Invasive Group A Streptococcus and Scarlet Fever

Lord Hunt of Kings Heath Excerpts

Monday 5th December 2022 Lords Chamber

[Lord Markham (Con)]

I know that the health agencies in each country work very closely together. I do not yet have the specific details, so I will happily follow up on this. I know that they are working very closely because it is clearly an area of concern. Right now, we have not seen any evidence of a new strain, so we think that we are looking at existing strains. We are seeing this number of cases because of a general situation where there is less immunity in the population because of the isolation related to Covid.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister will be aware that, on social media, there have been a number of recommendations by health professionals that concerned parents should go to their GP to seek advice. Yet he will know that GPs are under considerable pressure. The GP patients survey showed that over a third of people did not see or speak to anyone when they could not get an appointment at their GP practice. What special arrangements are being made to ensure that parents can get through the system to get advice?

Children in Care: CAMHS Waiting Times

Lord Hunt of Kings Heath Excerpts

Monday 5th December 2022 Lords Chamber

[Lord Markham (Con)]

Generally, we need to try to assess as many people as we can. I remember in my school there was a child in our class who we just thought was naughty and got into all sorts of trouble, but now, having had my own personal experience later on, I know that he had an autistic spectrum disorder. Clearly, he needed help and he was not assessed, so, as a statement, I agree that we need to increase assessment as much as we can for all these cases.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister has mentioned the provision of services in schools, which is very welcome, but does he accept that thousands of young people are now being home educated? Will he ensure that there is parallel support for those children in terms of mental health provision?

[Lord Markham (Con)]

I agree. Arguably, if you are being home schooled, you probably need a lot of help. As the noble Lord will be aware, a lot of the services are related to social prescribing, where often people with mental disorders can be helped by involving them more in community activities. Clearly, those who are home schooled are much more likely to be isolated.

NHS Waiting Times

Lord Hunt of Kings Heath Excerpts

Tuesday 22nd November 2022 Lords Chamber

Tabled by

[Lord Hunt of Kings Heath]

To ask His Majesty’s Government what steps they are taking to improve NHS waiting time performance.

[The Lord Speaker (Lord McFall of Alcluith)]

For the second time in a week or so, I do not notice the noble Lord in his place but I believe that the noble Baroness, Lady Merron, will kindly step in again.

Ambulance Delays

Lord Hunt of Kings Heath Excerpts

Wednesday 9th November 2022 Lords Chamber

Tabled by

[Lord Hunt of Kings Heath]

To ask His Majesty’s Government what steps they are taking in response to reports of long ambulance waits for serious conditions, including heart attacks and strokes.

British Heart Foundation: Tipping Point Report

Lord Hunt of Kings Heath Excerpts

Tuesday 8th November 2022 Lords Chamber

[Lord Markham (Con)]

I am afraid I do not have information on the number of deaths. I will investigate this. I can say that I am sure that we have all seen a great increase in the number of defibrillators and we very much encourage this.

[Lord Hunt of Kings Heath (Lab)]

My Lords, that is very kind of the Minister. May I take him back to his response to his noble friend about vaccination? Would he, none the less, tell the House that the Government are absolutely convinced that the Covid and flu vaccinations have brought huge benefits?

[Lord Markham (Con)]

I thank the noble Lord for giving me the opportunity to state this. I should have done so the first time around, so that is appreciated. As he says, vaccinations have brought huge benefits. We can all be proud to be the leading country on rolling them out, seeing the benefits that have come from it all.

Water Fluoridation (Consultation) (England) Regulations 2022

Lord Hunt of Kings Heath Excerpts

Tuesday 25th October 2022 Grand Committee

Finally, references to “available scientific evidence” should be supplemented by attaching particular weight to the latest evidence and should specifically include international evidence. The Secretary of State should be required to list the evidence that has been taken into account and state what evidence has been discounted and for what reason. In the last few years, an increasing number of international peer-reviewed studies have highlighted the distinct correlation between water fluoridation and serious health ailments, particularly with regard to the developing foetus. We would be committing a disservice to the public if all the latest available research was not analysed effectively.

[Lord Hunt of Kings Heath (Lab)]

My Lords, it is a great pleasure to follow the noble Lord, although I do not agree with him; we debated this during the passage of the Health and Care Act through your Lordships’ House only a few months ago. I must declare that I am president of the British Fluoridation Society.

I have form, because I remember when I was secretary of the Edgware/Hendon Community Health Council in the mid-1970s, taking part in an extensive consultation exercise in the London Borough of Barnet when the then Government were encouraging the introduction of fluoridation. We had two very well attended meetings in the borough where there was a clear view in favour of fluoridating water. Unfortunately, virtually no progress has been made since then. That is why I am very glad that the Government have brought forward primary legislation, and I was very glad to hear what the Minister had to say about the intention to move ahead in the north-east. That is very encouraging and I hope that that will be the first of many such schemes.

