Skills for Care Report
Baroness Wheeler Excerpts(3 years, 5 months ago)
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Baroness Wheeler (Lab)
My Lords, the Health Foundation has described the Skills for Care report as yet another signal of a social care system on its knees, with care providers struggling to compete with other employers and, in many cases, unable even to pay the national minimum wage to essential care staff. As we have heard, the figures are that one in five residential care workers in the UK was living in poverty, and that was before the cost of living crisis, compared with one in eight of all workers, which is a shocking figure in itself. When will the Government commit specifically to addressing the appalling low pay and poor working conditions throughout the social care sector?
Lord Markham (Con)
My understanding is that the pay of carers is always at least the national living wage. I will look into that, but that is my understanding. That is not to say that where they deserve, and should be paid, more that this should not be the case, but the national living wage is set, as the noble Baroness will be aware, exactly as it says: a national living wage. In terms of the cost of living pressures, the energy price cap is of course about focusing on those people who need it most, so there are a number of measures that we are putting in place to ensure that this happens. Most of all, it is about ensuring that this is a good, safe and enjoyable vocation for people.
Pharmaceutical Research and Development Spending
Baroness Wheeler Excerpts(3 years, 5 months ago)
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Baroness Wheeler
To ask His Majesty’s Government what steps they are taking to increase the United Kingdom’s share of global pharmaceutical research and development spending.
Baroness Wheeler (Lab)
My Lords, I am pleased to open this debate on behalf of my noble friend Lord Hunt, who sadly cannot be here today. As we know, this subject is dear to his heart and I am sure that the expertise of all noble Lords who will be speaking will do this important and vital issue full justice. I welcome the new Minister to his first Lords debate response and wish him well in addressing the mound of questions that he will face.
Our country faces a challenging time as we look to build back stronger from the impact of the pandemic. It has hit our people, our businesses and our growth hard, but here in the UK we already have a globally leading life sciences industry which, if we take the appropriate steps, can be central to unlocking our economic recovery. The industry currently makes up 18% of all R&D investment across the UK economy. It is the largest private R&D spending sector. In 2020, it was worth £5 billion and contributed more than half a million jobs to the UK.
Existing literature suggests that every pound invested in private R&D today leads to a stream of future benefits to the economy as a whole, equivalent to 50p per year in perpetuity. This sector’s R&D brings these benefits across a diverse geographic presence, with significant hubs in the south and north of England, Scotland, Wales and Northern Ireland. With private capital and UK industry playing the largest role in pharmaceutical R&D, they need policy stability and consistency in order to feel confident in investing. The Government must help, not hinder, this.
This kind of R&D has huge value for the NHS and its patients, not just through the end-stage innovation that is produced but through clinical trials. These are a valuable source of revenue to the NHS and provide access to medicines for patients with limited or no-treatment options in routine care, such as people with cancer, dementia and rare diseases.
The UK has the potential to be a global leader in life sciences R&D. We have a mature ecosystem, have historically been a leader in early-stage clinical research and have made huge strides with early access to advanced therapy medicinal products. However, this debate is vital today because of deep concerns that the UK is slipping against our competitor countries in a number of key areas. Between 2012 and 2019, the UK’s share of global pharmaceutical R&D expenditure fell from 7.7% to 4.1%. This has led to a loss on average of £3.2 billion per year for the past eight years. Since 2009, our manufacturing production volumes have fallen by 29% and 7,000 jobs have been lost and, between 2018 and 2020, the UK slipped down the global rankings across all phases of industry clinical trial delivery.
We can and must do something now. Urgent implementation of the Life Sciences Vision—it has been welcomed by the sector, which co-developed it—is now critical as the UK’s international competitors, spurred on by the pandemic, are moving at pace to enhance their life sciences offer and capture internationally mobile investment. Can the Minister say when the promised implementation plan for the one year anniversary of the vision, due last July, is to be published? Can he also reaffirm that the Government remain committed to the vision, not least its core ambition to make
“the UK the best place in the world to trial and test products at scale”?
The current uncertainty is not helping the deeply worrying situation that we are in. Moreover, an effective, joined-up approach is also needed on the Government’s wider overall science research and development strategy. We have had a number of separate R&D roadmaps, science plans, strategies and sector deals, ARIA and two reorganisations of the UKRI, for example, but without overall coherence across the board.
