Cancer: Staffing
Lord Dubs Excerpts(1 month, 2 weeks ago)
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Lord Dubs (Lab)
My Lords, I should declare an interest in that my wife is receiving treatment from the Royal Marsden. Is it possible that the national statistics mask a great variation between hospitals such as the Marsden, which is absolutely top of the range, and some others? Is it worth looking at the differences and what we can learn from them?
Lord Markham (Con)
Yes. Funnily enough, I was having a similar conversation just yesterday about how we can use data to really understand some of the differences in performance because, as the noble Lord said, we have all heard of some brilliant examples in our NHS hospitals and we have all heard of some other examples which, as pointed out by the ombudsman, were unfortunately not so good. Understanding those centres of excellence and those that need more help is vital.
NHS: Drug Shortages
Lord Dubs Excerpts(3 months, 2 weeks ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
Medicine supply chains are highly regulated and complex. Supply disruption is a common issue that affects countries all around the world. The department has a range of well-established processes and tools to help prevent and mitigate risk to patients. Most supply issues can be managed with minimal disruption to patients. We work closely with industry, the NHS and others to prevent shortages and resolve any issues that may arise.
Lord Dubs (Lab)
My Lords, I am sorry to say that I find that Answer very complacent. We are talking about drugs for the treatment of cancer and comments from the pharmaceutical industry that the situation is the worst it has ever been, with cancer patients and others seriously at risk. Surely the Government should do something to ease the anxiety of people who are seriously ill and depend on these drugs for their lives and their safety.
Lord Markham (Con)
I assure the noble Lord that a specific team, the medical supply team, works to manages this across the piece. It is a complex area, as we have said. There are 1,000 notifications a year about supply shortages—that has been consistent over the last so many years—that the team works to resolve. I am sure that, as this debate progresses, we will talk about some of the issues, including getting the MHRA to expedite regulatory approval, working with alternative suppliers, buying internationally where needed—we did that very well last year on strep A—and, where really necessary, introducing serious shortage protocols. It is an issue that we take very seriously, and we are managing it.
National Health Service: 75th Anniversary
Lord Dubs Excerpts(5 months ago)
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Lord Dubs (Lab)
My Lords, exactly 75 years ago today, I was as a child ill in Stockport infirmary, and I am totally taken by the memories of that day. In the morning, the consultant came by with his entourage of doctors, matrons, and so on. Consultants were very important in those days; they still are, but in those days, one did not speak unless one was spoken to. I said to him, “Excuse me—I have a question to ask”. He turned around. “What is it?” “Are we having a party today?” He asked, “What for?” I said, “The hospital is ours—it’s a great day”. He was not very impressed and walked on. Later on, they asked me at the other end of the ward, “What’s going on?” and I explained how the hospital was ours and what a great day it was. It was a privilege to be ill on the day the health service started.
Since then, I have served on an area health authority and on a mental health trust. It is no secret that I spent two months in Charing Cross Hospital earlier this year—the danger is that anybody in this House who is asked how they are can spend 20 minutes telling people about their health conditions. I am going to resist that, except to mention it in passing. There I was in intensive care at three in the morning, it was noisy and one could not sleep. The doctor came up and looked with interest at the books I had my table—which I could not read—and she said to me, “We know who you are”. I hope I had the presence of mind to say, “Yes, but please don’t tell anybody”. This is a good moment to thank the brilliant staff, nurses, doctors, nurses, physios and cleaners of Charing Cross Hospital, who are absolutely first rate. I was delighted to remember that when the Government threatened to close Charing Cross Hospital some years ago, I had gone on every demo imaginable to save it. Little did I think that I would be the beneficiary of that campaign.
The NHS, for all its weaknesses and faults at the moment, still works well once one is in the system—I was in the system, and it looked after me brilliantly. There was also excellent follow-up; physios and OTs came home, and so for another two months I had great support. That was pretty good, and I am grateful to all those who helped. I am also grateful to the many organisations who sent excellent briefings, which are helpful for the debate today.
There is one fundamental problem, among others, for the health service. It is too vulnerable to a Government who want to cut the service and save money. It is a real political difficulty with the health service that one decision by a Government can damage it. We have to find some way around that. Perhaps having a Government who do not believe in cutting the health service is the simplest answer.
