Covid-19 Vaccination: Coronary Disease

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 23rd April 2024 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend for this question. The ONS has provided this information and made it available for research purposes to make absolutely sure that we get to the bottom of this issue. For the understanding of noble Lords, every medical vaccine has side-effects, but the MHRA has investigated this, and the side-effect that people are worried about is heart inflammation. One to two people per 100,000 who have had a vaccine experienced side-effects, but, for people who have had Covid, it is 150 per 100,000. Having these vaccines is a much safer route to go.

[Lord Allan of Hallam (LD)]

My Lords, there is one substance that we put into our bodies during Covid that has been clearly linked to thousands of excess deaths: alcohol. Are the Government carrying out studies into what happened with alcohol consumption during the pandemic, who was most at risk and how we can ensure that in any future pandemics we do not see excess deaths? We are talking about 2,500 excess deaths during 2022.

[Lord Markham (Con)]

The noble Lord is quite right. There were much wider effects and impacts in the lockdown, and alcohol intake was one of them; mental health, particularly of our children, was another. My sincere hope is that these are the kinds of issues that the Covid inquiry should really be investigating: the wider impacts on society caused by lockdown.

Cass Review

Debate between Lord Allan of Hallam and Lord Markham

Wednesday 17th April 2024 Lords Chamber

[Lord Markham (Con)]

Understood. Again, I will come back in detail on that point. One of the points made to me about the difficulties of trying to recruit to these eight new services was that, when this is such a toxic space, how do you get good-quality people? I think we agree we need that more than ever, because it is such an essential and sensitive area. So I will take that back and make sure that nothing we are doing, such as that legislation, should have that sort of chilling effect.

[Lord Allan of Hallam (LD)]

My Lords, if I could add to the Minister’s correspondence list, this is really following up the point made by the noble Baroness, Lady Finlay. Dr Cass rightly highlights that we need data about all the young people who present to the services—what service they received and what happened to them over time. Can the Minister include in his letter the measures that the Government will be taking to encourage those young people to participate? If they feel intimidated or that the data is going to be used against them, they are going to opt out, and then we are not going to have the dataset we need to understand the best treatment.

[Lord Markham (Con)]

That is an excellent point—yes.

Midwives: Bullying

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 16th April 2024 Lords Chamber

[Lord Markham (Con)]

The noble Lord is absolutely correct. It is crucial. We have a whistleblowing system. It has had over 100,000 reported instances. We are trying to inculcate a culture where people feel able and free to stand up and point out an issue.

[Lord Allan of Hallam (LD)]

My Lords, workplace bullying is particularly toxic where managers are involved. This is where non-executive members of the NHS trust boards may come into their own if complaints involve executive members. What is being done to help non-executive members of trust boards be more responsive and able to deal with bullying complaints?

[Lord Markham (Con)]

The noble Lord is absolutely correct. This is the role of non-execs. Having done a bit of work on the Lucy Letby case, I understand that the non-execs should have said something. Obviously, the executives should have found out, but the non-execs clearly had a role. This is an excellent question. I have to be honest and say that I need to come back on it, if I may, so that I can give the noble Lord a full answer and make sure that this is happening.

Immunisation: RSV

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 16th April 2024 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, will the Minister commit to making the vaccination records for new programmes such as RSV available through the NHS app from the outset? I ask this as a parent who has just had to verify his teenage children’s MMR status by hunting down the red books last seen a decade ago to find the tatty piece of paper that is the only record of it. I now have a digital copy through my camera phone, but it would be much more useful to have this kind of record in the NHS app.

[Lord Markham (Con)]

It will not surprise the noble Lord to learn that I totally agree. It is absolutely on the road map. I cannot promise it is there today; it is more there for adults. The child digital red book is another objective we are working on, but that is taking slightly longer. But in terms of direction of travel—yes, absolutely.

Pandemic Preparedness

Debate between Lord Allan of Hallam and Lord Markham

Monday 15th April 2024 Lords Chamber

[Lord Markham (Con)]

I think our record in this speaks for itself. I am very proud of the action that we took as a Government to make sure that the AstraZeneca vaccine was prepared quickly, put in arms quickly and offered all around the world on a not-for-profit basis very quickly. Action speaks louder than words, and that is something that we are well-prepared on. I have been involved in some of the conversations about world pandemic preparedness. There is action that we think we can take collectively as a world, but what we are not prepared to see happen is our sovereignty—the management of our health services—being ceded to other countries.

[Lord Allan of Hallam (LD)]

My Lords, procurement during the pandemic has left a bitter taste in the country. While many good citizens stepped up in the public interest, there are legitimate concerns that others were profiteering at that difficult time. Can the Minister give a firm commitment there would be no VIP fast lane if there were another pandemic? Are the Government putting in place a much more transparent emergency procurement system as part of their preparedness planning?

Stroke Treatment

Debate between Lord Allan of Hallam and Lord Markham

Wednesday 27th March 2024 Lords Chamber

[Lord Markham (Con)]

This AI service, Brainomix, is one of the ground-breaking services that are part of the future of the NHS. It is part of the whole service, which will include video triaging. It is currently in 65% of hospitals, and I am sorry that it is not in my noble friend’s hospital. We have a target to increase that quite rapidly to 75%. I will look into the particular hospital that she mentions. It really is ground-breaking; overall, where we have got everything in place, full recovery has gone from 16% to 48%.

[Lord Allan of Hallam (LD)]

My Lords, to follow up on the issue of screening, atrial fibrillation is a well-known risk factor for stroke, but fortunately can now be checked for with some very cheap devices that connect to smartphones. What progress is being made on AF checks as part of screening programmes and routinely when high blood pressure is checked for? Can the Minister look particularly at the invites for the screening programme? I received one saying that I should come in for an AF check, not a stroke risk check or a cardiac risk check; they could be made much more user-friendly.

[Lord Markham (Con)]

The noble Lord is right to point that out, and I hope we are correcting it. I have seen the mobile app and digital being used to do all these things—I have even seen applications which can measure your blood pressure and pulse as you look at it. We need to check some of the accuracy around that, but it is all part of the programme. However, we need to make sure that it is in everyday English.

Prioritising Early Childhood: Academy of Medical Sciences Report

Debate between Lord Allan of Hallam and Lord Markham

Monday 11th March 2024 Lords Chamber

[Lord Markham (Con)]

I assure my noble friend that the numbers are correct; they are the lowest since 2006-07. I can also assure her that free school meals are at their highest level ever, at 33%. The whole idea behind those programmes, as well as the Healthy Start in school and the five-a-day, is to give children healthy diets early on, exactly as my noble friend says.

[Lord Allan of Hallam (LD)]

My Lords, I echo the condolences to Lord McAvoy’s family from these Benches. I always enjoyed working with him in another place.

On the Question before us, the Government have rightly been bigging up the digital revolution in the NHS, but many of the basic building blocks are still not there. Does the Minister agree that it would be helpful for the health of infants for there to be a digital red book, rather than relying on parents carrying around a physical one? Can he give a timescale for when we will move on from endless pilots and aspirational announcements to this being widely available?

Mental Health Patients: Discharge

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 5th March 2024 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, the Government have said that the additional discharge fund includes support for mental health in-patients leaving hospital. I believe that local areas are required to report fortnightly to the Government on the use of these funds. How much of the additional discharge fund has actually been spent on mental health patients? Does the Minister agree that it is important to have that information in the public domain, given concern that mental health services are treated as second-rate?

[Lord Markham (Con)]

The noble Lord is correct. I agree that it is important that the funds are spent on discharging mental health patients at a community level. I do not have the percentage figures to hand, but I will make sure that I provide them to him.

NHS: Neurology Care

Debate between Lord Allan of Hallam and Lord Markham

Monday 26th February 2024 Lords Chamber

[Lord Markham (Con)]

My noble friend is correct. The important step towards this was our appointment of the first national clinical director of neurology over the last year. The task force put out a progressive neurological conditions toolkit which sets out the pathways exactly as my noble friend mentions. It shows the treatments for over 600 conditions. This is a complex area so it is vital that the pathways are understood in each area and patients can understand how to navigate them.

[Lord Allan of Hallam (LD)]

My Lords, the Government have created a new occupational health task force, which is welcome, but it will not help somebody to stay in their job or get back to work if they face a wait of many months to see a neurologist because that is what their condition requires. Can the Minister confirm that he will be working with his colleagues in DWP to ensure that the neurology capacity is there to see referrals from occupational health services more quickly?

[Lord Markham (Con)]

Yes, absolutely. Of course, this is what the CDCs are about as well in trying to get that diagnosis capacity. At the Neurological Alliance forum I was just at, the main thing was needing help with early diagnosis, because getting treatment is key to it all and, also, seeing whether we can sometimes refer people directly to the CDCs so that the GP is not always the bottleneck.

NHS: Dementia Commission Report

Debate between Lord Allan of Hallam and Lord Markham

Thursday 22nd February 2024 Lords Chamber

[Lord Markham (Con)]

My Lords, I thank my noble friend, who is absolutely right. This is where things such as the Barbara Windsor Dementia Mission have been successful in raising awareness, as she states. The challenge in all this, as I have learned, is that because it is such a slow-moving disease it is difficult to see how it progresses. Apparently, it has one of the lowest failure rates in terms of drugs because it is really hard to monitor the progress behind it. That is why work is being done, such as retina scans, where you can measure data objectively. There is real hope in all this, and it means that we need to make all primary care workers aware of the situation.

[Lord Allan of Hallam (LD)]

My Lords, the commission recommends the creation of dynamic care records for dementia patients and their carers. We know from experience that information projects such as this work best when they have a clear owner who wakes up every morning worrying about delivering them. Who in the NHS owns the delivery of dynamic care records for dementia patients? If that person turns out not to exist when he goes to look for them, would he consider appointing someone?

[Lord Markham (Con)]

Yes, that is a very good point. For me, as I have looked into this, the reason for assembling the panel that we can all interrogate is that we have the value of different noble Lords in this House who can add those points to it. What the noble Lord said sounds sensible. The honest answer is that I do not know whether there is such a person today, but let us use this as an opportunity to find out, because I think there should be.

NHS Dentistry

Debate between Lord Allan of Hallam and Lord Markham

Monday 19th February 2024 Lords Chamber

[Lord Markham (Con)]

Yes, the noble Lord is correct that there is very good evidence of the effectiveness of water fluoridation, and the report as recently as 2022 showed there are no side-effects. The north-east will increase the number of recipients by about 1.6 million people, and there is a process that that needs to go through but I totally agree that we should expand it as far as we can.

[Lord Allan of Hallam (LD)]

My Lords, further to the question asked by the noble Lord, Lord Birt, I point out that we have very good data on the number of dentists engaged in NHS activity. It shows a pattern of falling numbers—down to 24,151 in the last financial year. Does the Minister agree that it is fair for us to judge the success or failure of the Government’s new plan on whether that number increases? Does he have a target for where the Government intend it to reach?

[Lord Markham (Con)]

The absolute measure that everyone cares about is output—the number of treatments—and this plan is all about increasing the number of appointments by 2.5 million. In the last year alone, we increased the number of treatments from 26 million to 33 million. There is more to do, granted, but the real measure of success is how many treatments we get done, which is a function not just of the number of dentists but of their productivity, and of the number of them we can persuade to provide NHS rather than private sector services.

NHS Dentistry: Recovery and Reform

Debate between Lord Allan of Hallam and Lord Markham

Wednesday 7th February 2024 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, from these Benches, I also echo our best wishes to His Majesty the King. We hope that he makes a speedy recovery.

In responding to this Statement, I also reach for that familiar phrase of it being a sticking plaster, before heading in the direction of dental metaphors. Rather than a scale and polish, it seems to me that this is something of a temporary filling when, as the noble Baroness, Lady Merron, says, NHS dentistry needs serious root canal work.

I feel for the Minister because I know he cares about dentistry and understands the scale of the problem. He has to sell the temporary filling hard in the hope that we will trust the Government to deliver on the more comprehensive course of treatment that is in the consulting on and exploring part of the document.

There are three elements in that long-term part of the plan on which I hope the Minister can comment further today or later in writing. First, we are told that the Government will ring-fence the £3 billion of NHS dentistry budgets from 2024-25 which have been underspent because of the lack of dentists willing to work at NHS rates. We cannot see this changing overnight, even with what is announced today. How will this ring-fencing work if an integrated care board has still not been able to get the take-up of the contracts that it wants? What kinds of things could they use these underspends for? Will these include additional local financial incentives on top of the ones we are discussing at a national level today?

Secondly, it is important to realise the benefits of people with dental qualifications moving to the UK. I know that the Minister would wholeheartedly agree. The policy document promotes the idea of a provisional registration of overseas qualified dentists while they are waiting for their full GDC registration. The phrasing in the Statement and in the document is quite hesitant. It talks about the Government working towards introducing legislation. Can the Minister give us more information about the complexity of the legislative changes that will be required and their likely timescale?

Thirdly, failures in emergency care both cause severe patient distress and additional work for NHS hospitals. The noble Baroness, Lady Merron, has already pointed out that many children are referred to hospital for emergency treatment. I looked at the description on the Smile Together website—a good service in Cornwall cited in the plan. It says that:

“Smile Together is commissioned by NHS England to provide urgent and emergency dental care to patients who would otherwise be unable to access treatment. Demand for this service is very high and the criteria set by our commissioners is very strict. We therefore offer emergency appointments that are independent of our NHS service”,


and people who call in who are unable to get an NHS appointment and do not wish to wait and try again the next day can basically go private. I am not sure we want to be in a situation where people needing emergency care are left hanging on the phone day in, day out, or face having to go for the private option. I hope the Minister can explain what the Government intend to do around emergency care. I hope he will agree that making sure people can get NHS emergency care will be better for both the patient and the NHS.

A temporary filling is designed to last a few weeks—or months at most—or perhaps until an election. We are grateful for the temporary relief it provides, but we know that more work is needed, and this has to be done urgently if we are to fix NHS for the long term.

[Lord Markham (Con)]

I thank noble Lords for their comments. First, the thing that brings us together is the desire on all sides to expand capacity. That is something that we are all behind. I hope that I can bring out the themes in this regard—the plans that we are talking about are designed to do exactly that.

The noble Baroness, Lady Merron, asked how the golden hellos will work. The idea is that it will be in the 12 most needy areas, and the ICBs will have the flexibility in how they attract people there. It might be existing dentists who they want to take from another area, or it might be private sector dentists or dentists who are just graduating. It is about making sure that they have the ability to bring those people into the areas of most need.

The mobile vans have proved quite successful already in areas such as Cornwall, where they have already been. They are designed to hit exactly those areas where it is hard to seed new dental practices, because there is a dental desert there, for want of a better word. Each of those vans alone should be able to do about 10,000 appointments a year, which is quite a sizeable number. Of course, what that does is put it in the areas of most need. The beauty of it—if beauty is the right word—is that, when you are talking about emergency-type situations, you will be able to tell exactly where they are.

The other thing that is important, with regard to all the payment mechanisms and how that will work, is that the dentists working in these vans are salaried. The idea is that we know that in those instances it is absolutely going to work in terms of the incentives. While we think that the patient premium absolutely will help in terms of access, and we know that the hardest one is getting them to see patients for the first time and that is what the additional £50 is all about, by bringing in these salaried people we can absolutely guarantee that those new people will be seen in those situations.

What I note from all this is that these are very concrete plans to create 2.5 million new treatments. I noticed that the noble Baroness, Lady Merron, mentioned the Labour plan of 700,000 extra, so I shall let noble Lords draw their own conclusions as to which one is more extensive. But to try to answer the question around ring-fencing, what this is all designed to do is to make sure that the contracted number of UDAs that we want to happen is delivered. Noble Lords will have heard me say before that the problem often is that it is not delivered because the dentists then go and try to sell to the private sector instead. So this is all designed to underpin that: first, by making it more attractive for those dentists to offer it to patients, in terms of the patient premium of £50, and the increase in the UDA price; and, secondly, by supplementing that with salaried staff, so you can absolutely make sure that it is being delivered in those circumstances. That is what we are trying to do—because we know that the UDAs are there in terms of the expansion, and we did see a large expansion last year. We increased the number of treatments from 26 million to 33 million, a 23% increase—so we have managed to do it. But we are talking here about wanting to do more of it, of course.

As for whether this is a temporary filling or a long-term fix, of course the long-term workforce plan is all about a long-term fix, making sure that we have the supply in place so we can supply the NHS services needed on a long-term basis. That is where we are talking about the 40% increase, and about making it easier to bring people in from overseas, to answer the question from the noble Lord, Lord Allan. As noble Lords know, I have a personal interest. I would not have a wife—or this particular wife—if she had not managed to become a dentist from overseas. But what I saw from all of that was that it is a two-stage process. It was one thing for her to be allowed to become a private dentist. I had to fill in the forms myself, and it was pretty hard. But it was an altogether new process then to become an NHS dentist. To be honest, the conclusion after all that was, “Why would I bother to do this? If I can already be a private sector dentist, why would I jump through a load more hoops to then become an NHS dentist?” It is designed to try to iron out those differences and not act as a disincentive in those situations.

To answer the question, those mobile vans, in terms of SMILE4LIFE, are there to make sure that they get people off on the right foot. The family hubs are for training would-be mothers about looking after gums and teeth. But also, crucially, it is about using those mobile services in the areas where they are most needed, putting in the fluoride varnish for 165,000 reception-age kids—so aged from four to five. That means really starting to get the right start to life in all this.

I hope that what we are seeing here is a comprehensive set of plans, expanding supply in terms of the golden hellos, mobile vans and increasing treatments, as well as the long-term workforce plan for increasing staffing. We are making it more attractive for dentists to provide NHS dental services in terms of the patient premiums. These will all start very quickly—in March, for instance. It is also about increasing the UDAs and making sure that our children get the right start to life, in terms of SMILE4LIFE, and making sure that their teeth are clean from a very young age.

There is a lot to do—I perfectly accept that—but I believe that what we have here is taking the right steps to achieve it.

Allied Health Professionals: Prescribing Responsibilities

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 6th February 2024 Lords Chamber

[Lord Markham (Con)]

I agree with my noble friend that not only are they the pillar of communities, but they are the front line in a lot of health services. This is about trying to put more business and activity their way to increase their viability, both in terms of paying for treatments such as these and increasing footfall generally. I completely agree with my noble friend that we want as many of these small businesses thriving in their own right, but also as a vital part of the health ecosystem.

[Lord Allan of Hallam (LD)]

My Lords, increasing the range of health professionals who can prescribe is welcome, but does the Minister agree that this makes it even more important that people are able to see their entire medical record in one place, as the Times Health Commission has proposed? What does the Minister make of that proposal, and what are the Government doing to ensure that, wherever you get a prescription, that record is located in one central point?

Premature Deaths: Heart and Circulatory Conditions

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 6th February 2024 Lords Chamber

[Lord Markham (Con)]

I agree with the noble Lord. We violently agree that it is all about early detection. That is why we have not just put it in pharmacies but have had mobile units going to leisure centres and high streets: so that we can catch people early, whatever their background or ethnicity, because that is the key starting point.

Digital is the way of the future in this. We are introducing digital health checks from the spring. Again, these will open it up to a wider bunch of people. Early detection is key.

[Lord Allan of Hallam (LD)]

My Lords, the relationship between cardiovascular disease and poverty is clear and well documented. What specific steps are the Government taking to encourage take-up of the new screening programmes, which the Minister talked about, in poorer communities where people are at higher risk? Will the Minister commit to publishing data so that we can understand whether the screening programmes are reaching everyone or just people in wealthier communities?