I will make a few points on specific issues, which I am sure will be followed up by noble Lords. First, as I have said, despite a strong policy ambition to make the UK a destination of choice for cutting-edge research, the delivery of industry clinical trials within the NHS is in crisis. In addition to the impact on patients, this means less R&D investment in the UK. The pandemic obviously had an impact, but it cannot be ignored that the UK was beginning to decline pre Covid.
Secondly, the use of health data is an area of vast potential, but we have had several false starts, for example care.data and the more recent GPDPR incidents. The data revolution is increasingly fuelling new breakthroughs in treatment, diagnostics and patient pathway redesign and is a key tool to support NHS staff. Given its large and diverse patient pool, the NHS has unique potential to be one of the most effective engines for data research. However, although this potential is well recognised, repeated attempts by successive Governments have failed to make best use of this resource, predominantly as a result of failing to engage both public and clinicians. As a result, the current state of play is a disparate data environment, with many custodians, different access arrangements and a lack of interoperability.
The Government’s Data Saves Lives strategy has taken on board many of the recommendations put forward by Professor Ben Goldacre in his independent review. Stakeholders such as the ABPI, which represents the research-based pharmaceutical sector in the UK, are urging that this must be a comprehensive strategy that appropriately balances the need for effective safeguards and public engagement with the ability of accredited researchers to appropriately access data to perform valuable research.
The false starts suffered from a chronic lack of co-ordination and failure to integrate effective communication with policy development and technical implementation. Provided that we can learn from these past mistakes, pressing forward will significantly enhance UK attractiveness as a destination for research. Will the Minister update the House on the action that the Government are taking?
Thirdly, the key issue is how we make the NHS an innovation partner—one of the areas with which we are struggling most. The life sciences sector is a strongly interconnected ecosystem. An NHS that supports innovation is central to this ecosystem and for that reason is one of the preconditions of success for the Life Sciences Vision. However, right now, the NHS struggles to approve these medicines for use and to provide access for patients once they are approved. Just 68% of medicines approved by the European Medicines Agency were made available in England between 2017 and 2020.
Looking at the uptake of medicines recommended by NICE, we see that the use of these in the UK typically lags behind that in other countries for at least five years after launch. For example, between 2016 and 2020, UK uptake was 60% of the average of 15 comparator countries in the first three years and still below average after five years, despite rising to 81%. This is contributing to patient outcomes falling behind those in countries in Scandinavia, as well as the Netherlands and Spain, for example. Recent data highlights how the UK ranks 17th out of 18 countries for life expectancy, is the worst for stroke and heart attack survival and ranks 16th out of 18 for five types of cancer.
Supporting access to and uptake of innovative medicines is critical not only to delivering better patient outcomes but to creating a thriving life sciences ecosystem. It is because of this link that in 2017 this House secured the amendment to the medical supplies Act specifically recognising that, when enacting policy in the scope of the Act, the Government must take due consideration of the consequences for the life sciences industry and the UK economy that depends on it.
Will the Minister say what action he will take to ensure that patients can benefit from the latest medicines and that the NHS supports a thriving life sciences sector in the UK? Specifically on the UK’s vaccination programme, so vital in the battle against Covid, how do the Government aim to deliver their pledge to develop new vaccines within 100 days? Will the Government continue with their plan to sell off our flagship vaccine manufacturing centre in Oxford? Does this not fly in the face of an effective pharma strategy and send out completely the wrong signals abroad?
In conclusion, recent analysis suggests that effective endorsement and delivery on the Life Sciences Vision could generate an additional £68 billion in GDP over the next 30 years through increased R&D alone and deliver 85,000 jobs through increased exports. We can also ensure that new medicines in the UK continue to be developed, trialled and launched here, meaning that patients benefit from the most innovative treatments in the world. This should be at the heart of the Government’s priorities to deliver growth and place the NHS on a sustainable footing for the future. The Government must act swiftly and decisively to reverse the very worrying downward trends in our life sciences competitiveness in relation to the rest of the world.
Care Homes: Energy Costs
Baroness Wheeler Excerpts(3 years, 6 months ago)
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Baroness Wheeler (Lab)
My Lords, what support will the Government specifically give those care homes whose pre-Covid Care Quality Commission ratings have been downgraded from good to inadequate as a result of staff shortages? This is on top of their deep concerns over energy costs. Recent press reports say that up to three-quarters of care homes in England have been reassessed in this way.
