hospitals
Baroness Meacher Excerpts(5 months, 2 weeks ago)
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Lord Markham (Con)
I am aware of the point that the noble Lord makes. About 48% of the reasons why people are not discharged are because of a lack of suitable housing. It is something on which we are working closely with Homes England and DLUHC, to make sure that we can utilise as much of the affordable housing grant as possible. I was not aware that legislation needed to be changed but I will happily look into that to see if it is the case.
Baroness Meacher (CB)
My Lords, is the Minister aware of the critical importance of early intensive education for severely autistic children? I hope so. I was involved in such an initiative some years ago and it is remarkable how a child with no speech and tremendous deficits can ultimately go to a normal school, and the prospects to then lead a reasonably normal life are enhanced enormously.
Lord Markham (Con)
Yes, I have some personal experience here and I know how vital it is to find out early, so you can put together the tools. I have seen some really interesting things. The Bradford pilot looked at children’s scores and whether that was an early indicator. I was at Boston Children’s Hospital a few weeks ago, which is looking at the way that children play on apps and whether that can give indications of whether there is some neurodiversity. There is absolutely the intention of early diagnosis.
Adult Social Care
Baroness Meacher Excerpts(1 year, 2 months ago)
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Baroness Meacher (CB)
My Lords, I recognise that the Government are understandably very concerned about public expenditure, but I wonder whether they have recently undertaken a cost-benefit analysis of spending on social care. For £1 million of additional spending on social care, what would be the savings to the health budget? I have a feeling that it could be at least £1 million, and possibly rather more.
Lord Markham (Con)
Absolutely, and that is the whole intention behind the ICSs: the ability in their areas to know local needs and invest in the right places—that is, in social care rather than having people in beds in hospitals, because it is a much more effective use of resources, and also in primary care. We all know that a lot of people go to A&E because they have not got primary care services, so the whole point of the ICSs is that they start to invest where demand is in the area, rather than using hospitals as the place of last resort to go to.
Plastics: Health Research
Baroness Meacher Excerpts(1 year, 4 months ago)
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Baroness Meacher
To ask His Majesty’s Government what plans they have to fund research into the health impact of plastic through a new National Plastic Health Impact Research Fund.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
The Government are funding a broad portfolio of research in this area through UK Research and Innovation and the National Institute for Health and Care Research; both funders welcome applications for research into any aspect of human health. Since 2018 the Government have committed over £100 million for research and development and innovation support, to tackle the issues that arise from plastic waste.
Baroness Meacher (CB)
My Lords, I thank the Minister for his reply and assurance that the private sector and trusts and others are investing in this area. But when almost four-fifths of people in this country have plastic particles in their blood, which means most of us in this Chamber if you think about it, and when these particles are associated with cancer, diabetes and other, serious, chronic illnesses, does the Minister accept that this really is a priority? Does he accept that a proportion of the Government’s R&D spending—we suggest 0.1%, which is hardly great—should be allocated as a priority to investigating the impact of plastic particles on human health, and how to tackle the problem?
Lord Markham (Con)
I have had the opportunity to speak to the chief scientific officer in this space, so I am guided by the science here, and I have also heard the impact from the Food Standards Authority, which considers it unlikely that the presence of plastic particles in food would cause harm. Further research in this space will be reporting in March 2023, but currently there is limited evidence to suggest that there is any harm.
NHS Waiting Times
Baroness Meacher Excerpts(1 year, 5 months ago)
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Lord Markham (Con)
We are committed to timely appointments. The whole point about the community diagnostic centres that were set up—and we have set up more than 90—is so that patients can be referred straight to those centres and get their screening and tests straightaway, getting them more quickly and, I hope, getting peace of mind more quickly as well.
Baroness Meacher (CB)
My Lords, I very much welcome the recent change, which enabled GPs to refer patients direct for assessments instead of having to refer to a consultant, and for the consultant then to refer, which I think saved about 30 days. What other procedural changes are the Government considering that would further reduce waiting times, without actually costing more money, and save doctors time—for example, patient self-assessments in the home, which we pioneered in east London 30 years ago?
