Pandemic Preparedness

Debate between Baroness Wheeler and Lord Markham

Monday 15th April 2024 Lords Chamber

[Lord Markham (Con)]

We definitely look to work closely with our colleagues, and I have spoken to my Health Minister counterparts on this. One of the lessons from the pandemic was that you also need to have your own capability. The work we have done on the100-day mission, and the strategic relationship we have entered into with Moderna—which can develop vaccines in as little as four to six weeks to answer some of those unknowns—is very powerful.

[Baroness Wheeler (Lab)]

My Lords, it is now two years since the UK Health Security Agency replaced Public Health England. As we await the Science and Technology Committee’s report on the threat caused by zoonotic diseases such as Covid, avian flu and Ebola, can the Minister update the House on the progress the agency is making in building resilience in these areas? It reported last year on global work on developing pandemic-fighting tools but not on the nitty-gritty needed to tackle underlying problems still hampering us, such as tackling widespread health inequalities, building systems for vaccine resistance and raising public awareness of the threats we all face.

[Lord Markham (Con)]

I thank the noble Baroness. The UKHSA has been working and there are four main areas we want to be responding on. First, there is the vaccine, and the 100-day mission is all about making sure that we have the vaccines quickly. We have 100 million vaccines prepositioned for flu and 250 million for other diseases. Secondly, there is the manufacturing scale-up. We have a fund in place so that we have UK domestic production capability to produce vaccines quickly. Thirdly, there is the stock of PPE, and, fourthly, there is the diagnostic capability. That is how the UK Health Security Agency is making sure we have all the bases covered.

Stroke Treatment

Debate between Baroness Wheeler and Lord Markham

Wednesday 27th March 2024 Lords Chamber

[Baroness Wheeler]

To ask His Majesty’s Government what steps they are taking to improve treatment and care for those of working age who are affected by stroke.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The Government are taking three major steps to improve treatment and care for strokes: first, a whole series of prevention measures to help avoid a person having a stroke in the first place; secondly, an updated and evidence-based stroke care pathway using AI, the latest technology in stroke rehabilitation, to maximise the chances of recovery; and, thirdly, post-stroke rehabilitation care and support to maximise the chances of recovery.

[Baroness Wheeler (Lab)]

I thank the Minister. We know that one in four strokes happen to working-age people, and that it is also a leading cause of disability. Speech and physiotherapy support after stroke is therefore vital, because it helps recover key skills such as motor functions and cognitive ability, and it can be the difference between returning to work and not returning, or giving up altogether. With serious delays across the country in getting people to hospital and scanned, and in providing the speech and physiotherapy that is needed, and with chronic staff shortages across the country in hospital and community settings, good care is just not the reality for thousands of stroke sufferers. Some 40,000 people missed out last year on essential six-month, post-stroke reviews. When will the up and coming major conditions strategy be published? How will it specifically support effective stroke rehabilitation and recovery, and what timescales will be set for that?

[Lord Markham (Con)]

I thank the noble Baroness for her tireless work in this area. As she quite rightly points out, aftercare and rehabilitation is the vital third leg of the three-step process I spoke about. In the major conditions strategy we talk about how we are basing it on a national model for an integrated stroke care service, based around personalised, wraparound care, for as long as is needed, with reviews every six months. I have seen some fantastic examples when I have been out and about, such as in Royal Berkshire and Leighton. The proof of the pudding is in the results; we have seen the number of people who are achieving a full recovery increase from 16% to 48%. That is the target we are going after.

Sodium Valproate and Pelvic Mesh

Debate between Baroness Wheeler and Lord Markham

Monday 25th March 2024 Lords Chamber

[Lord Markham (Con)]

Again, these are difficult areas. My understanding is that we are working from the conclusions of the expert working group in 2017, and its review of all the evidence was that it could not find a causal link between Primodos and the impact it had during pregnancy. This was again reviewed by the MHRA when more information was brought up in the last year. So I am afraid that, as we stand today, the evidence is not there that suggests that causal link.

[Baroness Wheeler (Lab)]

My Lords, the Patient Safety Commissioner’s report is all the more valuable because it is drawn from patients’ experiences, including physical, psychological and emotional impacts and their daily struggle with accessing health and other key services such as social security benefits and special educational needs support for the valproate-harmed children they are raising. What is being done to support mothers and families as they cope with the indecision and delay over the Government’s response to the commissioner and await the vital support they need?

[Lord Markham (Con)]

We have completed four of the initial recommendations in the report of my noble friend Lady Cumberlege, and another three are in process. The most important of those, to answer the noble Baroness’s question, is the setting up of these nine specialist centres which can provide the support needed, not just in terms of redress surgically or treatment-wise but in terms of the support that people need to help them cope with the issues.

NHS: Dementia Commission Report

Debate between Baroness Wheeler and Lord Markham

Thursday 22nd February 2024 Lords Chamber

[Baroness Wheeler]

To ask His Majesty’s Government what actions they are taking in response to the NHS Innovation and Life Sciences Commission’s Dementia Commission: 2023 Report.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con) (Con)]

We welcome the Dementia Commission: 2023 Report and are taking steps to address each of the recommendations. The Government remain committed to improving dementia diagnosis rates and providing high-quality care and support following a diagnosis. The Government have committed to double funding for dementia research to £160 million per year by the end of 2024-25. We welcome all research that will help us to improve how we diagnose and care for people with living with dementia.

[Baroness Wheeler (Lab)]

My Lords, the commission’s wide-ranging and comprehensive report is very welcome, but it heavily reinforces the urgent need for radical change in the way we diagnose, treat and care for dementia patients and support their families and carers. To ensure timely, speeded-up diagnosis, the training of primary care practitioners in dementia-specific symptoms and diagnostic methods is crucial. What steps are the Government taking to strengthen general practice and community pharmacy in this regard so that individuals with dementia can receive appropriate care and support as early as possible?

[Lord Markham]

I thank the noble Baroness for this Question. As ever, I have found that one of the real strengths of being in this position is that the questioning here makes me explore an area. This has been another area which I have enjoyed and found fascinating. Early detection is absolutely key, and what I have been learning from that is that, yes, we need to arm primary care staff and a potentially vital front line in terms of primary care staff are opticians, because retinal scans are a really good way to early diagnose. Apparently, people more than ever will have a frequent eye check. I have pulled together a panel to understand this more, and I invite the noble Baroness and others so that we can look at the latest research and really understand this more.

Care of Critically Ill Children

Debate between Baroness Wheeler and Lord Markham

Monday 29th January 2024 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is correct: the number of young people with life-limiting conditions has gone up, from about 33,000 around 2001-02 to about 87,000 more recently. A lot of that is, conversely, good news in that we have more and more treatments that can keep these children alive for longer. Clearly, that requires the wraparound-type service that the noble Baroness is talking about. It is the responsibility of the ICBs to provide that; I will provide details of the progress of individual ones when we meet.

[Baroness Wheeler (Lab)]

My Lords, I emphasise that the task force recommended by Nuffield to oversee its key recommendations needs to get to work urgently. The family-focused research work with parents, including parent carers, about their experiences of shared decision-making with healthcare professionals on care and treatment, is vital, as is the comprehensive information and guidance for parents and staff that is called for across the 16 Nuffield recommendations. What timescales are the Government envisaging for this crucial work to commence and become operational, including guidance to clinical and ethical committees?

[Lord Markham (Con)]

My understanding, now that the task force composition has been set up, is that this will be arranged shortly. I completely agree with the noble Baroness that these are important, as well as often heart-wrenching, matters, so urgency is required. As I have said, good progress has been made in a number of areas. Already, the MoJ is setting up a round table on this. The regional conflict managers have been established. We have training courses online so that communication can improve. A lot is being done, and the task force will push that forward further.

