Terminally Ill Adults (End of Life) Bill

Lord Markham Excerpts

Friday 19th September 2025 Lords Chamber

[Lord Markham (Con)]

My Lords, like many noble Lords, I come at this debate from a point of personal experience. My mum, Judy, was 62, a fit and healthy Macmillan nurse, when, out of the blue, she was diagnosed with terminal cancer and given weeks to live. She was taken to a hospice three weeks later, barely conscious, and, very quickly, the clinicians gathered round her next of kin and suggested that she was in a lot of pain, that she did not have long, and that maybe helping her to take an earlier train would be the kind thing to do. We all agreed, and we all thank that hospice to this day for the kind and peaceful death that they gave her.

This happened not in some far-away land but right here in the UK. I think we are all probably aware of many such instances in the UK where, informally and quietly, terminally ill people are helped to have a kinder, compassionate, pain-free death. It is because of that experience that I am in favour of finding a way to allow other people to experience a kinder, safer death in a way of their choosing. I know from talking to many terminally ill people that it gives them great comfort knowing that they could have the ability to take that earlier train home.

I understand the concerns of many noble Lords here. I understand that, for some, it is a point of principle, for religious or moral reasons. I understand the concerns that many others have about the risks presented by the Bill, which is why I support the approach taken by the noble Baroness, Lady Berger, in her amendment to have a Select Committee scrutinise the Bill to make it the best it can possibly be. That is, after all, what we do best in the Lords.

However, I believe that arguments against the Bill about the burden on the NHS can be addressed by making sure that the Bill enables provision by the voluntary sector, just as happens with our excellent hospices, which are majority funded by voluntary rather than government money. I do not believe that arguments about undue burden on the NHS should be a reason to oppose the Bill.

After speaking to many terminally ill people, I think that it is wrong to equate their wish to die in comfort and without pain with suicide. My experience is that these people very much want to live but unfortunately know that they will shortly die. They therefore want to have the choice to do that in a way of their choosing, with comfort and in a pain-free way.

To conclude, the Bill is about choices—whether terminally ill people are given the choice voluntarily to face a kinder, pain-free death and to take that earlier train home, or whether we choose that that choice should be denied to them because we feel that, somehow, they are not fit to make that choice or may have felt coerced into it. Giving people that choice is a fundamental right, which is why I want to work on the Bill to ensure we do it in the kindest and safest way.

Primary and Community Care

Lord Markham Excerpts

Thursday 5th June 2025 Lords Chamber

[Lord Markham (Con)]

Building on a point made by the noble Lord, Lord Hacking, and others, there are many examples where the ideal place to do a diagnostic test is in a primary care setting. Urinary tract infections are a typical example of that, because you can solve it quickly in that setting, avoiding future hospital visits and much pain and suffering. However, that means taking budgets away from secondary care settings and giving them to primary care GPs, pharmacists, et cetera. Are the Government prepared to do that to see these benefits arise?

[Baroness Merron (Lab)]

We are constantly reviewing how best to support where we need to go. In this case, it is about getting tests done closer to home. The noble Lord is right that, for a number of people, the GP practice is a good place to do that, but not in all cases. What matters is doing what is appropriate. We announced an £889 million uplift for general practice in 2025-26, which is the largest uplift to GP funding since the beginning of the five-year framework in 2019, and we have also agreed a new GP contract. The noble Lord will be aware that we recently announced over £1 million to help the quality of the primary care estate, to ensure that we can provide some 11 million further appointments this year. While I accept that this issue is about configuration, I assure the noble Lord of our support for GPs.

Dementia and Alzheimer’s Treatments

Lord Markham Excerpts

Thursday 1st May 2025 Lords Chamber

[Baroness Merron (Lab)]

I am glad that I will be joining my noble friend in signing up as a volunteer. Certainly, the Lancet commission of last year said that some 45% of dementia cases are estimated to be preventable or delayable. That report is going to inform our actions as we look to the future. Perhaps it is helpful to clarify to your Lordships’ House—I am sure that many of us have experience of this—that the NHS health check for adults in England aged 45 to 74 is designed to do exactly as my noble friend says and identify early signs of various conditions which are contributory factors.

[Lord Markham (Con)]

A lot of the challenges in testing the efficacy of some medicines lie in measuring the progression of the disease. That is mainly done verbally and, as we all know, people have good days and other not-so-good days, so measuring the progression and impact of the treatment is hard. As the Minister will be aware, things such as retina scans are showing quite promising measurements in terms of the onset and progression. What are we doing in research in that area?

[Baroness Merron (Lab)]

I will be pleased to write to the noble Lord on that specific point, but it might be helpful if I say on the point raised earlier by the noble Lord, Lord Kamall, that investment in discovery science by the UK Dementia Research Institute, for example, included the recently announced Shingrix study in partnership with GSK and Health Data Research UK, and we are also working via the Dementia Translational Research Collaboration. I am sure that the noble Lord will be aware of the NIHR dementia trials network, which offers people with dementia the opportunity to take part in early clinical trials irrespective of where they live. The summary of all this is that we have some way to go, but we have made considerable progress in investment and plans for the future. I will take into account the noble Lord’s point.