Lord Markham (Con)
I thank the noble Baroness. There are a number of areas where we can do this. I point to the possibility for home testing a lot more. Covid was a perfect example, whereby it became commonplace. Rather than samples being sent away to a laboratory, we came up with lateral flow devices and were able to do it cheaply and pretty accurately, although not quite as accurately. That is a perfect example of using technology to do more home-type diagnosis.
Long Covid
Baroness Meacher Excerpts(1 year, 5 months ago)
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Baroness Meacher (CB)
My Lords, I applaud the noble Baroness, Lady Thornton, for bringing forward this incredibly important debate and for her outstanding introduction to it.
Long Covid is undoubtedly a serious challenge for the NHS and, as the noble Lord, Lord Bethell, said, for the economy, and a devastation for about 1.5 million people across the country. My principal reason for speaking in this debate is a concern that, for reasons that I simply do not understand, the chronic fatigue syndrome that too often results from the Covid virus is not linked in doctors’ minds, or indeed in many other minds, to the chronic fatigue syndrome that can be triggered by other viruses, and from which more than 1.5 million people suffer and have suffered for many years.
The principal symptom of chronic fatigue syndrome, as we know, whether it is triggered by Covid or by some of the virus, is extreme physical and mental tiredness that does not go away with rest or sleep. Sufferers find it difficult to carry out everyday tasks and activities and, as others have mentioned, too often they cannot work. This applies to the 1.5 million or more people with chronic fatigue who have had it for however long—for years, in many cases—and to those with chronic fatigue from Covid. They are exactly the same.
Other symptoms, as other noble Lords have mentioned, may or may not include muscle and joint pain, headaches, flu-like symptoms or feeling dizzy or sick. Covid-triggered chronic fatigue may also include a loss of taste and smell, and that is a slightly misleading piece of the jigsaw. In the main, chronic fatigue triggered by Covid and chronic fatigue triggered by another virus are indistinguishable other than by this rather weird issue of the loss of taste and smell. Does the Minister have any evidence to suggest that these two chronic fatigues that I have mentioned are in any way distinct, other than in this little piece, which I think is just a separate element of the consequences of Covid?
As someone who will have asthma for the rest of my life as a result of Covid, I also experienced a complete loss of taste and smell for several months after Covid. I am not just being self-indulgent; there is a point to bringing this in. It seems clear that the loss of taste and smell following Covid should be regarded as separate from chronic fatigue and separate from asthma or any other post-Covid illness. The fact that post-Covid chronic fatigue sufferers may lose their taste and smell should not suggest that it is in any way different from other post-viral chronic fatigue syndromes. They are surely identical, and medical treatment and research should focus on all types of chronic fatigue syndrome, including Covid related CFS. We know there has been a lot of money devoted to research because of long Covid; it is crazy for that money and research not to include other causes of chronic fatigue. It just cannot be right.
I very strongly welcome the focus of the noble Lord, Lord Bethell, on the alarming economic consequences of long Covid. Again, the economic consequences of chronic fatigue, whether triggered by Covid or any other virus, are eye-wateringly large. Urgent attention, both medical and in research, should be given to the prevention and treatment of chronic fatigue, however it is triggered.
I raise this issue in part because in the past chronic fatigue sufferers have experienced the most unpleasant stigma from doctors and others who tended to take the view that chronic fatigue was in no sense a physical illness, just something in the mind. Clearly, post-Covid chronic fatigue syndrome is acknowledged to be a physical response to Covid with a deeply unpleasant set of symptoms. It would be very helpful if the same understanding were applied to CFS triggered by other viruses or events. I will be grateful if the Minister can respond to this point, and to the important economic concern raised by the noble Lord, Lord Bethell, in his summing up.
Primary and Community Care: Improving Patient Outcomes
Baroness Meacher Excerpts(1 year, 7 months ago)
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Baroness Meacher (CB)
My Lords, I too applaud my noble friend Lord Patel for tabling this important debate. As he and many others have said, the NHS is broken; I really do not think that is any exaggeration. The fact is that the demand for GP services has increased over the years, as we know and as others have mentioned. It is incredible when you think about it that between 1990 and 2010 life expectancy increased by 4.2 years. People are living longer with more long-term and complex conditions. Remarkably, over 15 million people now live with at least one long-term condition. Where do these people go? To their general practitioner, so it is no surprise that they are in trouble. The effects of the pandemic are going to be with us for years. Where do all these tens of thousands of people waiting for treatments, assessments and so on go? They go to their GP, who cannot really help them, but they are desperate.