Care Home Staffing

Debate between Baroness Wheeler and Lord Markham

Thursday 18th January 2024 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, the Minister told the House on Tuesday that hospital discharges have recently been reduced by 10%. However, he knows that this figure goes up and down as some people leave hospital while more come in at the other end, and it depends on which period of time is measured. From July to November last year there was in fact a steady rise, so we need to be specific about dates when we talk about making progress. On the care settings that patients are being discharged to—care homes—how are the Government keeping track of how the extra funding allocated to deal with chronic local staff shortages has supported the discharge process? Will it continue in the longer term?

[Lord Markham (Con)]

The noble Baroness is correct that the numbers are a result of flow. We are seeing thousands more people hospitalised through A&E, so the fact that we have managed to reduce the back end indicates a positive way forward. To measure precisely what the noble Baroness asked about, we have now set up a kind of flight control system for each integrated care board, as I have mentioned, which looks at data across the system to monitor the number of hospital beds and places needed on a case-by-case basis. The noble Baroness is absolutely correct that having that data is key.

Adult Social Care: Staffing

Debate between Baroness Wheeler and Lord Markham

Tuesday 12th December 2023 Lords Chamber

[Lord Markham (Con)]

I will absolutely clarify the number to the noble Lord in writing. It is of course a range, according to different local authorities, but I think we would all agree that it is a level that, as a percentage, is too high.

[Baroness Wheeler (Lab)]

The Nuffield Trust has called the NAO findings a

“damning indictment of the Government’s progress towards delivering social care change”.

To follow on from my noble friend’s question, the NAO points out that only 7.5% of the much vaunted £265 million allocated by the Government to addressing social care staff shortages and recruitment for 2023-35 has actually been spent, heavily impacted by the DHSC’s staff recruitment freeze. What specific actions are the Government taking to address this and ensure that the money they say is there is actually paid out?

[Lord Markham (Con)]

There were five parts to the programme of reforms mentioned and the £265 million. There was international recruitment, which we have done; it has worked well, and we need to continue doing that. The second part was a volunteer programme, which, again, we have done and it is working well. Thirdly, there were digital skills passports, so that staff could swap from place to place and take their qualifications with them; we have done that. The two other things will take longer. The care workforce pathway is out for consultation. It will mean that people can have a long- term qualification that can get them into other professions as well, such as nursing. Lastly, there is the care certificate qualification. That takes time. Everyone knows that, for that qualification to be meaningful, it will take time to set it up. That is the key expense item. The digital platform is going to be launched next June, so it will be rolling out from there.

Adult Social Care

Debate between Baroness Wheeler and Lord Markham

Wednesday 22nd November 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend is correct, in that having so many local authority and private sector providers means it is a confusing space in which to bring all this together. The People at the Heart of Care White Paper is trying to co-ordinate that and at the same time provide a career structure, because we know that the bedrock of all this is the staffing, and this needs to be an attractive space for people to work in. Therefore, giving them that recognised, transferable qualification which they can take into nursing and other areas as needed is vital in ensuring that we have the workforce to underpin this.

[Baroness Wheeler (Lab)]

My Lords, the NAO’s recent figures show that so far, only 7.5% of the much-vaunted £265 million allocated by government to addressing social care staffing shortages and recruitment for 2023-25 has been spent due to the DHSC staff recruitment freeze; and the training workforce development programme has also stalled because the department has not managed to set up the necessary systems to administer provider payments. What is the Minister’s response to this and the ADASS survey finding that government investment in social care so far has just stopped the ship sinking and has not moved local authorities out of the storm they are trying to navigate?

Autism: In-patient Care in Mental Health Hospitals

Debate between Baroness Wheeler and Lord Markham

Tuesday 14th November 2023 Lords Chamber

[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.

[Baroness Wheeler (Lab)]

Thankfully, my Lords, understanding of and support for autism have changed substantially since the now 40 year-old Mental Health Act, especially about being clear on what an autism-friendly environment looks like and should be, although sadly that is not often found in mental health settings and ATUs. Did the Government’s decision to abandon the new mental health Bill this Session include an assessment of the impact this would have on patients? This is particularly urgent now that changes to the code of practice, recommended by the excellent report on long-term segregation by the noble Baroness, Lady Hollins, will not be considered until we deal with the Bill. How and when will the Government deliver the significant changes needed?

[Lord Markham (Con)]

I think we are all agreed on the action; there was was an intensive and involved process by the whole House when it came to agreeing the action. That is why I am keen to ensure that we implement as much of it as possible that does not require legislation, which we are doing. I am happy for the noble Baroness to join me at the meeting with the noble Baroness, Lady Hollins, when we can look at the practical steps to see what is possible.

Children’s Hospices: Funding

Debate between Baroness Wheeler and Lord Markham

Tuesday 14th November 2023 Lords Chamber

[Lord Markham (Con)]

Yes, absolutely. Again, there is a balance we are trying to get over here, because we are all agreed on the importance of what they are trying to do. At the same time, we believe that ICBs, generally, are the right people make provision at a local level, because they know best what is required in their area. Clearly, where it makes sense for them to band together, that has to be sensible.

[Baroness Wheeler (Lab)]

My Lords, most of us will have the amazing work of our own local children’s hospice in mind today in response to this Question. Ours in Surrey is the care and support that the Shooting Star Children’s Hospices provide for babies, children and young people with life-limiting conditions, and their families. We fully support the children’s hospice grant going directly to a hospice. It is the most cost-effective way; it overcomes the patchy performance of many ICBs and their CCG predecessors on hospice funding, and it avoids hospices having to engage with multiple ICSs when their services go across areas. What actions are the Government taking to ensure that ICBs meet the NICE standards in supporting children’s hospice care and against ICBs that have made no attempt to access the current grant arrangements?

[Lord Markham (Con)]

As I mentioned, it is a statutory requirement for every ICB. NHS England is responsible and is reviewing those arrangements in all 42 trusts. At the same time, this is an element which the CQC follows up to ensure that care is in place. I echo the House’s feelings that the results of the voluntary sector and the hospices are excellent. We need to ensure they get the proper support.

Paediatric Care: Wating Times

Debate between Baroness Wheeler and Lord Markham

Monday 16th October 2023 Lords Chamber

[Baroness Wheeler]

To ask His Majesty’s Government what recent assessment they have made of the impact of the length of waiting times for paediatric care on children’s developmental outcomes.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

Cutting waiting lists is one of the PM’s top five priorities, and we are aware that waiting times impact more developmentally on a younger person’s life. Given this, we are committed to ensuring that babies, children and young people are prioritised in integrated care systems, and that the reforms in the Health and Care Act 2022 to improve child health and well-being outcomes are delivered on the ground.

[Baroness Wheeler (Lab)]

My Lords, the Academy of Medical Royal Colleges has described sick children as the

“forgotten casualties of the NHS’s waiting list crisis”

across hospital and community health. NHS data shows that over 220,000 are waiting for children’s and young people’s services, including paediatrics, autism spectrum disorder diagnosis, health visiting, and speech and language therapy. Even worse, almost 20,000 have been waiting over a year—that is 8% up on the previous month. What action are the Government taking specifically to address this appalling situation, and what cross-government measures are in place to try to mitigate the huge knock-on impact on children’s education, health and well-being, and on their families?

[Lord Markham (Con)]

I thank the noble Baroness for bringing this question up; this is an important area, and we all know that a year in the life of a child aged 10 is a lot more impactful than it is to a 60 or 70 year-old. It is a question very well put. Since receiving this Question, I have been working on it with the department and talking to the relevant Ministers about what we can do specifically. We are expanding capacity generally through the CDCs and the 95 surgical hubs designed around this space, but we are putting in measures with ICSs and tiering to make sure we are specifically addressing children’s wait times as well.