[Lord Markham (Con)]

First, I am happy to commit on the data front, because data and giving results always shine a light and will always help in these situations. On outreach to all these communities, the noble Lord might be aware that, on top of the pharmacies and leisure centres, we have been incentivising GPs. As an example, being in the right age group I have numerous texts and messages from my GP about getting those check-ups done. It is those sorts of measures that we are trying to use.

Pharmacy First

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 6th February 2024 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, the holy grail for health policy is a change which improves the service for patients at the same time as reducing the cost of delivering that service. I think we can all see the potential for Pharmacy First to be such a move, if executed well. I have a few questions for the Minister and his answers will help us to understand whether he is on the right path in this grail quest.

First, I understand that there will be a payment per consultation, if the consultation meets criteria that the Government have set, but that there will be a cap on the total budget. Can the Minister explain how this cap will work? Is it per pharmacy or per integrated care board, and what happens if it is exceeded? I do not think that we want people going back to more costly channels simply because of an accounting feature. Secondly, can he explain how the Government will assess value for money in comparing the cost of the Pharmacy First consultations with the estimated savings on the GP and A&E side?

Thirdly, while we are discussing urgent care today, can the Minister also say whether the Government are looking at using pharmacies for approving repeat prescriptions—this was raised by the noble Baroness, Lady Merron—for drugs such as statins that people may be on for many years? The current protocol requires them to go back to their GP for regular reviews. Are there any plans afoot to move some of that medicine review process for long-term conditions also into the Pharmacy First programme?

Can the Minister also explain how instructions will be given to NHS 111 services so that they can properly direct people, in light of Pharmacy First now being an available option? It could make a real difference to the pressure on A&E services if 111 moved appropriate cases over to pharmacies. There are concerns that 111 has a natural tendency to be risk averse and refer people to A&E. If we are going to ask it to refer people now to pharmacies, we need to understand how that shift in direction will take place.

Finally, I have a digital question. It is not the one about the joined-up records that we discussed earlier at Oral Questions, as I am confident that the Minister will tell us that the Government are on track for that. What I want to raise is, even when the pharmacy has issued a prescription and dispensed it, at present what happens is that it will then print it off and post it to the NHS Business Services Authority for payment. This happens with all the prescriptions in the pharmacy system at present. My understanding is that the business services authority will then scan them into its system to make the payments—which seems quite farcical in 2024. So I would be interested to hear from the Minister what plans the Government have to get rid of that piece of the equation or to make it more efficient, so that, when a prescribing process happens electronically, it happens all the way through, to the point at which the pharmacy is reimbursed for the work that it has done.

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

I thank both noble Lords for their general welcome of what we are trying to do here. My thoughts on this are that anything that we can do to expand supply should be a good thing in this context.

I will pick up on specific questions. As mentioned, we have not managed to achieve 6,000 additional GPs. To specifically answer the question, we have achieved about 2,799. However, through the use of additional staff, we have managed to achieve 50 million additional appointments in GP settings since 2019, so we actually hit our target on that earlier. I think that demonstrates—this goes back to the Question we had earlier today—that we are trying to use people to the top of their professional skills and supplement that with other skilled people coming in. In terms of output, 50 million appointments are a good example.

We are hoping that this will be a boost to community pharmacies. They are, as I mentioned earlier today, seen as a very important asset. They are often the first line in terms of health in the local community. This is intended to not only enhance the health service in an area but give community pharmacies a necessary boost. I think these figures have been reported, but for the sake of completeness I will say that we have had about 10,000 pharmacies sign up—about 95% of them—so clearly it has been welcomed. In the first three days we have had about 3,000 consultations. In answer to the question about pharmacies being overwhelmed, the early indications are that it has been managed well. You could say that the more business they get is a good thing in terms of their viability. Right now, we feel that it is so far, so good.

On privacy—I will try to group the app and IT questions together a bit later—part of the conditions for being available for Pharmacy First is that a pharmacy has a private treatment area available, so that there will not be privacy issues.

My understanding—I will definitely need to write on this—in terms of UTIs is that it applies only up to the age of 64, as they are less complex in those cases. For instance, as you get older UTIs can be a sign of other comorbidities. I think that is the thinking behind the age of 64, but I will follow that up in writing.

The general point was made by both the noble Baroness, Lady Merron, and the noble Lord, Lord Allan, about trying to expand provision. I would say that this is the first step. We have tried to pick the areas that we think suit the situation well. This gives us the ability to expand as the capability increases. Repeat prescriptions is obviously a very good example, as is managing cases such as hypertension and other similar areas. The direction of travel is very much: let us make sure that this works well and then build on that.

I will answer the questions on IT asked by the noble Lord, Lord Allan, together. The overall thinking on the cap is that we are trying to make sure that this does not run out of control—for want of a better word—in some respects, and that goes back to the value for money question. If you can really prove that it is enhancing and substituting for GP appointments, which we all want to boost the availability of, that has to be a good thing. As ever, you need to try to set up budgets at the beginning to make sure that they are sensible in terms of that control.

To give a sense of direction, it is very much the intention that 111—I include the app and other digital approaches in this—will point a person to the right pathway for them. If we then know that they have one of these seven conditions, such as a simple UTI, sinusitis, or something of that ilk, they will be guided towards Pharmacy First. That is very much the intention. I hope that that in some way answers the question. It is intended that more and more volume is put that way.

In terms of trying to make sure that there is a slicker system with the IT generally, obviously it has to be sensible—for example, not printing things off, and that there is an electronic payment mechanism. My understanding is that that is already occurring in some of the digital areas. Noble Lords will be aware of some of the digital pharmacies, which are paperless the whole way. Those sorts of mechanisms are being set up and it is a matter of expanding them, so that there is a complete digital service. I will come back with more detail on that, but I understand that it is happening.

On the IT systems and the holy grail of making sure that they are all connecting—to give everyone the benefit of our conversation in the Corridor—the idea is that it has to be two-way. You want to make sure that pharmacies have access to doctors’ records. That is not ready today, but it will be in the next few months. Likewise, you want to make sure that whatever the pharmacies do gets updated to GP records. Right now, that will be done by a simple PDF. This is not ideal because it involves a rekeying, but in a matter of weeks, it will update the GP records automatically. The value of that is that, obviously, while Pharmacy First is the forerunner, there are all sorts of circumstances it could be replicated for, whether appointments with physios or any other physician relevant to the patient records. I think that will be a positive when it comes in.

I have tried to answer most of the questions about execution. I think we will all freely admit that, as ever with these things, there is a certain amount of bedding in—it is something that I am glad to see everyone welcomes in principle. I hope that in a few months’ time I will be able to update the House on it; I will be happy to do so. If it is executed well, and we believe that this is working well, we will be looking to extend it to further services.

Medical Devices (In Vitro Diagnostic Devices etc.) (Amendment) Regulations 2023

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 6th February 2024 Grand Committee

[Lord Markham (Con)]

I thank noble Lords for their contributions and the spirit in which they were made in terms of helpfulness and trying to make the market as open and productive as possible.

I shall try to answer the questions in turn. To the noble Baroness, Lady Finlay, I say, yes, this is part of the four SIs.

On the noble Baroness’s whole question about making the UK market attractive to innovation, that is exactly what this is all about. On her point about clinical trials, my understanding is that there was a period when we slipped down the league on timings. I am told that a lot of that was because we were trying to prioritise Covid issues but, as I understand it today, we are now back within the timeframes. While we slipped down to 10th place in the league, the understanding from recent business coming in is that we think that we are making our way back up into the champions league spots, for want of a better phrase. I am assured that we have seen quite an improvement in the time taken in clinical trials.

On the noble Baroness’s question about what this means for the MHRA—the noble Baroness, Lady Merron, asked a similar question—we do not believe that this should have a significant impact. At the same time, I am totally with the sentiment that we do not want the MHRA to be a bottleneck, not just in this area but generally because speed to market is important here. In the last Budget, we agreed quite an increase in the MHRA’s budget, exactly so that it is able to pass such things through more quickly.

On the points about mutual recognition, it is absolutely our direction of travel. We are looking to do that with other authorities. Again—this also goes to the question of the noble Lord, Lord Allan—we are recognising the “CE” marks until 2030. That is probably a good example of mutual recognition.

[Lord Allan of Hallam (LD)]

The “CE” mark recognition is an example of one-way recognition, not mutual recognition, because it does not go the other way.

[Lord Markham (Con)]

Absolutely. Clearly, we would like it both ways, for obvious reasons. There are a number of areas where we are still being open about our rules—not just to the EU but to other countries as well, with the hope that there is some reciprocation down the line. That is definitely the intention. Talking to the regulators, I know that the situation is crazy. We know that the Australian, Canadian or Singapore regulators are top-notch, so we should be satisfied with their work in many cases. The feeling often is that stage one towards that recognition is that, while we might have slightly different standards, recognising that where they have conducted tests, rather than reconducting those tests, we should at least recognise that each other has done the tests correctly. We should take that data and that should speed things up.

In answer to the question of the noble Lord, Lord Allan, we are talking about any type of diagnostic test—

--- Later in debate ---

[Lord Markham (Con)]

I am probably not qualified to speak specifically about the Orbis project read-across but, at the general level, that is definitely the direction of travel, if you speak to the MHRA. As I said, there are almost two levels to it. The complete level is where you just take it lock, stock and barrel. That is the slightly harder one, but at least the preliminary step towards that is recognising when they have done a batch of tests. I know from a previous life—during Covid, for instance, when a lot of tests were about—that you have to do a number of samples, test them against a control group and see where they come out against that. Those were internationally recognised tests, so if the US, Canada or Australia have done tests on those devices, rather than doing our own tests, let us at least accept them. Those are the two stages of that.

On the point about divergence, this SI tries to make sure that the GB and Northern Ireland markets are as similar as possible. My understanding of how we used to regulate EU “CE” devices was that we would take the “CE” marks and then often tweak them slightly to make them relevant for the domestic market. Apparently, France, Germany and all the countries do that. With this SI, as I mentioned, we are recognising “CE” marks generally until 2030 on a voluntary basis—so, obviously, we can tweak them as much as we like. Northern Ireland generally has to accept those devices because of the Windsor agreement, but it still has that tweaking ability, for want of a better word, that we always used to have when we were in the EU. The idea behind this SI is to allow us to tweak it from both ends—the GB end and the Northern Ireland end—so that it is common, and we have read-across so that the product will work under the “CE” mark in both Northern Ireland and across in GB.

This was explained to me this morning, so my officials can tell me later whether I have been a decent student. For general clarity, as ever, I will happily write this all down, but I hope that makes sense.

[Lord Allan of Hallam (LD)]

It does; that was a helpful and clear explanation. However, if somebody has tweaked their test for Northern Ireland and they also want to sell to the EU, are they able to do so? For example, can they send it south of the border into the EU? Or would that require an untweaked “CE” mark, and, if so, who gives them that? That is really the heart of it.

[Lord Markham (Con)]

My understanding of all this—again, I will tell the noble Lord to the best of my knowledge and correct it if I am wrong—is that we always used to tweak it when we were part of the EU. It was generally accepted that we would tweak a bit, and so would France and Germany. That did not stop products being sold across, so I do not believe that they will need to untweak it, for want of a better word. Again, if I am wrong about any of that, I will clarify it.

On the question of what happens between March 2022 and now, I will let the noble Lord know in writing about what happens during that period.

My understanding is that the MHRA is neither a notified body nor an approved body. It does not set “CE” marks or “UKCA” marks itself; it tests them and looks at the conformity, but it does not establish any, for want of a better word.

On the questions raised by the noble Baroness, Lady Merron, that I did not pick up on before, we do not think the fee structure will have much impact on the MHRA.

The noble Baroness also asked what the opportunities are and what kinds of visions will come from this. I freely admit that this is a complicated space. However, one area where I have seen an opportunity is around the precision medicine space. For example, for the next set of cancer treatments, it will be possible to take a sample of the malignant tissue or cells and adjust the messenger RNA to, effectively, get your own body to attack those cells. The problem is that each one of those medicines you produce is individual to you, so it becomes difficult to regulate each individual medicine under the regulatory framework, as it would take ages and destroy the point of the exercise. The MHRA, however, has developed an umbrella mechanism, allowing it to treat all the individual medicines as regulated and approved. That is a major opportunity. My understanding is that the EU has not managed to be quite as fleet of foot, so it is not there yet. That is just one example I have seen; it is very important, as it allows us to charge ahead in terms of the precision medicine space. Moving forward, that will help us establish ourselves in the clinical trials and life sciences fields. I understand the points the noble Lord makes about all the complications due to some of these post-Brexit situations, but, actually, this is one area that is very positive. It will be a huge benefit for us going forward.

On the question asked by the noble Baroness, Lady Merron, about the future vision, I think it is sensible to agree a baseline based upon what we see in reputable countries with standards—such as Canada and Australia —making it as easy as possible to regulate. It would not be ideal if that meant we had to do it just one way, as we would prefer to do it both ways. However, it would still make us attractive as it would be possible to do clinical trials for our products here and know that it will work. However, where we can forge ahead in areas such as precision medicine, where you need tailored and expert help, let us really try and do that. So I think there are some really exciting possibilities.

I hope that gives a flavour of our vision and how we are trying to progress matters in this space. I realise I have not answered every question, but it has been quite a useful debate. I have definitely found it useful to tease out the details. If I may, I will go back to my notes.

I trust that I have provided sufficient answers to the questions and, as I said, I will write to follow up. I hope and trust that I have demonstrated the necessity of these regulations to honour our current commitments under the Windsor Framework agreement. With that, I commend this instrument to the Committee.

NHS: Fracture Liaison Services

Debate between Lord Allan of Hallam and Lord Markham

Monday 5th February 2024 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, the noble Lord, Lord Black, and the Better Bones campaign have done an excellent job in raising the public profile of fracture liaison services, so I was a little surprised that searching for them on the NHS website returned some general articles about fractures and advice about the Patient Advice and Liaison Service but nothing about fracture liaison services as such. Will the Minister look into this to ensure that people trying to find information about FLSs are given it and directed to their local service?

[Lord Markham (Con)]

I thank the noble Lord. His interventions around the communications side are always welcome, because we recognise that it is one thing having a service and another thing making sure that the world knows about it. I will go and find out more and write to the noble Lord.

Care of Critically Ill Children

Debate between Lord Allan of Hallam and Lord Markham

Monday 29th January 2024 Lords Chamber

[Lord Markham (Con)]

Clearly, the processes on these terrible cases have got to be as transparent as possible. As noble Lords probably know, legal aid is automatically available in all these types of cases to make sure that there is a level playing field. I also think we all believe that there is a case for seeing whether we can use mediation more as, obviously, courts should only ever be a last resort.

[Lord Allan of Hallam (LD)]

My Lords, the Minister has already flagged communication as one of the key areas that comes through in the report, around both palliative care and care more generally. Can the Minister assure us that the task force will have the skills it needs to ensure that that communication can take place with parents from a variety of different backgrounds—educational, with different levels of medical knowledge and in different linguistic and cultural contexts?

[Lord Markham (Con)]

Yes, the noble Lord is quite correct. We know that, in many walks of life, so to speak, there are certain sectors of society that do not get the same level of provision and sometimes miss out. We had the debate last week on maternity provision and saw instances in relation to ethnic minorities as well as people with learning difficulties. We need to make sure that all the communications are there and that everyone is armed to provide the right levels of interface and communication in what are some really difficult cases.

Smoking

Debate between Lord Allan of Hallam and Lord Markham

Thursday 25th January 2024 Lords Chamber

[Lord Markham (Con)]

Hopefully, my previous answer shows that we are investing major money in cessation services. I must admit to not being that familiar with the drug the noble Baroness mentions, so I will follow up in writing to give her the details.

[Lord Allan of Hallam (LD)]

My Lords, does the Minister agree that reducing the number of outlets that sell tobacco products does in fact have a positive effect on the prevalence of smoking? In this respect, can he indicate whether the Government are having any conversations with large supermarket chains, either individually or collectively, about voluntary reductions in the number of tobacco counters in their outlets? If that is not already happening, would he agree that it would be a good use of government time to do so?

[Lord Markham (Con)]

Again, we are mindful of trying to get the balance right. Inevitably, by taking away a major market, which the over-18s will become as we go into it, smoking sales through retail units will go down more and more. We expect them to reduce as a result of that. We think that is probably getting the balance right, rather than trying to be overburdensome by saying, “No, you shall not be licensed to do that any more”. We think that will happen naturally through the market, because we are of course taking out a whole segment of future customers.

Care Home Staffing

Debate between Lord Allan of Hallam and Lord Markham

Thursday 18th January 2024 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, as the Minister has likely anticipated, 2024 is going to be a year when we keep hassling him for a long-term workforce plan for social care. Assuming he is not going to announce the imminent publication of one, can I at least ask him to commit to commissioning and publishing an independent report into the potential impact of the visa changes described by the noble Baroness, Lady Pitkeathley? The Government are of course entitled to make it harder to get visas, but they should be upfront and transparent about the downstream effects.

[Lord Markham (Con)]

The Home Office has made an impact assessment of that. It thinks it will impact about 20,000 staff; we recruited about 100,000 last year. The main thing is that, by making sure that only CQC-registered bodies are able to recruit in this way, we are trying to make sure it is done in the correct, ethical manner by high-quality providers, which I think we would all agree is the right approach.

Health: RSV Immunisation

Debate between Lord Allan of Hallam and Lord Markham

Wednesday 17th January 2024 Lords Chamber

[Lord Markham (Con)]

As I mentioned, the tender is in place with a view to rolling it out in the autumn. Whether we go for the maternal vaccination or the infant one will depend on the communication plan, but I can assure my noble friend that a communication plan will be part of this ground-breaking rollout. Only one other public health rollout like this has happened in the world—in Galicia, Spain—so I am proud to say that we will be top of the list.

[Lord Allan of Hallam (LD)]

My Lords, during the pandemic, we learned the value of having a clearly identifiable owner of a new vaccination programme. Can the Minister tell us who the owner of the RSV vaccination programme is so that, in a year’s time, we can come back here either to congratulate them on a successful rollout next winter or to hold them accountable if it has not happened?

NHS: Drug Shortages

Debate between Lord Allan of Hallam and Lord Markham

Wednesday 17th January 2024 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord for my proposed promotion. My noble friend Lord Moylan has also raised pancreatic cancer a number of times. To be absolutely honest, this is one of those cases where we are on a journey. I think we have got on top of certain areas, such as prostate cancer, about which we have increased awareness to ensure we get detection early on, but we do not detect pancreatic cancer early enough and, unfortunately, it is then often too late. We are working on something to try to correct that. The noble Lord is quite right to bring it up, and I am happy to write to him to tell him exactly what we are doing.

[Lord Allan of Hallam (LD)]

My Lords, I hope the Minister will revisit his department’s response to the Times today, which comes across as quite dismissive of genuine difficulties that many people across the country have with access to medicines. I encourage the Government to offer a service where people can report their individual experiences of shortages so that they can be aggregated into real-time public reports about what is happening across the country. If he wants an example of what this could look like, he could look at Downdetector, which does something similar for access to internet services.

[Lord Markham (Con)]

I quizzed the team on exactly that Times newspaper report today, because like the noble Lord, they were saying that they did not recognise the numbers that the British Generic Manufacturers Association had produced. I wanted to understand why, and asked the team to sit down with them, and understand the differences, because one side or the other must be right. They are absolutely doing that, and will report back; I will be happy to update the House on the results of that.

National Health Service: Key Targets

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 16th January 2024 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is correct: staff numbers have gone up but, for a number of reasons that we are exploring, output has not gone up by the same amount. It is a key point, and I think all noble Lords agree that making sure we are getting value for money out of the service is important. We are engaged in a productivity study to discover the reasons right now.