NHS England Update

Lord Markham Excerpts

Wednesday 19th March 2025 Lords Chamber

[Baroness Merron (Lab)]

My noble friend will know—as I am sure the right reverend Prelate knows—that the Chief Nursing Officer has always played a role in advising Ministers; that the case was long before the establishment of NHS England and will continue long afterwards. The chief executive, Sir James, has announced his new transformation team, and that includes NHS England’s Chief Nursing Officer.

[Lord Markham (Con)]

As a former Health Minister, I too welcome this move, but the devil is in the detail. The point made about the NHS regions is completely right: that is another layer which will stop hospitals being freed up in the way the Secretary of State said he wants to happen. There is the question of whether lots of merged entities will be demerged again. As we all know, it is the uncertainty which hits productivity in the meantime, when people are naturally worried about their jobs.

I would really like to press the Minister on when we will see the detail behind the plan. When will it be produced, and when can we give the staff the information they need, so they know their position? Until that happens, the uncertainty will, unfortunately, hinder productivity and stop the changes we all want to see happening.

[Baroness Merron (Lab)]

I understand that point and the noble Lord’s wish for dates, which I am not able to give him, as I am sure he will appreciate. These reforms are not about front-line staff losing their jobs; we are talking about people employed directly by the department and the NHS. The noble Lord referred to the Secretary of State, and I would add that other arm’s-length bodies also need to be leaner than they are today.

I understand the problem, and we are going to work very closely with staff organisations, but it is not a neutral situation. Staff are suffering from box-ticking, duplication and red tape, which prevents them doing their job properly. Their morale is not good in this case—in any case. We do not want to add to that, but we do want to give them hope for the future.

Mental Health Treatment: Waiting Times

Lord Markham Excerpts

Monday 3rd February 2025 Lords Chamber

[Baroness Merron (Lab)]

I agree with my noble friend’s suggestions. Of course it is a team that provides the mental health support that is necessary, but I am particularly pleased that we are working to deliver a mental health professional in every school. That is a starting point, not necessarily the end point, so my noble friend makes some very helpful suggestions.

[Lord Markham (Con)]

I appreciate from my own time as Health Minister how difficult it is to meet the expanding demand, so I wonder if we are still looking at other methods to expand capacity, particularly digitally, both in terms of early diagnosis but also some of the digital mental health treatments which are quite impressive?

[Baroness Merron (Lab)]

I am glad for the understanding of the noble Lord. NHS England is encouraging the local use of digital tools, for example digitally enabled therapies, and it is an extremely helpful way also of managing waiting lists so people are not just left waiting but they are held and supported, often through digital means.

Government Policy on Health

Lord Markham Excerpts

Tuesday 10th September 2024 Lords Chamber

[Baroness Merron (Lab)]

I cannot answer that, I am afraid. I would be very happy to look at it for the noble Baroness.

[Lord Markham (Con)]

Although I understand completely the role of advisers—obviously Alan Milburn is a very reputable adviser—where is the line? My concern is that, when an adviser has a pass, has been in meetings without Ministers present and has perhaps directed civil servants in those meetings, a line has perhaps been crossed. I would welcome assurances from the Minister that this has not occurred and that there have not been any meetings where Alan Milburn has been there without Ministers—in effect, directing policy with no formal role.

[Baroness Merron (Lab)]

The right honourable Alan Milburn has not been directing policy; he also has no pass. I hope that is helpful to the noble Lord.

Human Medicines (Amendments relating to Registered Dental Hygienists, Registered Dental Therapists and Registered Pharmacy Technicians) Regulations 2024

Lord Markham Excerpts

Friday 24th May 2024 Lords Chamber

Moved by

[Lord Markham]

That the draft Regulations laid before the House on 29 April be approved.

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

My Lords, the Government are proposing changes that would improve patient access to medicines from dental practices and pharmacies. The draft statutory instrument before the House today covers two distinct professions: dental therapists or hygienists and pharmacy technicians. It will enable them both to use the full range of their skills to supply patients with the medicines they need, in a timely manner.

Our proposed changes will put exemptions in place for dental therapists and dental hygienists to supply or administer a range of medicines to patients which are part of their day-to-day job without having to refer to a dentist, so that they can deliver care without the need to organise additional appointments, or interrupt colleagues who are busy with other patients.

These are sensible, common-sense measures, freeing up precious time for clinicians and patients alike. Healthcare professionals have a responsibility to carry out care only where it is safe and they are competent to do so. Many of these professionals will already have extensive experience of using these medicines, but of course we will not compromise on safety.

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, from these Benches, we support the overall terms of these draft regulations, particularly the measures on pharmacy technicians and dental hygienists, who have great value in providing timely and quality care to patients where it is safe and suitable for them to do so.