There is another problem: the imbalance between those of us who are lucky enough to be ill in London and those who are unwell in other parts of the country. We are so lucky, if we are ill in London, to have excellent hospitals very close. In other parts of the country—I know the Lake District pretty well—it is a long way to a hospital and the quality is perhaps not quite as good as it is in London, where we are pretty fortunate.
Social care has been mentioned by my noble friend Lady Pitkeathley, who has spent a lot of time campaigning for better social care. In my experience, the people getting discharged are the ones who have family support in their homes. People who do not have family support are taking up hospital beds because there is not that much social care support. We cannot say enough about voluntary carers, the millions in this country who work for a pittance—I think it is £75 a week—and who keep this country going. We owe them such an enormous debt.
My son has MS. That has made me clear that MS needs far more focus. We need more neurologists. In France and Germany, there are seven neurologists for every two in the UK. We have a paucity of experienced neurologists and we are way down the list of countries. There is therefore a legitimate claim that there should be a neurology task force, as many NGOs working in this field say, to pull all this together: the NHS, social care, professional bodies and the voluntary sector. I also make a plea for MS nurses or neurological nurses. I believe they would not be an extra cost burden but would save money, because they would provide one place where people suffering from MS could go to get help, probably reduce the pressure on GPs and might be good value for money.
I say very clearly, in case there is any misunderstanding, that what I am about to suggest is not Labour Party policy—they are all sitting up on the Front Bench. It is certainly not Conservative policy. We are obsessed with saying that we must reduce taxes. I am obsessed with improving public services. We cannot have the two together. For all the propaganda that taxpayers want the money in their pockets because it is their money, it is also our health service and our public services. My living standard, my quality of life, probably depends much more on public services than it does on whether the taxman takes a bit more money from me or not in a particular year.
I repeat that this is not Labour Party policy, in case anybody starts hitting it on the head with this one. I do not see how we can deal with the difficulties in the NHS without providing more money for it. One obvious way is to have an increase in income tax, hypothecated to the NHS and social care, so that we can say to people, “Yes, we want you to pay a bit more, but every penny of that extra money will go to the NHS and social care”. We would all benefit much more from that than from this obsession with cutting taxes. That is my suggestion.
Adult Social Care (Adult Social Care Committee Report)
Lord Dubs Excerpts(6 months, 2 weeks ago)
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Lord Dubs (Lab)
My Lords, I congratulate my noble friend Lady Andrews and her committee on producing such an excellent and thought-provoking report. I will add a bit of my own experience; in my family, there is a person in receipt of social care and an unpaid carer, so I have lived with this issue, as it were, over some years.
I will talk about invisibility in a minute, but first I make a plea: we need more hard data on the nature of the field. I talked some years ago to a professor who pleaded desperately that we need the data so that we can make harder decisions. Most of it is based on estimates and a bit of speculation. Hard data would be extremely helpful.
I approve entirely of the recommendation that there should be a commissioner for care and support. I know that the Government do not like it; it might make the task of the Government and the Minister a bit more difficult, but it would be very healthy to have someone who can pull this together and be an advocate as the Children’s Commissioner is for children, as my noble friend Lord Bradley said. That would be a good move forward.
I turn to the invisibility of unpaid carers. One reason why they are invisible is that they do not have a voice, because they are so beaten down by day-to-day pressures. They can hardly surface at all, even to lead their own lives for a few minutes every day, so they do not have a voice to speak up. If they could, they would say many things with a lot of passion and emotion. Some of the people they care for are also not very articulate; they are too ill and vulnerable. The professional carers are so busy and underpaid that they too are invisible, because they cannot speak up either. The people who speak up in our society are those who have some space in their lives. People who do not cannot speak up.
I think £76 a week for an unpaid carer is derisory. I know one person—there must be many—who has had to give up all work to be a full-time unpaid carer, so she will not have a pension at all. Can a person live on £76.75 a week? If I have got the figure wrong, the Minister will correct me. There is also the stress that unpaid carers have to undergo and the difficulty of getting a break. Maybe once every two or three years they get a bit of respite care; most of us get a good holiday and we do not even work under such pressure. Goodness me, unpaid carers do. Some of them work flat out virtually seven days a week, so it is no wonder that they need respite care so much, but they get it very seldom.
We need a workforce plan for professional carers. We need to make what they do a profession, with training and a decent level of pay. We need a plan to look at how the whole sector operates and why there is such a low rate of retention—at why it is easier for a paid carer to stack shelves in a supermarket because they can earn more money. Stacking shelves in the supermarket is important, but what sort of society are we when that forced preference is imposed on some unpaid carers? We need a workforce plan.