[Lord Allan of Hallam (LD)]

My Lords, back in 2013, the Government set a target for the NHS to become paperless by 2018, which they later extended to 2020 when the target seemed too ambitious. This may come as something of a surprise to the millions of people who continue to have regular paper-based interactions with the NHS. Could the Minister tell the House when he now expects the target for the NHS becoming fully digital to be met? Would he agree that it is now even more important that we achieve it than when it was first set over a decade ago?

[Lord Markham (Con)]

I definitely agree that it is more important, and that is why I am pleased that we have made such progress. If we look at one area in terms of hospital records being available and doctors’ records to patients, that has gone up since the beginning of the year from about 1% of GPs to about 90% today. About 90% of all our hospital records are now digitised, compared to less than 3% in Germany. We have made massive progress, and it is key to all of the reform and to improving productivity across the NHS.

NHS Winter Update

Debate between Lord Allan of Hallam and Lord Markham

Thursday 11th January 2024 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, we should start by recognising and thanking the nearly 3 million health and care workers whom we depend on all year but who have to work especially hard during the winter months. We should also show our appreciation for the many millions more informal carers who spent the festive period looking after family and friends. That was the nice bit, but I now turn to some questions for the Government on what I thought was a predictably upbeat, “It’s all going swimmingly except for the strike” Statement; yet within it there were some significant gaps, some of which the noble Baroness, Lady Merron, pointed out.

It is notable that the Statement says nothing about primary care but instead focuses very much on hospital beds, which I will come to next. Can the Minister comment on how GP appointment waiting times remain unacceptably long in many parts of the country? This is a poor outcome both of itself and in terms of the knock-on effect it has on emergency services. I hope that the Minister can confirm that the Government have been monitoring GP waiting times during the winter months, and that he can indicate what they are doing about these.

The Government say they have added 3,000 hospital beds as part of their 5,000 target. That target was part of their response to last year’s crisis. Does the Minister have any new data on the utilisation of those beds and whether this matches up with the predictions the Government made when they set the target, and any analysis they made to come up with the 5,000 number in the first place? The Statement also highlights the 11,000 virtual beds that are now available, which instinctively seems like a positive development to me. But the important thing is how a broad range of people experience these and the health outcomes they deliver. What are the Government doing systematically to collect data about those virtual beds and whether they have been able to deliver a comparable level of care for people who are suffering during the winter pressures?

Another key area of delivering emergency care in winter is the availability of ambulances, which was rightly flagged by the noble Baroness, Lady Merron. The Minister may have seen a report in the Health Service Journal from 30 November last year, which said that in some areas there is a mismatch between the number of paramedics recruited and the number of ambulances available. It is great that the paramedics have been recruited, but if they are sitting around in the base stations because the vehicles are not there, that does not deliver the improved waiting times we are all looking for. I hope the Minister can comment on this report and whether the Government are able to deliver the vehicles in lockstep with the newly trained paramedics, which is what we all wish to see.

A further element of the response is the 111 service for less-urgent services, which, again, is not mentioned in the Statement. There are concerns about whether people are being directed to the right place—111, GPs, 999 or accident and emergency departments. Are the Government monitoring the performance of 111 in respect of flu, Covid and other winter respiratory diseases?

Finally, we have often discussed patient flow through hospital and out into the community with the Minister, who I know takes a particular interest in this. We know that some trusts are piloting systems to improve flow that could be described as like hotel booking systems that enable beds to be made available in a much more efficient and timely fashion. Will the Government compare the performance of trusts that have these systems in place with those that do not, as they go through this acute period of pressure in the winter months?

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

I wish everyone a happy new year and share in the thanks given by noble Lord, Lord Allan—and, I am sure, the noble Baroness, Lady Merron—for the hard work all the staff put in over the Christmas period. We have done a lot of work to prepare for this winter, and that was based on expanding supply. I will go into more detail in answering the questions so far, but that included the 5,000 additional beds, of which 4,000 are currently in place. It included the 11,000 virtual wards and 800 new ambulances, and again, I will answer some of the specific questions about the utilisation of those. It included the £600 million for adult social care discharge and the 141 CDCs, with 6 million more diagnostic tests, and the 50,000 increase in nurses—as well as mental health.

Of course, there have also been 50 million more primary care appointments since 2019, to answer the point made by the noble Lord, Lord Allan. That was accompanied by extensive planning, as I have seen. We have really tried to learn a lot of lessons from last year and get ahead of the curve with earlier plans, putting key management support teams in place to provide help in the areas where it is most needed. Everything is underpinned by a stronger technology infrastructure, digitalisation and the patient flow systems.

We are really trying to get ahead, so we brought forward the flu and Covid vaccines, so that, hopefully, we can make the situation better. I will not say that it is anything more than early days, or that one swallow makes a summer, but there are some promising early signs. On ambulance handovers, we have seen a 20% reduction in lost hours. The figure for category 2 response times is 45 minutes; it is still too long, but it is half that for this time last year. As for patient flow and the use of the system, we have seen a 10% reduction in so-called bed blocking, partly because of the flow mechanisms and partly as a result of early investment in the discharge fund.

All that is against the background of increased activity—and, of course, the strikes. To date, they have cost us 1.3 million lost appointments, 113,000 most recently. I say to the noble Baroness, Lady Merron, that we have tried to behave in a reasonable manner. We have reached agreements with all the other professions—the nurses, physicians, consultants and specialist doctors—and we have shown leadership, alongside the unions, in doing so. In contrast with that reasonable behaviour, the 35% pay demand is not reasonable, and nor is planning strike action at the busiest time of the year. Coming out only twice, when you have been asked 40 times by NHS trusts to act on patient safety, is also not reasonable behaviour. We want to resolve this issue. We have shown a capacity to resolve it in other areas, and we have shown leadership. I ask the BMA and junior doctors to come forward with reasonable expectations, and let us resolve this right now.

I have a polite suggestion to make. I thought that the noble Baroness, Lady Merron, might raise the issue of NHS targets. People know that I am a reasonable person, and the last thing I am going to do is say that all is rosy in the garden, but we are showing some solid improvement. I am definitely not happy with the fact that the England targets for a four-hour wait and 62-day cancer care were last met in July 2015. But I note that they have never been reached in Wales, which Labour has been running. In Wales, the 62-day cancer care target was last reached in 2010. Also, if you are in Wales, you are much more likely to be on a waiting list: 21% of the population are on a waiting list, compared with 13% here. In Wales, you are likely to wait five weeks longer, on average; and 50% of the time, you will wait for more than four hours in A&E, compared with 40% in England.

The England results need to be better, and we are working to make them better, but I politely suggest that the Opposition might want to look at where they are running the NHS and see what they can do to improve that, because on every standard you see a poorer performance from the Labour action in Wales. That is what all the evidence tells us.

I will try to answer some of the specific points. On ambulances, 300 new vehicles have been delivered to date. There is an issue with one supplier, but we are confident that the 800 new vehicles will be delivered. It is those, alongside the paramedics, that are allowing us to address ambulance wait times and bring them down. The 111 number is now on the app and is really directing traffic; it is up 8% versus last year, so, again, we are seeing real improvements. I think I mentioned that patient flow is improving as well.

On Covid, bringing forward the vaccinations has been helpful in terms of prevention. While we would all accept that 2.5 million is a large number, if we look at the number of beds being taken up by Covid and flu this year, we can see that it is half the number that it was last year. It is still a big number, but it is half what it was. We are in the early stages and a lot more work is needed, but one reason we are starting to see these improvements is that we have tried to get ahead of the curve with those vaccinations.

As regards virtual wards, so far we have about 70% utilisation of those. We need to collect the data; noble Lords have heard me say before that the results from virtual wards in places such as Watford and elsewhere show good results in terms of both satisfaction and, most importantly, not returning to hospital. Where people have gone into a virtual ward rather than just going home, there has been a reduction of as much as 50% in people having to return to hospital environments. So we are seeing results.

In terms of primary care, as I mentioned, we have seen 50 million more appointments take place. Pharmacy First, which will be introduced shortly, is a key way of expanding that supply still further. So I say politely that, yes, there is a lot more work that will need to be done, but we really have expanded supply. We have put plans in place, and the early signs are promising. I hope, like all of us, that we will see far more of this and I look forward to updating the House as the season progresses.

NHS App: Medical Records

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 19th December 2023 Lords Chamber

[Lord Allan of Hallam]

To ask His Majesty’s Government what measures they have put in place to mitigate the risk of people being coerced into showing their confidential medical records to third parties as records become universally available through the NHS app.

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

The Government want people to have access to their own records. For most, online record access is beneficial but for a minority, having access could cause harm or distress. In many cases, practices can identify these patients and ensure that safeguarding processes are in place. Furthermore, to access the NHS app, users must prove their identity through the NHS log-in and, before entering their record, are advised what to do if they are being pressurised to share their information.

[Lord Allan of Hallam (LD)]

My Lords, the design goals for the NHS app should be to make it as easy and frictionless as possible for legitimate users to access the system, while making it as difficult and frictionful as possible for people trying to gain unauthorised access. But there is a natural tendency to focus on the first part of this equation as developers believe in the systems they build and find it hard to put themselves in the shoes of the cunning and resourceful attackers who will try to break them. Given this dynamic, can the Minister confirm that the NHS has a red team tasked with trying to identify all possible vectors of attack on the NHS app, and that the requisite resources will be put into mitigating any risks that they identify?

[Lord Markham (Con)]

The noble Lord is absolutely correct on getting that balance right between the two; that is why the NHS has a safeguarding reference group on exactly this, which has been putting in protections as well as messaging patients, telling them to be aware and that they have the opportunity to redact their records if they are concerned. There are other features, such as multi-factor authentication and making sure that, for log-in with facial ID, you cannot have anyone else in the picture, to ensure that people are not being coerced. So, there are a number of measures in place, but I completely agree that we need to keep them under review with user groups checking all the way.

Adult Social Care: Staffing

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 12th December 2023 Lords Chamber

[Lord Markham (Con)]

I share the noble Baroness’s concern about the speed of deployment. At the same time, it is fair to say that we are developing a whole new set of social care qualifications, which we think we can all agree are key to this. We are also developing a whole new payment mechanism, because there are 17,000 independent providers and we need a mechanism to allow payment. It is a complex programme, but I agree that we need to do everything we can to speed it up.

[Lord Allan of Hallam (LD)]

My Lords, a key part of the equation for long-term social care sustainability is charging reform, yet the National Audit Office report points out that the Government have scrapped their charging reform programme board and have no overarching social care programme in place. Can the Minister confirm where responsibility for charging reform now sits, and whether we can expect any progress in this critical area in 2024?

[Lord Markham (Con)]

Charging reform is still part of the Government’s commitment. At the same time, I think we all recognise that, largely as a result of the pandemic, we had to stabilise the social care situation first. That is what the £8.1 billion in funding has been all about and what the investment and recruitment have been for—so that we can stabilise first. I am glad to say that we are reaching a more stable footing. For the first time, staffing went up over last year and, likewise, the number of people in social care went up. We have to stabilise before we move on to the reform. I think we would all agree that the speed of reform needs to be a bit quicker, but it is sensible that we stabilise the situation first.

Cancer Research UK Report

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 5th December 2023 Lords Chamber

[Lord Markham (Con)]

I agree that research funding is key. That is why I mentioned the £100 million that we spent in 2021-22. The Medical Research Council is also spending £125 million per annum on cancer research. That is allowing us to introduce vital things such as the point-of-care cancer treatments that our regulators that have brought in ahead of anyone else in Europe, showing the key flexibility that our regulators now have, meaning that people can have individualised cancer care. I agree that we need to invest in these sorts of activities.

[Lord Allan of Hallam (LD)]

My Lords, I recently had a meeting at one of our excellent specialist cancer hospitals. It explained that it had tens of millions of pounds in the bank that it would like to spend on facilities and equipment to support new cancer treatments, but it cannot. The only blocker is that it cannot get a certificate from the local integrated care board to authorise the capital expenditure. Frankly, I was astonished by that. I invite the Minister to explain, in terms that even I can understand, why the Government think it a good idea to prevent a world-leading hospital trust from spending money that it already has on much-needed cancer research facilities.

[Lord Markham (Con)]

I am not clear on the details of the case but will happily take it up with the noble Lord afterwards. I agree that, clearly, we want our leading institutions spending money where they can really impact change, and that is exactly what we are doing.

Health Protection (Coronavirus, Testing Requirements and Standards) (England) (Amendment and Transitional Provision) Regulations 2023

Debate between Lord Allan of Hallam and Lord Markham

Monday 27th November 2023 Lords Chamber

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

My Lords, I draw the House’s attention to my declaration of interest in the company that I founded, which was accredited under these rules. The fact that it is accredited means I have some experience, which always helps in an area. It is not affected by these regulations, but I was keen to state that for the record.

The 2023 regulations update the legislation introduced in 2020 to impose requirements on private providers of Covid-19 diagnostic testing. Once they are implemented, private providers will need to be accredited by a signatory of the International Laboratory Accreditation Cooperation mutual recognition arrangement before they can supply testing. These measures replace the current three-stage UK Accreditation Service process with a simplified and streamlined one. They also remove requirements that are no longer necessary due to legislative developments that have taken place since 2020. The changes will empower consumers to choose a private testing service with confidence, continuing to improve safety and quality. During the Covid-19 pandemic, the Health Protection (Coronavirus, Testing Requirements and Standards) (England) Regulations 2020 focused on enabling providers who met appropriate quality standards to be able to rapidly enter the private testing market. This struck the appropriate balance at the time between protecting public health and growing the market quickly.

I am pleased that the worst of the pandemic is behind us, so the urgent need to grow the Covid-19 testing market quickly no longer applies. The department has therefore reviewed the 2020 regulations and proposes that all private providers must be fully accredited before providing testing services. This amendment will bring in requirements and standards that help to strengthen consistency, safety and high-quality Covid testing services.

I am pleased to be debating the statutory instrument that is necessary to implement our proposed updates to the existing legislation. The 2020 regulations introduced a three-stage accreditation process for organisations providing Covid testing commercially. The three-stage accreditation process requires providers to satisfy the UK Accreditation Service that they meet the relevant ISO standards within a set timeframe. Stage 1 requires the private provider to make an application to UKAS for accreditation and make a declaration to DHSC that they meet and will continue to meet certain minimum standards. Stage 2 requires the applicant to demonstrate, within four weeks of applying for accreditation, that they meet requirements published by UKAS. From January until June 2021, stage 3 required providers to complete their application within four months.

We wanted to ensure that a greater number of high-quality applicants were given sufficient opportunity to complete the process and reduce resourcing constraints on UKAS while maintaining quality control. In June 2021, we passed legislation to update stage 3. Applicants were now required to achieve a “positive recommendation” from UKAS within four months of completing stage 2. Provided they received this, they then had a further two months to achieve accreditation. Providers who fail to meet any of these deadlines, or fail to satisfy UKAS that they meet the relevant standards within this timetable, have to stop supplying testing. The purpose of this approach was to ensure that enough providers were able to enter the market soon enough to meet the public demand for testing. It ensured that we were not as a country left with insufficient testing capacity while still putting providers through an appropriate process.

Now I move to the substance of the regulations. The 2023 regulations implement several policies coming into force from 1 January 2024. First, private providers—diagnostic laboratories, sample collection and point-of-care testing—must be accredited against the appropriate ISO standard by a signatory to the International Laboratory Accreditation Cooperation mutual recognition arrangement before they can start supplying their service. This replaces the three-stage accreditation process. Since setting up this process, the Medical Devices Regulations 2002 were updated to prescribe a specific process for the validation of Covid-19 test devices. We therefore no longer need test validation measures in these regulations as well, so we are removing those. Secondly, the amendments reflect the publication of the updated ISO Standards 15189:2022. The amendments are forward-looking and do not affect private providers who applied under the previous ISO standards—ISO/IEC 17025:2017—before this instrument came into force. Lastly, this instrument removes the requirements to make a declaration to DHSC at the start of the application process and shifts the legal responsibilities for the clinical service to the private providers providing the clinical service, rather than the customer-facing part of the testing service.

The amendments will hold providers to high standards, by requiring them to be accredited before they can join the market. This will give confidence to individuals choosing Covid-19 testing services. The amendments also remove the additional requirements and administrative steps that were necessary in the early stages of the pandemic. Those who have already achieved accreditation will be unaffected by the change; that is, they will not need to reapply for accreditation under the new regulations. All private providers will be required, as normal, to transition to the new ISO standard by 6 December 2025 at the latest.

The amendments allow private providers who are accredited by a signatory of the International Laboratory Accreditation Cooperation mutual recognition arrangement to enter the market. The UK Accreditation Service is one of 90 accreditation bodies that have signed the arrangement. It enhances the acceptance of products and services across national borders. By accepting accreditation from these signatories, we help to remove barriers to trade such as the retesting or inspection of products.

Private providers must be accredited to the relevant ISO standards for clinical testing services. These standards were reviewed and updated in 2022 and transition proceedings have begun: the old standards will be revoked in 2025. The existing 2020 regulations do not reflect the updated ISO standard. So, if we did not make these amendments, providers who transition to the new ISO standards—as they are required to do—would not under our own rules be able to provide testing services. This is a clear lacuna that we need to address.

I am happy to be bringing forward this legislation today. These regulations will reduce bureaucracy whilst still delivering rigorous accreditation requirements, important for public health. I commend these regulations to the House.

[Lord Allan of Hallam (LD)]

My Lords, it is good to be able to debate a piece of legislation that is quite technical but still quite important. The regulations themselves are entirely sensible as tidying-up legislation after the coronavirus pandemic, but they trigger a few points that are worth putting on the record and seeking a response from the Minister on.

The first is just to note that it is good that we are following the international standards on this. I am sure all noble Lords experienced that period during the pandemic when there was confusion around which countries accepted whose tests and it became blindingly obvious that we needed international recognition. It is pleasing that we are following a standard that, as the Minister said, 90 bodies are now signed up to. It is good to have the confidence that when we pay for tests here in the United Kingdom, there is a good chance that they will have that international recognition. Does the Minister have a sense of whether other countries are following a similar path, where they implemented a special regime during the pandemic that they are now transitioning into a normal regime, just as we are doing today? Is the United Kingdom in step with other countries or are we ahead of or behind them? It would be interesting to know that; I assume the department has done some work around it.

Adult Social Care

Debate between Lord Allan of Hallam and Lord Markham

Wednesday 22nd November 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, I know the Minister is keen to ensure that people who are fit to leave hospital can do so quickly, but is he concerned that local government spending restrictions, imposed because of the state of the finances highlighted in the Question from the right reverend Prelate, may lead to more delayed discharges this coming winter? What steps are the Government taking to ensure that that does not happen—a hospital saying that a patient should leave, but the local authority saying that there is nowhere to go?

[Lord Markham (Con)]

The noble Lord is absolutely correct that the flow through the hospital is vital to A&E and other wait times. That is why we have announced things such as the virtual ward: the 10,000 beds are designed to get people out of the hospital and into a care environment where they still feel supported, thereby using technology to help take the strain. The point about this year, and the whole reason why we announced the £600 million extra investment over the summer, is that we learned the lessons of the previous year, recognising that the earlier we can get this money to the local authorities, the better they can spend it to put the provision in place.

Mental Health Act 1983

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 21st November 2023 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is absolutely correct. With the mental health units to detect problems early, we are now at around 35%; last year it was only 25% but in the next 18 months or so we should be at 50%, which is higher than ever before. I freely accept that 50% is not 100% but it is clearly a step in the right direction. The £2.3 billion investment we are putting in means 350,000 extra places for young people as well.