It seems that the consultation progress that the Government have set out is entirely reasonable. We must remember that the principle is decided—it has been decided by primary legislation. The local consultations that will take place are not a reason for reopening arguments about the effectiveness of fluoridation; they are about the detailed proposals, making sure that the areas are covered correctly and that individuals can have a say about that. However, I have to say that I noted in paragraph 7.3 that in the consultation a higher weight is to be given to individuals affected by the proposals

“who reside or work in the area.”

I am sure that that is right, but I ask the Minister to agree that the highest weight has to be given to the statement by the Chief Medical Officers of all four UK countries last year that water fluoridation is both safe and effective as well as being the most cost-effective way to reduce inequalities in dental caries prevalence. That must be the principle that lies behind any consultation process. I wish these regulations all speed ahead and very much hope that the foundations for a second wave of fluoridation schemes can now be laid in the north-east.

[Baroness Brinton (LD)]

My Lords, I welcome the Minister to consequential SIs from the passage of the Health and Care Act. Some of those present will remember the long debates we had during the passage of that legislation, some of which the noble Lord, Lord Reay, has returned us to today.

I will start on water fluoridation. My points were actually about consultation, and I will return to those, but the noble Lord has a point: there are now scientific records to show that excess levels of fluoride do cause damage. There is a very good academic article entitled “Assessment of fluoride levels during pregnancy and its association with early adverse pregnancy outcomes”. It concludes that this happens mainly in developing countries where the level of fluoride is not managed. I echo the point that the noble Lord, Lord Hunt, just made, that if the four Chief Medical Officers for the four countries of the United Kingdom believe that it is safe, that should be enough for us.

Of course all care must be taken and monitoring must continue, but the other point I want to make is from a dentist in Australia, who was very supportive of Australia’s move to fluoridation a while ago. He said that the region where he lives was one of the last to add fluoride. He talks about the experience of having to give very small children repeated anaesthetics and pain relief, and the effect on them. He says:

“Since fluoridation was introduced to Geelong in 2009, my colleagues are much happier, as severe dental abscesses requiring tricky anaesthetic techniques are much less common, and tend to mainly come from areas in the region which still aren’t fluoridated.”


He goes on to say:

“The other anecdote … was that one of my colleagues who had worked in Europe for a few years went away with 3 children under the age of 6, who were the same age and social demographic as our own children. When they returned … 2 of his 3 children had needed dental treatment”


under general anaesthetic. The key point is that they went to unfluoridated places. Although I hear the concerns of the noble Lord, Lord Reay, I hope we can be reassured that everything we debated during the passage of the Health and Care Bill shows that this is being done very carefully.

During the passage of that Bill, my noble friend Lady Pinnock made a very important series of points about how to decide where to consult about fluoridation of water, given that we have so many reservoirs where water goes in lots of different directions. Often, you cannot identify each of those areas. Although it was good to hear the Minister talk about the way that consultation will happen, and it is good news that there has been broad consultation in the north-east and that there are some resources there, might the Minister comment on how it is possible for civil servants to identify the relevant areas for consultation? This was one of the reasons why we said during the passage of the Bill that there needed to be very broad consultation.

Moving on to the other statutory instrument on training on learning disabilities and autism, and on virginity testing and hymenoplasty, I signed both of those amendments during the Bill’s passage. Each time it came back I spoke to both of them. It was wonderful that the Government listened and accepted the amendments on training for health staff working with people with learning disabilities and autism. I know that this is only a technical amendment to remove the CQC, but this is a moment to thank the Government for listening to the concern of those of us who work with and know many in the learning disabled and the autistic communities, who have often found that they have been treated by people who do not understand their conditions, which makes it that much harder to communicate with them.

I will now move on to virginity testing and hymenoplasty—I welcome the Minister to the language that we have all had to learn. We were very pleased that the Government decided to support measures on this. I have one question for the Minister. He mentioned that this was about the suitability of foster parents or of their household. It is not clear how wide that household is regarded; is it literally the people who live in that house, or, as in other safeguarding issues, would it also include a member of the foster parents’ family who might be visiting that house on a regular basis and who, in any other safeguarding terms, would have to be notified? If the Minister cannot answer that today, I would completely understand, but I look forward to the answer because I have a particular interest in safeguarding. Apart from that, I support all three elements in front of us today.