I know that the dental profession is very supportive of the intention to enable dental hygienists and dental therapists to supply and administer the majority of the medicines listed in the regulations. The Minister described the regulations as “common-sense”, and I certainly share that assessment.

However, I just draw the Minister’s attention to the inclusion of two medicines on the list: minocycline and nystatin. These were not supported by the BDA or the College of General Dentistry—I am sure the Minister is aware of this—for a number of reasons, including antimicrobial resistance. In the case of minocycline efficacy, it is not recommended in any national clinical guidelines and its use in dentistry is no longer accepted practice. Perhaps the Minister can therefore say whether the concerns of the key dental stakeholders were taken into account when the decision was made to retain these two drugs on the list. Can he also assure the House that there has been full and proper consultation with both the British Dental Association and College of General Dentistry on ensuring that the regulations are compliant with both national practice and existing clinical guidelines?

Efforts to increase the skill mix in our NHS dentistry workforce and across pharmacy more generally are welcome, but I am sure that the Minister will forgive me for thinking that we perhaps need to go rather further than technical tweaks if we are to reverse the crisis in which NHS dentistry finds itself. However, as I said at the outset, we support these regulations, and I hope that the Minister will be able to reassure us about the medicines that are included in the list.

As this is the last day that the House is sitting in this Parliament, I, like my colleagues before me and, I am sure, after me, would like to take the opportunity to say to the Minister, the noble Lord, Lord Markham, what a pleasure it has been to work with him while he has been in his role. He has always carried out that role with the greatest courtesy, but also with care and determination to improve things, no matter what obstacles he perhaps found in his way. I thank him for his dedication to his role. As he is standing in for the noble Lord, Lord Evans—who was due to be standing in for the noble Lord, Lord Markham—I also thank the noble Lord, Lord Evans, similarly, for the manner in which he has conducted himself in this House. He too has always been most helpful and a real pleasure to work with and has always tried his best to make progress, as I know we all wish to do.

[Lord Markham (Con)]

I thank the noble Baroness for her kind words. Likewise, if the right words are “thoroughly enjoyed” then I have thoroughly enjoyed working with both the noble Baronesses on the Front Bench on that side, the noble Lord, Lord Allan—he is not here—and many other colleagues, including the noble Baroness, Lady Hayter. There are a number of common-sense things that we have managed to work through together.

I too take this opportunity to thank all noble Lords. It was a baptism of fire when I started two years ago, but I have come to really respect the function of the House and how well it holds our feet to the fire. We are all, in British society and in the Government, much the better for it.

On the questions raised, particularly regarding minocycline 2%, there were concerns raised, as the noble Baroness said, including by the British Society of Periodontology. However, when it was looked at, it was felt overall that it was best to keep it on the list because the concerns are quite low. On balance, it was worth keeping it on the list, but keeping it under watch—for want of a better word. Concerns were also raised around nystatin oral suspension but, again, it was felt that there were certain health benefits for certain groups of patients. But there will be training associated with these medicines, to ensure patient safety.

I will happily write in more detail on these—as is my wont; that is my “get out of jail free” card, in many cases—to make sure those questions are properly answered. I welcome the comments from the other Front Bench that these are sensible arrangements. With that, I beg to move.

Motion agreed.

Inflammatory Bowel Disease

Lord Markham Excerpts

Monday 20th May 2024 Lords Chamber

[Lord Hunt of Kings Heath]

To ask His Majesty’s Government what action they are taking to improve awareness of, and services for people with, inflammatory bowel disease.

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

NHS England’s national bladder and bowel health project is delivering better care for people with inflammatory bowel disease, with a focus on developing clinical pathways. Additionally, NHS England aims to reduce variation in care for people with inflammatory bowel disease through its Getting It Right First Time gastroenterology programme. To raise awareness of IBD among GPs and other primary care staff, the Royal College of General Practitioners has produced an inflammatory bowel disease toolkit.

[Lord Hunt of Kings Heath (Lab)]

My Lords, the Minister mentioned variation in care. He will be aware that over half a million people in the UK suffer from IBD and that the actual quality of care is very varied throughout the country. For instance, the overall waiting time for new patient appointments at gastroenterology clinics varies between one week and 27 weeks, with a big impact on the outcome of the care the patient receives. My understanding is that there are IBD national standards but that they are not adhered to. Can the Minister tell me why that is, and when will the Government insist that the NHS gets the variation of care down to at least an acceptable limit where good-quality care is guaranteed to all patients?

[Lord Markham (Con)]

The noble Lord is correct. I spent time with the clinical lead in this area this morning; there is a Getting It Right First Time pathway and it is clear that the initial cohort of 25 hospitals have shown real progress in this area. That is being rolled out across the pathway—we have now had cohorts 2 and 3 doing it—so we should see those improvements happen across the board. However, it is my job as a Minister to make sure that that happens.