[Lord Allan of Hallam (LD)]

The Government keep telling us that they plan to take other measures to improve mental health outcomes in the absence of the legislation. I hope the Minister will understand why, having been let down on the promised Bill, we want to see the colour of the Government’s money. Can he go back to his department and ask it to produce a list, with details and dates, of all the measures it intends to take to improve mental health practices via statutory instrument and new guidance in this parliamentary Session?

[Lord Markham (Con)]

Yes. I am happy for the noble Lord to come to the round table and put those points himself as well.

Black and Minority Ethnic Babies: Mortality Rates

Debate between Lord Allan of Hallam and Lord Markham

Wednesday 15th November 2023 Lords Chamber

[Lord Markham (Con)]

The database from which all the evidence and data have come has just been published. That is exactly why we are publishing the database: so that we can understand the reasons behind it. We are also tying that to the NIHR to see what research is needed in those areas.

[Lord Allan of Hallam (LD)]

My Lords, behind every figure in the national child mortality database lies a personal family tragedy, which we all need to try to understand and reduce as far as we can, as the Minister said. The regional breakdown of the figures shows that there is much less variation between different ethnicities in London than in other English regions. Will the Minister look into that to see whether there are things we can learn from London—perhaps there the staff follow procedures where they are more responsive to people from varied cultural and ethnic backgrounds —so that those lessons can be applied in the rest of England?

[Lord Markham (Con)]

Yes, absolutely. One main reason for that is that in London there is generally a more ethnically representative mix of staff, who are better placed to understand and work in that way. Clearly, we need to increase training as well as recruitment across the rest of the country to make sure that they achieve the same levels.

Children’s Hospices: Funding

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 14th November 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend is correct; it is a long-term part of the statutory requirements of all ICBs to provide palliative care, so it is written into that NHSE mandate. It has to review all 42 ICB arrangements, and we make sure that in each setting they have the 24/7 care set-up required of them.

[Lord Allan of Hallam (LD)]

My Lords, following on from the Minister’s answer to the noble Lord’s supplementary question, most integrated care boards will have only a very small number of residents who need services from local children’s hospices. Given that, it raises concerns that spending on those services will not be prioritised at that very local level. Does the Minister accept that there is a case for integrated care boards to band together at the regional level and fund hospice services that way?

[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.

Suicide Prevention Strategy

Debate between Lord Allan of Hallam and Lord Markham

Thursday 26th October 2023 Lords Chamber

[Lord Markham (Con)]

What the strategy is trying to do is to look at those high risk groups and the risk factors behind them. One of the biggest risk factors causing suicidal thoughts are financial difficulties, which of course out-of-work disability benefits come into. One of the highest groups in terms of priority are middle-aged men, who are often the people suffering in this space. There are other groups as well, such as children and young people, pregnant women, new mothers and autistic people. There is a range, and what we are trying to do in this strategy is hit those areas of highest risk. To put this into context, those people on all DWP benefits in the reviews done on suicide make up less than 1% of the population of suicides. What we are trying to do is hit the major risk groups.

[Lord Allan of Hallam (LD)]

My Lords, the suicide prevention strategy says that DWP staff will be trained to identify benefit claimants who express suicidal thoughts and escalate these appropriately. Can the Minister confirm that the DWP will collect data on out-of-work disability benefit claimants who are caught or flagged by the system, so that we can understand whether or not this new policy is as effective as we would all want it to be?

[Lord Markham (Con)]

Yes, and I had the opportunity, because I used to be the lead NED at DWP, to go along to a number of jobcentres and see the sorts of work that they do. They have two things. They have an independent review of each of these, and those are the stats I was using: they get about 50 cases a year in these categories. Where there is a serious case they have a serious case review, independently chaired with a Permanent Secretary on it as well.

Ultra-processed Food

Debate between Lord Allan of Hallam and Lord Markham

Thursday 26th October 2023 Lords Chamber

[Lord Markham (Con)]

The rationale was very clear. The measures that we introduced by the modelling showed that in what we were trying to do we were attacking the things that cause 95% of the reduction in calories—namely, the product positioning, which has the support of 78% of people to reduce the so-called pester power. Early evidence shows that it is working, because foods that are not high in the bad stuff have gone up by 16% and those with high sugar, salt and fat content have gone down by 6%, all through the product positioning. It is working, but the most important thing is that we have gone after the big numbers, those that effect 95% reductions in calorific intake.

[Lord Allan of Hallam (LD)]

My Lords, to follow on from the questions asked by the noble Baroness, Lady Boycott, there is a public expectation that the delayed junk food advertising regulations will mean that children will be less likely to see ads for products from companies such as KFC and McDonald’s. But my understanding from the Minister’s previous comments is that the Government’s expectation now is that the advertising will carry on as before and children will continue to see just as many ads, albeit with the products reformulated to get around the ad ban. Is that correct?

[Lord Markham (Con)]

I have said many times that the prize is reformulation. I do not think that any of us should have a problem per se with the food if the bad stuff is taken out. Diet Coke is a perfect example. It is not particularly good for you but not bad for you either, so why should Coca-Cola not be able to advertise Diet Coke? If you take out the bad stuff, we should encourage industry because advertising works. It wants to advertise, so if it is encouraged to take out the bad stuff, that is a big incentive.

Paediatric Care: Wating Times

Debate between Lord Allan of Hallam and Lord Markham

Monday 16th October 2023 Lords Chamber

[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.

[Lord Allan of Hallam (LD)]

My Lords, it is naturally very stressful for any parent when they face a long wait for their child’s paediatric referral. That stress is often compounded by the fact that it is left to the parents themselves to chase things up through confusing referral systems and systems that are still far too manual and depend on paper letters that get lost. Will the Minister make a priority of improving the information flow to parents about a child’s referral, so that they can quickly and easily see what is happening and know what to expect?

[Lord Markham (Con)]

That is a point very well made. as the noble Lord knows, that is one of my priorities and what we are trying to do with the app. There will be a number of launches, but already we are seeing hundreds of thousands of messages going out via the app to make sure that people are getting them on time. That has become the backbone of our communication system and will expand across the piece to try to cover exactly the points the noble Lord raises.

Nursing Courses: Reduction in Applications

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 19th September 2023 Lords Chamber

[Lord Markham (Con)]

Yes, absolutely. Clearly, we want to recruit, but we also want to retain our workforce and again that is what the long-term workforce plan is all about—trying to look at a clear professional development path and other things we can help with, such as childcare support and the culture and leadership, and really make nursing a very successful and rewarding career structure. There is a lot to do on it, but I think there has been a lot of good progress as well.

[Lord Allan of Hallam (LD)]

My Lords, the NHS Long Term Workforce Plan will make funding available for an increased number of nurse training places, which is of course welcome, but the increase in capacity for the NHS will happen only if there are sufficiently qualified candidates applying for those places and completing the training. Would the Minister be willing to share the assumptions his department made about application and attrition rates when setting the targets in the workforce plan, so that we can compare those assumptions with reality as revealed by the numbers in the Question today?

[Lord Markham (Con)]

Yes, my understanding is that all the workings behind the long-term workforce plan are currently being analysed by another body— I am not quite sure whether it is the NAO, the ONS or whoever. The point is that all the modelling and the underlying assumptions are being analysed, and I believe there will then be a report on them so that everyone can see what we are trying to do and how reasonable those assumptions are.

National Health Service: Major Conditions Strategy

Debate between Lord Allan of Hallam and Lord Markham

Monday 18th September 2023 Lords Chamber

[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.

[Lord Allan of Hallam (LD)]

My Lords, in June, the Government announced a ring-fenced AI diagnostic fund of £21 million to support the major conditions strategy. Will the Minister update the House on progress with the rollout of that fund? What other steps are the Government taking to ensure that NHS patients in all parts of the country can benefit from the latest developments in artificial intelligence?

[Lord Markham (Con)]

AI is a key point. Take stroke, which is one of these conditions. I saw a very good example in the Royal Berkshire the other day of what we all know as the golden hour, and the results from it. The Royal Berkshire has AI scans that go straight to the responsible physician, who can say straightaway whether a thrombectomy, for instance, is needed, the timing of which is critical. That is now being used in that cluster of hospitals and will be one of the six key technologies, the roll out of which we will encourage across the board to others.

Reinforced Autoclaved Aerated Concrete: Hospitals

Debate between Lord Allan of Hallam and Lord Markham

Wednesday 13th September 2023 Lords Chamber

[Lord Markham (Con)]

First, we are doing everything we possibly can to make sure that the programme is accelerated as quickly as possible for good-safety reasons and for clinical reasons as well. In terms of the other hospitals, it is a case of making sure every step of the way that we have structural engineers and we take every safety measure. I managed to visit a lot of these hospitals over the summer and saw first hand the expert work they are doing there.

[Lord Allan of Hallam (LD)]

My Lords, to give credit where it is due, the DHSC has produced a very good fact sheet on RAAC in the NHS. I draw the Minister’s attention to the last line of it—the place where the bad news is usually buried. It says:

“Privately owned primary care estate is not part of the national programme. NHSE has issued RAAC guidance to private landlords who hold the responsibility for surveying and maintaining their own property”.


That reads a bit like “not our problem”. Can the Minister assure the House that the department will ensure that those smaller primary care settings get surveys done quickly? How will the department be staying on top of that?

NHS: Staff Numbers

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 12th September 2023 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend. Like all of us, I am sure, I was appalled to hear about that study. The most fundamental purpose of any employer is the safety and well-being of their staff, obviously, and I am afraid that the hospitals that allowed that to happen and allowed that culture to take place clearly failed. Clearly, we need to get to the bottom of that. As I often say, it starts with the leadership in each hospital and the culture that is built up within each college. Those are the people who need to be looking at themselves in the mirror and asking whether they have the right culture to make sure that everyone feels safe in the workplace.

[Lord Allan of Hallam (LD)]

My Lords, we know that the Minister is a big fan of data dashboards for tracking such things as the flow of patients through hospitals. Does he agree that such a dashboard would be an excellent way for us to track the Government’s progress against all the various targets that they have put into their workforce plan? Will he commit to producing one?

[Lord Markham (Con)]

I believe that the whole point of the workforce plan is that every couple of years there is a review of our progress against it and how it needs to be adapted, since it is a moving feast. So, absolutely, it is vital and something we are working on. Overall, the things that we said that we would do we are on course for. We said that we would increase the number of nurses by 50,000 over the course of this Parliament. It is currently 47,000. We said that we would increase doctors’ appointments by 50 million. That is currently on track. So a lot of good work has already happened. A lot of targets have been hit. Yes, there is more to be done and we are happy to track it.

Children’s Health: Sugar

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 12th September 2023 Lords Chamber

[Lord Markham (Con)]

Many noble Lords will recall the Question we had on this before. It is the actual ingredients that are the problem. Ultra-processed foods, in and of themselves, are not a good definition because bread is an example of an ultra-processed food. The problem is that many of these are high in fat, sugar and salt, and that is what we need to be tackling. That is what we are going after, not the definition of ultra-processed foods per se.

[Lord Allan of Hallam (LD)]

My Lords, the Minister has told us previously that the Government are going slow on their ban on junk food advertising because they want to give time to manufacturers to reformulate their products. For many of us, this is disappointing because, as long as the food continues to be advertised, there will be excessive consumption. Could the Minister give us a progress update, so that we can get to the point where these foods, which are bad for health, will no longer be promoted—particularly in front of children?

Countess of Chester Hospital Inquiry

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 5th September 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, we have all been appalled at what happened at the Countess of Chester Hospital, and we would also like to extend our sympathy to all those affected, especially those parents of children who were taken from them. Those were losses that we now know that could, and should, have been prevented. I echo the comments of the noble Baroness, Lady Merron, in praise of those doctors who did raise concerns and fought to have them taken seriously. The accounts that we have seen of legitimate concerns either being ignored, or in some cases being actively suppressed, are truly shocking and represent a call to action that we must heed.

The inquiry is welcome, and will cover a lot of important ground, and I will not try to pre-empt their work today. Instead, I want to focus on one aspect where the department could act now without cutting across the work of the inquiry, and that is the role of NHS trust non-executive directors. This is something which the patient safety commissioner also highlighted in her statement on the Letby case. She said of NHS non-executive directors that

“it is vital that they are able to ask the right questions and escalate concerns where needed.”

The relationship between non-executive directors on a board and senior management teams in any organisation involves the delicate balance of responsibilities. Would the Minister agree that NHS trust non-executive directors should see patient safety as a priority responsibility—perhaps the single most important among their broad set of duties? Would he also agree that it is a healthy and positive situation if trust managers feel that they are under scrutiny from their non-executive directors on safety issues and believe that they will be pulled up if they are not fully open with them? We saw in this case claims of management not presenting the full sets of facts to their boards. They must be entirely candid with their non-executive directors and must expect to be challenged; that is the culture we want to see on trust boards, not one of cover-up and misleading.

In this context, could the Minister confirm whether the department will take steps now to reinforce with trust boards the importance of non-executive directors being able to raise safety issues? Importantly, will they be providing non-executive directors with training on how to perform this function effectively, so that they understand the best ways in which to challenge executives where necessary?

As I said at the outset, we welcome the inquiry from these benches, but I hope that the Government will not wait until the inquiry has completed its work to start making changes, and that they will be equally committed to making changes now where these would improve governance, and that the Minister can confirm that they are looking at strengthening the role of non-executive directors on NHS trust boards.

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

I would like to thank the comments, and the spirit of the comments, made by noble Lords. I start by adding my condolences to the parents and families in question. As we all know as parents, it is the most horrible thing we could ever imagine happening to us.

Clearly, the inquiry will find out the full facts of the matter, but at the same time it is important that lessons are learned quickly. To the point of the noble Baroness, Lady Merron, the families will continue to be consulted throughout this time. We would all agree that what happened is unforgivable, and we should praise the doctors for the work that they did and the courage that it took to bring it forward. I am convinced, as mentioned by the noble Lord, Lord Allan, that we need to make sure that we are doing sensible things in the meantime to ensure that we learn those lessons quickly. The foremost responsibility—the first line of defence as I like to call it—is the role of the board and the NEDs.

Speaking to colleagues about this, Chris Whitty was just saying that any sensible statistician and someone with sound common sense should have been able to say that there is something seriously awry here. We must all ensure that the boards are equipped to be able to challenge in the right way. That does take training, but it is important to make very clear to them that their primary duty must, beyond anything else, be the safety of the patients in that hospital. That has to be the first line of defence. There are things that we need to do to help them, including training—and to the noble Baroness’s point, that they are equipped with the records of those people so that it is known whether they are fit and proper people. One of the questions that I have asked, and got answered, is that I know there is a list so that, when you are looking to employ people, you know now whether a person is not a fit and proper person. As happened in this case, people moved on to other trusts in intervening periods, and there must be a mechanism where the trust can annually review, or review even more frequently, whether they are fit and proper through past cases that have just come to light, so that they have the ability to act.

It is our role to arm those boards, and give them the information and training to be that first line of defence. Tragically, we know in this case that first line of defence failed. These actions should bolster that first line of defence, but we also need to look at some of the second lines of defence. Medical examiners are a good way forward. From April 2024, they will now oversee all deaths that have not been put to coroners. I am told that this happens quite regularly already in the hospital setting; the challenge is more in the primary care setting. Along with other lines of defence, there is the duty of candour, allied with the freedom to speak up, so that we are gaining knowledge from the staff and people on the front line. Again, it is clear in this case that, while doctors were very brave in bringing it up, a lid was kept on it for too long. Clearly, we need to do more in terms of that whole approach of them feeling emboldened to speak up.

At the same time, the steps being taken in terms of the Getting It Right First Time programme and the health and safety investigations board and CQC are all good steps in that direction. But what is vital is that we do not, by putting in those central measures, somehow give boards the feeling that the first responsibility does not lie with them. It is the most important job that they can do, and the last thing that any of us would want is the feeling that they do not have to worry so much about that, because there are these other bodies looking into it. Absolutely fundamental to all of this is that they realise that it is their primary duty and that we in the centre are arming them to do that properly.

I hope that gives a good sense of the direction of travel we are going in, and I hope it accords very much with the points made. As to whether we should be going further in terms of registers to make that regulatory, we are absolutely open to that. It is just about trying to work out the practicalities and where the right level is. There are, however, some things, such as making sure this fit and proper persons list is up and running. That is something that we can do very quickly and are doing tomorrow. Clearly, there will be other opportunities for questions that I am taking in a moment. As ever, I will follow up all of this with a detailed reply. Most of all, I want to give a moment’s pause.

Folic Acid Fortification

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 25th July 2023 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend, and I agree. I hate the words “in due course” because they mean “whenever”. While I freely admit to using words such as “soon” and “imminent”, “in due course” is not a term I use, and I understand the point being made. The consultation will be published late in the summer. It is a complex area, and I have said that I want to get personally involved now; I want to make sure that we get the balance right between the many competing interests. The legislation is planned for early 2024. All I can do on my side is to undertake to push that forward as much as possible.

[Lord Allan of Hallam (LD)]

My Lords, the Minister said in reply to a previous question that a lot of the industry is already voluntarily adding folic acid to bread and other foodstuffs. Of course, “a lot” is a well-known scientific term for “more than a little”. I invite the Minister to offer us a more precise figure. Does the department know what percentage of bread and similar products are currently fortified on a voluntary basis? If not, could it carry out a survey so that we can have that number?

[Lord Markham (Con)]

Probably the best thing to do is for me to give the noble Lord the detailed information we do have and try to find out more. I am told that “a lot” means the majority of bread products, but I will give the noble Lord a more precise answer.

Stroke Care

Debate between Lord Allan of Hallam and Lord Markham

Monday 24th July 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, we are fortunate to have the Sentinel Stroke National Audit Programme—SSNAP—to help us monitor compliance with the national guideline. In its very good easy access report for the first quarter of this year, it tells us that three out of five stroke patients are not taken to a stroke unit immediately and it calls for urgent action in this area. What are the Government doing to make sure that stroke patients are immediately admitted to stroke units in line with that guideline?

[Lord Markham (Con)]

The noble Lord is absolutely correct. As mentioned, speed to the right place is vital; videos in ambulances are one way of communicating ahead and speaking to the paramedics so that they are ready to receive them, which is really important. The latest data I have seen is that 92% of people are now sent straight to the stroke ward on arrival, which sounds promising but is somewhat at odds with the Sentinel figure he mentioned. I will find out more about that and get back to the noble Lord.

MMR Vaccine

Debate between Lord Allan of Hallam and Lord Markham

Thursday 20th July 2023 Lords Chamber

[Lord Markham (Con)]

There are two main approaches. If a child is under 11, we would prefer to have a parent present, for obvious reasons—because it involves a vaccination—so that is normally done through the primary care system, through nurses. Post 11, because you do not need the parent there, that is where schools really come into effect. In particular, there is a school-age assisted immunisation providers programme that goes into every school in a particular area, targets it and speaks to every child to see whether they have had their vaccination—and they can give it on the spot if they have not.

[Lord Allan of Hallam (LD)]

My Lords, does the Minister agree that the experience of both the MMR and Covid vaccination programmes shows that vaccine hesitancy is actually a very complex problem with multiple factors? Given the importance of high vaccination rates for public health, are the Government commissioning any research from academic experts in misinformation and disinformation so that we can understand what kinds of government campaigns will work and which ones will not and will only reinforce vaccine hesitancy?