The impact of all this on GPs is colossal, made worse by the falling number of GPs, as the noble Baroness, Lady Finlay, referred to. We now have a downward spiral in primary care as GPs suffer ever greater pressure of work, ever longer days, burnout and the sense that they cannot deliver the quality of service that they wish to for their patients. A growing number are leaving the service or planning to do so—terrifying numbers of GPs are now actively engaged in the business of how and when exactly they will leave the service.
A family member is cutting their hours, as are many others, so, when we talk about the number of GPs, are we talking about full-time equivalents or are we merely talking about heads, many of whom will be working part-time? A family member GP works at a practice with 13 GPs but only three are now working full-time—he himself has cut his hours to six sessions—yet about 10 years ago I believe that all of them were working full-time. Of course, those who are working full-time are working 12 hours a day so they are literally burned out, and I watch that happen.
A common response is that GPs must employ more pharmacists and nurses. That is right, of course, but this has been happening for years and the main problem is that these people are also very hard to recruit. There are not enough of them. The big issue, raised by the noble Lord, Lord Hunt, is of course the inadequate level of prevention and preventive work within general practice even today. I must say that I feel that every general practice should have a dietician to take on the vast numbers of people in this country suffering from obesity, many of whom take up large amounts of a GP’s time. Frankly, they need to go to a dietician and get things sorted out. Perhaps that is rather a tough view but it is mine. Another specialism that I feel could take on a lot of work in a preventative capacity is psychological therapy. How many people go to their GP because they are basically a bit depressed, unhappy or whatever it is? Again, if a GP could really make sure that people’s distress was being handled, I think that would make an enormous difference.
I want to address a further point. I regard the Pulse proposal to end GP contracts and bring the vast majority of GPs into trusts as salaried doctors as foolish and potentially costly and dangerous. Too often, Governments seek to resolve the problems of the NHS through reorganisation, but this distracts all the managers from top to bottom into worrying about their own jobs, their colleagues’ jobs and so on instead of focusing on patients, and the patient focus gets lost. Personally, I would warn against revolution and say that, really, we need to deal with all these things through evolution. As I have said, a lot could be done by bringing in preventive personnel who could alleviate a lot of the problems of GPs. Employ more medical and pharmaceutical staff, psychological therapists, dieticians and nursing staff—definitely, yes.
Also, as the noble Baroness, Lady Finlay, mentioned, the Government need to sort out the pensions crisis rapidly and urgently. I hope that the Minister can give us an update today on what exactly the Government plan to do on this, because very senior and valuable doctors are leaving the NHS every day because of this problem. We cannot afford for this to be delayed at all, so please could the Minister give us some help on that one?
As a Dutch GP who came to work in the UK said recently, GPs are not the problem:
“They are knowledgeable, driven and hard working.”
He said that the NHS structure, secondary care and the media are the problem. I do not know what to make of all of that, but we need to value our GPs—that is what I take from that. We need a serious review and urgent support to ensure the sustainability of the primary care services that we value so highly. I strongly support the proposal of my noble friend Lord Patel to establish a special committee in this House to take on this work.
Integrated Care Boards
Baroness Meacher Excerpts(1 year, 7 months ago)
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Baroness Meacher (CB)
I understand from a senior ICB medical member that doctors expect general practice to be in the position that dentistry is in today in a bit of time. In other words, access to a GP will depend on the ability to pay. That is incredibly serious—it is the end of the NHS as we have known it, free at the point of delivery and need. Will the Minister take back to his colleagues the absolutely essential point that the Government must ask the ICBs to prioritise the assessment of general practice in their areas and to develop a strategy to ensure that general practice continues to be free at the point of need?
Lord Kamall (Con)
The noble Baroness makes the point about general practice. One thing that we are looking at, which will probably come up in the debate later in the week on the future of primary care, is the whole issue of what GPs do. There are many things they do that they do not have to do—these could be done by local partners, practice nurses, physiotherapists or social prescribing, and so on. In addition, Ministers and the NHS have been in conversation with GPs’ representatives, looking at these particular issues.