Nursing Courses: Reduction in Applications

Debate between Baroness Wheeler and Lord Markham

Tuesday 19th September 2023 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is quite correct that mental health is a particular case in point. When we introduced the £5,000 grant for all nurses each year, we gave additional add-ons, and mental health nurses get an add-on in addition to that £5,000 a year. We also increased the travel and accommodation costs allowance by 50% to cater for those who have to travel far and wide.

[Baroness Wheeler (Lab)]

My Lords, the figures on overall declining numbers are concerning, particularly since this is the second successive steep fall, with, as the Minister said, the Department of Health relying on the UCAS clearing system and future nurse apprenticeships to try to make up the numbers. What changes does the Minister consider need to be made to the NHS workforce plan in the light of escalating problems with both the recruitment and retention of key staff?

[Lord Markham (Con)]

I am sorry to keep coming back to the data, but it suggests a 45,000 increase, which shows that we are doing pretty well. A 20% increase across all the different fields since the pandemic also shows that we are doing a good job on recruitment. Clearly, we cannot rest on our laurels, so we need to look at all those routes in, but I do not understand why people characterise the numbers as dropping when in fact the data shows the overall increase is far greater.

National Health Service: Major Conditions Strategy

Debate between Baroness Wheeler and Lord Markham

Monday 18th September 2023 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

My Lords, the Government are providing additional funding of £3.3 billion in 2023-24 and £3.3 billion in 2024-25 to support the NHS in England. The Government have not committed further additional funding specific to the major conditions strategy. However, as part of the strategy, we will be identifying innovative actions to help alleviate pressure on the NHS and support improvement within the current settlement, such as maximising the use of new technology to screen individuals for conditions.

[Baroness Wheeler (Lab)]

My Lords, the major conditions strategy has been well received in both approach and content, particularly the focus on primary and secondary prevention as part of a life-course approach, and bringing together a strategic framework for the six major conditions that drive over 60% of morbidity in England, including cancer, heart disease and stroke. However, key stakeholders have warned that, without adequate resources, NHS trusts and other bodies will struggle to deliver, especially given their current and future focus on trying to cope with ever-escalating waiting lists. Do the Government acknowledge this and how will January’s future strategy address it?

[Lord Markham (Con)]

We are investing about 11% of the economy—£160 billion—in the NHS, and the conditions in the major conditions strategy account for 60% of all the causes of death and long-term illness. What we are really talking about is prioritising spend around prevention and personalised care, as the noble Baroness said, and channelling the money we are already investing towards those aims, on which I think the whole House agrees.

Respiratory Syncytial Virus

Debate between Baroness Wheeler and Lord Markham

Tuesday 25th July 2023 Lords Chamber

[Lord Markham (Con)]

We had this question on MMR just the other day. Some groups are much harder to reach than others. Very young children are the prime at-risk group. There, it is much easier because, naturally, they are seen by their GP and medical staff either prenatally, if it is maternal, or post in terms of the baby check-ups. The group that we are talking more about here is post 75 year-olds, and there those education programmes will be put in place.

[Baroness Wheeler (Lab)]

My Lords, the JCVI advice endorses the vaccine programme for 75 year-olds and for ages above, but we know that evidence shows that there is serious underestimation of RSV infections among older adults and an urgent need to improve testing and treatment of, in particular, those with congenital lung or heart disease or spinal muscular atrophy. What steps are the Government taking to raise awareness among these key groups and to develop information and monitoring systems that identify those most at risk?

[Lord Markham (Con)]

This is where nirsevimab is very promising, in that it gives six months’ protection. The problem with the previous jab is that it needed monthly injections and was only 50% effective. We are talking about 70%-plus effective now, which makes it more practical to have that sort of rollout. To date, we have been looking at the very targeted group of 75 year-olds only, particularly as each course costs £2,000 and has to be given monthly over the winter months. Now that we are opening up to this injection, which is much cheaper and lasts for six months, we can look at a broader range, and then there is a much more general education programme to go with it.

Stroke Care

Debate between Baroness Wheeler and Lord Markham

Monday 24th July 2023 Lords Chamber

[Baroness Wheeler]

To ask His Majesty’s Government how they are ensuring that integrated care systems across England implement recommended best practice in stroke care in line with the updated National Clinical Guideline for Stroke, published in April.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

The National Clinical Guideline for Stroke, published in April 2023, is an initiative of the intercollegiate stroke working party made up of representatives from the professional bodies involved in stroke care. National regional SQuIRe managers, who are responsible for managing stroke services, are working with integrated stroke delivery networks and newly formed integrated care systems to implement the NHS integrated community stroke service and improve the provision of community-based stroke rehabilitation.

[Baroness Wheeler (Lab)]

My Lords, the update of the national stroke guidelines is welcome, particularly its now UK-wide remit, with one of its major changes being significant expansion in the number of patients eligible for thrombolysis and thrombectomy. Given that both these powerful clot-busting interventions are most effective the faster they are used following a stroke, what assessment has been made of the impact of the current NHS delays in the expansion of their respective uses and how will the Government ensure that ICSs address the huge regional variations in both thrombectomy and in the vital post-stroke rehabilitation in hospital and at home that is so necessary?

[Lord Markham (Con)]

First, I thank the noble Baroness for the work that she does in this area; I know that it is very close to her heart. I have set up a meeting with the NHS COO David Sloman and with Sarah-Jane Marsh, and would be delighted if the noble Baroness would like to join me. The benefit of these sessions is always the shining of a light on areas.

It is vital that people are seen within the first hour; currently 59% of people are, which is an improvement on the last couple of years when the figure was 55%. However, we would all agree that we want that number to be as high as possible. The SQuIRe managers’ job is to make sure that all the different integrated care boards are delivering best practice in each area.

Healthcare (International Arrangements) (EU Exit) Regulations 2023

Debate between Baroness Wheeler and Lord Markham

Wednesday 5th July 2023 Grand Committee

[Baroness Wheeler (Lab)]

My Lords, I thank the Minister for his introduction to the SI and the other noble Lords who have spoken to it. For the record, we wanted to look very closely at it, given the discussions, commitments and reassurances made last year by the Government and the then Health Minister, the noble Baroness, Lady Penn, about the Government’s policy intentions on reciprocal health agreements during the passage of what is now the Health and Care Act.

We had strong concerns that any provisions under the Act which reflected post-Brexit arrangements should be confined to the implementation of reciprocal healthcare arrangements, not to the negotiation of international health agreements which could be used for wider and different purposes, such as the privatisation of parts of healthcare. The Healthcare (European Economic Area and Switzerland Arrangements) Act 2019 included explicit constraints to make such agreements on the powers of Secretary of State in this regard. We also had concerns that the new arrangements should not change the definition of future reciprocal healthcare agreements.

Reassurance from the Government that the purpose of the 2019 Act was not to implement trade deals and that reciprocal healthcare agreements do not relate to the commissioning and provision of services for the NHS were very welcome. We are therefore content that the SI properly reflects this; I thank the Minister for his reassurances in his opening remarks. We are also pleased that the affirmative procedure ensures that Parliament is able to be kept up to date with developments and that these issues are properly debated.

The Explanatory Memorandum is very helpful. I look forward to the Minister’s response to the issues raised by the noble Lord, Lord Allan, about scope, because they are important.

We recognise that the regulations are vital to implement international healthcare agreements following our exit from the EU. Reciprocal healthcare agreements support people to access healthcare in the listed countries. Those faced with the stress and worry of a healthcare emergency abroad will rightly expect suitable arrangements to be in place where possible. That is particularly true of people with a disability, those who are older or who live with a pre-existing or chronic health condition.