Lord Kamall (Con)
Clearly, one of the issues in the overall review of the social care sector is that, when the CQC and others report on care homes and other places, action is taken. One of the things we will do is talk to the right stakeholders and individuals, but we also have to work in partnership with local authorities—as quite often it is their responsibility—to try to make sure we raise the standard.
Thyroid Patients: Liothyronine
Baroness Wheeler Excerpts(3 years, 8 months ago)
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Lord Kamall (Con)
I am afraid that I am not able to fully answer my noble friend’s question. However, I know that my right honourable friend the former Secretary of State for Health did organise a round table with some of the relevant charities to discuss this and to discuss where they can source elsewhere, outside of the UK, and whether they could build up UK capacity. My honourable friend Maria Caulfield, the Minister, has also met with a number of organisations on this, and they are determined to get as much as they can. One issue is the stock for the future as opposed to for now, and feeding that through, but I know that the department is on to this.
Baroness Wheeler (Lab)
My Lords, the evidence clearly shows that many patients with hypothyroidism would benefit hugely from the declassification of T3 as a high-cost drug back to being a drug that is routinely prescribed in primary care. Can the Minister explain exactly what the Government will do to ensure that the actual NICE guidelines that enable T3 to be prescribed by clinicians according to their judgment reflect this position, are implemented consistently across new NHS structures and stop the current postcode lottery? Would this not be better than repeating the record of the majority of CCGs who ignore the guidelines?
Lord Kamall (Con)
The noble Baroness raises a really important point about some of the blockages to patients getting T3. It is both the first and second-line advice from NHS England but also the NICE advice too. NICE always reminds us that it is independent, and that Ministers should not intervene, but we can call for meetings. NICE also recognises that a price change does change the equation. It has told me that it is open to new evidence with people able to consult and contact it about this.
Pharmacy (Responsible Pharmacists, Superintendent Pharmacists etc.) Order 2022
Baroness Wheeler Excerpts(3 years, 9 months ago)
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Baroness Wheeler (Lab)
My Lords, this debate has been a welcome opportunity to clarify the role of responsible and superintendent pharmacists, as set out in the SI, and to take a closer look at the wider industry, its workforce and, in particular, the support and funding community pharmacies need to enable them to operate effectively and undertake the extended role they need as an integral part of the local primary care team.
I congratulate my noble friend Lord Hunt on his excellent speech and presentation of the strong case for his amendment. All speakers have rightly paid tribute to the role played by community pharmacies during the pandemic, which remained open and continued to offer their full range of services. We all acknowledge the huge contribution they made then and make now to front-line care: the delivery of mass vaccination programmes for both Covid and flu, providing essential preventive programmes, such as blood pressure checks, providing medicine support for patients discharged from hospital, and supporting patients, particularly those with long-term conditions, with their self-care and self-management. All this takes pressure off GPs and ensures better access for patients to healthcare information and advice, and more efficient use of NHS resources. The estimate that the NHS could save £640 million through nationwide treatment of minor ailments by community pharmacists is an example of how their role should be extended.
The new community pharmacy consultation service mentioned by my noble friend Lord Hunt—involving GP surgeries, NHS 111 and pharmacies—for minor illness or medication consultations, and the pilot schemes for NHS Direct cancer referrals to pharmacies for patient scans and checks, are both key developments which we very much welcome.
I also pay tribute to my colleague Peter Dowd MP for his excellent Westminster Hall debate last week, which I commend to your Lordships. It set out a compelling case on the contribution community pharmacists could make with the right support and funding and increased collaboration with GPs, a case which had strong cross-party backing from supporting speakers. However, no part of the extended role we all want to see can be delivered unless the major workforce issues across community pharmacies are acknowledged, and the ongoing discussions with the Pharmaceutical Services Negotiating Committee on the current agreement and future funding acknowledge the scale of the resources needed.
On the SI, we support and welcome the aim of clarifying and strengthening the governance requirements of responsible and superintendent pharmacists. I thank the General Pharmaceutical Council for the reassurances in the note it prepared for this debate on extensive public consultation and engagement with patients, the public and the pharmacy and health sector on the rules and standards to operate under the extended remit the SI gives them.
