NHS: Long-term Sustainability

Lord Hunt of Kings Heath Excerpts

Thursday 18th April 2024 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am very grateful to the noble Lord, Lord Patel, for opening the debate, and very much welcome my noble friend Lady Ramsey on the occasion of her maiden speech.

The noble Lord, Lord Patel, talked about the NHS being severely constrained, but we know that the NHS can work well. Fourteen years ago, the NHS was in rude health, with new hospitals, new services, and waiting times that had come down dramatically. In 2010, the British Social Attitudes survey reached the highest level of satisfaction ever at over 70%.

What have 14 years of coalition and Conservative Governments brought us? The latest survey, published three weeks ago, recorded the lowest levels of satisfaction since those surveys started in 1983, of 24%. Long waits have become the norm; access to GPs, dentistry and CAMHS services have become very difficult for many people; ambulance waits are outside safety targets, and social care is unreformed. As the noble Lord, Lord Patel, said, we have very poor health outcomes as well. If the NHS is to be sustained, it has to respond to health and care needs very different from those that existed in 1948. There are complex long-term conditions among a growing older population—yet the NHS at the moment seems woefully unprepared or, as the noble Lord, Lord Patel, said, it has not reached an equilibrium.

To turn this around, I agree with the noble Lord, Lord Patel, that we first have to start upstream, with a bolder preventive focus to reduce health inequalities and improve life expectancy. As my noble friend Lord Filkin, the noble Lord, Lord Bethell, and others say in their recent report, Health is Wealth, our nation’s poor health damages lives, communities and our economy. Then major surgery is required of the NHS. Wes Streeting has outlined a decade-long programme of modernisation, with plans to digitise massive amounts of NHS paperwork and to make proper use of the NHS app to give patients real control. What the noble Baroness said about genomics really fits into that model.

However, three major changes need to accompany this. First, we need a step change from the current overcentralised and bureaucratic NHS. As Nigel Edwards of the Nuffield Trust has said, we have a culture of checking, assurance, performance management and other manifestations of a controlling and low-trust approach, alongside a system with a very large number of priorities. I do not know whether the Minister is aware how much NHS England’s approach is despised and hated within the health service at the moment. I would suggest that that comes from the approach that Ministers are now taking to NHS England. It comes right from the top.

This has to go with the workforce. We need a fundamental change in how we treat our people working in the NHS. Bullying, problems of recruitment, retention and morale—these are everywhere in our health service. I have been fascinated to read the outcome of a King’s Fund and RCN project entitled Follow Your Compassion, which looked at the experience of 22 newly qualified nurses and midwives. The work that they do is high stakes, with significant and often disproportionate responsibility placed on them almost immediately after qualifying. Life, death and human suffering are everyday encounters, and the work of caregiving is emotionally demanding. But the overwhelming experience of participants was reported as their feeling unprepared, anxious, silenced and exhausted. You can have as many workforce plans as you like but, unless we get to grips with how our people are treated in the health service, you will never really sort the workforce problems out.

Finally, we must invest in leadership and management of the NHS. I remind the House that I am president of the Institute of Health and Social Care Management. Unlike the military and many private organisations and companies, the NHS does almost nothing to select, nurture and develop the next generation of executive leaders. Training and development are often sporadic, which, combined with the lack of a systematic appraisal, makes development and deployment of key talent almost impossible. The Government’s insistence on carving yet more managers out of the system at the moment is having a very damaging impact on their ability to take forward the kind of change that needs to happen.

If we do not sort this out, if we do not change the culture, if we do not put more trust in the NHS locally and if we do not sort out social care, all the other changes that we need to make will come to very little. This Government have now had 14 years; they have had their opportunity—it is time for change.

Midwives: Bullying

Lord Hunt of Kings Heath Excerpts

Tuesday 16th April 2024 Lords Chamber

Asked by

[Lord Hunt of Kings Heath]

To ask His Majesty’s Government what assessment they have made of the impact of bullying of students and newly qualified midwives in the NHS on (1) retention of staff, and (2) the treatment of pregnant women, as highlighted in the #Saynotobullyinginmidwifery report published on 12 November 2023.