Childhood Obesity

Lord Hunt of Kings Heath Excerpts

Monday 17th October 2022 Lords Chamber

[Lord Markham (Con)]

My Lords, as the House will be aware, the tax on sugar in drinks has reduced consumption of sugar by 44%, so I totally agree with the sentiment. We have been successful in this. We are looking to improve in the area of sugary food, where we have managed to reduce some of that content by as much as 13%.

[Lord Hunt of Kings Heath (Lab)]

My Lords, has the Minister seen the startling statistics showing the number of economically inactive people aged 50 and over, much of which is caused by ill health, with obesity thought to play a major role. Given that, why on earth do the Government need to fudge around and review? Why do they not get on with an assertive campaign to tackle obesity?

[Lord Markham (Con)]

I do not believe that we are fudging around. Noble Lords will see some very firm action. If the noble Lord goes into the supermarkets today, he will see a very big difference in how you see the food. There are big changes. I totally agree on the importance of this. I was the lead NED of the DWP, so I know how many inactive people there are in the workforce and how much better it will be for them and the economy if we can get them active and into work. I completely agree with the sentiment and the action that we are taking to drive it forward.

NHS: Winter Challenges

Lord Hunt of Kings Heath Excerpts

Monday 10th October 2022 Lords Chamber

[Lord Markham (Con)]

The noble Lord is correct that care is at the centre of all of this. The flow of patients through hospitals is vital, and we are all aware that 13% of all hospital beds are held up by people who should be discharged into care. The £500 million investment is all about freeing up those beds. That will ease the flow right the way through the system—right the way into A&E, so that people can be discharged straight into hospitals, and right back to ambulances being able to discharge into A&E. I completely agree with the noble Lord; that is the focus of what we are doing.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Lord has talked about £500 million going in, but he knows that the efficiency savings target annualised is £12 billion. He also knows that unfunded inflationary pressures are estimated by NHS England to be £6 billion to £7 billion on top of this—and the Treasury is demanding further cuts in order to shore up its disastrous mini-Budget. Given that, how are the Government going to meet winter pressures, cut the Covid backlog and balance the books?

[Lord Markham (Con)]

We are facing unprecedented challenges, as the noble Lord states. We also have unprecedented investment, a plan for patients which is focused on the key elements that will make a difference—ambulances, the backlog, care, and doctors and dentists—and a group of Ministers who are focused on making a difference where it really counts. We have record investment, and a record number of doctors, nurses and people ready to face those challenges.

Primary and Community Care: Improving Patient Outcomes

Lord Hunt of Kings Heath Excerpts

Thursday 8th September 2022 Lords Chamber

[Lord Hunt of Kings Heath (Lab)]

My Lords, it is a great pleasure to follow the noble Lord and to thank the noble Lord, Lord Patel, for his speech. I fully echo his desire to see a special Select Committee created; I hope that the Liaison Committee members present will take note of that.

The noble Lord said that primary care is the bedrock of our health service, and I agree. If it does not function effectively, the whole healthcare system suffers, and it is clearly suffering greatly at the moment. It is not just workforce shortages or the crumbling estate. A recent Civitas report made for sober reading. It ranked the performance of the UK healthcare system with that of 18 comparable countries and, lamentably, it placed the UK second to bottom across a series of major healthcare outcomes, including life expectancy and survival rates from cancer, strokes and heart attacks. Recently, the Health Foundation has drawn attention to the UK having an astonishingly low number of MRI machines and CT scanners: fewer per person, according to the OECD, than any other developed country. That is besides having fewer doctors and nurses than our north European neighbours and very poor uptake of new medicines.

We see England’s hospitals being caught in a vice. On the one hand, the race to work through the enormous backlog of care means an unceasing stream of new patients into fewer beds. On the other hand, a decade of flatlining, at best, funds for social care means that even when treatment is concluded, thousands of patients remain in hospital beds waiting for follow-up care. Emergency departments have no beds to send new arrivals to the wards, patients with urgent needs wait for hours on end, ambulances cannot hand over patients, and are stuck in a queue outside A&E. We have to see the inadequacies of primary care in this much wider context.

The pandemic has accelerated the move to online booking and phone consultations with general practitioners. That has made care quicker and easier for many people, and we should not ignore that. On the other hand, it has led to many other patients facing enormous difficulties in getting face-to-face access to their general practitioner. The NHS England stat last October which showed that over 15% of practices recorded less than 20% of their GP appointments being held face-to-face is very worrying indeed. Last month, Pulse magazine reported that 1.5 million patients had lost their GP in the last eight years after the closure of almost 500 practices. Recruitment issues were part of the problem but we should not ignore the issue of workload, inadequate premises and sheer morale issues.