[Lord Allan of Hallam (LD)]

My Lords, the Getting It Right First Time review that the Minister mentioned recommended increased access to endoscopy services over six and seven days and with extended hours. These are especially important for people trying to manage a bowel condition and work. Is the Minister satisfied with progress since that report in 2021 in terms of the availability of these services at weekends and in the evenings?

[Lord Markham (Con)]

I think there are two things. One is the CDC programme; the 160 centres and 7 million tests that we have rolled out are now very much helping in that space. However, it is also about making sure that the right people get the tests. On the question of awareness as well, we now have these faecal tests—a bit like bowel cancer screening—which can tell with 90% sensitivity whether you have inflammatory bowel disease or irritable bowel syndrome. With one, you absolutely need to see a specialist for endoscopy, while with the other, you do not. Telling the difference is key.

[Baroness McIntosh of Pickering (Con)]

My Lords, does my noble friend share my concern that a number of people, increasingly women, are being wrongly diagnosed with IBS when in fact they have an underlying cancer condition? How does he imagine that we can rectify this situation?

[Lord Markham (Con)]

For the benefit of the House, I would say they are often confused. Irritable bowel syndrome is suffered by about 10% of the population while inflammatory bowel disease—we are talking about Crohn’s disease and colitis—is suffered by less than 1% of the population. The key thing is trying to understand the difference between the two; as I say, we have this poo test, for want of a better word, which can do that. With people who test positive, you absolutely need to get them into that screening programme and get it right the first time, so you can pick up those problems and things such as cancer.

[Lord Turnberg (Lab)]

My Lords, more years ago than I care to remember, I was a gastroenterologist and saw many patients with inflammatory bowel disease. We were desperately seeking a cause or causes and we did research on infectious agents, unsuccessfully. Can the Minister update us on where research into the causes of these diseases is going? It has been going on far too long.

[Lord Markham (Con)]

The noble Lord is correct. This is an area where we still need more knowledge. We have spent about £34 million in research in this space over the last few years, but there is still a lot that we are learning. I can say freely that if there are good research projects there, the resources are available to make sure that they are funded, because we need to learn more in this space.

[Baroness Manzoor (Con)]

My Lords, many health authorities are sending out these tests to people. What percentage of these tests—“poo collections”, to use my noble friend’s words—are not being returned? It could be relatively high, particularly if we are not explaining the difference between the two types of illness.

[Lord Markham (Con)]

As described by the clinical lead in this, these really are game changers, so getting them back is key. I do not have the figures to hand as to the amount that they get a response from but, in the case of the bowel cancer screening, many of us will be aware that there has been a whole programme which has been very successful in getting those poo tests measured and responded to. We need to learn the same lessons in this area.

[Lord Kakkar (CB)]

My Lords, I draw your Lordships’ attention to my registered interests. To achieve the best outcomes for complex conditions such as inflammatory bowel disease, there is a requirement to ensure that patients are managed by properly skilled multidisciplinary teams. Is the Minister content that, with all the workforce pressures that exist, we are investing sufficiently to develop those teams to ensure the best clinical outcomes?

[Lord Markham (Con)]

The long-term workforce plan sets this out. We are getting a good response in terms of filling up the places. We have about 98% or 99% of the training places filled. The challenge is that this service, more than anything else, suffers from the highest burnout. That is the area where we are struggling to fill the places. Therefore, we are trying to ensure that this scarce resource is used by people and that this early screening test is used so that people can see who they really need to see.

[Baroness Redfern (Con)]

My Lords, I welcome the Government’s commitment to appoint a senior official to take responsibility for home care medicine services as a way forward to address awareness of coeliac disease and Crohn’ disease. Will there be a periodic update of data on how home care medicine services are functioning and a date for commencement of that data?

[Lord Markham (Con)]

We had a very good debate on this a couple of weeks ago. All noble Lords accepted that it was a bit of a Cinderella service at the moment, but vitally important to a lot of people’s everyday well-being, so I am happy to do that.

[Lord Watts (Lab)]

My Lords, is the Minister monitoring what is happening in Europe and the US to see whether we can learn any new lessons from the research programmes that are being carried out there?

[Lord Markham (Con)]

The Getting It Right pathway was very much informed from that best practice around the world and, in the last year, NICE has approved four new drug treatments. We are trying to look at the best medicines around the world. One of them, risankizumab, has resulted in a 44% reduction in the disease—so, yes, we are trying to learn from the best in the world.

[Lord Kamall (Con)]

My Lords, the noble Lord, Lord Hunt, asked about awareness. We know that certain communities are vaccine hesitant or less aware of some of the conditions and less likely to come forward. What lessons have been learned from some of the other programmes? Are there communities that are underrepresented for this? What efforts have been made to learn from other programmes to make sure that those communities come forward?