Like my noble friend and the noble Baroness, Lady Brinton, I await the Minister’s response to the concerns of the Secondary Legislation Scrutiny Committee on the profession’s general distrust of the council on the setting of appropriate standards and concerns about patient safety if the pharmacist is absent from the pharmacy. As the committee rightly stressed, the Government need to improve on the reassurances they offered the committee. How are the profession’s concerns and reservations to be addressed? How will the Minister address the Pharmacists’ Defence Association’s deep worry that the new focus of the GPC in exercising its rule-making powers, minimising the burden on businesses, could lead to less focus on patient safety, which surely must be the council’s number one concern?
On workforce, all the excellent stakeholder briefings we received for this debate point to a crisis across the pharmacy industry. While the numbers of pharmacists on the register and of pharmacy technicians have increased, there has been a serious reduction in the numbers of students in training and of dispensary and counter staff. As we have heard, the primary care networks, with pharmacists working in GPs’ surgeries and away from pharmacies, have had a significant impact on staffing levels in high-street pharmacies, which to cover vacancies have to make increasing use of locums, the cost of which is spiralling. The Company Chemists’ Association’s estimate of a shortfall of 3,000 community pharmacies in England is not the setting or context in which any newly extended role for community pharmacies can develop strongly and flourish.
There is also the PDA’s serious concern about the pressures on staff in some pharmacies, such as unsafe staffing levels, poor pay and working conditions, long hours and suffering physical abuse from customers, which cause them to want to change jobs or leave the profession. What are the Government doing to ensure that risk assessment and preventive safety measures are in place, as well as a zero-tolerance approach when incidents occur? How can the welcome development of primary care networks and pharmacy services in GP surgeries develop hand in hand with ensuring enough staff and resources for community pharmacies to provide the quality of professional care that they want to deliver and we all want to see? How will the Government help pharmacies invest in staff training and development?
On funding, the Minister will have heard the concerns from across the House. The CCA’s estimate of funding last being increased for the sector eight years ago, in 2014, and the cuts of £200 million that it had to find two years later, paint a sobering picture of how the industry has fared. The current community pharmacy contractual framework agreed in 2019 has not been adjusted despite the pandemic and rising inflation and costs. The £370 million from the Government to meet pandemic costs was a loan, as we know from valiant attempts in this House to ensure that the industry did not have to repay it. I understand that it was repaid and then a separate admin process was established for the industry to claim back the extra costs incurred during Covid. Does the Minister have any further information on the sums reclaimed under this procedure? Can he reassure the House that the current negotiations with the PSNC on year 4 of the five-year funding agreement will include funding recognition for the extended and full role that community pharmacies need to play?
The need for an overall strategy for the primary care workforce across GPs, pharmacies and community services becomes ever more urgent, as this debate and the questions from noble Lords have clearly demonstrated. I look forward to the Minister’s response. We will fully support my noble friend’s amendment, should he put it to the vote, highlighting the vital importance of having the clear, long-term strategy and vision for community pharmacies that we have all been calling for.
Lord Kamall (Con)
My Lords, I thank all noble Lords for their contributions and once again apologise for the delay in bringing this matter before the House. I welcome the essential role that your Lordships play in scrutinising measures. I experienced that during the passage of the Health and Care Bill, and I think we have a better Act as a result of the scrutiny from across the House. I will try to address as many as possible of the points raised before I conclude. I will try to cover most of the points but I pledge to write to noble Lords if I have missed any specific points.
If we look at the overall picture of the NHS, I am sure noble Lords recognise that we seem to have more doctors, nurses and pharmacists than ever before. As someone said to me the other day, that is all very well but the supply is not keeping up with the demand. If we consider our whole understanding of health, some of the things we ignored many years ago are now things we deem as needing treatment. For example, the whole area of mental health was ignored for many years. PTSM, which people talk about now, was officially recognised only in the 1980s. I know that we will probably talk about that in the next debate.
Before a debate the other day about neurological conditions, I asked my officials to give me a list of all the conditions. They said, “Minister, there are 600 of them.” Let us think about this. We were not even aware of that previously. It shows the great complexity as we become more aware of conditions and issues, putting even more pressure on our health service and health professionals, even though we have more health professionals than ever before.
The Secretary of State recently pledged to start with pharmacies when it came to overall primary care. The community pharmacy contractual framework, to which the noble Baroness, Lady Wheeler, referred—the 2019 to 2024 five-year deal—set out a joint vision for the sector, and an ambition for community pharmacies to be better integrated in the NHS and provide more clinical services. We saw this during the pandemic when pharmacies provided vaccines and we have seen recently that they will be providing more initial advice on issues such as cancer—and they welcome this.