The noble Lord, Lord Patel, mentioned Dr Claire Fuller’s very interesting report to the NHS England CEO. She concluded that patient satisfaction with access to general practice is at an all-time low and described the 8 am Monday scramble for appointments as synonymous with huge patient frustrations. She said:

“left as it is, primary care … will become unsustainable in a relatively short period of time.”

We have all had evidence from the Royal College of GPs, which says that despite a government agreement to an increase of 6,000 in GPs, the number of fully qualified full-time equivalents has actually fallen by 1,622 between September 2015 and 2021. I mention again that I do not understand how the Government could have reduced the number of medical training places to 7,500 this year, following two years of there being about 10,500. It is amazing and extraordinary that the Government could have allowed that to happen. I had better declare my interest as a GMC member in that regard. The Health Foundation predicts that the shortage of GPs is set to become worse. It thinks that the current 4,200 shortfall will rise to more than 10,000 by the end of this decade.

Noble Lords have mentioned the recommendations of the Royal College of GPs: a new recruitment campaign, freeing up bureaucracy and investing in new technology—and I very much agree with the noble Lord, Lord Bethell, on that. But that is really not sufficient to tackle the fundamental issues we face. Noble Lords may be aware of a recent report by your Lordships’ Public Services Committee which looked at public service workforce issues generally. The stark conclusion is that every part of the public sector has targets for recruitment and none of them will be met. There is a lack of realism in accepting that and starting to do the work that needs to be done when faced with these acute problems. Again, I agree with the noble Lord, Lord Bethell, on that.

We need a realistic conversation about what we can expect primary care to do in future. Most of the evidence we have received says basically that we need more GPs but assumes that we carry on with the same 1948 model of primary care. That is not sustainable at all. We must be realistic and start talking about why that can no longer be the way we go forward.

Dr Fuller’s report to the NHS CEO was interesting. She argued for the streaming of services, with access to care for people who get ill but use health services only infrequently, and a distinction between their needs and those of people who are chronically ill and need care, to know their GP and access to multidisciplinary support. That is the start of thinking more fundamentally about primary care in future.

We must ask ourselves about the role of gatekeeper. People are wedded to the idea of the GP as gatekeeper—or, let us be truthful, as rationer of services. But when we look at outcome figures for, say, cancer, we must ask whether the lack of direct access to specialist care is one of the reasons that our outcomes are so poor. I do not know whether that is true or not, but we certainly need to ask the question.

How can we increase GPs’ job satisfaction? We must do something to give them the confidence to carry on in primary care in a way in which they get job satisfaction. We have many overseas doctors coming to work in the hospital sector. Can we change some of the rules and understandings in primary care to enable them to work there as well?

Finally, is the organisational model fit for purpose? We know that many GPs no longer aspire to partnership. What ought to take the place of that? If we are moving to a salaried service, partly in the employ of private-sector providers, how can we ensure that those GPs are getting the support, professional leadership and confidence to wish to stay in the sector in future?

I look forward to the Minister’s response. We do not need a lot of statistics, which, frankly, is not the answer to the fundamental issues we face. If ever we needed a special Select Committee, this is it.

NHS: Access to Treatments

Lord Hunt of Kings Heath Excerpts

Wednesday 7th September 2022 Lords Chamber

Asked by

[Lord Hunt of Kings Heath]

To ask Her Majesty’s Government what steps they are taking to improve access to treatments for NHS patients.

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

To improve access to treatment, the Government have committed to spend over £8 billion from 2022 to 2025, and this in addition to the £2 billion elective recovery fund and £700 million targeted investment fund made available last year. This funding is increasing capacity through community diagnostic centres and surgical hubs, supporting hospitals to prioritise treating the patients waiting longest, as well as accessing capacity via the independent sector. We are also making it easier for patients to choose treatment at different providers with shorter waiting times.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the noble Lord will be aware that access to the NHS, whether in primary care, the ambulance service, A&E or discharge, has become worse and worse. All the organisations that submitted evidence this week said that the core issue is workforce. I declare my interest as a member of the GMC. Can the Minister explain why has the number of medical training places this year been drastically reduced to 7,500 compared to 10,500 for last two years, and 9,500 in the pre-Covid year? The Medical Schools Council has said that we should have 14,500 medical places. How can the Minister justify 7,500?

[Lord Kamall (Con)]

We are looking at a number of different things when it comes to doctors across the service. One is clearly opening new medical schools in areas which are underserved: sometimes we have doctors, but not in the right areas. We are also looking at overseas recruitment but, on the specific issues, we are having discussions—let us put it that way—on the cap. That is constantly being debated and I will take that back to the department.