[Lord Markham (Con)]

First off, it is trying to learn the lessons: the best parallel that I have so far is around the bowel cancer screening and that faecal screening programme. The real thing here is the difference between the 10% of the population who suffer from irritable bowel syndrome, a lot of which is diet-based in terms of the cure, and the 1% which really is serious in terms of inflammatory bowel disease. That is where we need the education and awareness.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, the Minister has twice mentioned the bowel cancer screening programme, which I think is universally accepted to be very successful, and is also very reassuring to those people who are part of it, whatever the outcome of the tests. He will also know that that screening programme and others drop people once they reach a certain age, which coincidentally is the age at which they become more likely to develop the cancers that the screening programme is intended to detect. Do the Government have any plans to increase the age up to which people can be routinely included in bowel cancer screening and other screening programmes?

[Lord Markham (Con)]

The noble Baroness makes an important point. In this and other areas, we are guided by the science; we have been guided by the science on the advice to date. I will go back and ask for the latest thinking on that, and get back in detail in writing to the noble Baroness, but, generally, being guided by the science will be the approach.

[Baroness Goldie (Con)]

My Lords, further to the question of the noble Baroness, Lady McIntosh, and indeed the question from the noble Lord, Lord Turnberg, I understood that there was a link with a weakened immune system. I wonder if that is still an active field of research. Is there any update the noble Lord can provide? Many people, for other reasons, are diagnosed with weakened immune systems.

[Lord Markham (Con)]

These are all areas we are trying to find out about, such as Crohn’s and colitis. The trouble is that this whole area has a big field within it. The honest answer is that it is not absolutely understood, hence the need for research on what is causing this in the first place. As I say, we have spent quite a bit on research, but more needs to be spent on understanding the real issues. If the research projects are there, we will happily undertake them.

Integration of Primary and Community Care (Committee Report)

Lord Markham Excerpts

Thursday 9th May 2024 Lords Chamber

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

I too thank the noble Baroness, Lady Pitkeathley, and all the committee, for their work on this report. I hope that noble Lords will see from my speech that this report is appreciated. Directly on the question of the noble Baroness, Lady Finlay: the recommendations are welcome, and I hope that my speech will set out how we are acting on them.

Before I get into the detail, like other noble Lords, I want to acknowledge my noble friend Lord Jamieson’s maiden speech. He brings a wealth of experience to this, both professionally and from local government. I was particularly struck by his passion for housing. I must admit it is one that I share: it is core to so many people’s lives, in terms of well-being, their sense of happiness, security and stability, and, of course, their health. I look forward to discussing further how we can make that the core of so many things. As the noble Baroness, Lady Merron, rightly said, the noble Lord’s mother would be proud of him today.

I will start by recognising the points made by all noble Lords about the importance of primary care and community care integration. The noble Baroness, Lady Pitkeathley, said that nearly all of the four former Ministers strongly made the point that we see more and more resources going to hospitals, and we also know that there are more and more patients who do not need to go there. Around 50% of the people who go to A&E do not really need to be there. We see a lot of children under 12 going in with tooth decay, when better primary care and dental services would avoid that. Unless we change things, we will see the situation set out by the noble Lord, Lord Jamieson: staff levels in healthcare will go from one in seven of the population to one in four, and then one in three.

I think we all agree that we have to get upstream of the problem. The noble Baroness, Lady Tyler, rightly set out the need for prevention. I have seen some excellent examples of that, and Redhill is just one. The noble Lord, Lord Altrincham, and others described the excellent examples we have seen in the work of Professor Sam Everington in east London: making primary care central to care in the community, and assessing how many services can be taken out of acute settings.

As the noble Baroness, Lady Armstrong, said, centring the service around the needs of the individual, in contrast to the existing set-up, needs a shift in resources towards primary care. Our belief is that that can occur only if the ICBs, ICPs and ICSs are equipped with the information and have that helicopter view and the ability to shift resources from one to the other.

The noble Baroness, Lady Merron, asked a very direct and correct question about why we are increasing hospital care resources. I have some lived-in experience of that. It is a gutsy move to say that we will shift resources away from the hospitals. To make the whole equation work, you are often talking about reducing hospital services and the number of hospital beds, and putting them in the community instead, which we all agree is absolutely the right way to go. But we all know the reaction you get from local groups as soon as you try to do something like that. I completely agree that “neighbourhood health service” should be the name. It takes cross-party work to do that, regardless of who is in government after the next election. Speaking candidly, we need to provide each other with air cover during some of those difficult conversations, including with the ICBs and ICSs. For my part, I pledge to play that role, whether I am sitting on this Bench, the Bench opposite or any other bench after the election.

I am sorry that the government response was seen as disappointing. I hope we can address a lot of the issues raised by the noble Baroness, Lady Pitkeathley. We agree with the whole emphasis of the report and its recommendations, the analysis of the problems and the need to focus resources on primary care and prevention. We also agree with the substance of most of the recommendations.