At the same time, we are seeing an overhaul of the overall model. It is time to move away from the old model, in which you see your GP for five minutes and then hope for a referral somewhere else. Services previously considered part of secondary care are now being taken over by primary care centres. Areas previously considered the work of GPs are now being taken over by nurses and physiotherapists, as well as by pharmacists in the community.
Despite the challenges of the last few years, we have jointly delivered the introduction of a new range of clinical services at the community level. These are important in their own right and we are negotiating with the Pharmaceutical Services Negotiating Committee on the expansion of additional services to be introduced in the fourth year of the five-year deal. I very much hope that my right honourable friend the Secretary of State will be able to make an announcement soon. Longer term, we want to build on what has already been achieved and make better use of existing skill sets and those that are developing; for example, the prescribing and assessment skills that all pharmacists graduating from 2026 will have acquired during their training.
I turn to some specific points. We now have more pharmacists than ever before. Data from Health Education England shows that we now have an additional 4,122 pharmacists employed in the community compared with 2017, and the number of registered pharmacists has increased year on year. The number of primary care pharmacy education pathway trainees coming from community pharmacy increased by nearly 2,500. Reforms to initial education and training of pharmacists means that pharmacists qualified from 2026 will be qualified to prescribe at the point of registration. On top of the £2.5 billion that we are spending on the sector, Health Education England is investing £15.9 million over the next four years to support the expansion of front-line pharmacy staff in primary and community care.
We are also supporting a significant expansion in primary care capacity through the additional roles reimbursement scheme, enabling primary care networks to recruit clinical pharmacists and pharmacy technicians, two of 15 roles that PCNs can choose to recruit to. We saw the strength and potential of community pharmacies —many noble Lords referred to it—during the Covid vaccination campaign and the role that community pharmacies played in it. It is not yet known whether recurrent boosters will be required annually. We are looking into that and whether pharmacies will be once again called on.
Noble Lords will recognise—we had this debate many times during the stages of the Health and Care Bill—that to support long-term workforce planning, we are looking first at the long-term strategic drivers of workforce demand and supply. Building on this work, we have commissioned NHS England and NHS Improvement to develop a long-term plan for the workforce for the next 15 years, including long-term supply projections. Once this work is ready, we will share the conclusions and start to home in on what it means for recruitment, skills needed and skill gaps.
A number of noble Lords raised fears or concerns about what the regulators will do with their new powers. This is understandable: community pharmacies are private businesses and increased regulatory burden will be a concern for many of them. However, once again, we have to get the right balance between regulation and making sure of safety. The proposals include safeguards to ensure that any changes the regulators make are subject to full consultation, in much the same way as is expected from the Government. This will ensure that patients, the public, pharmacy professionals and the pharmacy sector have their say on what the standards should say.
There were some concerns about remote supervision. It is important to emphasise that a lot of the issues raised today do not affect this legislation, but I completely understand the point about taking advantage of the situation to debate the wider issues.
Social Care: Adults
Baroness Wheeler Excerpts(3 years, 9 months ago)
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Baroness Wheeler
To ask Her Majesty’s Government what assessment they have made of the survey by the Association of Directors of Adult Social Services, published on 13 May, which found that more than 500,000 people in England were waiting (1) for a social care assessment, (2) for their care package to begin, or (3) for a review of their care.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
Local authorities are responsible for meeting the needs of those who require care and support under the Care Act. The ADASS survey highlights that their waiting lists are increasing, which is why we are investing to support improved outcomes and experiences of care for people and their families, including through an additional £5.4 billion over three years to begin a comprehensive programme of reform.
Baroness Wheeler (Lab)
My Lords, both the ADASS survey on social care waiting lists of 500,000 and Age UK’s estimate of 1.6 million people with unmet care needs are a stark wake-up call for the Government’s mantra of having fixed social care. The Minister knows that the official figures that he always quotes and quotes today are nowhere near enough to meet current and future demands, as key stakeholders and the expert think tanks routinely remind him. What are the Government doing to prioritise care and support in people’s homes and local communities? Does the Minister not recognise that the situation is getting worse, not better?