The amendments to the Act allow the Government to implement more complex agreements with the ability to make financial reimbursement at cost, as the UK currently does with many EEA countries, and confer further powers on the Secretary of State. Can the Minister outline further details about the Government’s plans for other international healthcare co-operation outside the EEA and Switzerland and what these plans might look like?

From our understanding of the SI, we think that payments can be made only if both the following conditions are met: the healthcare treatment is in a country with which we have an international healthcare agreement, and the Secretary of State considers that exceptional circumstances justify the payment. Can the Minister explain the Government’s thinking on what would constitute exceptional circumstances and how the policy framework might work? What guidance is being issued by the NHS Business Services Authority, which has certain administrative functions conferred on it through the SI?

The public consultation on the policy has just closed but we understand that the results and an analysis of it will be published this month. An early indication of the timetable and results would be welcome.

On the role of the NHS BSA, can the Minister provide more detail on the work currently undertaken to establish and maintain the public information and advice service on healthcare provision under relevant healthcare agreements, as set out in the SI? Again, the noble Lord, Lord Allan, mentioned this important function. The importance of transparency has been underlined. It will be crucial in the future to help people understand how reciprocal healthcare agreements work and can be accessed, to ensure they are doing all the right things to be properly covered, and to make claims, as the noble Baroness, Lady McIntosh, said.

I look forward to hearing answers to the questions about the issue of EHIC and GHIC. Specifically, can the Minister update the House on how the transfer from EHIC to GHIC has worked and whether any complications have been experienced—for example, the impact of the non-application to the UK of the EU cross-border healthcare directive, which enabled UK patients to pay for qualifying private healthcare in Europe and to receive reimbursement up to the amount that the treatment would cost the NHS? UK travellers can now no longer seek reimbursement, and I wondered if there had been any instances where the lack of awareness of that has caused problems—for example, for patients needing kidney dialysis where reimbursement for private treatment has not been allowed.

I appreciate that the Minister might need to come back to me on that. I think we are about to have a vote, but I look forward to his response.

[Lord Markham (Con)]

I will try my best, potential votes notwithstanding. I thank noble Lords for their contributions to today’s debate and for the generally received welcome. To try to answer them in turn, on the point made by the noble Baroness, Lady McIntosh of Pickering, I believe the arrangements made with the EFTA countries were signed on 30 June 2023. The expectation is that they will become operational by the middle of 2024—saved by the bell.

Dementia Palliative Care Teams

Debate between Baroness Wheeler and Lord Markham

Thursday 15th June 2023 Lords Chamber

[Lord Markham (Con)]

Dementia is an important part of the major conditions strategy and obviously there will be more coming out of that going forward. As I said, the Health and Care Act made the ICBs firmly responsible. Some are excellent examples, such as Derbyshire; for the others that are not, it is very much our responsibility in the centre, and I include Ministers in that. I have mentioned before that each of us has six ICBs that we look after, and part of our job is making sure that they are commissioning to the standards they need to.

[Baroness Wheeler (Lab)]

My Lords, the ONS figures showing that dementia and Alzheimer’s were the leading cause of death last year make it even more urgent to get dementia palliative care right. Given average life expectancy in care homes, what steps are the Government taking to ensure the Care Quality Commission has sufficient oversight of end-of-life care for people living with dementia?

[Lord Markham (Con)]

It is absolutely one of the things that it has to do. We are at the forefront of this. We are backing the Dame Barbara Windsor Dementia Mission, and have doubled the funding to £160 million to make sure we are doing more research in this space. There is a lot more to do but there are a lot of good examples of work as well.

General Practitioners: Recruitment and Retention

Debate between Baroness Wheeler and Lord Markham

Monday 12th June 2023 Lords Chamber

[Lord Markham (Con)]

The primary care plan was a very good example of something new, substantial and backed by £1.2 billion of investment to beat the 8 am morning rush and use technology—which I know the noble Lord is very interested in—to allow people to self-help in a lot of these situations.

[Baroness Wheeler (Lab)]

The Minister will know that the Health Foundation independent think tank summed up the Government’s recent primary care recovery plan as falling

“well short of addressing the fundamental issues affecting general practice”.

Staff shortages and the sheer number on NHS waiting lists are a key reason for such high demand on GP services. Do the Government accept that, unless they urgently get a grip on waiting lists, the crisis in general practice will only deepen?

[Lord Markham (Con)]

What we totally accept and believe is that primary care is where a stitch in time saves nine, to take that saying. That is why I believe that the primary care plan is a big step forward. As I said, the fact that we are doing 10% more appointments per day is significant, as is the Pharmacy First initiative that we have announced, which will bring on stream another 10 million appointments a year, allowing people to navigate whether a pharmacy is the best place for them to get treatment, in which case they can go there first. These are all practical plans that are in place and are making a difference.

Mental Health Services: Huntington’s Disease

Debate between Baroness Wheeler and Lord Markham

Monday 12th June 2023 Lords Chamber

[Lord Markham (Con)]

I have learned in the process of researching this that it is absolutely vital that commissioners understand what the patient pathway needs to be in each area. That is why we have tasked the NHS with a neuroscience transformation programme to set out those care pathways.

[Baroness Wheeler (Lab)]

My Lords, we know that people living with Huntington’s disease, and their families, are faced with significant challenges throughout their lives. Many young people grow up in the shadow of the disease, are caring for their relative while worrying that they will get the disease themselves, and often face daunting choices around starting a family and genetic testing. All this underlines the need for mental health care and support for all the family. What steps are the Government taking to ensure that NHS mental health trusts take a whole-family approach to this vital issue?

[Lord Markham (Con)]

The noble Baroness makes a very good point; it is a whole-family problem. The investment we are talking about, in allowing us to access 2 million extra mental health patients, is about making sure we have got the numbers. The digital therapeutics are another way we are making sure there is access. The specific point the noble Baroness makes about looking at the families of people with Huntington’s disease is a good point that I will take back.

Medical Devices (Amendment) (Great Britain) Regulations 2023

Debate between Baroness Wheeler and Lord Markham

Monday 5th June 2023 Grand Committee

[Lord Markham (Con)]

Yes; that is what I mean by pooling capacity, for want of a better phrase. My noble friend is saying that we can effectively use the EU’s capacity if we are willing to accept that it is doing proper scrutiny and measurement of products. By and large, we would all agree that that is a sensible approach, just as, similarly, there are situations in a lot of clinical research where, even if the regulators want a final sign-off, accepting each other’s data has to be sensible in terms of pooling capacity.

As ever with these things, it takes two to tango. We need to prove willingness on our side. I hope that the recent Windsor Framework agreement is a way to put things on a co-operative basis. Building trust on both sides takes a series of steps but we are trying to put our best foot forward and we hope that that is met in response.

This goes to the point about the EU-wide shortage of approved body capacity, which impacts us all. If, as we all agree, we want the best supply of products here, it must clearly be a concern if they cannot get through that way. If a company is finding that, through a lack of capacity, they cannot get through the EU route because there is no capacity there, it now has the opportunity to take the UKCA route if our capacity is in place, with the increases to the MHRA to which I referred.

[Baroness Wheeler (Lab)]

When the Minister writes—I understand that this is very complex; I would certainly appreciate having it in writing—could he refer to three things? The first is small businesses; the SI says that it will not have an impact on them but it is clear that it will. When? The second is the timetable for the new MHRA framework being in place, whether there will be consultation around it and whether that process is separate or uses the consultation that took place last year. The final issue is that of the timetable for the new MMD regulations—that is, the timescale by which we will see them coming along. It will help us make sense of the totality of this if we know when all this work is coming forward.

[Lord Markham (Con)]

It is probably best if I write on those points. In terms of timing, the MHRA is planning a further consultation on its future regime from October, but I will come back on those other points.