Our main difference is whether we should be mandating the recommendations on the ICBs, ICPs and ICSs, versus enabling them to adopt them. For want of a better word, this is a bet that we are putting on the ICBs, that they are the right bodies to do this, giving them the time and the space to try to do that. I admit that I am naturally resistant—and that is likely to show in the emphasis in many of my replies—on whether we should be mandating them, when we want to give them the flexibilities to do those things at a local level. We should be enabling them to do it, and we should be encouraging them to do it, but where we stop earlier is on whether we should be insisting and mandating them.

I hope that that gives a general sense, but I shall turn to each part, starting with structure and organisation. I agree with the committee’s recommendations to allow the ICSs the appropriate time to mature before introducing any wholesale system reforms. I hear the point of the noble Lord, Lord Allan, that three years is a long time. We need to make sure that we get some of those early indicators as we go along, but at the same time we need to give them time to bed down and accept that some will do a better job than others, which of course is the inevitable consequence of giving people the ability to manage their own local systems.

On the integration, we are giving these bodies the ability to bring together the NHS, the councils, the voluntary sector and the others, with the focus on prevention and better outcomes. The noble Lord, Lord Altrincham, and the noble Baroness, Lady Tyler, emphasised the importance of prevention, and the noble Lord, Lord Jamieson, addressed the raising of life expectancy and quality of life. I am pleased to inform the House that we see the NHS health check as a flagship cardiovascular disease prevention programme. As mentioned, using the app is a key way in which people can engage with that, book their services and have a lot of those type of tests at home.

With respect to the committee’s recommendation relating to a single accountable officer and coterminosity, ICSs have the flexibility to develop accountability arrangements that best meets the need of their local population. We have various successful models of accountability implemented, including as partnerships and committees. Again, where an ICS identifies that its boundary is not meeting local needs, it can request a review. Local authorities are a critical partner here. The NHS has recently published a process for boundary change requests that requires support from all local authority partners in this. At the same time, the noble Baroness, Lady McIntosh, mentioned in her speech some of the challenges around being coterminous with borders, and how that can cut across some of the things that we want to see happening in terms of choice. It is not always a straightforward question. Again, that shows that this should not be something we are mandating, but we are enabling the ICBs to address that, if it is the right thing for their area.

On the question of the noble Baroness, Lady Tyler, on elected officials chairing ICBs, NHS England has set criteria prohibiting all ICB chairs and non-exec members from holding a public office role, or a role in the healthcare organisation within the ICB area. However, the elected local authority, the local government officials, are able to chair the ICP—the partnership—which of course is a very important committee that sets the health and care strategy.

The committee recommends that the CQC pilot ICS assessments are widely disseminated—a point the noble Baroness, Lady Tyler, also raised. I can confirm that the CQC will publish the pilot findings as narrative reports that will be available to the public. The CQC assessments will consider how well health and social care are working together to deliver high-quality care, and the assessment will also score each ICS against the three themes of leadership, integration, quality and safety—I think that is four themes, actually; that is what happens when you try to adjust the brief.

On primary care contracts and funding, as the noble Baroness, Lady Redfern, also mentioned, the primary care contracts are kept under review and we will consult the profession on any proposed changes. As I think noble Lords know, we launched a public consultation in December 2023 on inclusive schemes and expect to publish a government response later this year.

On the co-location point which the noble Baroness, Lady Pitkeathley, raised, the Government agree with the benefits of co-location and multiple disciplinary teams for promoting integration, and we expect the different models of integration to be implemented across the country based on local needs and the availability of estates.

The noble Baroness, Lady Merron, mentioned investing in primary care. We want GPs to deliver the best care to patients, which is why we are backing the NHS with this significant capital investment in this space. That includes the £4.2 billion this year in operational capital for integrated care boards to allocate locally, including to primary care.

The committee outlined a suggestion to better utilise the better care fund and pooling of budgets. The Government encourage local areas to maximise the full potential of the better care fund and to pool budgets. We have seen local areas committing additional money to their better care fund to support joint commissioning and integration. Place-level committees are crucial to delivering integration, and the Government published a toolkit in October 2023 to support the development of shared outcomes as a powerful means of promoting joint working.

As the noble Baroness, Lady Armstrong, raised, proactive care involves providing personalised and co-ordinated care and support for people living with complex health and care needs. A good example of where this works well is the Jean Bishop Integrated Care Centre in Hull, a geriatric-led multidisciplinary service. Measured outcomes show that, between April 2019 and September 2022, the service contributed to a 13.6% reduction in emergency hospital attendance for patients aged over 80. Over the same time, there was a 17.6% reduction in emergency department attendances for patients in care homes. However—this also relates to the point on training later on—where we have fantastic examples such as that one, we need to make sure that that is disseminated and understood as part of the integration sharing.