Finally, there is a need for independence. People can be properly independent by being at home as much as possible and by having the support to lead their lives there. Surely that must be the aim. It is a great report and I hope it will make a difference.
Food: Two-For-One Offers
Lord Dubs Excerpts(9 months, 2 weeks ago)
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Lord Markham (Con)
The noble Baroness is correct; this is a complicated area, and a number of measures need to be taken. The best thing is the promotion of healthy foods, and the fresh fruit and veg initiatives that we have talked about today are perfect examples of that.
Lord Dubs (Lab)
My Lords, some years ago, the British-Irish Parliamentary Assembly looked at obesity in children, during the course of which we went to Amsterdam to look at what was going on there. Two of the things that were very enlightening were educating children in schools and educating pregnant mothers. What about that?
Lord Markham (Con)
I am aware of the Amsterdam initiative. Off the back of that, the OECD said that there were four main strands to what countries should be doing: first, information and education, such as the good examples I spoke about; secondly, increasing healthy choices through the reformulation of foods, which again is something we are doing; thirdly, the modifying of costs—the sugar tax, which has reduced sugar consumption by as much as 40%, is a perfect example of that; and, fourthly, restrictions on where product placement should take place. I am absolutely familiar with the initiative in Amsterdam, and am pleased to see that we have taken action on a lot of those things.
NHS: Doctors’ Strikes
Lord Dubs Excerpts(10 months ago)
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Lord Markham (Con)
First, I absolutely echo the sentiment about the 75th anniversary and the hard work of all our doctors, nurses, dentists and medical staff. Clearly, we want to find a negotiated solution. I think we showed in the case of the nurses and Agenda for Change that we have a framework and the ability to find a solution between ourselves as parties. That is why we encourage them to please stop the strike action so that we can have a sensible conversation.
Lord Dubs (Lab)
My Lords, I join in wishing the National Health Service a happy 75th birthday—especially as, 75 years ago today, I was a teenager in Stockport Infirmary. Despite my efforts at persuading the consultant, he would not throw a party to celebrate the occasion. This dispute is dragging on, and there are some suspicions voiced in the papers that the Government do not mind too much, because on the whole they want to cut back on the health service—their heart and soul is not with the health service. Could the Minister reject that by demonstrating a greater willingness to negotiate with the doctors?
Lord Markham (Con)
I can totally reject that by pointing to the record spend we are putting in this area and the fact that, just on Monday, we launched the long-term workforce plan, with a £2.4 billion investment in expanding the workforce to make sure we are set fair for the next 75 years. We absolutely want to resolve the strike by all means possible.
Hospital Beds: Social Care
Lord Dubs Excerpts(1 year, 4 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
There are around 13,000 people in hospital who do not meet the clinical criteria to reside, including, but not limited to, people waiting to go home and people awaiting access to residential care. We constantly look to reduce these delayed discharges to ease flow in the system, and we have provided a £500 million discharge fund to support people to be discharged at the right time, to the right place and with the right support.
Lord Dubs (Lab)
My Lords, I am grateful to the Minister for answering the Question. Does he understand that many of us will think it is a complete disgrace that, for a long time now, hospital beds have been blocked by people who could be discharged into the community or residential care? These people would be better off and have a decent quality of life. Should we not be making this a high priority, instead of saying that we are planning to do this? We have heard that for so long.
Lord Markham (Con)
It absolutely is a high priority. Noble Lords have heard me say many times that the key to the whole system is flow through the system, to relieve times in A&E and ambulance wait times. That flow depends on us discharging the 13% of beds that are currently held up. That is why we put the £500 million discharge fund in place and will put £2.8 billion of funding next year, and £4.7 billion the year after, to solve exactly this problem.
Childhood Obesity
Lord Dubs Excerpts(1 year, 5 months ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
Addressing childhood obesity remains a priority for the Government and we remain committed to achieving our ambition to halve childhood obesity by 2030. We are delivering an ambitious programme of work to create a healthier environment to help people achieve and maintain a healthy weight. We recognise that there is more that we need to do, and we will continue to work with the food industry to make it easier for people to make healthier choices.