Sodium Valproate

Debate between Baroness Wheeler and Lord Markham

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

The regulatory authorities absolutely work closely here. It is my understanding that it is the intent of all the devolved Administrations to make sure that while there are circumstances in which this drug might be the correct treatment, as I mentioned, it is used only when everything else has been tried—and, in our case, in England—that two independent specialists will be required to prescribe it.

[Baroness Wheeler (Lab)]

My Lords, ensuring that patients’ decisions are based on informed consent and shared decision-making with their doctors and pharmacists is vital, especially in relation to the exception to ensuring that valproate is always dispensed in its original packaging. What steps are the Government taking to raise awareness among the health professionals involved and ensure that there is a properly joined-up approach to the advice and treatment given to the patient? How is data collection on this issue being improved, so that the effects of the safety measures and issues can be fully identified and addressed?

[Lord Markham (Con)]

The noble Baroness is correct. In terms of data, it is vital: first, that we have a register of all the people who are taking valproate so that we can be sure that the information is there; secondly, that we then keep a record of where patients have signed the annual acceptance; and, thirdly, that we are gaining data on testing. The latest suggestion is that we should also be looking at males taking valproate because there is evidence that it can, through their sperm, cause difficulties in pregnancies. On all those factors, data is central and we should make sure we collect it.

New Hospitals

Debate between Baroness Wheeler and Lord Markham

Thursday 25th May 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, when I worked in business we had a maxim that we should always try to undercommit and overdeliver as a way of pleasing clients. It feels like the opposite is applying here, with the Government scrambling to show that they are not underdelivering on their overcommitment. Of course, 40 hospitals was a classic election promise, oversimplifying a much more complex need, with the reinforced autoclaved aerated concrete hospitals being one of those such complications that emerged once they had turned over the aerated concrete block.

I do not expect the Minister to comment on the election promise, but I hope he can comment further on three aspects of the Government’s programme that he has set out. The first is the modular hospital design approach, which certainly seems a very smart way to proceed if it can provide more and better-quality hospital capacity at lower cost. Of course, any negative impact of failures in design will be multiplied if you are using a similar, consistent design. We should remember that RAAC was the future once, and public buildings were built according to that specification because it was seen to be cheaper and better back in the 1950s and 1960s. What assurances can Ministers give us that they will get it right this time and that the modular approach being used everywhere is the right one? By the way, on branding, 2.0 is now very 1.0, and it might be more appropriate to call it “the metahospital” or “Hospital.AI” these days.

The second is the planning process, which the noble Baroness, Lady Wheeler, raised. It does not matter if the modular design allows much quicker construction if everything is held up in seeking the relevant permissions to build the hospital in the first place. I would be interested to hear how many of the schemes have been given planning permission already and the extent to which the Government see planning as potentially a disruptor to their plans.

Finally, on the risks, if there are delays or cost overruns, which we hope there will not be—but inevitably one sees those with schemes of this kind—I look for assurances from the Minister that the contracts are written in such a way that any additional bills will not fall back on the taxpayer and, crucially, that if some schemes overrun or get into difficulties and incur extra costs, it will not mean that other schemes in the programme have to be cancelled as the overall budget runs short.

[Lord Markham (Con)]

I thank noble Lords for their comments. On a personal front, this is a project I have been working on directly. It is very close to my heart and is something that I am delighted to be able to put forward. I would like to mention a couple of hospitals that probably did not get quite the prominence they deserved in the earlier Statement, which happen to be quite close to my heart as well: the North Manchester General Hospital, which is one of the Cohort 3 hospitals. I have worked closely with Manchester City Council in the past on the redevelopments around Manchester Mayfield, and that is very much part of the plans. Also, being an ex-deputy leader of Westminster Council, I am excited by the plans around St Mary’s, where we are looking at a couple of alternative sites. That will be in conjunction with the plans for the refurbishments of Charing Cross and Hammersmith so we have got three hospitals in one. Just to clarify an earlier statement: the surgical hub is planned for Chorley and South Ribble Hospital rather than the Royal Preston Hospital.

I am not quite sure on the point from the noble Baroness, Lady Wheeler, about the target being abandoned. What we were saying before was not that at all. We were saying we are positive about how it is progressing. To the point from the noble Lord, Lord Allan, about overpromising and underdelivering, I am sorry for the branding of the hospital 2.0 approach, and I take the blame for that. In terms of MMC, I was at one of the plants the other day, and it really is amazing the way its builds them and the speed with which they will go up. Many buildings have built like that for a long time. When I was up there, I saw them constructing the new Everton stadium, which is just one example. I believe that they will give the necessary speed we need for them all.

In terms of the funding, the estimate, as mentioned, is more than £20 billion. Each hospital has an indicative allocation. They are fully funded. We are not publishing them for obvious reasons: when you go out to tender, you do not want to tell the marketplace what you are expecting to pay. I hope noble Lords understand the reason for that. I am confident that the funding is in place. The hope in all of these things, as we have seen in the prison space and the schools space, is that if the first hospital costs £100 to build, the next one costs £95, the next one £90, the next one £85 as you get the economies of scale. So, you should be seeing 20% to 25% reductions, as you do a large production line. The benefit of all this is that there is such a mass volume of them all that you get the economies of scale. I genuinely hope that this will become the way we build hospitals for generations to come. It is very much cross-party, something that we all believe is a good way forward.

Some hospitals, as mentioned—as part of the timing and to try to make sure it all works in terms of the funding envelope—have been pushed into the 2030-35 bracket. They were mentioned in the Statement, and we have been speaking to them about that. They include Eastbourne, the Royal Berkshire, all the ones around St Mary’s with the complications there, Lancashire and Charing Cross to name just a few. In all those cases, they understand the reasons, and I think most people understand the need to prioritise the RAAC hospitals as a matter of absolute urgency.

On the questions about the planning process, we are on target. Obviously, you do not want to get planning permission too early, given the time it takes. In all the programmes I have seen, we do not yet have planning permission because we do not yet need it. I am confident that we are on track. We know that there are always X factors in these types of projects but, when you have so many, you want the flexibility to move some forward and some back, in a portfolio-type approach. That is well known when you are running as many projects as this.

At this stage, in all honesty I can say that we are as confident as we can be that we are on target to build them. Undoubtedly, there will be bumps in the road, and we are grown up enough to know that there are challenges, but I can say with a high degree of confidence that this really is the best approach. We will have world-class hospitals that will be state of the art, not only in their design but in their use of digital technology. A hospital today that is fully digitised costs 10% less per patient. With these hospitals, we should be looking at savings of 20% or more. That will really make a material difference to how we treat patients, increase productivity and be seen as the real way forward. I am very hopeful that the economics will become so compelling that this programme will not stop at 40 hospitals—in fact, 45, because of the extra ones we have brought in—and will become a rolling programme across the whole estate.

I am sure that we will have many more questions on this. As I say, it is my pet subject, as the priority lead, so I would be happy to talk about it in greater detail at a suitable juncture.

[Baroness Wheeler (Lab)]

Can the Minister say something about NHS maintenance costs, which I did ask about? I do not have the actual question in front of me, as my speech has just been taken away, but if he would like to write to me on that, it would be helpful.

[Lord Markham (Con)]

Yes, I will happily write. We are spending a record amount in capital. The current capital budget is about £12 billion, which is a 50% increase on 2019. Speaking of underpromising and overdelivering, believe it or not, we have been hiding our light under a bushel regarding the hospital upgrades. Just this morning I visited Frimley, one of the RAAC hospitals, and they said, “Oh, we’ve just had a new hospital at Ascot”. We have not called that a new hospital but they refer to it as such, and when you see it, it is a new building. It is not massive, but by most definitions it is a hospital.

I will happily provide that extra detail and information. We know that there is a lot to be done on maintenance, but we are putting more resources into it.