On systems and data sharing, I have to admit that, like the noble Lord, Lord Allan—this will not be a surprise to many people—I am a fellow data anorak. I understand the importance of the NHS number and common place references in that. I learned about fuzzy data matching the hard way in one of my earlier jobs. You need only to look at what happened to the local Laura Ashley store in Kyiv, funnily enough, to see the consequences of fuzzy data matching and having a misallocation of dress sizes, shapes and colours because I did not fully understand the skew references in terms of fully data matching. Therefore I understood the hard way and the consequences of that.

I think we all understand the point the noble Baroness, Lady Finlay, made about the frustration that many people increasingly express.

The DHSC was called by the report to

“publish high level guidance to standardise the collection of data and portability requirements in commercial data-sharing software, especially for social determinants of health”,

and mandate how clinicians “code” information. The noble Baroness, Lady Barker, raised a key point on responsible handling of data. We already set standards of coding for data and set national standards for data systems to ensure interoperability. The Government have published a plan for digital health and social care that includes milestones for setting standards on interoperability and systems architecture, enabling all relevant health and care data to be accessed by those with a legitimate right to access it at the point of need, no matter where it is held. We are also moving to a system of data access by default for secondary users of NHS data, which will be supported by the implementation of the secure data environments—SDEs—which mean that data from NHS and related services can be used for research without identifying information needing to be shared.

The report also calls for one or more interoperable data systems to be centrally procured, as was rightly flagged as a key issue by the noble Baroness, Lady Barker. We do not believe that the solution lies in the purchase of a single system for the NHS—we have all seen the past problems that has led to—but we believe it involves the need for a common set of standards and cloud-based architecture to ensure that digital records can be shared electronically, that services are interoperable, and that you can connect information based on the NHS number of the individual rather than one organisation. That will improve the provision of safe and personalised care as patients move between different parts of the health service and the social care system. The approach taken seeks to strike an effective balance between central and local initiatives.

On the question from the noble Baroness, Lady McIntosh, about sharing one prescription record, I say that this is where we see that Pharmacy First has been a vital enabler. Making sure that we have the systems right so that the pharmacy can write into the GP records to show what it is prescribing the patient gives a blueprint that we can repeat across all the systems—it gives the writing capability to do that, so to speak. All 42 ICBs have had a connecting care record solution since March 2022, which is fundamental to how services can share their information.

I am coming up to time. I will quickly say that I agree with the point made by the noble Baroness, Lady Merron, on workforce and training, and that integration of training should be part of all that. I conclude by saying that I will follow up in writing, as ever, to make sure I pick up any questions that have not been answered. I thank all noble Lords for their contributions, particularly the noble Baroness, Lady Pitkeathley, and congratulate the noble Lord, Lord Jamieson, once more on his maiden speech.

Immunisation: Children

Lord Markham Excerpts

Wednesday 8th May 2024 Lords Chamber

[The Lord Bishop of St Albans]

To ask His Majesty’s Government what plans they have to address the decline in uptake of childhood immunisations.

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

NHS England’s 2023 vaccination strategy set a range of ambitions, including to improve uptake of children’s vaccines across the board. On mumps, measles and rubella in particular, between January and March the NHS and partners administered around four times as many MMR vaccinations to those aged five to 25 as last year and focused on engaging groups with historically lower vaccination rates. We intend to build on these experiences to further improve uptake.

[The Lord Bishop of St Albans]

I thank the Minister for his reply and pay tribute to the NHS for its sterling work in this area. I have a couple of points. First, I wonder what consideration His Majesty’s Government have given to working with leaders of harder-to-reach groups, some of the smaller groups and some of the faith groups, where messaging can be more powerful when it is done by a local leader. Secondly, there is a worrying increase in the level of whooping cough. Indeed, I believe there has been a childhood death recently. Can the Minister update us on what is being done about this worrying development?

[Lord Markham (Con)]

I thank the right reverend Prelate. First, I completely agree that using faith leaders is often a very good way to reach hard-to-reach communities, particularly as it is often ethnic-minority communities that have lower rates of vaccine uptake. Whooping cough has been a concern; we had about 850 cases in January 2024 compared with about 550 for the whole of 2023. We are deploying a number of strategies that have been proven to work in areas such as MMR: using outreach groups, having leaflets in 15 languages and having recall programmes. In the case of whooping cough, if we can get pregnant mothers vaccinated, that is 97% effective.

[Lord Allan of Hallam (LD)]

My Lords, I know the Minister agrees that it would help if parents had online access to their children’s vaccination records and, with his customary efficiency, he kindly wrote to me following a previous exchange on the digital red book to say that parental access to baby records is being piloted in 70 general practices. Can I ask the Minister to give us a ballpark date for when it might be rolled out to the other 6,000-odd GP practices in the United Kingdom? Will it be shortly, soon or in due course?

[Lord Markham (Con)]

Or “none of the above”. The noble Lord is quite correct. Of course, data is vital in this whole area, and getting that sharing of data and understanding with people is vital. I will come back on the precise date, but I hope it will be soon.