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

This report makes difficult reading, highlighting unacceptable levels of bullying in midwifery. We know that culture and leadership have a significant impact on retention and staff experience. NHS organisations should have robust policies in place to tackle bullying and harassment. Through the NHS long-term workforce plan and the NHS equality, diversity and inclusion plan, we are seeking to expand the workforce and make the NHS a better place to work.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I am grateful to the Minister. As he says, all NHS trusts have those robust policies. The problem is that they are not coming out into practice. This report describes the experience of midwives working in a toxic culture. One newly qualified midwife is quoted as saying that they were left

“burnt out by bullying and the terror of working on understaffed wards”.

Another said:

“I would return home crying most days and became suicidal from the fear and treatment at this trust”.


Does the Minister accept that much more fundamental change is required to deal with understaffed maternity units, NHS trusts preoccupied with reputation management over patient safety, and a reluctance to take whistleblowers seriously?

[Lord Markham (Con)]

I thank the noble Lord for his work in this whole area. That is genuine appreciation, because I know that he looks not just at bullying in this area. He is a very important conduit and I am personally grateful for the work he does on this and how much he cares. It is a combination of all the things that he mentioned. I had a meeting with the chief midwife on this subject this morning because of it being brought to my attention. I was actually quite reassured. Each trust now has what is called a quad leadership team, where the chief midwife, a neonatologist, an obstetrician and the general manager spend time together in a six-month process where they work together as a team on how they will address all these vital cultural issues.

Stroke Treatment

Lord Hunt of Kings Heath Excerpts

Wednesday 27th March 2024 Lords Chamber

[Lord Markham (Con)]

That is what these SQuIRe centres are about—trying to roll out best practice. As I mentioned, I have seen fantastic examples, including simple things such as at Leighton Hospital, which gets every patient, not just stroke patients, to exercise for a couple of hours each day. That makes a difference to their length of stay and their ability to go back into the community and into the workplace.

[Lord Hunt of Kings Heath (Lab)]

My Lords, to follow on from the encouraging intervention of the noble Baroness, Lady Meacher, the Minister will know that, in 2010, London centralised hyperacute services into a small number of expert units. What progress are we making throughout the rest of the country, because in some parts it has been disappointingly slow?

[Lord Markham (Con)]

The stroke quality improvement for rehabilitation—SQuIRe—services are where we are trying to take best practice from London, France and around the world and roll it out. The good news is that we have the model; it is based on a national model for an integrated community stroke service. We have got that in 65% of locations, with the goal of making it 75%.

Sodium Valproate and Pelvic Mesh

Lord Hunt of Kings Heath Excerpts

Monday 25th March 2024 Lords Chamber

[Lord Markham (Con)]

The 2025 date is the timetable that the Patient Safety Commissioner recommended in terms of financial redress. The point that the noble Baroness makes, quite rightly, is about the non-financial aspect: if you are suffering pain from it all, you want to be treated as quickly as possible. That is why we have set up these nine specialist centres to allow exactly that sort of redress to occur.

[Lord Hunt of Kings Heath (Lab)]

My Lords, can I remind the noble Lord that, of course, it was not a matter of months since this first recommendation came? The noble Baroness, Lady Cumberlege, recommended a redress scheme some years ago. Why was it rejected in the first place, and why are we waiting many more months, as the Minister said, when, as the Patient Safety Commissioner has said, the intention is

“an initial, fixed sum in recognition of the avoidable harm they have suffered as a result of system-wide healthcare and regulatory failures”?

Why are the Government being so slow to respond?

[Lord Markham (Con)]

That is precisely what I put to Minister Caulfield this morning. She commissioned the review because her feeling was that the period from when my noble friend’s initial report came in until when Maria Caulfield was in post was too long. So it was absolutely she who commissioned it last year, and it is absolutely she who very much said that she is determined that there should be a substantive reply from us in the next few months.

Sexual and Reproductive Healthcare

Lord Hunt of Kings Heath Excerpts

Tuesday 19th March 2024 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I congratulate the noble Baroness on her contribution and fully endorse what she has to say. We clearly have a crisis in sexual and reproductive healthcare.