Lord Kamall (Con)
Many noble Lords recognise the challenges faced by not just this sector but all sectors, during Covid. One issue we have been looking at for many years, over subsequent Governments—we discussed this during the Health and Care Bill—is that social care was seen as a Cinderella service for many years. For the first time, thanks to noble Lords’ support, we managed to get the Health and Care Bill through to have a properly integrated health and care system. We are also looking at how we can make sure that we properly understand the health and care landscape, with the register and the hub, and that it is a vocation that more people find attractive.
Neurological Conditions
Baroness Wheeler Excerpts(3 years, 9 months ago)
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Baroness Wheeler (Lab)
I am very pleased that my noble friend Lord Dubs secured this important debate and grateful for his excellent speech. We know that he values every opportunity to underline the urgent need to improve services in social care for all people with neurological conditions. We have often spoken about MS, the impact the disease is having on his son and the experience of his whole family in caring for and supporting him. We also heard from my noble friend Lord Monks of his experience of the care of his son. He also spoke very movingly today.
One in three people with MS does not get the social care or rehabilitation they need to cope with the disease and be able to lead as independent a life as possible. The experience of both my noble friends over many years, sadly, reflects that. The noble Baroness, Lady Thomas, also made a compelling plea for muscle-wasting and other neurological conditions to be better and more effectively managed through timely treatment and access to rehabilitation services and specialist support, with regular access to specialist teams.
I also pay tribute to the work of the 80 charities within the Neurological Alliance. I hope yesterday’s Westminster Hall launch of its excellent survey—which I was, sadly, unable to attend—went well and received the attention and support it deserves. Noble Lords’ contributions have drawn heavily on the survey results in respect of a range of neurological conditions, including MS, dementia, migraine and Parkinson’s. My noble friend Lady Gale is always a great advocate of the work of Parkinson’s UK, but was, sadly, unable to be here today.
My special focus is on stroke, as a carer for a disabled adult stroke recoverer. Stroke strikes every five minutes in the UK and 100,000 people have strokes each year. It is a leading cause of death and adult disability in the UK, with more than two-thirds of people who have had a stroke leaving hospital with a disability. To underline the neuro survey key data highlighted by noble Lords, the one in six people in the UK who have a neurological condition have the lowest health-related quality of life of any long-term condition. One in five adults waited more than 12 months between seeing a GP and then a neurologist, and 55% experienced referral delays in routine neurologist appointments—all of which needs to change, as we have heard. The Chartered Society of Physiotherapy estimates that only 40% of people receive essential neurorehabilitation.
Workforce shortages are the biggest reason behind delays, and I look forward to the Minister explaining the Government’s specific plans to address the chronic neurological staff shortages across all key conditions. How do they account for the UK having only two neurologists for each seven that France and Germany have, and how is this situation being addressed? Does this not reinforce the urgent need for the long-term workforce plan to tackle these and other acute staff shortages, as we have been calling for? In Parliament yesterday, almost as an aside, the Secretary of State referred to work being undertaken “on a 15-year strategy”. That is the first time we have heard mention of any timeframe, so perhaps the Minister could tell us more about who is leading the strategy’s development and when it is expected to be published.
Specifically on MS, last year, NHS England’s Getting it Right First Time adult neurology report recommended that all MS teams have enough administrative staff to carry out non-clinical duties and free up clinicians’ time to treat patients. Can the Minister update the Committee on what progress has been made?
The Government’s acceptance of the alliance’s call for a UK-wide neurological task force of key stakeholders from Governments, departments, professional bodies and the voluntary sector must be a key factor in identifying how treatment, rehabilitation and social care support can be provided and improved, running alongside the strategy, resources, front-line specialist workforce and other clinicians that are vitally needed where shortages are most acute. I hope that the Minister will recognise this as a key way forward.
I have a few further points. The My Neuro Survey rightly makes much of the impact on unpaid carers and families of the lack of support available for the people they care for; a number of speakers mentioned this. In this national Carers Week, it is important that carers feature strongly in today’s debate. According to the Alzheimer’s Society, unpaid carers supporting someone with dementia save the economy £11 billion every year. On Tuesday, the Minister promised that the Government want to help carers to make sure that they are looked after while they provide a service for their loved ones. Can he say what specific immediate steps are being taken to do this?