[Baroness Finlay of Llandaff (CB)]

My Lords, there have been more than 1,000 cases of measles in the last six months. What action are the Government taking to make sure that mothers are given options, which maximise convenience, of places to go and times when they could take their children for vaccination, rather than tying them to appointments that may clash with the working day when they cannot get childcare for other children?

[Lord Markham (Con)]

That is an important point. We must try to make sure that vaccination clinics are widespread. We have used pop-up clinics successfully in many locations, particularly around London, and that has helped get 25,000 more jabs into unvaccinated people’s arms in the last few months.

[Baroness Manzoor (Con)]

My Lords, I welcome the action that the Government are taking to ensure that MMR vaccinations are going up in underrepresented groups. Can my noble friend the Minister say what action the Government are taking for people seeking asylum? What kind of service are they being offered, and what access do they have to vaccination?

[Lord Markham (Con)]

I thank my noble friend for the question. Actually, it is not just asylum seekers; it is often migrant groups full stop. Their communities or the countries they have come from often do not have the same level of vaccination programmes. It is part of the check we try to give people as they come into the country, and something we ask GPs to look out for, so that we can get them in a catch-up programme. A lot of the work we are doing on outreach is also particularly focused on those communities.

[Lord Watts (Lab)]

My Lords, is it not the case that we need to make the case for public health, and that our public health policy is determined by parents getting their children vaccinated? Do we not need to make the case that they put their own and other people’s children in danger unless they comply with vaccination?

[Lord Markham (Con)]

Yes, absolutely. Unfortunately, we are all aware of the Wakefield effect on the MMR vaccine. That knock of confidence was completely unjustified and irresponsible, but we know the impact it had. Clearly, a lot of the anti-vax sentiment around Covid has not helped either. We need to overcome all these messages.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, on the Wakefield effect, as the Minister called it, he will remember that the impact it had on a lot of people was very profound. In particular, some of that was associated with incidence of autism, which again was completely unjustified. Can he tell the House whether any work has been done, in the interests of public information, on what happened to the children who were not vaccinated at that time, and what the outcomes were for them? As a deterrent, it might be useful for people to know what the worst that can happen is if you do not get your children vaccinated.

[Lord Markham (Con)]

The noble Baroness is quite right. I had two young sons at around that time, and it was a concern. Of course, we did go ahead, but it was a consideration. It is an excellent question. I have not seen the study of those various cohort groups but I will go back, because it is something we need to bring out.

[Baroness Merron (Lab)]

My Lords, it is concerning that measles cases continue to rise, with a particular spike in London, where certain areas have low vaccination rates. With the advent of microarray patch technology, can the Minister confirm that this is being looked at? Does he agree that the chance to dispense with using needles and special storage, and the opportunity to use less of professionals’ time, could present an opportunity to drive up vaccination rates?

[Lord Markham (Con)]

It has to make sense to take more measures that are easy for people, including maybe less skilled people, to operate. Funnily enough, I was talking just today to the head of Moderna about how it is packing syringes, or has planned to for vaccinations going forward, rather than vials, to take that step out of the process. The easier we can make it, the better.

[Lord Kamall (Con)]

My Lords, the right reverend Prelate rightly spoke about the role of faith communities in reaching those hard-to-reach communities. I know that my noble friend the Minister has answered these questions previously, but I wonder what lessons the department has learned from previous vaccination campaigns—Covid, MMR, et cetera—to make sure that the initiatives it is using to reach those hard-to-reach communities are more effective.

[Lord Markham (Con)]

It really is about having the whole toolkit. Clearly, it is about making sure that we are using communications in 15 different languages. It is about the outreach groups and, particularly, the catch-up programmes. We have been doing one for 17 to 25 year-olds for polio and MMR. It is about all those strategies and the pop-up clinics, so that it is very easy to catch people in places that are convenient for them.

[Baroness Hollins (CB)]

Does the Minister agree that the anti-vax sentiment is a powerful deterrent with some of the misinformation on social media? Is there anything more that can be done to try to counter that misinformation?

--- Later in debate ---

[Lord Markham (Con)]

We are trying to get the facts out there. I appreciate the efforts of all noble Lords in doing that. I welcome any ideas on what more action we could be taking. The UK measures at the highest level internationally in terms of parents who believe that vaccines should be used. The level is 97%. That is high, but the trouble is that 3% in concentrated areas can still be quite dangerous.

[Lord Geddes (Con)]

My Lords, further to my noble friend’s question about asylum seekers and immigrants and the Minister’s answer, how are GPs going to check whether such children have been immunised? They will not be carrying any paper proof, and they will certainly not have an app on their phones.

[Lord Markham (Con)]

It is often a case of asking them and seeing what they recall. There are a lot of vaccinations, such as the six-in-one ones. Often, they might not have had any vaccinations. My noble friend is correct that it is not easy to find out that information, but in many cases, where we can, it is good to apply the precautionary principle and offer vaccinations anyway.