I refer the Minister to evidence given to the Commons Women and Equalities Committee only in January by Dr Claire Dewsnap, president of the British Association for Sexual Health and HIV. She said that

“a lot of the presentations in clinics and potentially in other settings like primary and secondary care, are things that we have not seen for 50 or 60 years”.

In the same session, Dame Rachel de Souza highlighted that in the past, schoolchildren could go to the school nurse with sexual health issues but there has been a 35% cut in school nurses over the last 10 years. This issue of access means that it is significantly harder for young people to access sexual health services, particularly in rural areas. According to Dr Dewsnap, because of budget cuts only 10% of sexual health services offer a drop-in facility. That makes it far less likely that young people and children will seek the support they need.

A further, highly effective resource that has been totally cut is the Sexwise website. This highly valued sexual health resource for professionals and the general public was developed by the FPA in 2017 on behalf of Public Health England and handed to PHE to run in 2019. But, alarmingly, the Minister’s department ended the contract to deliver maintenance support for the website from 4 March this year. Twice, the department has refused an offer from the FPA to take it over, and the reasons given are clearly spurious. The first rejection was based on Crown copyright considerations of the Sexwise brand—a ridiculous argument. The second rejection, after the FPA clarified that the Crown could keep ownership of the brand, was, quite frankly, nonsensical.

The basic need for what Sexwise gave, which was accurate and free-to-access sexual and reproductive health information, has not gone away. I hope the Minister will instruct the DHSC either to put Sexwise out to a public tender—we are talking about tens of thousands of pounds of cost—or to accept the generous offer from the FPA to run it on the department’s behalf. I am afraid that the Sexwise saga just reflects the Government’s attitude towards public health, perhaps apart from smoking.

I would like the Minister to reflect on the effective dismantling of the Office for Health Improvement and Disparities. It took over the funding of the public health grant when Public Health England was disestablished in 2021, which in turn, of course, replaced the Health Protection Agency following the Health and Social Care Act 2012. It has now been authoritatively reported in the Health Service Journal that unannounced changes to the office have led to its fragmentation and decimation.

So over 12 years we have seen, through a number of iterations, the Government essentially move from having a large, mainly independent public health agency to a disparate group of people spread thinly across a number of directorates in the Department of Health. At what cost? I have seen reports that OHID has been reduced by about 60% in staffing terms, with a loss of several senior and experienced officials and the downgrading of many functions, including sexual health. Can the Minister tell me how many qualified public health specialists have left OHID and how many remain within his department? It is a far cry from the triumphal tone of the announcement launching the office, followed by the September 2021 statement by the then Health Secretary, Sajid Javid, who said he wanted OHID to work on preventing poor mental and physical health, addressing health inequalities and improving access to health services, and to work with partners within and outside government to respond to wider health determinants. That ended well, didn’t it?

My noble friend Lady Merron anticipated this in her regret Motion of 9 November 2021. As she put it, it is hard to see how the UK Health Security Agency or the OHID could be “independent or effective”. They were not set up in statute and were created

“without parliamentary scrutiny or approval”.—[Official Report, 9/11/21; col. 1675.]

As we can see, it is very easy then virtually to dismantle OHID without any public or parliamentary scrutiny whatever. Hunter, Littlejohns and Weale, in a forthcoming BMJ opinion column, will argue:

“Set up in haste with no consultation, OHID lacks any of the … independence PHE had, being an opaque body scattered through the Department of Health and Social Care. Given its low profile and lack of a clear mission, it comes as no surprise that, despite denials from the government, it has been virtually eviscerated”.


Or, as Dave West from the HSJ has put it,

“the latest restructure, as well as being damaging to a functioning national public health system, suggests any idea of greater push and support from the centre for independent for ICSs’ long-term agenda—of population health, prevention inequalities—remains for the birds. Hopes of tougher preventative action on alcohol or sugar, for example, equally so”.