[Lord Markham (Con)]

The noble Lord is correct about trying to make sure that we learn the lessons from all these areas. The approach that they have been responding to so far is very much “horses for courses”. In the last six months alone, they have had four different types of campaign. We do not have the results from those campaigns yet, but the point is a very good one and I will make sure that we get those results from the research and share them.

Food: Two-For-One Offers

Debate between Lord Allan of Hallam and Lord Markham

Wednesday 19th July 2023 Lords Chamber

[Lord Markham (Con)]

We are trying to educate, inform and nudge. The best example of all is encouraging the industry to reformulate its foods to be healthier. At this point, I am glad to say that, since we introduced these restrictions, Mars, Galaxy, Bounty and Snickers have reformulated, and even Mr Kipling’s Deliciously Good cakes are compliant.

[Lord Allan of Hallam (LD)]

My Lords, next week it will be three years since the Government committed to legislate to end the promotion of high-fat, salt and sugar foods by volume. Would a reasonable person think that this commitment has been met when the legislation has been passed but not implemented, and will not be for another couple of years?

[Lord Markham (Con)]

As I mentioned, the key is giving industry time to adjust so that it can reformulate. We would all agree that, if you can get the same taste but it is a lot healthier, with less fat, salt and sugar, that must be a good outcome. The examples that I just gave show that, and it is working.

Ultra-processed Food

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 18th July 2023 Lords Chamber

[Lord Markham (Con)]

Absolutely. That is why we are at the highest level of free school meals for children ever. More than a third of children are now receiving free school meals, including all infant schoolchildren. The noble Lord is correct that a healthy start to life is vital, and if we can make sure that children are getting a good, nutritionally balanced school meal, that is a good start to life.

[Lord Allan of Hallam (LD)]

My Lords, as the Online Safety Bill works its way through this House, we see how interventionist the Government can be in the interests of public health and well-being when they put their mind to it. Learning from that effort, does the Minister agree that the phrase “legal but harmful” is quite an accurate description of some of the kinds of ultra-processed food that are sold and marketed in the UK?

[Lord Markham (Con)]

Absolutely. Some of the foods are not healthy at all, and we totally want to discourage them. We have taken a lot of steps in that space. The whole product positioning strategy, whereby you cannot now put such foods in places where there will be so called pester-power influences, is beginning to have an effect. We are already seeing healthier foods outgrowing non-healthy foods from that. Those sorts of actions were modelled to show that they were effective for 96% of the things that we are trying to target to reduce in terms of calories.

Community Health Services: Waiting Lists

Debate between Lord Allan of Hallam and Lord Markham

Wednesday 12th July 2023 Lords Chamber

[Lord Markham (Con)]

We are starting to see a blue- print which is beginning to work. The highest waiting list for adults is related to musculoskeletal issues. Since we put an improvement framework in place, 91% of people are now being seen within 12 weeks—a big improvement. We are moving to self-referral also, and digital therapeutics beyond that. There is a road map in place that we need to apply across other areas.

[Lord Allan of Hallam (LD)]

My Lords, within the published data for wait times in community health services, we see that some people face very long waits for home oxygen assessments, including some waiting for over a year. Given that home oxygen is key for many with respiratory conditions staying out of hospital, will the Minister prioritise looking into why we are seeing these delays, and ensure those who need home oxygen do not face unnecessary waits?

[Lord Markham (Con)]

As noble Lords probably know, we published this data for the first time in March, so it is only now we are getting the data that we can truly work on it. It sets out 35 different areas where we understand those waiting lists for the first time, so we know which ones to prioritise—home oxygen being clearly one of those.

NHS: Doctors’ Strikes

Debate between Lord Allan of Hallam and Lord Markham

Wednesday 5th July 2023 Lords Chamber

[Lord Markham (Con)]

Clearly, that is the last thing anyone wants. I trust all the medics who, first and foremost, care about patient safety to inform their local management so that they can make sure that the correct processes are in place to ensure that patient safety is looked after.

[Lord Allan of Hallam (LD)]

My Lords, yesterday, we discussed the Government’s plans to increase the number of doctors in training. But does the Minister accept that junior doctors are facing real challenges in dealing with the rising costs of living on their current pay rates, especially in their early years? Is this need to retain trainee doctors part of the Government’s submission to the independent review body, so that we do not end up bringing in more trainee doctors at year 1 only to lose them at years 6, 7 and 8?

[Lord Markham (Con)]

Yes, of course, the noble Lord is absolutely correct; retention is key in all this. That is looking at all aspects of the package and work conditions and everything around those. That is what the workforce plan addresses, I hope, because recruitment and retention are key.

NHS Long-term Workforce Plan

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 4th July 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, I shall try not to be too grudging, as we have been calling for this plan for so long. I start by recognising the enormous amount of work that has gone into this from people working in the NHS and the department over a very long period, but the reality is that the plan is too late for those who are waiting for treatment today and are unable to get it, because the investment was not made in the workforce years ago for it to be available now on the front line. However, the plan certainly is substantive and there is much to welcome in it, looking forward. There are several areas where I hope the Minister can explain the Government’s thinking further.

First and perhaps most importantly, we need a similar, sister plan for the social care workforce. As we have discussed many times across these Benches, health and care work in symbiosis and both have seen too little supply to meet demand in recent years. Can the Minister confirm that the Government have no plans to further reduce capacity in social care by acceding to some of the requests from his political colleagues to limit visas being made available for essential social care staff? Can he say when the Government intend to release a sister plan to the NHS plan dealing with the social care workforce?

The plan also depends on ambitious productivity gains, and these will require certain things to be put in place. First, we need technology that will make life easier rather than more difficult for staff. Will the Minister explain what work is being done to understand how front-line staff in the NHS actually experience the technology they are being provided with, to ensure that we are not setting them back? Technology, when implemented well, leads to productivity increases, but technology poorly implemented can simply add to the frustrations of staff and make their jobs more difficult.

Another key factor in productivity is good management. This is a much less fashionable area to comment on than additional doctors and nurses, but the evidence seems to suggest that the National Health Service is actually quite lean in terms of its management. Will the Minister comment on what is in the plan to boost management capacity so that we can make savings on that other kind of consultant, the management consultant? Far too much is still being spent on externalising management expertise rather than building capacity within the service.

The final area I want to comment on is retention. The plan has hard numbers and new targets for getting new people into training but is much less precise on how we can improve staff retention over the long term. This is of course, quite importantly, a matter of pay and working conditions across all grades of staff. I invite the Minister to comment on some of the press stories we have seen saying that there seems to be some reluctance on the part of the Prime Minister to implement pay review body recommendations in full, something that he himself has said we should rely on to resolve issues particularly around junior doctors. Certainly, understanding that pay is important and that review body recommendations are going to be respected is critical for retention.

We can see that the Government have looked very closely at the specific factors that discourage senior doctors, in particular, from staying on as they approach retirement age. I suggest to the Minister that similarly detailed work needs to be done to understand the precise factors that are leading more junior staff at earlier stages in their career to leave the profession. Similar attention must be paid to resolving those specific issues if we are to address the retention problem.

One way we can motivate staff to stay on is through continuous professional development and retraining into more highly skilled roles, yet training opportunities can be constrained by the capacity of those delivering it. Can the Minister assure us that training opportunities will be provided for existing staff as well as new staff, so that we do not end up holding back Peter in order to train Paul? It will be net negative if we lose staff from the existing workforce through missed training opportunities as we bring in new staff. More generally, is there an understanding of how we are going to build up that capacity for training existing and new staff?

When I was younger, I had a teacher who would often write on my essays, “Okay as far as it goes”. This would annoy me, but with the benefit of wisdom and age I have to concede that it was often fair and accurate. Today, we might say that this plan, into which I know a huge amount of work has gone, is okay as far as it goes. We can be confident that it will really make a difference only if it is delivered in full, and in particular if there is a sister plan for the social care workforce and a real effort made on staff retention. I hope the Minister will comment on some of those aspects.

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

I thank noble Lords. Before I answer their points, and while I shall not repeat the Statement, it would be remiss of me not to repeat one thing, which is about Lord Kerslake’s passing. Lord Kerslake inducted me into government many years ago when I was a non-exec director at the Ministry of Housing, as it was then, and I always found him a very wise head and a very kind man. I am sure that condolences go from all of us, and particularly from me.

I welcome the constructive responses from the opposite Benches. As we have said, a huge amount of work has gone into this plan from some 60 organisations, including royal colleges, and it is an NHS document. I must admit that while I will take the description from the noble Lord, Lord Allan, of “Okay as far as it goes”, I prefer the description of Amanda Prichard:

“This is a truly historic day for the NHS”.


On a personal note, I am very glad not to have to answer about how quickly it is coming any longer.

On the detailed comments, the noble Baroness, Lady Merron, said that this is a living document, with the two-year update, and that is a critical part. I agree with her that this is going to be effective only if it is a live document that we continue to review, amend and improve as time goes on. On the quality management of staff, this comes to the point about retention. There is no silver bullet, as we know. I liken it to the approach we see in the cycling, in the Tour de France, with Team Sky: there are lots of little things that you have to do and it is the collective effect of putting those things together which really makes the difference.

Clearly, pay is an important element of that; the point of view of the pay review body is clearly going to be very important; clearly, pensions are a big move; clearly, professional development is a big part of it, not just for new staff but absolutely for existing staff as well. It is also about the conditions that people work in; it is not just the culture and leadership but the place they work in as well. That is why I am pleased that the capital parts of this are seen as very important in driving the right culture and environment that people want to work in: these are key to retention and driving productivity. The new hospital programme is a very important part of that, and so is the capital programme generally.

Equally, technology is a key part of this, as mentioned before, and that includes front-line staff. Just on Friday, I was at Chelsea and Westminster, where they showed me at first hand how they found the databases they were using really helpful, with basic patient tracking, making sure they were following them through the whole care pathway and managing their whole journey, so to speak. They were using it and enjoying it, if that is the right word, and that was key.

The point about NHS management and leadership is very important; this plan looks at the medical side, but we all know that leadership is so important for the effectiveness of hospitals and a key part of this.

The noble Baroness mentioned the focus on hospitals. Clearly, hospitals are a very important part of this, but underlying that is a key shift towards primary care and prevention. If you delve into the details of the numbers, you will see that the level of people who need to be trained for primary care is going up and that they are becoming a bigger proportion of the workforce. I think we all agree that that should be the direction of travel. To deliver that, we will need to look at the capital estate behind this and make sure that we have the GP surgeries and everything else in the right places.

I turn to social care. The increase in medically trained people can only be a good thing for social care and the sector as a whole. However, social care is not included here. It is difficult. We can make an NHS plan because we are the employer behind the NHS; whereas there are hundreds, if not thousands, of different employers in social care so it is not for us to make that plan. However, it is for us to make sure that we increase the supply of medically trained people, as set out in this plan. We know how important international workers are to that; we recognise that and the importance of visas. Notwithstanding that, the value of this plan is that, eventually, it will reduce our dependence on the need to recruit internationally. We will see it go from about 25% of recruitment, as currently, to about 10% because we are increasing the supply base and the pool of people who can do that, rather than making a change on the visa front.

As ever, I have tried to cover most of the points raised in the time available. I will follow up in writing on the rest, but I conclude by welcoming this report.

Mental Health In-patient Services: Improving Safety

Debate between Lord Allan of Hallam and Lord Markham

Monday 3rd July 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, I am grateful to have an opportunity to discuss mental health provision, and my comments will very much follow on from those of the noble Baroness, Lady Merron. We are also interested in the Government’s latest thinking about the draft mental health Bill. Now that the workforce plan is out—we will discuss it tomorrow—our new refrain may be, “When will the Government get on with the mental health Bill?”. It is long overdue, and a huge amount of work has gone in that is clearly fundamental to trying to deal with some of the structural issues.

Turning to some of the issues raised in the Statement, I first want to ask about people’s journeys when they are in need of mental health support. The Statement said that 111 will now provide mental health advice, which is very welcome, but can I ask the Minister for his thoughts on what is happening in primary care? My understanding is that at the moment mental health nursing provision is not a requirement of all general practices—some offer it and others do not. Can the Minister, who I know cares about joined-up, seamless services, give us some insights into the Government’s thinking on ensuring that people who present with mental health problems to general practice—which is the first port of call for many of them, before they even get to 111 or 999—see more consistency of support available at that level?

Thinking about the review—a major part of what is in the Statement—a significant proportion of providers of mental health in-patient services are private sector, which has been the case for some time. Can the Minister confirm that they will be included in the review and comment on whether the inspectorate’s powers will be applied equally to the private and public sectors? That is critical to understanding what is happening in all settings.

Will the Minister also talk a little about the input the review may get from related services? Again, we know that the police, local authorities and accident and emergency departments often pick up the pieces where mental health provision has not been made available. Can the Minister assure us that the review will also look at all those other parties to this journey of care that people require? Can he also comment on the data questions? I have seen evidence from freedom of information requests to the Office for National Statistics asking about deaths of people in mental health in-patient settings. My understanding is that the data is not recorded consistently. If we are to have a review and to understand what is happening in the mental health sector, it would be helpful to know what measures the Government will take to improve the consistency of data collection so that, when someone unfortunately suffers a tragic incident, we know where they were at the time and have the data available to build up the national pattern.

The final issue I want to ask for the Minister’s comments on is out-of-area placements. Will he acknowledge that it remains a serious issue that many people with serious mental health conditions are able to get treatment only in places that are far from home and therefore far from their families and support networks? I note from the Statement that the Government are providing three new hospitals. This is of course welcome, but I hope the Minister will also be able to confirm that there is a locality-based strategy, with the Government thinking hard about matching local facilities to local need so that we can end the situation in which people at a time of extreme distress are sent very far away from home, which can only add to the crisis they are facing.

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

I thank noble Lords for their questions and their general welcome for the Statement. On timing, we had hoped that doing it on a non-statutory basis would have been sufficient. The advantage is that you get the results that much quicker; you can often get them within a year, versus three years. We have many examples of where it has worked quite well, such as the Kirkup report. To answer the question of why it is taking so long, in the first place we had hoped that doing it on a statutory basis would not have been necessary. There was a course correction in January, when we were not getting the response we needed and not enough staff were making themselves accessible. There was some improvement at that point, but it was felt by the chair that it was not sufficient, hence the decision now.

We believe that we can build on the work that has been done so far, so we are not starting again from zero. However, there are some lessons. On a number of occasions, trusts and staff have responded well to a non-statutory inquiry, but we have learned from this that sometimes it needs to have the teeth of a statutory inquiry so that it is taken seriously enough. Somehow, there was an impression that, because the inquiry was not statutory, it was not seen as serious enough to trigger that. There is a key lesson to learn from all of that.

How we can seek to restore confidence is absolutely the right question to be asking. We believe that the additional investment of £2.3 billion that we are putting into this space is a key part of that, and the increase of 27,000 staff is another. We are learning from the reviews that we are doing, and we are quickly learning from the rapid review. We are working fast, so I cannot give an exact date for those results. We asked for it to be a rapid review so that we could get on with it and make the most of the findings.

The other key part of this is the Healthcare Safety Investigation Branch. We are asking it to look into a number of questions, one of those being out-of-area in-patients and the impact that has. I think we all agree that it is best if people can have in-patient services locally. That is one of the key parts that it will be asked to review. On the timing of that review, it will start in October and should be able to conclude within a year. We should get results back quite quickly.

On the timing of the mental health Bill, we are working through the parliamentary calendar now. We do not know the timings yet, but the scheduling is being looked at.

The noble Baroness mentioned the prevention agenda. I completely agree that care in the community and the training of staff in GP settings and schools are vital to this. As noble Lords have heard me say at the Dispatch Box before, we are making good progress: about 35% of schools are trained up in mental health support. Last year it was only 24% and next year we think we will be pushing 50%. Those are big increases, but I freely accept that 50% is not 100%. A lot of progress is being made in that area but we accept that a lot more needs to be done.

As for the private sector being included in the review, I have every reason to think that it should be and that there should be equal powers, but I will check that. I am talking off the top of my head now as it seems perfectly sensible, but I will come back properly on that.

I will do likewise with the comments on the recording of and use of data. Again, one of the rapid review findings was that we do not have enough real-time data. That is very much the direction of travel but, again, I will come back with more detail. As ever, noble Lords will know that I like to bring all these things together in a lengthy letter where I hope I am able to cover any points I did not cover here.

There are steps in the right direction, and the investment I talked about is another step in the right direction. I completely agree with the emphasis that it is vital we restore confidence in this area.

Lung Cancer: Screening

Debate between Lord Allan of Hallam and Lord Markham

Monday 26th June 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, I would like to follow the noble Baroness, Lady Merron, in welcoming the Government’s acceptance of the National Screening Committee’s recommendation to introduce a targeted lung cancer screening programme, and echo her tribute to the late James Brokenshire, whom I dealt with in a previous capacity when he was a Minister advocating for child safety online. I found him to be very effective; a firm Minister who was also very pleasant to deal with—the most effective model for all of us.

The new programme is especially welcome as a step towards addressing the glaring health inequalities we face in the United Kingdom. I hope the Minister will reassure us that sufficient data will be collected in order to understand whether it is having the kind of impact the Government intend, as he outlined in the Statement.

I hope the Minister can also provide more information about how it can be delivered, given that we already have dire shortages in capacity to deliver diagnostic tests. This shortfall is reflected in today’s report from the King’s Fund, which shows a serious gap in CT and MRI scanner capacity between the UK and comparable countries. When can we expect to see investment from the Government in additional scanners, to bring us up to something more like the international mean? As well as the lack of machines, we do not have sufficient people to operate them or to assess the test results. I invite the Minister to refresh his formula for when we may see the long-awaited NHS workforce plan, including the element that relates to radiologists, perhaps updating it from “shortly” to “in the next week”, as it surely has to come before the 75th<sup>anniversary of the NHS on 5 July.

The concern we continually have with announcements of new services by the NHS in the current context is that they will come at the expense of existing services; the noble Baroness, Lady Merron, also referred to this. I believe this is a rational and reasonable concern to have, given the evidence of missed targets and unacceptable wait times that is all around us. I hope the Minister can give us further assurances that, as the Government will the end of catching more cancers earlier, they will also be willing to will the means to deliver on this promise.

Anyone with eyes in their head can see that vaping is being cynically promoted to young teenagers; it is all around us in high street shops and in the evidence from the litter around schools. The Statement refers to the role of vaping as a tool to help existing smokers give up their harmful habit, but there is increasing evidence that vaping is creating new nicotine addicts, with associated risks. The Australian Government have found that young people who vape are three times as likely to take up smoking, and they have plans to bring in a range of measures to suppress vaping among young non-smokers. Can the Minister explain what assessment the UK Government have made of the Australian evidence of vaping leading to higher smoking prevalence among young people, and are the UK Government considering similar measures to reduce vaping use here? It took us five years to follow Australia in introducing plain packaging for cigarettes. I hope we can follow faster here, on vaping.

The new screening programme is welcome, but it must be properly resourced with both machines and people. I hope the Minister can give us some insights into how that will happen, and at the same time explain what action the Government intend to take to reduce vaping among non-smokers, so that we do not end up creating a new wave of people who are at risk of lung cancer.</sup>

[Lord Markham (Con)]

I will start with a small correction to the Statement. It should have said:

“We are investing £123 million in AI tools such as Veye Chest, which allows radiologists to review lung”


scans, not X-rays. I do not whether the etiquette is that I should have said that during the Statement. I repeated the Statement verbatim because I was told I should, but the correct word is “scans”.

I thank both the noble Baroness and the noble Lord for their comments and support. I too had the pleasure of working with James Brokenshire, and I realise what an effective and kind person he was. Like others, I am delighted that we are making these positive steps today and welcome the constructive and supportive comments.