Specifically on social care, NHS data shows that only 14% of the total social care budget is spent on people living with neurological conditions. Living well with neurological disease means getting the right home support and equipment, regular occupational and physio therapy, and eating, washing, dressing and other essential social care help. But as the latest social care directors’ ADASS survey showed, more than 500,000 people in England are waiting for a social care assessment, for care to begin or for a review of their care. Can the Minister explain how this immediate situation is to be addressed, given that the existing resources pledged for social care at best just shore up existing wholly inadequate services?
Finally, what research is being undertaken by the Government into the impact of long Covid on neurological conditions, following the two studies by Mater Hospital in Dublin that found “significant evidence” of it leading to new neurological conditions? Have the Government any further information on or assessment of this? How is this troubling link being monitored? I look forward to the Minister’s response on all these issues.
NHS: Respiratory Syncytial Virus Infections
Baroness Wheeler Excerpts(3 years, 9 months ago)
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Baroness Wheeler (Lab)
My Lords, I too thank my noble friend Lady Ritchie for her excellent speech and her tenacity and determination in drawing this important issue to the attention of the Committee. Her warning was timely when she last raised her concerns, earlier this year, about the serious impact of the Covid-19 pandemic on the epidemiology of other seasonal viruses such as flu and RSV, pushing them out of sync. It is vital that plans are in place to ensure that the NHS has the capacity and resources to cope with a potentially extended, or more than normally prolonged, winter season, in particular of RSV.
As noble Lords have underlined, raising awareness among parents about RSV and how to spot the more severe symptoms is crucial. I pay tribute to the Sanofi Pasteur Together Against RSV campaign and its excellent report from last November highlighting the costs to the NHS of RSV, which were outlined so ably by my noble friend and the noble Baroness, Lady Brinton. The Mumsnet baby health website is also doing a great job in supporting parents and linking them to the Sanofi guidance and briefings. However, the fact that its recent survey showed that 37% of parents feel that they have a lack of understanding on how to manage their child’s respiratory illness from home, while 69% have found online information from various health sources overwhelming or confusing, shows the scale of the work still to be done.
Earlier this year, the Minister assured the House that the NHS has plans in place for raising awareness of RSV among parents and at schools. I look forward to hearing the detail of those plans from him. How will be Government support the Together Against RSV awareness-raising campaign among parents? When will government guidelines be updated to adopt the much more user-friendly and accessible information provided by this campaign and parent support organisations, such as Mumsnet?
The pressures on NHS primary care from RSV in children, in terms of GP visits, hospitalisations and antibiotics prescriptions, as highlighted in the Sanofi report and demonstrated by my noble friend Lady Ritchie, are pretty stark: 450,000 GP visits, 125,000 ear infections, 416,000 prescriptions and 30,000 hospitalisations in an average UK RSV season. Hospitalisations and GP visits are substantially higher among younger children infected with RSV than among those who have flu. Last year, the British Lung Foundation warned parents of young children to be alert for signs of RSV after a sharp rise in cases. It estimated that 1,000 children in England alone had needed hospital care for it in just three months. I thank the noble Baroness, Lady Brinton, for explaining her experience with her own grandchildren and underlining how serious RSV can become, as it did in the case of her granddaughter; I am glad that she is now recovering.
Noble Lords have also underlined the global effect of RSV. Experts behind the recent Lancet study, which showed that RSV kills more than 100,000 children worldwide, believe that more children are likely to be affected in future because lockdown and mask-wearing have meant that they have little or no natural immunity to it. Again, my noble friend Lady Ritchie referred to this reduced immunity point.
In the UK, we know that 92% of hospitalisations are estimated to occur in infants under the age of two. During winter months, one in six of all UK paediatric hospital admissions are bronchiolitis-related, with RSV estimated to be the cause of 60% to 80% of those admissions. As the Sanofi guidance warns:
“It is not only the infected child who feels the burden of RSV: families, carers and the health systems are all impacted. The seasonal and contagious nature of this infectious disease has raised national concerns over the possible impact on healthcare capacity at a time when it is already over-stretched … the UK faces a future with co-circulating RSV, Covid 19 and other respiratory viruses”.
What is the Government’s latest assessment of the impact of these co-circulating viruses on primary and secondary care, and on workforce capacity?
We also know that the very young and elderly are at the greatest risk from RSV. The Government guidance points out:
“Only a minority of adult infections are diagnosed, as RSV is not widely recognised as a cause of respiratory infections in adults.”