That has to be on a par with the Government’s tepid approach to public health measures, smoking aside. The shamefully postponed implementation of the obesity strategy is but one example, and it is in this context, of course, that we see the problems arising in sexual health. How else can we explain the LGA’s analysis that, between 2015 and 2024, the public health grant received by local authorities has been reduced in real terms by £880 million, which has resulted in a reduction in councils’ ability to spend on STI testing, contraception and treatment? As David Hunter and his colleagues argue, revitalising public health in the UK requires changes, including a cross-government approach to tackle the social determinants of health alongside restoring the funding cuts to public health funding. Will the Minister effect that change, including restoring the real-terms value of the public health grant, the cut to which has so decimated sexual health services in the way described by the noble Baroness, Lady Barker?

Prioritising Early Childhood: Academy of Medical Sciences Report

Lord Hunt of Kings Heath Excerpts

Monday 11th March 2024 Lords Chamber

Asked by

[Lord Hunt of Kings Heath]

To ask His Majesty’s Government what assessment they have made of the report of the Academy of Medical Sciences Prioritising early childhood to promote the nation’s health, wellbeing and prosperity, published on 5 February, particularly regarding children under 5.

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

The Government welcome the report. We have taken significant action to improve children’s health in the early years. This includes reducing sugar in children’s food, supporting healthy diets for families from lower-income households through schemes such as Healthy Start, and investing record amounts into children’s and young people’s mental health services and around £300 million in the family hubs and Start for Life programmes. We are also improving children’s oral health through our dentistry recovery plan.

--- Later in debate ---

[Lord Hunt of Kings Heath (Lab)]

My Lords, I pay tribute to my noble friend Lord McAvoy, who was an incredible parliamentary servant in both Houses over many years.

I thank the Minister, but he will be aware that we have a frightening number of people of working age who are not able to work because of long-term illness. The implication of the academy report is that we are storing up huge problems for the future. As one example, 20% of under-fives are obese or overweight. If the Government are so keen to take action, why have they postponed the implementation of their obesity strategy, which would start to take action against unhealthy food and encourage young people towards more exercise and a healthier lifestyle?

[Lord Markham (Con)]

First, I add condolences from myself and this side of the House for Lord McAvoy.

Secondly, I am grateful for the direction of the report. I think that we all agree that early investment in childhood, and in young people, is vital. That is what our vision for the first 1,001 critical days is all about. A lot of the things in the report are helpful. I must admit that I did not recognise that particular stat, because rather than it being one in five children suffering from obesity at age five, the latest report—and it is an extensive study—shows that it is less than one in 10. It is the lowest number since 2006-07. So, in the area of obesity, we can show that our plans are working. I say again: we have the lowest level of obesity among reception age children since 2006-07.

Anaesthesia Associates and Physician Associates Order 2024

Lord Hunt of Kings Heath Excerpts

Monday 26th February 2024 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, I was a member of the GMC until the end of January, so at the council meetings I was involved in a number of discussions about the responsibilities of the GMC in the lead-up to this order being laid. Unsurprisingly, I strongly support it.

I listened to the noble Baronesses, Lady Bennett, Lady Brinton and Lady Finlay, and clearly they raised issues that the Minister will need to respond to. However, the combination of statutory regulation by the GMC and a proper governance framework within each employment body seems the most appropriate course for us to take. Therefore, I say to the noble Baroness, Lady Bennett, that passing the order is the best way to secure the safety of patients, which is why I hope the House will give it resounding support tonight.

My second point comes back to the noble Baroness, Lady Bennett, on democratic accountability and legitimacy. The Minister mentioned that a combination of the Health Act 1999 and the Health and Care Act 2022 has brought this order before us. Since I took the 1999 Act through this House, I feel some responsibility to stand up for what it essentially aims to do. The whole problem of regulation of the professions in the health service is that it has never had the priority it deserves from the Government. The Law Commission reported in 2014, and here we are 10 years later, just about getting round to the first tranche of orders that we need to modernise the regulation of our health professions.

If you rely on primary legislation to make this kind of change, nothing will ever change. It is slow enough with secondary legislation, but with primary legislation it becomes almost impossible to get sensible change made. All the regulatory bodies are utterly frustrated that they have very old-fashioned processes and procedures, because they do not have the discretion needed to make changes that would be to both the public’s and the professions’ benefit. Therefore, I am glad we have this order and I hope we can follow it through.