Regarding trying to show that we are matching the will with the means on MRI scanners, that is exactly what the 100-plus CDCs are all about. It is a recognition that we do not have the same diagnostic capability, as highlighted by the King’s Fund report. That is what the investment in those centres is all about. My understanding is that about four million tests have already been done, so we are looking to match that. We will need 184 radiographers and 75 radiologists to do this work, but the other big support will be the use of AI. We are seeing some promising technology, which will help to a large degree. I am glad to say that a lot of this will be set out in the long-term workforce plan in the coming days—a new formulation. In other words, pretty soon.

In terms of the comments about screening being targeted at those most in need, that is where I have been most pleased by the pilots. Use of the mobile trucks really made a difference in those areas most in need. It really made a difference in the most deprived areas, which, as the noble Baroness, Lady Merron, mentioned, have higher levels of smoking. I am glad that it is targeting those areas.

Can we work to hasten the timetable? I think we would all like to but what we are trying to do here is to put down plans that we are confident we can hit. To answer the money question, it is £1 billion of extra investment during that time and that increases over time so that by the end it is about £270 million extra per annum.

What does that mean in terms of the Dr Khan responses? As I mentioned, we are committed to the smoking cessation results. As part of that we are considering all the points in the Khan review. I think we all accept that vaping is much better than smoking. We are very much trying to encourage vaping over smoking. But you have to be careful of the side-effects of that. As we have seen, vaping can be used in a somewhat cynical way—to borrow the phrase—with young people. More work undoubtedly needs to be done in that space but it is recognised that there needs to be a balance. I think I will need to come back in writing on air quality and cystic fibrosis.

I have tried to cover the points at this stage and look forward to further questions.

NHS Procurement: Palantir Contract

Debate between Lord Allan of Hallam and Lord Markham

Thursday 22nd June 2023 Lords Chamber

[Lord Markham (Con)]

Again, it is important to say that the whole point of this transition arrangement was to allow us to have an open bidding process across loads of suppliers, knowing that, when they were able to put their solution in place, their transition arrangements were in place. That opened up the field to British suppliers and suppliers from around the world. We have had an open process, which has been going on for a number of months now and continues. We expect a contract award around autumn time and I can assure the noble Lord that we have looked at a whole range of suppliers to make sure that we get the best outcome.

[Lord Allan of Hallam (LD)]

My Lords, can the Minister confirm something that he said in a previous answer: namely, that whoever wins the federated data platform contract will not have the right to use any NHS data outside the terms of that contract? Secondly, assuming that the current provider, Palantir, does not get the contract, will the NHS put in place by the end of this transition period procedures to ensure that all the data and access that Palantir had is removed safely so that there is no ongoing situation?

[Lord Markham (Con)]

I thank the noble Lord for giving me an opportunity to clarify that absolutely. The answer is yes on both counts. If Palantir is not successful in winning the contract, no data will remain on its systems; it will be transferred over completely and, as the noble Lord says, whoever ends up winning the contract will be allowed to use that data only in an NHS context—that is, in no other context at all.

General Practitioners: Recruitment and Retention

Debate between Lord Allan of Hallam and Lord Markham

Monday 12th June 2023 Lords Chamber

[Lord Markham (Con)]

First, I would agree—I think we all agree—that continuity of care is very important. We absolutely want a career structure that attracts and retains exactly those types of people, so that they feel it is more rewarding, both financially and as a job, to work in such a practice environment.

[Lord Allan of Hallam (LD)]

My Lords, I expected this Question to be the cue for our weekly reassurance from the Minister about the workforce plan, which will be coming “shortly”, “imminently”, “in the blink of an eye”, or whatever the latest formulation will be. In spite of all the reassurances that he has given about numbers, the stark reality remains that many people up and down the country find it extremely hard to see a GP when they need to, and that has knock-on effects for everyone else, including accident and emergency services. Does the Minister have anything new to offer that might give us some confidence that we will turn the corner in the near future?

[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.

Mental Health Services: Huntington’s Disease

Debate between Lord Allan of Hallam and Lord Markham

Monday 12th June 2023 Lords Chamber

[Lord Markham (Con)]

The research from the Huntington’s Disease Association, albeit with a small sample size of only 100, suggests there is an issue here. That is why I spoke to Minister Whately about this just this morning. She is being very firm in terms of tasking the NHS to come back with a plan to make sure we get that diagnosis. We will not know until we see the situation across a larger sample size, but clearly it is something we need to work more on.

[Lord Allan of Hallam (LD)]

My Lords, the Huntington’s Disease Association is pressing the Government for a number of actions in its campaign “Mindful of Huntington’s”. Could I press the Minister on one of these: that there should be a care co-ordinator in each area to help manage the various professionals? Do the Government agree in principle with this approach? What specifically are they doing to work with integrated care boards for situations such as this, in which you need primary, secondary, mental health and social care to all work together?

NHS GP Surgeries: Purchase by US Companies

Debate between Lord Allan of Hallam and Lord Markham

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

I think it was the noble Lord opposite who introduced patient choice. That looked to the independent sector to increase supply, which is what we care most about. I do not believe that anyone should be fundamentally against who owns a business. What they should care most about is the supply of good-quality services.

[Lord Allan of Hallam (LD)]

My Lords, further to the Minister’s answers around quality, does he agree that there is a significant public interest in understanding how well different general practice ownership models perform for patients? In this context, can he confirm whether his department is carrying out any research into patient satisfaction and outcomes by ownership type, using sources such as the general practice patient survey and the OpenSAFELY trusted research environment for GP data?

[Lord Markham (Con)]

I am not aware of any correlation between the type of ownership and the quality of the services from it. If there is one, then we can look at that, but we are focusing resources on the areas where they make most difference, and the focus is: what is the performance of that clinic? That is what we should all care about. How are the doctors there performing in terms of appointment times and everything else? I will not put a false target on who owns it and the structure of it, because that is not relevant. What is relevant is the quality.

Cancer Referral Targets

Debate between Lord Allan of Hallam and Lord Markham

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

I am not exactly familiar with the test that my noble friend might have taken but many of us will have heard about the early promise shown by the GRAIL programme. It is a simple blood test and, right now, has a two-thirds success rate for early detection. Those are early indicators, but early diagnosis and innovative approaches such as the GRAIL blood test are important.

[Lord Allan of Hallam (LD)]

My Lords—

--- Later in debate ---

[Lord Markham (Con)]

The noble Lord is absolutely correct that we always need to keep these things in balance. What I was trying to express was that we have an opportunity to innovate in this space. We have another innovation in our targeted lung cancer programme, which has now been rolled out to 43 sites. In 2019, 50% of such cancers were not detected until stage 4. Now, through mobile delivery of services to these sites, we are detecting 60% of such cancers at stage 1. Those are the sort of innovations for which we have very solid data, and they do show promise for the future.

[Lord Allan of Hallam (LD)]

My Lords, national waiting times for cancer treatment have fallen way off target, as the noble Baroness, Lady Merron, set out in her Question, but these national numbers mask significant regional variations. In March, they ranged from 45% of referrals within the target time in Birmingham and Solihull to 80% within target in Kent and Medway. How does the Minister account for such significant variations and what are the Government doing to level up those integrated care board areas that are falling furthest below the targets?

[Lord Markham (Con)]

That is exactly the example I was giving when I mentioned lung cancer targets, where mobile devices are being used. Interestingly, the most deprived areas have been targeted because they are often areas of high smoking, and these are the areas where they have managed to get screening times down the most. We have the opportunity to put CDCs in the areas of most need. We all agree that there is unprecedented demand and that we have to expand supply; there is no other way to meet that demand but to expand supply.

National Health Service (Dental Charges) (Amendment) Regulations 2023

Debate between Lord Allan of Hallam and Lord Markham

Monday 5th June 2023 Lords Chamber

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

My Lords, I am pleased to respond to this debate on these regulations and to address the concerns about their impact on patients and access to dental treatment. I thank the noble Lord, Lord Hunt of Kings Heath, for securing this debate on this important matter, and I thank noble Lords on all sides of the House for their contributions to the constructive debate.

Dentistry is an important part of the NHS and we acknowledge the gravity of the challenges that some people have faced in accessing these services—and the real impact on the health service and A&E, and on young children, that the noble Baroness, Lady Merron, mentioned. So, to answer clearly the point of the noble Lord, Lord Hunt, about this not being about decreasing access, I say that access challenges are at the top of our minds. Hopefully, this speech will show that we have an aspiration to increase access to dentistry, as the noble Baroness, Lady Merron, said.

In July 2022, we announced a package of dental system improvements, having fully engaged, via the NHS, with the dental profession and patient representatives. These initial changes were aimed at improving information for patients, improving incentives in the contract to deliver more complex care and enabling the NHS to better work with the sector to ensure that dental care is delivered.

Most importantly of all, I will address the underspend head on. I appreciate the noble Lord’s maths, but I will be absolutely clear that we do not want the underspend; it is caused by dental surgeries that are not delivering on their contract. In many cases, they declare a number of UDAs to underpin their business and then try to sell in the private sector, ending up with an underdelivery at the end of the year. The changes that we introduced on 18 May were all about being able to adjust those contracts so that, where dentists underperform, we can remove those UDAs from them and redistribute them to those who are performing. So, effectively, I can say categorically that we are not trying to bank that £400 million—which is not the final number, I should say—or to bank an underspend; rather, we are trying to find ways to prevent that happening, because we absolutely accept that we want access to increase in all of this.

The dental patient price increase—I will not say “charges uplift”—is very much about generating money which will be used around the system. This is not a case of saying, “Oh, we’re going to try to bank the underspend and generate some more for us”; this is about trying to get to where people can afford to pay. Let us remember that 50% of people, including those in the most need, receive their dentistry completely free, so this is for the 50% or so of people who are in a position to afford it. Of course, since dental charges were last increased, we have had an increase in inflation of 17.9%, so what we are doing here is increasing those prices by only half that amount. This is about making sure that the money is there to fund an expansion of dentistry.

We consider that the 8.5% is a proportionate increase; it is about £2 on the cost of an NHS check-up. I reiterate that it is being paid only by those people who are in the best position to be able to afford it; we are making sure that those who cannot afford it continue to receive it free at the point of care. We know how important it is to provide the courses of treatment. We provided 8 million courses, 5.6 million of which were to children. The noble Lord, Lord Hunt, will be pleased to know that 54% of those are for fluoride treatments. We understand that it is vital that we provide those preventive measures to children.

To answer the noble Lord, Lord Allan, we know that we need to go further; the creative thinking has continued, and there will be further, wider-reaching changes to improve access to NHS dental care that we hope to announce shortly. I can say, hand on heart, that we are actively looking at ways to fund these increases. This is not about trying to bank underspend; this is about trying to make sure that those underspends are delivered. If those we are contracted with are not delivering it, we will find others who will do it. That is also where some of the creative ideas will come in.

[Lord Allan of Hallam (LD)]

I am curious about the point the Minister made about the underspend resulting, in a sense, from accounting practices—or, as I understood it, that people are seeking additional contracted amounts to boost the financial health of their dental practices. It is first time I have heard that. I wonder whether he thinks that that is a temporary phenomenon that will somehow come out of the system, or whether it is something that is inherent in the way the system has been established so that private dentists are contracting for blocks of NHS work.

[Lord Markham (Con)]

I will try to unpack that point a bit more. A dentist can say, “Okay, I can provide so many UDAs over the course of the year”, and they will be contracted to do that. But there is then the situation whereby some of them—I am not saying all of them—having that banked in and knowing that they have the money to afford it, might go out to try to sell private healthcare, underpinned by that money. At the end of the year, if they have not delivered all the UDAs, then, in effect, the only reason that they have not delivered it is because they substituted that for private care work, resulting in that underspend, which we do not want.

That is what the changes we talked about in May were about: removing the UDAs from those persistent underdeliverers, for want of a better word, and having the capacity to give them to those who are persistent deliverers, so that we can increase their amounts by 110%. This is very much about taking away from those who are not delivering and giving to those who can, and also having money in the bank for some of the more creative ideas that Minister O’Brien is very focused on, and that we look forward to delivering. I can say, hand on heart, that is not about banking underspend; this is about making sure that we can redistribute it. These price increases—which, again, are half the rate of inflation—are for funding a dentistry plan through which we want to improve access; that is fundamental to all of this.

I hope that noble Lords understand a bit more where we are coming from and understand that it is an 8.5% increase versus 17% inflation. We are looking to recycle that increase and put it into more access for those who are not receiving it at the moment. I hope that noble Lords will see this in a better light and that it is all about increasing access.

In conclusion, as the noble Lord, Lord Hunt, mentions, it is important that patients can access NHS dental care and that it is affordable. No price increase is easy but we hope it is seen that this is a proportionate increase at less than half the rate of inflation and only for those 50% of people who are in a better position to pay. Most of all, this is part of a package of measures, of which more will be announced shortly, about expanding access to NHS dentistry—because I completely agree with the noble Baroness, Lady Merron, that it is vital to the health of our children, particularly, but to all the people in England.

Medical Devices (Amendment) (Great Britain) Regulations 2023

Debate between Lord Allan of Hallam and Lord Markham

Monday 5th June 2023 Grand Committee

[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.

[Lord Allan of Hallam (LD)]

On the labelling question, I wonder if I could helpfully suggest to the Minister something like an infographic, which shows what labels are needed in Great Britain and Northern Ireland and which labels would be helpful on which dates. Somebody who is making devices could just look at that and go, “I’ll need that kind of labelling at this stage of the transition process”. That would help.

[Lord Markham (Con)]

I absolutely agree. To clarify—I may have used the terms interchangeably—I am talking here about the Great Britain market. It is a great British market as well but we are talking particularly about Great Britain because we know that, under the Windsor Framework, Northern Ireland has separate CE arrangements.

I think I have answered as much as I can at this point. I will clarify further in writing. I thank noble Lords because this debate has been incredibly valuable in making sure that we are getting this right; it is non-trivial, to say the least. With that, I commend this instrument to the Committee.

New Hospitals

Debate between Lord Allan of Hallam 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.

Pharmacies: Medicines at Home

Debate between Lord Allan of Hallam and Lord Markham

Wednesday 17th May 2023 Lords Chamber

[Lord Markham (Con)]

Yes. There are occasions when it is absolutely appropriate that medicines are packaged in that way; I am sure we all have plenty examples of friends and relatives for whom that is very useful. The whole point is that the blanket application of blister packs is not the right approach.

[Lord Allan of Hallam (LD)]

My Lords, the Government’s welcome plans for pharmacists to play a broader role in primary healthcare depend on there being pharmacies present in every area of the country, yet we have seen hundreds of community pharmacies close over recent years. If this trend is not reversed and there are even fewer community pharmacies in a year’s time, would it be reasonable for us to see this as a failure of government policies?

[Lord Markham (Con)]

No. What I want to be tested on is how many people are using their pharmacies for primary appointments—that is the real measure. I think we will see a marked change, and we will see it as a real convenience. The fact that this will drive more footfall to pharmacies will mean that more pharmacies will probably gain extra business and stay open. We have 24,000 more pharmacy workers than in 2010—there has been an increase in that number since then.

Life Expectancy: Pensions, Health and Insurance

Debate between Lord Allan of Hallam and Lord Markham

Wednesday 26th April 2023 Lords Chamber

[Lord Markham (Con)]

I am aware that there has been a similar phenomenon across all the G7 western nations. Life expectancy has been plateauing for the last few years, and the only country to buck that trend is Japan. A lot of this is to do with obesity, which I know noble Lords regard as a very important issue. While we are improving issues such as alcohol intake, the impact of obesity on healthy lifestyles is an important factor that we will need to tackle.

[Lord Allan of Hallam (LD)]

My Lords, as well as falls in overall life expectancy, there have been significant falls in disability-free life expectancy, as shown in the recent ONS figures. Can the Minister describe the steps his department is taking to understand why more people are acquiring long-term conditions earlier in their lives, and to ensure that health and social care services are geared up to meet that extra demand?

Long Covid

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 25th April 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord and applaud the research work that has been done. As I said, we have invested £50 million on top of the £118 million for Covid research. Just as we were one of the front-runners in developing the Covid vaccine, with AstraZeneca, it is very much our ambition to be a front-runner in developing cures for long Covid.

[Lord Allan of Hallam (LD)]

My Lords—

Adult Social Care: Challenge Procedures

Debate between Lord Allan of Hallam and Lord Markham

Wednesday 19th April 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, Section 72 of the Care Act 2014 empowers the Secretary of State to regulate for an appeals system through which people can challenge social care decisions. It seems odd that we went to the trouble of legislating for this and yet, nearly a decade later, it still has not been implemented. What more evidence do the Government need to come to a decision about whether the benefits of such an appeal mechanism would outweigh the costs?

[Lord Markham (Con)]

The main point is that we already have two levels of appeal. In the first instance, someone can appeal to a local authority and if they are not satisfied with that, they can appeal to the local ombudsman. Thousands of people do this every year, and compliance in terms of replies to them is very high. I must admit that I am not sure whether an additional, third level of appeal is really necessary in this case.

Diphtheria

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 18th April 2023 Lords Chamber

[Lord Markham (Con)]

Absolutely. As the noble Baroness is aware, vaccination take-up is the responsibility of the ICBs in their areas. Like many other places, London has unique demographics. As I mentioned, our record is pretty good in this area, but it needs to be done nationally on a uniform scale.

[Lord Allan of Hallam (LD)]

My Lords, in response to the questions from my noble friend Lord Roberts and the noble Lord, Lord Hunt, the Minister has twice told us how well his department’s officials are working with the Home Office. But his department’s officials are not present in local communities; directors of public health are. Can the Minister undertake to lobby the Home Office on behalf of the public health officials to make sure that they similarly have a good dialogue with the Home Office, which does not seem to be the case to date?

[Lord Markham (Con)]

Clearly, I am always going to support good dialogue—that is common sense, and we should do that. The proof of the pudding is in the eating, and 88% is a very good result. That notwithstanding, clearly it makes sense that they should work closely with local officials as well.

Junior Doctors’ Strikes

Debate between Lord Allan of Hallam and Lord Markham

Monday 17th April 2023 Lords Chamber

[Lord Markham (Con)]

I think we all want fair outcomes and negotiated settlements, and I think we felt that the agreement reached with the Agenda for Change parties was fair and was something, as mentioned in the Statement, that the union leadership recommended to the union members. Of course, we need to wait to see the outcome of the staff council of all the Agenda for Change unions from 2 May to see where we end up on that. Our hope is that, across the majority of those, we will see support. As noted, this is a generous offer; it is higher than the offer made in Wales, for example, and we hope it will be a way forward after 2 May. If that is not the case, we need to sit down and think about next steps.

[Lord Allan of Hallam (LD)]

My Lords, the Secretary of State in the other place rightly referred to the workforce plan as essential to dealing with some of the stress that is contributing to the industrial action. I checked the record, and the Minister first told us that this plan was going to be released “shortly” on 2 February. Yet Valentine’s Day came and went, and there was no plan. Now, Easter has come and gone, and there is no plan. I wonder if the Minister could tell us whether “shortly” is getting shorter or longer? Should we be expecting the plan closer to the Coronation or the 75th anniversary of the NHS in July?

[Lord Markham (Con)]

I am afraid I cannot provide a lot more information to the noble Lord, except that complications now include the purdah for local government elections, so I am trying to find out more details on this very subject as to when a date could be set. I am afraid to say I cannot give much more of an update than to say it will be released shortly. What I will say is that, among all this, we are still seeing increases in staff. I was delighted to see that we now have 5,100 more doctors in place than last year, and we have had an increase over the last few years of 30,000 nurses. So, there are movements in the right direction, but clearly more needs to be done.