Branded Health Service Medicines (Costs) (Amendment) Regulations 2023

Debate between Baroness Wheeler and Lord Markham

Thursday 25th May 2023 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, I thank my noble friend for his usual expert and comprehensive explanation of his regret Motion on this SI, which is so important for the future of the NHS and the UK’s pharmaceutical industry and life sciences sector.

While the Government’s argument for maintaining equivalence between the two schemes makes sense, we certainly do not want companies to choose to leave the voluntary scheme for better rates. We on these Benches fully recognise the strong concerns about the impact and potential damage that the 27.5% clawback rate will cause to the manufacturer of branded medicines, to the availability of those medicines to the NHS and its patients and to future investment in the research and development of new drugs.

I point out that this is the first opportunity, on such an important subject, that we have had to discuss in depth the key issues my noble friend and other speakers across the House have raised, since the short Grand Committee debate last October on pharmaceutical research and development spending. The Minister will recall that it was his first debate as Health Minister and that he surprised us all by bursting into maiden speech mode when he summed up the debate. He expressed his confidence that the Government

“through Life Sciences Vision … will develop the end-to-end improvements required to attract an ever-growing proportion of pharmaceutical investment to the UK”.—[Official Report, 13/20/22; col. 135GC.]

He also made the acknowledgement that growing the UK’s proportion of global pharmaceutical investment meant improving

“every aspect of the life science ecosystem”.—[Official Report, 13/20/22; col. 133GC.]

As my noble friend and other expert speakers have shown today, this is just not happening.

The continuing dramatic decline in the UK’s share of global pharmaceutical investment is clear evidence of this, causing the loss of billions of pounds to the industry over the past 10 years. We have heard the stark figures. The NHS faces huge challenges and obstacles to becoming an effective innovation partner in supporting the access to and uptake of new and innovative drugs, which are so critical to developing better outcomes for patients and creating a thriving life sciences ecosystem. If the NHS continues to be slow on the uptake of innovative medicines and treatments, the UK could lose its position as a world leader in life sciences, particularly with the rapid advancements in biotechnology and AI.

For the UK to become a destination of choice for cutting-edge research, urgent action has to be taken to reverse the sharp decline in industry clinical research trials within the NHS and to address the standstill we have reached in developing the comprehensive strategy on patient data and research that is vitally needed. We need to balance the safeguards for patients and public engagement with the ability of accredited researchers to access the data they need to develop the valuable research at the heart of innovative medicines and treatments. What consideration are the Government giving to further embedding research within the NHS, both to underline the importance of patient participation and to allow a more direct link between health and science? During Covid we saw how, with the right drive and attitude, this can be done successfully for vaccine development, with life-saving results.

That is why the background and context of the proposals in this SI are so important. Despite the “remote” risk optimism of the impact assessment, and all the flaws that noble Lords outlined, the SI’s proposals for a substantial clawback, in 2023, of net sales income for UK biopharmaceutical companies greatly increases the risk of them reducing their current level of R&D investment. I look forward to the Minister’s explanation of how other countries that have similar clawback schemes—Ireland, Germany and Spain—managed to keep their clawback rates considerably lower than half what is proposed in the UK. This was mentioned by a couple of speakers. What assessment have the Government made of the impact these lower rates would have on investment in the UK? Why do they think that AbbVie and Lilly chose to leave the voluntary scheme?

In 2023, manufacturers of branded drugs in the voluntary scheme will be required to return almost £3.3 billion—or 26.5% of sales—to the Government, up from around £0.6 billion in 2021 and £1.8 billion in 2022. ABPI says that this means that the money spent on branded drugs has declined by 14% in real terms over the past decade, despite rising demand. The noble Lord, Lord Warner, pointed out that, overall, the savings to be made are minor when compared with the likely damage.

On the consultation exercise, I look forward to the Minister’s explanation of how 39 days of consultation over the Christmas period was sufficient to provide this. This is made even starker by the fact that 32 out of 33 respondents opposed the proposals. One thing we know businesses need in order to invest their money is certainty, but they are not getting it.

Finally, today’s discussions have made a convincing case for taking a long, hard look at the current scheme and how it is working. Negotiations are under way for the new voluntary scheme for pricing, access and growth, and we will watch them carefully. The priority must be to find a solution that allows patient access to the best-quality treatments, with good value for the NHS and taxpayer, while ensuring a fair return for the industry. We need to secure arrangements that will build confidence and provide mutual benefit for the NHS and industry. Can the Minister provide an update on the early talks or negotiations that have taken place? I noted the comments of the noble Lord, Lord Warner, about how this SI’s approach could be paused in the light of any significant developments that are likely to take place.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

I thank noble Lords for the debate, and I particularly thank the noble Lord, Lord Hunt, for bringing forward this important subject. It was clear from the contributions of noble Lords that we all want the same thing here, and this is a discussion about how best to achieve it. We all want the UK to be a

“science and technology superpower by 2030”,

as quoted by the Prime Minister. We all want a thriving life science sector, we want access to the best medicines for the NHS and we all want to ensure that the NHS is achieving value, in terms of money for the front line—I think we are united on those things. I also commend the fact that this debate was very much a discussion, so I will respond in that vein, rather than reading out a speech. I will try to discuss this from the Government’s point of view. I apologise if that means that I might not come across as quite as polished, but I would rather respond directly to the points raised.

We would all accept that we are striking a delicate balance here: between having value for the NHS—through, for example, the funding of £2.5 billion this year—and having value and making savings for frontline services, which we all want to see. While we are focusing on those, we also want to make sure that we do not go too far and damage what is, and what we want to be, a thriving sector.

The noble Lord, Lord Hunt, asked whether the Government are being complacent about this. The words of the Prime Minister, saying that he wants a negotiated outcome with the ABPI, are probably the strongest sentiment in terms of wanting a sensible, negotiated outcome. At this point, I say to the noble Lord, Lord Warner, that I am responding on behalf of the Government.

As the noble Lord, Lord Warner, pointed out, just today, the Chancellor is having a round table with the life sciences industry. That, too, is very much about getting a solution that works all the way round. Having said that, please remember that some of the comments I am making in this debate are about a balance. We are all aware that we are entering into a negotiation and obviously, in any negotiation, sides make points—sometimes at the negotiating table and sometimes publicly. Please take my comments in that vein; we want to make sure that a balance is brought to the debate.

Pharmacies: Medicines at Home

Debate between Baroness Wheeler and Lord Markham

Wednesday 17th May 2023 Lords Chamber

[Baroness Wheeler]

To ask His Majesty’s Government what steps they are taking to ensure the provision of essential services provided by pharmacies, particularly the assembly of blister medicine packs, to support the safe administration of medicines at home by patients, care workers and unpaid carers.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

Pharmacies in England do an incredible job, dispensing over 1 billion medicines every year and supporting patients with their medication. Where appropriate, that includes blister packs or other medicine adherence aids. To support patients with taking their medication, we have introduced structured medication reviews in general practice and extra support in community pharmacy. On 9 May, we announced an additional investment of up to £645 million in community pharmacies over this and next year.

[Baroness Wheeler (Lab)]

My Lords, given the urgent need to get thousands of people out of hospital and provide care and support in the community and in their homes, it is surprising that the Government do not recognise the importance of having a national or local data overview of the scale of funding for this essential core service for home care, which is being withdrawn from hundreds of chemists across the country. Hard-pressed domiciliary care workers, providing daily care to thousands of people in their homes, depend on blister packs to administer medicine safely. They will not have the time to sort out multiple medicines each day for their clients, or to risk responsibility for possible mistakes and overdosing. Are the Government saying that, in the future, it is okay for the complex task of sorting out daily medicine doses to be yet another burden placed on unpaid carers, on top of everything else that they have to do? How will people living on their own be able to cope and stay safe?