My third point is about the noble Baronesses saying that they do not like the campaign of what is essentially vilification that has been going on over the last few months against the physician and anaesthetist associates. I wish they had paid a little more tribute to the members of those professions and the fantastic work they do. I have met physician and anaesthetist associates, and they are going through a torrid experience. They have been subjected to a nasty campaign and, even in their own employing body, there have been reports of bullying at work and they have been subjected to rude and antagonistic comments from colleagues.

What is the context in which we are to judge this litany of mistakes that they have made? They seem to be isolated examples and, to my knowledge, there is no comparative data on errors by consultants, principal GPs or postgraduate medical trainees. I would not like to see a list of all their mistakes. What would happen if we asked people to report mistakes made by F1 medics each August? The BMA is playing with fire in the campaign it has adopted of putting these poor professionals, who are doing their best, in this frame. I protest about this and the general lack of medical leadership from the profession when it should have been defending the associates. The way it has run away from this issue has been a disgrace. It will find that its lack of leadership and strength will bite it in future. I have not been impressed by the way in which employing authorities have dealt with this either; they have left individual AAs and PAs to withstand the pressure and bullying without the support they need.

The Minister needs to reflect on some of the points raised. First, in addition to declaring his confidence in physician and anaesthesia associates, he needs to set out a long-term plan for their contribution to the NHS, ensuring that the voices of those professions are heard. The Government’s ambitions on the numbers of AAs and PAs seem very modest. Why? Does he think we need to revisit that? Secondly, he needs to make it clear to NHS England and to employing authorities that bullying and intimidation of any healthcare professional in their employment must not be tolerated.

Thirdly, in response to the noble Baronesses, Lady Brinton and Lady Finlay, the Minister needs to ensure that each employing body adopts an appropriate local governance framework to deal with some of the issues that they have legitimately raised. Fourthly, we need research on the clinical outcomes of physician and anaesthesia associates and, frankly, comparative data with other health professionals. That is the only way to deal with the toxicity of these lists of mistakes that have been circulated. Finally—here I agree with the noble Baronesses, Lady Finlay and Lady Brinton—there clearly needs to be a plan of communication to the public to explain the role of the associates and the contribution they can make in future.

The order is important. Some legitimate issues have been raised, but equally we need to defend the associates, uphold the work they do and give them confidence about the future.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interest as a NED of the NHS Executive. I support this order, for many of the reasons that the noble Lord, Lord Hunt, has just explained, but stress that I am extremely unhappy about the division between the reports from various medics and the associates that are planned. One of the big problems is that we do not value junior doctors enough. The phrase we use is inappropriate. I have been married for 43 years to a doctor who has been called a house officer, a senior house officer, a registrar and a senior registrar—those things would now be referred to as a junior doctor. I want to put that on record.

I also support what the two noble Baronesses have said, which is that we need a distinguishing factor for a qualified doctor, be that “MD” or whatever else is selected by the medical profession. I am a nurse, and I am proud of being a nurse. We have nursing associates, but I know that I am a registered nurse and I know that I have a doctorate, but I would never refer to myself as a doctor in the clinical area. These issues are difficult to deal with because we need to value people’s different experience and training.

I was appointed by a previous Secretary of State to chair the grandfathering of the paramedics on to the new register, when it came into being, and look at the success that that has been.

--- Later in debate ---

[Lord Patel (CB)]

My Lords, I begin with a slight disagreement with the noble Lord, Lord Harris. I take his point about how dental professionals, not just dentists, are regulated by the GDC, but I agree with the comment from the noble Lord, Lord Lansley, about the impression it would give if other professions apart from doctors were regulated by the General Medical Council. Hitherto, the GMC has regulated only doctors, so it would have to be clear in the register how these people were differentiated. I am afraid that the solution of having a prefix on a register would not mean anything to patients.

In the past, if you walked around a hospital, it was easy to know who was a doctor, as they mostly wore white coats; who were the nurses, because they wore different uniforms, including the matron’s uniform, which was a different colour; and who was a trainee nurse, because they wore a pink uniform, which is why junior doctors referred to them as “pinkies”. Physiotherapists wore yet another colour of uniform. However, nowadays everyone wears suits or jackets or jerseys, so you cannot distinguish from that which profession is looking after you.