Stroke Rehabilitation and Community Services

Debate between Lord Allan of Hallam and Lord Markham

Wednesday 22nd March 2023 Lords Chamber

[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.

[Lord Allan of Hallam (LD)]

My Lords, the Minister told the House yesterday that the long-awaited NHS workforce plan is due “shortly”, which we are reliably informed is sooner than “soon”. We now wait with bated breath. I know that the Minister cannot speak to the specifics of the plan until it is released but I hope he can comment on its structure. Will it have the kind of detail that we need to see how staff shortages in specialist areas such as stroke rehabilitation will be remedied, or will it be so high level that further subplans will need to be developed so that specialist functional needs are not lost in the mix?

[Lord Markham (Con)]

I can confirm that it is a detailed plan. Services such as physio are an important part of that and will be planned accordingly.

Social Care: Workforce Strategy

Debate between Lord Allan of Hallam and Lord Markham

Wednesday 22nd March 2023 Lords Chamber

[Lord Markham (Con)]

The noble Lord is correct, in that this is pivotal to the whole health service and to health and well-being. It is very much the duty of the integrated care boards, and our Ministers are personally holding them to account on this. I have frequent meetings on seven integrated care boards, and this is very much on the agenda. The other six Ministers have 42 in total, seven each, so that we can make sure we hold them to account.

[Lord Allan of Hallam (LD)]

My Lords, the Minister has repeatedly agreed on the need for increased social care funding when replying to questions in debates. His party set out an ambitious plan for making such an investment in the Government’s Build Back Better strategy of September 2021. How have social care needs changed since then, such that the Government now seem comfortable to cut hundreds of millions from the commitments that they made less than 18 months ago? Does he think that we no longer need more supported housing or better digital services, two of the areas that the reports tell us are facing cuts?

[Lord Markham (Con)]

I do not recognise “cuts” in this context. Noble Lords are aware that we have committed to a £7.5 billion increase over the next two years, which amounts to about a 20% increase. We will see record investment and provision in this area.

Patient Deaths: Ambulance Waiting Times

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 14th March 2023 Lords Chamber

[Lord Markham (Con)]

Clearly, we regret any circumstances where capacity is taken out of the system, and this is a clear example. Patient care is primary, and we hope to sit down and resolve the differences. I am glad to say that we are now having good conversations with the nurses’ unions and other unions, and I hope we can have similar productive conversations with the doctors.

[Lord Allan of Hallam (LD)]

My Lords, NHS data shows that there are significant variations in ambulance response times in different areas of England, and we see especially long response times in areas like the east of England, where some category 4 patients were waiting for over eight hours in February. Can the Minister explain how we got into this situation with what are supposed to be national targets? What are the Government doing specifically to help areas that are currently missing the targets by a country mile?

[Lord Markham (Con)]

Local ICBs—integrated care boards—are integral to this, understanding the need for ambulances in each of their areas. As noble Lords have heard me say before, often, having a fall does not require an ambulance response at all, but it is much better to have a full service. Now, it is the responsibility of every ICB to set up a full service so it can respond more appropriately. Additionally, we are tasking each ICB with getting on top of ambulance wait times.

Strikes (Minimum Service Levels) Bill

Debate between Lord Allan of Hallam and Lord Markham

Committee stage
Thursday 9th March 2023 Lords Chamber

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

I thank the noble Lord, Lord Collins, and the noble Baroness, Lady O’Grady, for their amendments. I also thank the noble Baroness, Lady Chakrabarti, for her kind words.

Amendments 3 and 4 seek to remove the health sector and health services from being within scope of having minimum service levels implemented. As my noble friend Lord Callanan said earlier, the key sectors outlined in the Bill broadly stem from the 1992 Act, as amended by the Trade Union Act 2016, as they have long been recognised as important for society to function effectively. Strike action in some areas of health services can put lives at risk or cause serious harm to patients. As my noble friend Lady Noakes rightly pointed out, it is about protecting the patients; that is why we have brought this provision. It has the potential for far-reaching consequences for members of the public who are not involved in the dispute. That is why we are looking to include the health services within the legislation.

I will try to answer some of the specific questions from the noble Baroness, Lady O’Grady, the noble Lord, Lord Allan, and others on why we are including health in the minimum service levels. We need to point only to recent experience in the ambulance negotiations, where there were concerns that many trusts were not sure, right up until the night before, whether derogations would be approved. The thinking behind the need for consultation was that we can have that certainty.

At the same time, the nurses’ and the doctors’ unions said, in their recent strikes, that they would not cover A&E. In those circumstances, noble Lords must accept that there was a real possibility of not being able to provide A&E services, which would obviously threaten the lives of patients. That is why we feel the need to put those protections in the minimum service levels. However, the most important thing in all this is that the Bill is just enabling legislation; our sincere hope is that it is never needed.

[Lord Allan of Hallam (LD)]

On the recent actions, the Minister talked about how often discussions went to the wire and agreements were reached the night before. Are there any instances he would share with the Committee in which the cover of the voluntary arrangements actually failed, as opposed to going to the wire but getting there in the end?

--- Later in debate ---

[Lord Markham (Con)]

I thank the noble Lord. I believe that there will be a group of amendments specifically on transport later on. That will be the opportunity to answer those questions. I have been drafted in—dare I say it—at the last moment, because it is a very important issue and I wanted personally to talk about the health aspects, which I am attempting to do, so please forgive me if I try not to stray into other areas. There will be the opportunity to discuss transport later on.

The noble Lord, Lord Allan, asked who wants this. It is a backstop power. Trusts will never need to use it if they do not want to. I believe that most trusts, and I hope all, have excellent relations and are able to make sure that these provisions are never used or needed.

[Lord Allan of Hallam (LD)]

It is helpful having the Minister here—we appreciate it—because he will be responsible for those health trusts. I am cautious about the notion that it is a backstop power. It is something that the Minister repeats often, but is he concerned that there will be pressure either for the legal reasons that the noble Baroness, Lady Chakrabarti, and I have outlined—that there will be judicial processes that force trusts to think that they have to impose a minimum service level whether or not they want to—or just political pressure? The Government have brought this legislation in. If trusts say, “Look, we don’t want to impose this, because we think it is bad for our area”, are Ministers really going to sit back and say, “Fine, we’re not going to bother”?

[Lord Markham (Con)]

As I answered earlier on the devolved Governments, by definition, we accept that different trusts have the ability to work out what is best for their own area. Clearly, devolved Governments will each have their own opinion on how they want to act. The same principle exists in each place. We are not saying to each trust, “Thou shalt enact it in this way”; we are just giving those backstop powers. The most important thing here, which I think we all agree on, is for there to be the ability in all circumstances to protect life and limb. If doctors, nurses and ambulance crews all go on strike at the same time and say as part of that that they do not want to provide A&E cover, that is a circumstance where we are not able to provide those minimum services. I think that most fair-minded people would conclude that there is a risk to life and limb in that case.

The points made about civil claims—I know that they are very much the concern of the noble Lords, Lord Kakkar and Lord Patel—will be addressed in considering later amendments.

--- Later in debate ---

[Lord Markham (Con)]

Again, I believe that it is trying to work off the 1992 definitions and work. The beauty of these debates, as I have come to appreciate about the House of Lords and the job that it does, even in the short time that I have been involved, is that they make sure, through this good critical challenge, that we can ensure that the legislation is doing exactly what we want it to do. We need to make sure that we get those definitions correct and, clearly, the beauty of where we are at this stage is that we have that ability. I thank noble Lords for that, and I hope that they can see by my responses that this is something that I want to make sure we get right.

I am glancing through the remaining questions—but I hope that I have answered the substance of the questions.

[Lord Allan of Hallam (LD)]

I appreciate the Minister taking so many interventions. On the question of whether the Government have done any modelling, when they did their analysis of the legislation, was any modelling done to try to understand the potential impact on legal liability, civil claims and claims against the NHS for compensation? It would be helpful for us to have that information, because it will be a material factor as to whether a trust, as the Bill says “may” issue work orders; it says “may” rather than “shall”. Whether the trust feels that it can exercise that discretion will depend very much on whether it is incurring additional legal risk. If there is material on that, it would be helpful for us to have it as we go through the scrutiny process.

Covid Pandemic: Testing of Care Home Residents

Debate between Lord Allan of Hallam and Lord Markham

Monday 6th March 2023 Lords Chamber

[Lord Markham (Con)]

The first major finding was setting up the UK Health Security Agency, because of a feeling that the bodies that were there at the time were not best placed. That was the first learning. From that, things such as the 100-day vaccine challenge were set up to make sure that we are well placed should another pandemic occur. We have tried to learn lessons all the way through and have made sure that testing capacity is still in place, so that we are able to react quickly, and stocks are there. I like to think that sensible measures are being taken and that we are not waiting for the inquiry, but I am sure we will learn more as the inquiry is fully engaged and when it makes its own findings.

[Lord Allan of Hallam (LD)]

My Lords, the Government’s defence of their entire testing strategy has been that we should trust them but, based on all that we have seen of the former Health Secretary over recent months—far too much, would be many people’s reaction—can the Minister say whether he is a person who displays consistent good judgment or is he capable of making some quite serious mistakes?

[Lord Markham (Con)]

I do not know the said ex-Minister, so cannot comment on that. If we cast our minds back, it was a very pressurised environment in which lots of decisions had to be made very quickly. Mistakes were undoubtedly made as part of that. As to how we did overall, it is best for the inquiry to make findings rather than for me to give my opinion.

Physiotherapy: Rehabilitation Services

Debate between Lord Allan of Hallam and Lord Markham

Thursday 23rd February 2023 Lords Chamber

[Lord Markham (Con)]

I start by wishing the noble Baroness a happy birthday. I was pleased to read the three recommendations from the Chartered Society of Physiotherapy: return the rehab space to use; include physios in the long-term workforce plan; and give staff and space to the physio service. As I have said in my earlier responses, we are working on all three: we are working with the NHS trusts to return the rehabilitation space; we are putting physiotherapy in a very important part of the workforce plan; and we are providing the services. So we are making a lot of progress, but I welcome the involvement of the Chartered Society of Physiotherapy in that.

[Lord Allan of Hallam (LD)]

My Lords, it is pleasing to hear that physiotherapists are included in the proposed and long-awaited workforce strategies; there is clearly a shortage in this area. Can the Minister comment on today’s press reports that, while his department is persuaded that there needs to be a dramatic increase in training places across the medical professions, his friends in the Treasury are declining to support that essential expansion?

[Lord Markham (Con)]

As we are all aware, the Chancellor was very keen to kick this off in the first place. We have been participating in this by working very closely with the Treasury, and I am heartened by the work we are seeing on it all. There are some early reports, and, while they do not yet know the full picture, I am looking forward to being able to talk to the whole House about it in the not-too-distant future.

GP Appointments

Debate between Lord Allan of Hallam and Lord Markham

Thursday 23rd February 2023 Lords Chamber

[Lord Markham (Con)]

Absolutely. One of the key benefits of the digital approach is the triage system. We all know that a lot of people who call at 8 am for an appointment could probably be well served by a pharmacy, a physio service or nursing. So proper triage through a digital-type system is a big step forward. It will end up with them being able to make an appointment with the pharmacy, physio—or the GP in this case. It will also free up resources so that those people who are not able to access digital services are able to get through at 8 am and speak to a person. So I really believe there is a win-win for both sides and personally I am very excited to take this through the House later in the year and see all the services that will be launched.

[Lord Allan of Hallam (LD)]

My Lords, following on from the Minister’s previous answer, what steps are the Government taking to develop the profession of care navigator? They are skilled staff who can make sure that people are directed to the right resource, whether a GP, nurse or pharmacist. Some people can use digital, but others need a personal contact for that direction process.

[Lord Markham (Con)]

Absolutely. I know that a lot of the best trusts that I have seen and visited have that right at their front door. It applies to A&E as well. One of the first comments I made when I joined the department was about expanding pharmacy services. That is brilliant and is part of the increase we are seeing but, if we are not telling people when they should go and under what circumstances, how is this going to help? So, yes, there will be both digital and analogue navigation.

Maternity Services

Debate between Lord Allan of Hallam and Lord Markham

Thursday 9th February 2023 Lords Chamber

[Lord Markham (Con)]

Yes, one of the Kirkup recommendations—recommendation 3, I believe—was about an improvement in teamwork, and that is what will be done under the guidance of national and regional maternity safety champions. I should say that while there is much improvement that we want to do, the overall context is a 19% decrease in stillbirth since 2010 and a 36% decrease in neonatal mortality over 24 weeks since 2010. So it is an improving picture, but it is something that we want to improve further.

[Lord Allan of Hallam (LD)]

My Lords, another day, another area of the NHS that is suffering from serious staff shortages, and these shortages are having a real impact on the willingness of midwives to stay in the profession, more than half of whom are considering leaving the NHS, according to surveys by the Royal College of Midwives. What is the Minister’s view on the proposals that have come from various groups that there should be nationally agreed minimum staffing levels for maternity and neonatal staff?

[Lord Markham (Con)]

Again, I think there are certain things that we are saying we want to see in place. Continuity of care is part of that, and the workforce plan is how we put teams around to do that. It will always be a feature that we then expect the local health trusts and ICBs to work out how best to do that in their own situations. I also say in this context that we are increasing our numbers but this is not like other demographics where we have an ageing population. The birth rate, as we all know, is actually constant/declining, so it is not like those other areas where we are talking about that. Notwithstanding that, as I mentioned before, we are increasing the number of graduate places.

Hospitals: Maintenance

Debate between Lord Allan of Hallam and Lord Markham

Thursday 9th February 2023 Lords Chamber

[Lord Markham (Con)]

We are actually making a lot of progress on them. A number of them, dare I say it, were introduced by Governments of a different colour and we are now working through and correcting those. At the same time, private capital can do a lot of good things. Many in the House will have heard me say just yesterday that if we put LED lightbulbs in every hospital, it would cost £400 million and save £100 million a year. That is the sort of thing private capital will fund every day of the week, probably at a 5% yield, giving us £95 million of savings a year. That is a good use of private capital, and the sort of thing I am looking at.

[Lord Allan of Hallam (LD)]

My Lords, I am surprised that more noble Lords have not dived into this report. It is fascinating, especially sheet 7 of the spreadsheet, which tells us that NHS England is spending £234 million a year on storing medical records. So while some parts of the NHS are working towards all-singing, all-dancing federated data platforms, in other places the height of modern technology is a new shopping trolley to move mouldering files in and out of a dingy basement. Will the Minister share with the House the Government’s plans to digitise or securely dispose of those paper records so that in future editions of this ERIC report, we will see that that £234 million has fallen close to zero?

[Lord Markham (Con)]

The noble Lord makes an excellent point. As he knows, we are investing heavily in a federated data platform, which is precisely about stopping storing paper and making such savings. Even more importantly, it is about improving patient care so that we can ensure that records are transferred instantaneously and really build on the knowledge that will bring.

NHS Staff: Food Banks

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 7th February 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord. The lowest paid, who are obviously most at risk in this category, we have sought to protect the most. They received a 9.3% pay increase. In all these circumstances, we have been looking to follow the guidance from the independent bodies, which we will continue to do.

[Lord Allan of Hallam (LD)]

My Lords, the Minister will be aware that food price inflation is now running at over 16%. This disproportionately affects lower-paid workers, including many health and social care staff, yet the Government’s approach seems to be, “Crisis? What crisis?” Does the Minister accept that nurses are seeing real-terms pay cuts at present? Is he worried about the effect of these cuts on his long-awaited workforce strategy?

[Lord Markham (Con)]

As has been mentioned many times, the workforce strategy is key; being able to recruit and retain staff, and pay, are vital elements of it, so I accept the challenges in this space. At the same time, I am mindful that we have sought to protect the lowest paid through these increases, as I mentioned. I am confident that the new pay review body, which is coming up, will seek to take the inflationary pressures into account to make sure that there is a fair settlement for everyone.

Urgent and Emergency Care Recovery Plan

Debate between Lord Allan of Hallam and Lord Markham

Thursday 2nd February 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, as is usual for this kind of Statement, it is peppered with promises of more of everything. I hope the Minister will help us to dig into the numbers we have been given to see how much lies behind them. First, on the new hospital beds, this seems to come from a process of making winter surge beds permanent. For a real long-term increase in capacity, we need the promised 40 new hospitals. How many of these will be on stream by next winter?

The Statement also tells us that there will be 800 new ambulances, which I think most people would interpret as fully staffed, blue-light vehicles. Can the Minister offer a more detailed breakdown of the different types and capabilities of what is being offered here? The Statement itself said that, for example, 100 of these will be mental health emergency vehicles rather than classic blue-light ambulances.

Of course, staffing these beds and ambulances and the other measures in the Statement will depend on good workforce planning. Here, I echo the comments made by the noble Baroness, Lady Merron, and by these Benches over many months. The Statement tells us that the plan will come this year; can the Minister offer any more precision on when this year we might expect it?

The Statement also talks about data and transparency. We are told that integrated care boards will now have to focus much more on data about patient flow. Can the Minister commit to making more of those statistics public, as well as the ambulance wait time statistics?

Finally, the promised new care hubs can add value only if care services are actually there. This brings us back to workforce limitations. I end with three questions for the Minister: where is the staffing for the beds, where is the staffing for the ambulances, and where is the staffing for the care services?

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

First, I thank the noble Lords for their questions. To put the UEC recovery plan in the context of the three plans we will be announcing, there was last month’s elective recovery plan, which we spoke about, followed by this UEC recovery plan, and then, within the next month or so, we will also talk through the primary care recovery plan. That plan will seek to address exactly some of the points the noble Baroness, Lady Merron, rightly made about getting care in the right places, such as primary care.

I hope noble Lords agree that what we see today is a sensible and pragmatic plan. It has been welcomed by NHS Providers and described by the Royal College of Emergency Medicine as a

“significant step on the road to recovery”,

seeking to increase capacity in urgent and emergency care. The 5,000 beds that the noble Lord, Lord Allan, mentioned are a recognition that more capacity is needed in that space.

As has been mentioned many times, and as was raised by the noble Lords today, growing the workforce is crucial. This includes student places and getting to the bottom of whether there is a cap on those numbers, on which a written reply will be given soon. Again, the workforce plan is in draft and will be shown shortly—as I say, in weeks. I cannot give a date, but it will be soon. It is designed to tackle the whole question of how we are going to staff all of this and the points that have quite rightly been made. We need the staff: the nurses, the ambulance staff and all the others. There are 30,000 more nurses than three years ago, so we are on target to hit the 50,000 increase. There are 5,000 more doctors than a year ago, but that is not to say that we do not need more. That is what the workforce capacity plan should be all about.

This plan is looking to show those milestones and what we are trying to do to increase capacity, with the 5,000 new beds, growing the workforce, speeding up discharge, expanding and having better joined-up community services and making it easier to access the right care in the right places, such as primary care. I would say this, probably, because I am biased, but I feel that this is a useful and pragmatic plan because it is trying to build on the evidence of the things that we have seen work, which noble Lords have heard me talk about over the last few weeks. They include the Maidstone “mission control”, which really is making a difference there and we are now looking to roll out to all trusts and ICBs; the Watford virtual wards, which we are looking to roll out to 50,000 places; and, in all instances, using data-driven analysis to make sure we are making the right decisions.