Lord Dubs (Lab)
My Lords, first, could the Minister clarify whether the previous Administration’s policy, either to weaken or to repeal much of the 2020 obesity strategy, still stands or whether the Government will do better than that? Secondly, does he agree that health visitors play an important part in educating and informing families and parents so that, when children are young, they are brought up in an environment where they are encouraged to have a diet that tackles obesity?
Lord Markham (Con)
I agree that health visitors play a vital role. We all know that a good start to life with healthy eating is a good foundation for the rest of your life. We also know that a lot of the problems around adult obesity obviously start in children under the age of five. I completely agree on continuing to strive to do better in government. I will answer some more questions on the actions we are taking, from which the noble Lord will see that we are very active.
Cannabis: Medicinal Use
Lord Dubs Excerpts(1 year, 9 months ago)
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Lord Kamall (Con)
The noble Baroness raises an important point about working with the importer of those medicines. The MHRA is exceptionally continuing to allow those medicines and is hoping to work with the importer and the Israeli company itself to see whether they will go through the MHRA approval process. In Israel, there are two ways of supplying the product: one is medicinal and the another is for non-medicinal cannabis uses. It has advised us that this is not a licensed medicine in Israel, and therefore we are asking the company to come forward. In the meantime, we are looking at an interim solution.
Lord Dubs (Lab)
My Lords, will the Minister confirm that, for certain very severe forms of epilepsy that affect children, medical cannabis is absolutely appropriate? Can he explain why only three such prescriptions have been issued?
Lord Kamall (Con)
Yes, but I should start by saying that I have been warned a number of times that it is inappropriate for Ministers to tell doctors and clinicians what they can prescribe. In certain cases, given that it has not been regulated as a medicine in this country, doctors can make an exception and ask for it to be prescribed on the NHS. They will go to their CCG—and now to their ICS—and ask for that. However, that has been agreed to in only a few cases.
Neurological Conditions
Lord Dubs Excerpts(1 year, 10 months ago)
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Lord Dubs (Lab)
My Lords, I welcome the opportunity to debate this matter in order to hear the Government’s plans to improve health and care services for people with neurological conditions and to ensure that the sector’s workforce is properly staffed and adequate to meet demand.
It is estimated that one in six people have a neurological condition. Living with such a condition can be a daily battle—a battle made harder by a system that turns away people who are in need of mental health support, where people experience waits of more than year for a few minutes with a specialist and where people do not get the information they need when diagnosed. Of course, in one sense, this is an invisible condition for many people. Some people have obvious neurological conditions but some do not and, because it is invisible, they do not get the care and support they would otherwise attract.
I thank some of the people with neurological conditions who have been helpful and the organisations that represent them, including the MS Society, the Neurological Alliance, the MS Trust, Overcoming MS, MS National Therapy Centres and the Migraine Trust, which provided briefings to inform my remarks today. Of course, I also thank the client engagement team from Parliament, which carried out a survey.
I should mention in passing that, yesterday, I went to a Carers Week event in the Attlee Room in Portcullis House. A lot of caring organisations—not necessarily those connected with neurology—were there to explain what they are about. It was a very impressive occasion, particularly in terms of the voluntary carers and the work they do. It left me quite emotionally drained when I heard how they cope and how people have spent years caring without any time off.
I should declare an interest. My son has MS, a condition that affects 130,000 people in the UK. It can be painful and exhausting, and can cause problems with how people walk, move, see, think and feel. It can gets worse over time. However, it can be managed—at least partly—through timely treatment, access to rehabilitation services, lifestyle changes and specialist support.
Yesterday, the Neurological Alliance published its report, Together for the 1 in 6. Unfortunately, I was unable to be there because I was in a Select Committee but I have managed to read the report quickly. It is based on a survey of some 8,500 people affected by neurological conditions across the UK. The data found that one in five adults waited
“more than 12 months between first seeing a GP and seeing a neurologist.”
More than half of people with MS had experienced long delays; I will not go through all the statistics.
In the year to March 2022, the number of people waiting for a neurology appointment on the NHS rose from 120,000 to 180,000, according to the latest NHS waiting times data. Some 37% of people are waiting more than 18 weeks for a neurology appointment. The Migraine Trust is calling for simple pathways for those who need to be referred to a neurology or specialist migraine clinic with reduced waiting times. We are talking about a situation where there are long waiting times and difficulties in getting access to mental health support. Most of the surveys support the finding that there is a lack of support; people therefore feel that the system has failed them.