[Lord Markham (Con)]

NICE and the Royal Pharmaceutical Society are clear that they do not recommend widespread adoption but prefer a case-by-case basis. There are many examples of where blister packs are not appropriate: some pills cannot be stored next to each other, some pills need to be stored in their original packaging and some blister packs cannot have more than four pills. So it is clear that you need a case-by-case review to make sure of what is right for the patient.

Adult Social Care: Challenge Procedures

Debate between Baroness Wheeler and Lord Markham

Wednesday 19th April 2023 Lords Chamber

[Lord Markham (Con)]

First, we will respond in detail to the report the noble Baroness mentions. On funding, as I have mentioned before, the £7.5 billion over the next two years is a 20% increase and is substantial by any measure. I spoke to Minister Whately about this issue this morning, and she was at pains to say that, in terms of funding and overall numbers, everything is in place in this latest programme. Also, £600 million is being held in reserve to follow up in the areas that really need it.

[Baroness Wheeler (Lab)]

My Lords, the report underlines just how difficult the current social care system is to navigate and challenge, as we have just heard, yet it showed that fewer than two-thirds of local authorities commission advocacy services that can be accessed by users and unpaid carers to help them challenge vital decisions on care and support. The postcode lottery, the complexity of local challenge systems and the overall lack of consistency, national standards and effective monitoring prevent vital decisions about care being overturned. How are the Government ensuring that, as per the 2014 Care Act requirement, independent advocates are available across all parts of the country to help users and carers understand and access the system?

[Lord Markham (Con)]

As the noble Baroness says, it is a statutory part of the 2014 Care Act that advocacy be provided where people need such additional support. That is why we were keen to bring in the CQC to oversee local authorities, which it has from 1 April. This is one area where it will be making sure that advocacy is provided.

Gender Identity Services: Children and Young People

Debate between Baroness Wheeler and Lord Markham

Wednesday 19th April 2023 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, the Cass review interim report underlines that the expansion of gender identity services to regional centres can be successful only if the NHS can attract and engage the workforce within those centres and for crucial network secondary services. This week, however, as we have heard, we have seen just how under pressure these key services are. Over a quarter of a million children in Britain with mental health problems are awaiting NHS referral due to major shortages of psychiatrists and specialist nurses. How are the holistic, person-centred services that young people desperately need going to be provided in the continued absence of a clear government workforce strategy?

[Lord Markham (Con)]

I am glad to say that there is a workforce strategy, which, unfortunately, we have not been able to publish yet. I assure your Lordships that a lot of work is being done, and there is a lot of work in place. I would be happy to meet with the noble Baroness and go through the findings of that, because it needs to cover a lot of these specialisms.

Stroke Rehabilitation and Community Services

Debate between Baroness Wheeler and Lord Markham

Wednesday 22nd March 2023 Lords Chamber

[Baroness Wheeler]

To ask His Majesty’s Government what steps they are taking to address staffing and facilities shortages in stroke rehabilitation and community services, and to ensure the national integrated community stroke service is fully resourced to deliver personalised, needs-based, goal-orientated rehabilitation to every stroke patient.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

We are increasing the number of qualified staff and ensuring a widened pool of trained staff who can work across pathways. This will help ensure that the national integrated community stroke service is fully resourced and address the workforce challenges in rehabilitation and community services. I have raised the issue of access to appropriate facilities with the CEO of NHS England, who will engage with NHS trusts to ensure access to appropriate facilities as the pressure on NHS space abates so that physiotherapists can continue their vital rehabilitation work.

[Baroness Wheeler (Lab)]

My Lords, following my previous Question on this issue, I thank the Minister for writing to ICB CEOs on the urgent need for pre-Covid hospital and community rehab facilities to be returned to their former use. Can he tell me what timescales have been set and how this will be monitored to ensure that it actually happens? Strokes cost the NHS £3.4 billion a year and social care £2.3 billion in year 1, with another £2 billion on top of that for every subsequent year. What specific plans are there to expand the national integrated community stroke service, to ensure specialist rehab within five days of a stroke and to tackle the 68% of stroke sufferers who currently do not get an assessment, let alone rehab treatment, after hospital discharge?

[Lord Markham (Con)]

I thank the noble Baroness for her question and for her tireless work in this space. I have fortnightly meetings with the NHS chief executive. One of the matters that I regularly raise with her is the timing of the return of physio space for this. As for ensuring that we are properly rolling out the services, the national integrated stroke service guarantees people individualised programmes of work and stroke rehabilitation services, in their homes if need be.

Physiotherapy: Rehabilitation Services

Debate between Baroness Wheeler and Lord Markham

Thursday 23rd February 2023 Lords Chamber

[Baroness Wheeler]

To ask His Majesty’s Government what assessment they have made of the survey by the Chartered Society of Physiotherapy, published on 1 December 2022, which found that there was a shortage of rehabilitation services, that rehabilitation spaces had not been returned to use for physiotherapy care following the COVID-19 pandemic, and that stroke survivors were being “imprisoned at home with a bed and commode” while waiting for care.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

We welcome the Chartered Society of Physiotherapy survey and the valuable insights it gives us regarding rehabilitation services. Integrated care systems are responsible for commissioning appropriate services for their local populations. Decisions on the use of physical estates are rightly for local organisations. Rehabilitation and physiotherapy are critical to many patients’ care and recovery. For stroke survivors, the NHS aims to deliver personalised, needs-based, goal-oriented rehabilitation to every stroke survivor in their home environment.

--- Later in debate ---

[Baroness Wheeler (Lab)]

My Lords, the CSP survey paints a dismal picture of the state of rehabilitation services: overstretched and underresourced prior to the pandemic and still struggling to re-establish physio rehab services that had their staff, space and facilities diverted to deal with the crisis and with chronic staff shortages. The recent stroke audit showed that only 10% of the UK’s stroke survivors were able to access the recommended amount of rehabilitation they need. What actions are the Government taking to address this unmet demand for the vital services that will help prevent patients deteriorating and becoming more frail and vulnerable?

[Lord Markham (Con)]

I thank the noble Baroness for bringing this to our attention; again, I believe that the advantage of these Questions is that they shine the spotlight on particular areas. As the survey pointed out, there are a lot of places which, for very understandable reasons, were swapped over to Covid uses during the pandemic and which now need to be brought back into physio use. That was one of the main recommendations from the society, and we will now write to all the NHS chief executives on the back of that. As the House will be aware, I am doing some work anyway to make more space available as part of the capital programme, so this is very much on my list to make sure that we expand that space and provision.

Adult Social Care

Debate between Baroness Wheeler and Lord Markham

Monday 20th February 2023 Lords Chamber

[Baroness Wheeler (Lab)]

My Lords, on that theme, the Minister makes much of the Government’s historic £7.5 billion social care funding settlement, but he knows that it has been and remains seriously underfunded—the Health Foundation’s estimate is a £12 billion a year shortfall. As the excellent Lords committee underlines, it is no good attempting to resolve the social care crisis by providing short-term funding for more care packages while still depending on local authority council tax flexibility to raise the extra funds. Is the Minister concerned that three-quarters of the largest councils in England with responsibility for social care have been left with no choice but to raise their council tax by the full 4.99% increase, just to keep current inadequate levels of service going?

[Lord Markham (Con)]

I am aware of some of the challenges raised by funding through the local authority system—and I say that as a former deputy leader of a local authority, so I am very familiar with the situations at play there. At the same time, we have put a lot of the central funding in place to make sure the security is there. As I said, we will see more measures as Minister Whately announces them in the spring, not far from here; there will be further progress in this area.