The plan is backed up by funds and is part of a long-term plan. We are using the £1 billion of support for this year and the £500 million for social care capacity, but this is in the context of an increase of £14 billion over the next two years. It is part of a sizeable plan, but it is realistic action. I would love to be able to stand here today and give targets, but we are trying to be realistic about where we are coming from—for example, in setting the 30-minute category 2 ambulance wait time. Likewise, the target of 76% of patients being seen within four hours is not the limit of our ambition. That is the minimum, and from there we would look to increase it beyond that target. I would much rather come to your Lordships’ House with targets we think are realistic, with achievable plans behind them, as a statement of intent from which we can grow, rather than setting unrealistic expectations.

Of course, I say all of this in the context of what the House knows is an unprecedented challenge. It is not just England facing these challenges; I have spoken to colleagues across Europe, the US and Canada, and within the UK, in Wales and Scotland. Every health system is facing these problems off the back of Covid, and there are also the demands coming from flu coinciding with that this winter in particular.

I believe that this is a realistic plan. It is centred on the workforce; I agree on that. Prevention is also a key element of this. The five-year life expectancy improvement target is still key. We are looking at what we realistically need to do to make a difference on that—so, what are the causes of death, and what are the things we need to tackle? Again, the House has heard me speak many times about Chris Whitty’s concern about cardiovascular disease, and that it could be the next cohort of potential excess deaths among 50 to 65 year-olds, because they missed out on their blood pressure monitoring over the last couple of years. We all agree that rectifying those sorts of prevention actions is key.

When this plan is seen in the context of the primary care plan, which will also come out shortly, I hope it is understood that this is about treating people in the right place, which is not A&E. We all know that far too many people go to A&E who do not need to be there, and that is because we need more primary care spaces. We are on target to achieve the 50 million more primary care spaces, but, again, we need to do more. We really need to look to expand capacity in pharmacies, as I have mentioned before. We need to look at what some of our colleagues in Scotland are doing and the ability of pharmacists, for instance, to prescribe a lot more. Longer term, the new hospitals are a key part of this. Just this morning, I was going through the plans and some very good virtual reality examples, which we are going to bring to Westminster Hall for one day in the next few weeks. I look forward to showing colleagues exactly what is happening and how that will be the future.

I hope that noble Lords will see this plan in the context in which it is meant. I will, as ever, write in detail on the points I have not managed to cover in this quick reply. I hope noble Lords will see this as a down payment for the future, within the context of the elective care recovery plan and the primary care plan that we will see later, building on solid things that we know work and making sure that we are expanding those rapidly, so that we have learned the lessons from this winter and have them in place in time for next winter.

PPE Expenditure

Debate between Lord Allan of Hallam and Lord Markham

Wednesday 25th January 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, as well as the financial cost of failures in the PPE procurement process, does the Minister agree that it is important to remember the human cost paid by care workers who became ill when looking after vulnerable and elderly people without adequate PPE? Does he understand how frustrated care workers must now feel to see this level of wastage when their services are crying out for more investment? We could buy a lot of care packages for “£600-odd million”.

[Lord Markham (Con)]

In the circumstances at the time, I think we were all worried that we were going to run out of PPE. If the noble Lord remembers, it was the Wild West out there in terms of trying to purchase it, with planes gazumped literally on the runway and flying to other countries. That is why we stepped in. We bought to a worst-case projection, because we knew we could not afford for PPE to run out in our social care homes or our hospitals. We ended up buying 20% too much as a result, and that is what we are dealing with now. However, only 3% of everything that we bought ended up being faulty, which I think people will agree was a pretty good result.

Respiratory Syncytial Virus

Debate between Lord Allan of Hallam and Lord Markham

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

I know that this, like all those areas that were unfortunately missed out during the pandemic, is something the department is working on. There are catch-up activities. I have seen it personally with my four year-old, who of course was two and three during this time. I will happily provide the detail in writing.

[Lord Allan of Hallam (LD)]

My Lords, does the Minister agree that it is wise for the UK to maintain a good level of baseline PCR testing so that we can ramp it up when confronted with novel viruses such as Covid-19? In that respect, does he agree that it is important to consider this resiliency benefit when looking at the business case for PCR testing for other viruses, such as RSV?

[Lord Markham (Con)]

Yes. I should probably declare an interest, having set up a PCR business—in the private sector, I might add. I know at first hand from that how versatile these PCR machines are. They can be used to diagnose all these sorts of treatments, so we absolutely have to make sure we keep that strategic capacity alive.

Times Health Commission

Debate between Lord Allan of Hallam and Lord Markham

Thursday 19th January 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, when confronted with evidence of problems in our health system, the tendency of government is to play it down or to blame anyone but themselves while, candidly, the instinct of opposition is to say that everything is a catastrophe entirely of the Government’s own making, even when the facts are more complex. Does the Minister agree that it is essential to have the data for us, the Times and others to come to firm conclusions? The critical piece of data that we are still missing is the workforce strategy for health, social care and public health. When are we going to see that data in order to be able to have a better informed debate?

[Lord Markham (Con)]

I agree with the noble Lord that data has to be the basis of any decision-making. I know that early drafts of the workforce strategy have already been formed so he and the House will see that before too long.

United Kingdom: Future Pandemics

Debate between Lord Allan of Hallam and Lord Markham

Monday 16th January 2023 Lords Chamber

[Lord Markham (Con)]

They will absolutely look at the use of lockdowns. The House will see that, even during Covid itself, we evolved our approach significantly, as we learned more about some of the wider consequences. We were far more hesitant in the case of omicron not to lock down, quite rightly, whereas other countries went ahead. That proved that our judgment was correct and we will learn those lessons going forward.

[Lord Allan of Hallam (LD)]

My Lords, for many people, the most effective tools for contact tracing during the pandemic were messaging services such as WhatsApp, as family and friends kept each other informed about test results and infections. But you were often left in the absurd position of someone calling from the official track and trace system about a contact who had let you know about their infection several days earlier—including, sometimes, people who lived in your own home. Can the Minister assure the House that the Government’s plans for future pandemics will look at how best to work with these local, informal, peer-to-peer networks, rather than think that the solution always lies in centralised, expensive systems?

[Lord Markham (Con)]

I agree. There are many examples of where centrally run initiatives did not work so well, test and trace being one. That is what the inquiry is all about. There are many examples of things that worked very well, such as our vaccine preparation and our creating the first test for Covid, through the PCR process. There are many lessons to learn, including from many of these centrally run initiatives.

Social Care: Integrated Care Systems

Debate between Lord Allan of Hallam and Lord Markham

Wednesday 11th January 2023 Lords Chamber

[Lord Markham (Con)]

Absolutely. It strikes me—again, I mentioned this yesterday—that less than 10% of the 13,000 so-called blocked beds contain people who will need to be in social care full-time in future. Most of them need short-term support and, once they have it, will be able to go back to living in their home, which is the best place for them to be.

[Lord Allan of Hallam (LD)]

My Lords, as the Minister has recognised, social care provision is largely in the domain of local authorities. The level of local authority representation on integrated care boards is therefore likely to have an impact on how powerful the social care voice is in integrated care system decision-making. Does the Minister have any information to share with the House about local authority representation across the 42 integrated care boards, including whether it goes beyond the statutory minimum, so that we can understand whether it is sufficient and likely to lead to the step change that I think we all want to see?

[Lord Markham (Con)]

It is, as the noble Lord says, a statutory requirement that the local authorities are represented on the ICBs. In the last few months, I and other Ministers have met and had discussions with all the ICBs. Every ICB is asked to put up a few people. I have had the local authority representative there as one of only three or four people in the meeting—that is key to all of this. They have been critical participants. They are very involved, and it is vital that they remain so.

Care Homes: Staffing

Debate between Lord Allan of Hallam and Lord Markham

Wednesday 11th January 2023 Lords Chamber

[Lord Markham (Con)]

We absolutely need both. For years, ever since the NHS was founded, we have had international workers. It is a very important part of it now. Of the funding going in—up to £2.8 billion next year and up to £4.7 billion the year after—70% will translate into wages, because this is a staff-based business. That is a huge injection of money into the sector, and it will go into staff, salaries and welfare.

[Lord Allan of Hallam (LD)]

My Lords, we know from surveys by the Association of Directors of Adult Social Services that there is already a shortfall in domiciliary care capacity, such that people are not getting the services they need at home. While additional, funded care home places are welcome, we need to ensure that this does not worsen the domiciliary care situation by drawing staff away from other vital roles. I raised this question on yesterday’s Statement, but I think it important enough to come back to. Will the Government monitor workforce changes to ensure that both residential and domiciliary care capacity benefit from any new funding?

[Lord Markham (Con)]

Since the question yesterday, I have had a chance to talk to colleagues further about domiciliary care and understand its vital role. I talked to one ICB today, which has its own arm’s-length body, set up by the local authority, which does exactly what was suggested by employing domiciliary care staff full-time. They know the patient best and are ready to take them back out of hospital and put them in place. This is central to what we are doing.

Excess Deaths in Private Homes

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 10th January 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, we are fortunate to have in the Office for National Statistics a source of trusted data to inform our policy deliberations. It provided essential data about excess deaths during the pandemic, and we should equally reflect on what this data says about the health of our nation post-pandemic. There is clearly a range of potential factors that could have led to the excess deaths, as the Minister has outlined, but it is really in the public interest to test all those hypotheses and establish any causality. Can the Minister commit the department to carrying out research, such as the noble Baroness, Lady Merron, asked for, into any potential link between the pressures that we know about on the ambulance service and the excess deaths at home?

[Lord Markham (Con)]

Again, I spoke further to Sir Chris Whitty exactly on this. He writes an annual report on this. We will be doing so in the same way and looking at all the factors.

NHS Winter Pressures

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 10th January 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords, we welcome the fact that the Government are making a Statement, as it is abundantly clear to everyone that we have a crisis on our hands, and we on these Benches have been calling for this to be recognised as a national major incident. In that context, will the Minister clarify the status of the NHS recovery forum that was announced with great fanfare last week? Was it a one-off, or will it be meeting regularly and taking ownership of this crisis? If it is not the NHS recovery forum, what group within government will be taking us through the rest of the winter? This requires daily, serious leadership at the highest levels in government.

I have three questions on the specific measures outlined in the Statement. First, the Government have told us about the block-booking of care home beds, which should provide some immediate relief for hospitals, but they are much less clear on how they plan to increase domiciliary care so that people who can and should be in their own homes do not get stuck in care homes unnecessarily. The last thing we want to do is to move people out of one inappropriate care setting into another one, and domiciliary care remains the key to providing the best care for the vast majority of people who need neither hospital nor permanent care home residency. Can the Minister offer us any assurances on what the Government intend to do about domiciliary care provision?

Secondly, the Statement referred to the new NHS system control centres that will be in each integrated care board area, and which are a welcome development. There is published information about the data that will go into these new centres, but no information about what the centres themselves will make available to the public. Does the Minister agree that it would be helpful for people to know much more about the pressures on the NHS in their local area through these NHS system control centres publishing regular updates with as much information as they can provide to help patients make informed choices, with full knowledge of where the blockages are in the system?

Finally, the Statement referred to the use of artificial intelligence systems to help release patients sooner and track their progress through hospitals. There have been recent press reports about Welsh hospitals using tools developed by a British company called Faculty AI to improve patient discharges. Can the Minister add any insights into how these and similar technologies are going to be tested and deployed in England? I know that nothing is a silver bullet, but the reports suggest that they could make a significant difference to discharging people more efficiently and quickly. If that is so, we do not need to wait to deploy these technologies, and should be getting on with it.

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

My Lords, I thank noble Lords for their comments. As I mentioned in answering the previous Question, this is a reflection, from our part, of trying to understand the situation. We did some plans in October and looked at demand and supply, and that led us to make the announcements about the 7,000 extra beds and the £500 million adult social care discharge fund. It was clear to us that the bed occupancy issue was going to be at those danger points, and that was the plan.

Then, of course, as with any plan, you amend and review it all the time. Over the last few weeks of December, with the onset of flu beforehand, it became clear that we had higher levels of bed occupancy than we had planned for at that time because we had 7,000 or so extra beds taken up by flu while, at the same time, still requiring higher levels of Covid care than planned. It became clear from all this that the bed occupancy levels were still too high to be comfortable. This was causing the knock-on impact on the flow across the whole system, backing right up into the A&E wait times. That is why, very responsibly, we looked at the latest data, planned, and realised that we needed to do more. That was very much the components of the plan.

In answer to the point from the noble Baroness, Lady Merron, some of those short-term measures were about bringing in extra adult social care funding packages and, candidly, looking within every area of our budgets at what we really needed to spend over the rest of the year and at what we could prioritise. We managed to make some in-year savings through reducing headcount, particularly in admin and central areas, and then looked to redeploy that to make sure it was going to the front line.

As well as that, we looked at things such as the expandable modular space. This goes back to the flight control systems, which I would recommend to anyone. It is well worth a visit to Maidstone, where you will see what we plan for the longer term and what we are looking to do across the system in time for next winter. It became very clear there that, because it has the data, it can manage demand and supply. It sees the incoming from the ambulances; it sees the bed situation; it sees those people who are getting close to be ready for discharge. It is working with clinicians to say, “Actually, we’ve got some incoming and we need to free up that space. Let’s get the social care places ready. Let’s have transport ready and clean the bed quickly.” It is absolutely those micro-improvements and the Team Sky cycling-type approach that address it. AI comes in very much as part of that; you can speed up the flow all the time. It is not silver bullet stuff, but it is about looking at those micro-improvements as you go through it. That is very much the background to all this.

Dom care is an important aspect of that as well. I went through the stats with the team today, which said that of the 13,000 people ready for discharge, probably only 3% should require social care in the long term, and the other 97% should be in a home environment. Some of them might need a few weeks, which is where those care packages come in, and a lot of them need dom care, but 97% of them should not be in care going forward. That is why we need to focus these things towards that. That is the thinking behind this.

The modular space is an important component of this. Look at Maidstone again; it has looked very carefully at the patient flows and at where you can have same-day emergency care and get people out again so that they never have to go into a hospital. But you need extra space to do that. We have made this available so that the hospitals can decide where they most need that expandable space—whether it is pre-A&E, when they are finished in A&E and waiting in a decent space for a bed to come free, or step-down or discharge areas. It is about providing that flexibility and putting it in place quickly for them all.

What we were trying to do here was show flexibility and be fleet of foot to be able to course correct as time goes on; to put our hands up and notice when things were difficult and more challenging because bed occupancy was higher than expected—as I say, due to flu, Covid and other factors—and put in the measures to address them. That is exactly what we are doing in the short term.

In the longer term, next year—not that many people would say that nine or 10 months away is the longer term—we need to make sure that adult social care has further funding, as the House has heard me say many times. There will be a substantial increase next year, up to £1.7 billion, and a substantial increase the year after, of up to 20%. With flight control systems, expandable modular care and the rollout of virtual wards, we have a number of things that, on their own, are not a silver bullet, but, by putting them all together, you will start to get the changes and improvements that we expect to see. I say unashamedly that, if there are other facilities in the independent sector that we can make use of, be it making more use of pharmacies or expanding virtual wards, then we should do so.

I am sure there will be more questions as we go on in this debate, but I hope your Lordships can see that we have tried to respond to the challenges through a range of measures that we believe will make a difference. At the same time, we must be open to the need to do more; we will need to add more things and course correct as time goes on.

Plastics: Health Research

Debate between Lord Allan of Hallam and Lord Markham

Monday 19th December 2022 Lords Chamber

[Lord Markham (Con)]

I am mindful that my brief as Health Minister is fairly large but maybe not quite that large. But I note that in this space we have already replaced plastic bags, very successfully introduced a usage charge, and reduced consumption by 95% in the main supermarkets, so that is a tool that we know works. But currently there is limited evidence suggesting that it is a health hazard.

[Lord Allan of Hallam (LD)]

My Lords, while the global production of plastics continues to grow, the literature tells us that there is still very limited information about their long-term health effects. As we are trying to shift behaviour so that people and businesses reduce their use of plastic, for a variety of reasons, would the Minister agree that more research into the health effects would be helpful to support that public awareness effort?

[Lord Markham (Con)]

We have set up a research fund; as I say, £100 million has been spent around plastic waste in the last few years. Again, I have spoken to the chief scientific officers on exactly this, and if there are good research proposals in this space, they are ready to look, assess and commission them if they will be valuable here.

Streptococcus A: Antibiotics

Debate between Lord Allan of Hallam and Lord Markham

Thursday 15th December 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord and I agree. We are looking at every sensible measure we can to ensure we have the greatest flexibility of supply. Expiry dates are clearly one thing we can look at, and I will take that back to the department. I wish the noble Lord well and hope that he feels better soon.

[Lord Allan of Hallam (LD)]

My Lords, community pharmacies in Northern Ireland were warning back in October of serious problems with the supply and pricing of a range of drugs. While it is welcome that there now appear to be investigations into the wholesale supply chain for antibiotics, may I also urge the Minister to look at whether there were missed opportunities for earlier intervention?

[Lord Markham (Con)]

Absolutely—clearly, we always need to learn in such circumstances, so we will be happy to do that.

NHS Industrial Action: Government Preparations

Debate between Lord Allan of Hallam and Lord Markham

Tuesday 13th December 2022 Lords Chamber

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

I thank the noble Baroness. On the other actions, so to speak, we have already met a couple of times with the union and are very happy to meet to talk about other things we can do on terms and conditions. As regards the main element around pay, we are following the results of the independent pay review body, which, as the House will be aware, has been in existence since 1984. Parties from each side have taken its expert advice and followed it, and that is what the Government have done in this situation.

[Lord Allan of Hallam (LD)]

My Lords, patients will naturally feel very anxious whenever there is disruption to services that they need, but this anxiety can be mitigated by effective communication. Many of us will have had experiences of great communication by the NHS, such as during the Covid-19 vaccination programme, but also of frustrations, where letters are lost or delayed or we are playing telephone tag with hospital administrative staff. What steps will the Government be taking to ensure that patients receive clear, timely and relevant information during the forth- coming industrial actions?

[Lord Markham (Con)]

I thank the noble Lord for the question. Clearly, we want to ensure that there is as little disruption as possible, and appointments will go on as normal where possible. The general advice is that, if you have not been communicated with, you should turn up to your appointment as normal. As ever, there is a bit of fluidity in the situation, because, as I am sure noble Lords are aware, a nurse does not have to give notice of whether they are going to be attending work that day, so there needs to be some fluidity. But the expectation is that, if you have not heard from us already, you should turn up to your appointment and, in all likelihood, you will receive your planned treatment .

Covid-19: PPE Procurement

Debate between Lord Allan of Hallam and Lord Markham

Wednesday 30th November 2022 Lords Chamber

[Lord Markham (Con)]

I do not know why they did not reply. What I do know is that there were many companies like the ones mentioned who wanted to do their bit. They stepped up to the mark and provided all sorts of goods and services, sometimes at no cost and for no profit, because they all wanted to be part of the wartime effort. I will find out why they did not get a response.

[Lord Allan of Hallam (LD)]

My Lords, there is considerable public interest in understanding whether businesses were stepping forward at a time of crisis, sourcing PPE helpfully and passing it on to the NHS, with a minimum mark-up to cover their costs, or rather seeking to maximise profit. Will the Minister agree to publish sufficient information about the distribution of profit margins made across the community of suppliers for us to make that determination?

[Lord Markham (Con)]

I do not believe we could possibly have that information; obviously, we would need to know the cost base of these companies to supply it. I am afraid that I do not believe we can do that. Further to my last reply, some companies supplied things at a very reasonable margin and did a great job, but unfortunately, as we have seen in some of the examples, others were not so publicly spirited—let me put it that way.