It also explains:
“Elderly patients are frequently not investigated microbiologically, as there are fewer viruses present in their respiratory secretions compared with children.”
As a result, adult infections are underestimated. Older adults are at greater risk of serious complications from RSV than younger children because our immune systems weaken as we get older. This can lead to exacerbations of underlying lung and cardiac disease. Can the Minister explain what action is being taken to improve testing, reporting and treatment for older adults?
Obviously, the good news is that RSV infection causes mild respiratory illness for most people and can be reduced or prevented through the standard infection control measures that we all got so used to—and, I hope, permanently wedded to—for Covid, of respiratory hygiene, handwashing and cleaning surfaces. My noble friend stressed the importance of working with the devolved Governments on tackling RSV and increasing awareness of the threat it poses. I hope the Minister can reassure us on this, and on how learning, awareness-raising, prevention and treatment are being shared across the UK.
I understand from an article I read in Nature of 21 December last year that there is also hopeful news in the development of a vaccine for RSV after what researchers have called decades of failure. There are four vaccines in late-stage clinical trials involving stabilising the F protein that the RSV virus uses to fuse with cells and infect them. The structure of the F protein has been identified as the best target for making vaccine-induced antibodies that could prevent the virus entering human cells. I understand that these trials are initially testing older people aged over 60. Does the Minister have any further information on this? Can he tell us what research into and funding of RSV are currently taking place?
This has been a valuable debate, and it is clear that there must be action to stop the rampant spread of RSV post Covid—especially this coming winter—causing poor health, soaring costs for the NHS and particular threats to young children. I look forward to hearing the Government’s future plans for addressing this infectious but not widely known about virus.
GP Access
Baroness Wheeler Excerpts(3 years, 9 months ago)
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Lord Kamall (Con)
I thank my noble friend for that question and for highlighting the role of community diagnostic centres. When we look at the backlog and the waiting lists, about 80% of the waiting list is for diagnosis, not necessarily surgery. Of course, once they have been diagnosed, some of those people will require surgery. After that, about 80% of those who require surgery will not require an overnight stay. They can be daily in-patients, as it were. The role that CDCs will play in trying to tackle that backlog is to encourage more diagnosis in the community, so rather than people having to go to NHS settings, diagnosis will go to the people in shopping centres and football stadiums.
Baroness Wheeler (Lab)
My Lords, this is national Carers Week, and I am sure the whole House will want to pay tribute to the tremendous work our 6 million unpaid carers do, often at great cost to their own health and well-being. This week’s Carers UK survey highlights the alarming neglect by carers of their own health, be it mental health conditions, long-term illness or disabilities, or putting off treatment because of their caring duties, like the carer who delayed a hysterectomy for five months because of the urgent care needs of the loved one she was caring for. The Carers UK survey shows that only 23% of carers are offered health checks for themselves when they phone the GP’s surgery to make their loved one’s appointments. Rather than just flagging up on the system that a person is a carer, what action will the Government take to ensure that GP surgeries are able to do much more to monitor carers’ health and well-being and what guidance will be issued on this important matter?
Lord Kamall (Con)
The noble Baroness raises a very important point, as does the noble Baroness, Lady Pitkeathley, who frequently champions the role of unpaid carers. The new model of primary care is taking on some of the services that were previously provided by secondary care, and it will be a more modern, networked service. Clearly, part of that mix, not only in primary care but at the ICS level, will be how we make sure that we have a proper integrated health and care system and how we can help carers and make sure that they are looked after while they provide a service for people.
National Institute for Health and Care Excellence
Baroness Wheeler Excerpts(3 years, 10 months ago)
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Lord Kamall (Con)
I think my noble friend will find that lots of departments and lots of public bodies are working within budgets at the moment, given the financial situation. NICE is very aware of this, and has looked at how it can do more with the same money to increase capacity and be more responsive.
Baroness Wheeler (Lab)
My Lords, NICE is a critical participant in the Innovative Licensing and Access Pathway, launched over a year ago. It aims to make use of regulatory freedoms post Brexit to speed up access for NHS patients to new drugs, including cancer treatments. Can the Minister tell the House how many treatments have been or are being considered through ILAP and when we might expect to see the first ILAP treatment being made available on the NHS?
Lord Kamall (Con)
I know I have the answer here somewhere but I cannot find it, so I commit to write to the noble Baroness.