I take the point that the noble Lord, Lord Winston, made, that for all of us who have done surgery, a qualified, competent anaesthetist is our friend. But sometimes—as he and I have no doubt done—we operate on pretty vulnerable patients for whom the surgery is necessary but they are not a safe bet for anaesthesia, unless by an extremely competent anaesthetist. But I interpret the anaesthesia associate as someone who does not induce anaesthesia but only maintains anaesthetic under strict supervision by a qualified anaesthetist. And that is quite distinct from what a physician associate might do, because they might be involved in different ways in assisting the physician. The point made by the noble Lord, Lord Winston, is important because it is an example that shows up the importance of the scope of the practice of physician associates and anaesthesia associates.

It does not help—and this debate is an example of why so much concern has been expressed—when the NHS health careers website says, in relation to physician associates, that they will be trained in

“taking medical histories … performing physical examinations … diagnosing illnesses … seeing patients with long-term chronic conditions … performing diagnostic and therapeutic procedures … analysing test results … developing management plans”—

which I presume means patient management plans. If you see that, you can see why there are concerns and confusion over what their responsibilities will be and the limitation of the scope of their practice.

I absolutely appreciate the need for physician associates —I keep calling them assistants—and anaesthesia associates and the need for regulation, but I think this crosses the Rubicon since it is the General Medical Council that will regulate this. It is important that what it defines as the scope of the practice is understandable to patients and professionals clearly.

The noble Lord, Lord Hunt of Kings Heath, commented that he took the legislation through this House in 1999, and that Act will subsequently be the vehicle for SIs to be used for future regulation. I am sorry that some of us were not here at the time because some of us might have opposed it. An Act from nearly 25 years ago cannot be the one that continues to be used. If we are going to have further reforms of the regulation of doctors and nurses—where we are talking about 1.5 million health professionals, not 3,000 physician associates or anaesthesia associates—I hope we are not going to have an SI to do that, because there are lots of issues of regulation.

[Lord Hunt of Kings Heath (Lab)]

My Lords, to be fair, I said that that Act had been subsequently amended by the Health and Care Act 2022. If you do not have flexibility through regulation, you will never get anything done in relation to modernising health regulation. Governments simply do not find time in primary legislation to update regulation.

[Lord Patel (CB)]

I hope they do find time, because that allows for better scrutiny and better ability to amend, which we always claim to be our key role—to scrutinise and amend. It is a major piece of legislation to go through using SIs, and it is inappropriate to do so. Maybe we must consider how else we could do it in a way that maintains flexibility.

Moving on from that, as the noble Lord, Lord Harris, already mentioned, if this legislation is going to be the template for future legislation to regulate all health professionals, some issues will need to be discussed. This order does not require that health is considered as a category in the regulation of physician and anaesthesia associates. The statistics show that, when the GMC or, I presume, any other regulator investigates, it is a very stressful situation for the person involved. Some statistics suggest that one in three considers suicide; they are depressed by it. If the category of health is removed as a consideration when a person is investigated, as this order does, it is a backwards step. I need to ask the Minister why health has been removed as a consideration. If this is the template, I presume that this will also apply to other regulations in the future.

NHS Dentistry

Lord Hunt of Kings Heath Excerpts

Monday 19th February 2024 Lords Chamber

[Lord Markham (Con)]

The noble Lord is correct in talking about the supply challenges. That is what the long-term workforce plan is all about, and why we are committing to a 40% increase in training places by 2030. The other issue that he rightly raises is the balance between the cost-effectiveness of providing private versus national health dentistry. The problem is that it is often seen as more lucrative for a dentist to go down the private sector route. That is why we are trying to rebalance that and have introduced an increase in the minimum charge to £28 for a unit of dental activity, and £50 for a new patient, to try to bring services back more in favour of the NHS.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I declare my interests as president of the British Fluoridation Society. The Academy of Medical Sciences reported very recently that nearly a quarter of five year-olds have tooth decay. Unless we deal with this there will be many more queues and great difficulties with access. The Minister will know that shortly there will be a consultation in the north-east to introduce fluoride. Surely the current situation demands that we extend this throughout the country.

[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.