Bread and Flour Regulations 1988

Debate between Baroness Wheeler and Lord Markham

Tuesday 7th February 2023 Lords Chamber

[Lord Markham (Con)]

I do not know the precise number; I know there are many stakeholders in this. The devolved Administrations have been involved in all of this. Part of the delay is because, once we go ahead, we have to notify the EU, because of the Northern Ireland elements of it, and that is a six-month notification. We also have to notify the World Trade Organization. All these aspects mean that this is not as quick as we would want, and then we need to let the industry have time to adjust. It is a process involving many people, but we are getting there.

[Baroness Wheeler (Lab)]

My Lords, despite their seriously delayed decision-making, the Government promised nearly two years ago that major efforts would be made to step up awareness raising of the importance of taking folic acid supplements, particularly among at-risk groups such as Afro-Caribbean women and women under 20 years old. Can the Minister tell us what actions have been taken, and what measurable impact awareness raising has had among these risk groups and on ensuring that women whose pregnancies were unplanned are not missing out on these vital nutrients in the early stages of their pregnancies?

[Lord Markham (Con)]

The noble Baroness is correct. Key to all these things is awareness that the best advice is to take folic acid supplements, as suggested. I am happy to provide precise figures of how that has moved in recent years. I completely agree that, as ever, education and awareness are key to this.

Times Health Commission

Debate between Baroness Wheeler and Lord Markham

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

As I said, we have already announced big increases in funding, with more than 20% over the next two years. Two years is not the short term. Minister Whately is working very hard on this because we know that the flow in social care is a key element of the whole solution.

[Baroness Wheeler (Lab)]

My Lords, I welcome the Times setting up the commission. So far, it seems to have a clear and coherent view on the scale of the crisis facing the NHS and what needs to be done, which seems to be sadly lacking from the Government. In the light of all the Times research in articles this week on the resuscitation that the NHS needs, the waning faith people have that they will be cared for and the rising billions that levels of ill health are costing the country, does the Minister agree that the Government’s ABCD policy for addressing the crisis needs a complete rethink?

[Lord Markham (Con)]

No, not at all. In fact, the things I have read in the Times are about what we are implementing. The House has heard me talk about virtual wards; I saw an article on how important those are in helping with the step-down care that is needed in some social care. I have seen that in many places already and it is a way forward. It has also talked about the need for AI and robotic surgery; again, I have seen examples of that in different hospitals. The commission is taking a lot of the good ideas that are already in place throughout the health service and, as I want to do, looking at the ways in which we implement that across the board.

Respiratory Syncytial Virus

Debate between Baroness Wheeler and Lord Markham

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is correct. In fact, my maiden speech was in a debate about how we can bring life sciences to bear more. The point about NHS clinical trials and the fact that we are not using this massive potential asset was very much a feature of that. It is key to the work we are doing—I had a meeting on it just this week—so I agree with the noble Baroness and hope we will see improvements in this space.

[Baroness Wheeler (Lab)]

My Lords, we know that older adults are at greater risk of serious complications from RSV infections in children, because our immune systems weaken as we get older, which can lead to exacerbations of underlying lung and cardiac disease. What action is being taken to address the serious underestimation of older adult RSV infections and to improve testing, reporting and treatment for this key group?

[Lord Markham (Con)]

I thank the noble Baroness. The key risk groups in the elderly as well are, as I mentioned earlier, those with congenital lung or heart disease or spinal muscular atrophy. The problem is that the current vaccination needs monthly immunisation to be effective, and I think most people will agree that it can be used in only the most severe cases because it is not a very practical way forward and is very expensive. That is why I am really excited by the new treatments, particularly nirsevimab, which is 75% to 80% effective, versus palivizumab, which is more around 50%. I think we have a good way forward.

Social Care: Integrated Care Systems

Debate between Baroness Wheeler and Lord Markham

Wednesday 11th January 2023 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)]

ICSs need to include social care fully in planning and strategic decision-making. Local authorities are responsible for social care and have a clearly defined role within ICSs. The Health and Care Act 2022 includes local authorities in its minimum membership requirements for ICBs, giving local government a greater voice in NHS decision-making than ever before. In July 2022, we also published guidance on how ICPs and adult social care providers should work together.

[Baroness Wheeler (Lab)]

I thank the Minister for his response but ICBs and ICSs have been fully operational only since last July—less than six months. The Minister is quite right that, when they were being set up, we argued strongly for the need for effective social care representation in both bodies to ensure that health and social care are integrated and fully embedded in both. However, this just is not happening. The ADASS spring survey found 73% of directors reporting that ICS management has had little impact on local investment in adult social care to date; some even said that ICSs were reducing investment. How does this help ICSs play a key role in their respective areas in, for example, tackling the staffing crisis in both services, prioritising adult social care and producing the urgently needed ICP integrated care strategies, which are due in June?

[Lord Markham (Con)]

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

Care Homes: Severely Disabled People

Debate between Baroness Wheeler and Lord Markham

Wednesday 30th November 2022 Lords Chamber

[Lord Markham (Con)]

The financial health of this sector is an area of interest; we all of course recall some of the problems and failures about 10 years ago. I had a meeting on this subject just this week, identifying the health of the providers to see if that is of concern. The margins made in this space are fairly typical of other industries, so they are not indicative of an area under particular stress. But I have my mind on this issue and will keep an eye on it.

[Baroness Wheeler (Lab)]

My Lords, ADASS reports that in the past four months,

“64% of councils … reported that providers in their area had closed, ceased trading or handed back council contracts”

either through an inability to recruit staff or escalating care home running costs. We all know that the extra funding to councils, which the Minister repeats in almost every response, just about props up existing services and does not provide the sustainable and long-term funding that was promised to commence with the again delayed social care cap. When will the Government fulfil their pledge to fix social care?

[Lord Markham (Con)]

My Lords, the 200,000 extra care places that this funding provides is a solid example of an expansion of supply, and I hope all noble Lords agree that that is a substantial number. I hope they also agree with the work we are doing to recruit from overseas to increase the workforce in this sector, which is indeed increasing. Areas such as these show that we are committed to expanding the supply, and we are seeing that rewarded in the increase in the last few months.

Adult Social Care

Debate between Baroness Wheeler and Lord Markham

Thursday 24th November 2022 Lords Chamber

[Lord Markham (Con)]

I think we all agree on the vital necessity of adult social care—I think the noble Lord has heard me say it many times from this Dispatch Box—and that is what the £2.8 billion and £4.7 billion are about over the two years. The noble Lord is correct that we need to look longer-term, because the whole health service and the care of our elderly are obviously dependent on us getting this right.

[Baroness Wheeler (Lab)]

My Lords, the backlog of care assessments, estimated at 500,000 by ADASS, lies at the heart of the complaints coming through to the ombudsman. They are all about assessment delays for people and their carers, not enough funding or staffing to deliver those assessments that are agreed and failures in home care and care home support. The latest NHS figures show that 145,226 people in England have died waiting for social care over the past five years, and nearly 29,000 previous self-funders have made a new request for council social care support because they have depleted their funds. Can the Minister tell the House exactly what impact the 200,000 more care packages to be delivered in place of the two-year cap delay will have on the huge backlog of assessments and what percentage of the original money earmarked for social care this actually represents?

[Lord Markham (Con)]

I thank the noble Baroness. As mentioned, 200,000 care packages is a significant number and will make a significant impact on everything we are talking about here, and that is in conjunction with all the other measures we have put in place, including the £500 million discharge fund this year. In terms of the precise percentages of those allocations, I will quite happily commit to write on that, but I can say to your Lordships that the £4.7 billion represents a 22% increase in 2024-25. By any standards, I think that people would agree that a 22% increase is a significant amount.

Skills for Care Report

Debate between Baroness Wheeler and Lord Markham

Thursday 13th October 2022 Lords Chamber

[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.