Let me turn to treatments. The Neurological Alliance survey showed that 35% of adults with MS who require drug treatments in hospital experienced delays in accessing these essential treatments in the past year, including disease-modifying therapies. DMTs are a vital form of MS care as they can slow the progression of MS for some patients. DMTs need to be started as early as possible after diagnosis, which of course means that early diagnosis is needed, and prolonged delays between doses can be harmful. Of course, there is a difference between those people who have progressive MS and those who have relapsing-remitting MS. There are more therapies available for relapsing-remitting MS than there are for progressive MS. This is also made more acute because relapsing-remitting MS sometimes converts into progressive MS.
There are very few treatment options for people with progressive MS. There is a new one called siponimod. Although this should be good news, NHS data shows that, nearly a year after its approval by NICE, just 1.5% of those eligible have been able to try it. The problem is that there are long waiting times for some new therapies. It is vital that people with neurological conditions have access to symptom management treatments and evidence-based lifestyle changes. The MS Society found that only 10% of people with MS were able to access any form of symptom management treatments.
Some people living with MS use cannabis to alleviate their symptoms. Although there is a product called Sativex, very few—I think only 17.5%—of those for whom it would be helpful have access to it. Some people say that cannabis does not help, but my view is that where a patient feels that cannabis is helpful it is by definition helpful. It is no good a doctor saying there is no evidence it is helpful; if the patient feels it is helpful then it clearly helps.
I also thank the noble Lord, Lord Blencathra, who regrets that he is not able to be here this afternoon, for sharing his experience accessing fampridine, which has been helpful for mobility. However, again, NICE has decided to no longer prescribe this drug to selected new patients.
Let me talk briefly about the workforce in neuroscience. This is what I find quite shocking. According to the Association of British Neurologists, the UK ranks 44 out of 45 European nations for the number of neurologists for each person with a neurological condition. Adjusted for the population, France and Germany have over seven neurologists for every two that the UK has. These are absolutely unacceptable figures, which mean that the caseload for neurologists in this country is much too high and they cannot give each patient the treatment they need.
Let me turn very briefly to MS specialist nurses. Neurological nurses in the more general sense, but specifically specialist MS nurses, can provide excellent help. They provide a holistic approach. I believe that if the Minister was to do an assessment he would find that having MS nurses reduces the pressure on GPs and might even reduce hospital admissions. It could be financially helpful as well as beneficial to the patients. Some studies should be carried out to see whether this hypothesis can be borne out in fact. Many people with MS do not have access to MS nurses. The MS Society’s survey found that 63% of professionals were finding it extremely, or very, challenging to provide a good service to their patients.
Most of the problems I have discussed will not be overcome without addressing the chronic workforce shortages in neuroscience, whether neurologists, MS nurses or other specialists who can provide support. I would welcome the Minister’s remarks on what the Government are doing to attract, recruit and retain the neuroscience and other allied health professionals needed to deliver holistic care on a sustainable basis. The key is holistic care; there are piecemeal approaches, but holistic care is the most efficient and effective way of providing support. I believe that specialist MS nurses are a profession who can possibly co-ordinate support in a way that can lessen the burden on others. The NHS must take forward recommendations from NHS England’s Getting It Right First Time adult neurology report and must urgently explore opportunities to free up clinicians’ time by ensuring all MS teams have a sufficient number of admin staff to carry out non-clinical duties. Again, that would reduce the burden on doctors and specialist nurses.
Regarding the way forward and positive action, I would be extremely grateful if the Minister would meet MS and neurological charities, including the MS Society and the Neurological Alliance, to discuss establishing what I would call a “neuro-taskforce” to bring together relevant departments, health and social care bodies, professional bodies, people affected by neurological conditions and the voluntary sector from all four nations of the UK. That should cover all areas of health and care, including rehabilitation, mental health, and access to treatments. I would like the Minister to see this as a challenge. It would be a good way forward. It is a way to improve the conditions of people with neurological conditions. It is long overdue, and I hope the Minister will accept this proposal.
Lord Kamall (Con)
The task force, yes—I thank the noble Lord for the prompt.
That is all I will say for now. I apologise if I have not covered all the questions; I will endeavour to write. I will diligently read Hansard and offer to write to noble Lords on those questions I have not answered. I thank the noble Lord, Lord Dubs, for raising this issue and all noble Lords for taking part in the debate and for their questions. It means I have to go back to the department and not only learn more myself but make sure we have some meaningful answers to the questions that noble Lords asked.