Pharmacy First

Lord Hunt of Kings Heath Excerpts

Tuesday 6th February 2024 Lords Chamber

[Lord Markham (Con)]

My noble friend is absolutely correct to bring that up, and that is why it is quite specific on “simple” UTIs. The devil is in the detail, but the reason behind saying simple UTIs is that so the capacity is there, and you can have a referral to a GP.

In this space I speak from personal experience with my partner. It is much harder these days to get antibiotics for UTIs. We know that this is generally a good thing in terms of antimicrobial resistance, but in many cases, as my wife often says, she knows when she has a UTI—and boy does she need those antibiotics.

Some of the things I have started to see in terms of technology, which is relevant to the question of complexity, include point-of-care devices in surgeries or pharmacies that can detect a UTI very quickly, so that you then know you can give a prescription for antibiotics. That is what we see in terms of the direction of travel.

[Lord Hunt of Kings Heath (Lab)]

My Lords, when I had responsibility for community pharmacy more than 20 years ago, one of the schemes we instituted was incentivisation for private consulting rooms and spaces. I wholly endorse what my noble friend Lady Merron said about the importance of this, and the noble Baroness’s intervention reinforces this. It sounds as if most community pharmacies have some kind of private area, but they are not always as good, secure or private as they ought to be. So I very much hope that the incentive that I hear the noble Lord has built into the scheme will actually lead to ensuring that patients have confidentiality, which is really important here.

On the cap, I understand the need for probity and making sure that there are no perverse incentives to overcount, but it would be a bit of a disaster if, nine months into the financial year, a very good community pharmacy ran out of its allocated funding. What would happen? Will integrated care boards at the local level have some discretion to come in at that point to ensure that that service can continue?

On integrated care boards, some clinical commissioning groups were very poor at getting community pharmacy around the table. It always amazed me that, in their winter planning, they seemed to forget the need to have community pharmacies as equal partners. Can the Minister assure me that, when this programme is taken forward, integrated care boards will be clearly told that they are expected to treat community pharmacies as important partners in this and in planning for winter, which, as the noble Lord knows, continues for much of the year?

[Lord Markham (Con)]

I thank the noble Lord and will answer his questions in reverse. On getting the ICBs around the table, I absolutely agree. This is seen as a key part of those initiatives and handling those pressures. Generally, going back to privacy, I would expect to see, as ever with these things, some pharmacies that become very good and set up really nice areas, with a lot of expertise. I am sure they will push ahead. I am making this up, to be honest—this is not policy—but I would not be surprised if it started off with a base level of ones that can do only the seven, with others that are more skilled and show that they can manage more things, such as hypertension. There will be some very successful ones. On the cap, it would be perverse if those really successful ones suddenly hit the buffers, so to speak. As I understand it, the cap looks at this much more in terms of a global presence. In the department as a whole and the Treasury, we are going into this with a budget in mind and with the appropriate safeguards. But, going back to the value for money question, overspending is actually probably good news because it shows that it is working.

National Health Service: Key Targets

Lord Hunt of Kings Heath Excerpts

Tuesday 16th January 2024 Lords Chamber

[Lord Markham (Con)]

Funnily enough, I had this conversation in terms of productivity just today. The virtual wards—the 11,000 extra beds we have put in—are actually making a real impact on that, because of course it is much better that people can be treated in their own home, knowing they have the comfort of these virtual displays and treatment to look after them. We have 11,000 extra beds, with 72% utilisation, and, yes, it is really working.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister keeps talking about progress being made, but if he looks at, say, the four-hour A&E target, he knows that the latest figures show that the NHS reached only 69% in December. In 2010, his party inherited a performance of 98.3%. What does he think that says about his party’s stewardship of the NHS?

[Lord Markham (Con)]

I can talk about what we are doing now, which is showing real progress. But I have to say that the saying “People who live in glass houses shouldn’t throw stones” comes to mind, because, looking at those same targets, I notice that the Labour-run NHS in Wales never reached the four-hour A&E target; the last time it hit the 62-day cancer target was in August 2010, 14 years ago; and the last time it hit the hospital treatment target was in August 2010. I say politely that the noble Lord might want to get his own house in order first.