Care of Critically Ill Children

Lord Markham Excerpts

Monday 29th January 2024 Lords Chamber

[Lord Balfe]

To ask His Majesty’s Government what steps they have taken, or propose to take, following the publication in September 2023 of the review they commissioned from the Nuffield Council on Bioethics, Disagreements in the care of critically ill children.

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

The department is working closely with other organisations to ensure that recommendations are taken forward and oversight is maintained. Together, we have taken steps on several recommendations aimed at improving the experience families and healthcare professionals have of navigating disagreements. NHS England has introduced regional conflict champions and launched resources and conflict management training on e-learning for health. The Ministry of Justice will hold a round table on how less adversarial court models could be used.

[Lord Balfe (Con)]

I thank the Minister for his reply. This review arose from an amendment to the Health and Care Act 2022, moved by my good friend, the noble Baroness, Lady Finlay, that I helped to draft. What steps have the department taken to establish a task force, as was recommended in the report? Secondly, there are a lot of recommendations in the report—far too many for an Oral Question. Will the Minister meet the noble Baroness, Lady Finlay, and me to review where we have got to with this most necessary look at administrative procedures?

[Lord Markham (Con)]

First, I thank my noble friend and the noble Baroness, Lady Finlay, for their work in this field. Of course I will very happily meet to talk about progress. Minister Caulfield has agreed to chair the task force itself, and we have agreed the constituent parties; we are including the Ministry of Justice, the Royal College of Paediatrics and Child Health, the Royal College of Nursing and health qualification providers, which will all take part in the task force.

[Baroness Finlay of Llandaff (CB)]

My Lords, I am grateful for the compliment paid; it was a privilege to be involved. I declare my interests in palliative care. Given that the number of children with life-limiting and life-threatening conditions has more than doubled in the last 20 years, particularly in the nought-to-19 age group and especially in the under-ones, do the Government recognise the importance of early involvement of multiprofessional specialist palliative care teams, which can support families to come to terms with what they have to come to terms with, help other clinicians to understand the families’ perspectives and avoid some of these disputes happening in the first place? Can the Minister tell us how many of the integrated care boards have commissioned specialist palliative care services that work between hospitals, ICUs and wards, out into the community and into hospices?

[Lord Markham (Con)]

The noble Baroness is correct: the number of young people with life-limiting conditions has gone up, from about 33,000 around 2001-02 to about 87,000 more recently. A lot of that is, conversely, good news in that we have more and more treatments that can keep these children alive for longer. Clearly, that requires the wraparound-type service that the noble Baroness is talking about. It is the responsibility of the ICBs to provide that; I will provide details of the progress of individual ones when we meet.

[Baroness Wheeler (Lab)]

My Lords, I emphasise that the task force recommended by Nuffield to oversee its key recommendations needs to get to work urgently. The family-focused research work with parents, including parent carers, about their experiences of shared decision-making with healthcare professionals on care and treatment, is vital, as is the comprehensive information and guidance for parents and staff that is called for across the 16 Nuffield recommendations. What timescales are the Government envisaging for this crucial work to commence and become operational, including guidance to clinical and ethical committees?

[Lord Markham (Con)]

My understanding, now that the task force composition has been set up, is that this will be arranged shortly. I completely agree with the noble Baroness that these are important, as well as often heart-wrenching, matters, so urgency is required. As I have said, good progress has been made in a number of areas. Already, the MoJ is setting up a round table on this. The regional conflict managers have been established. We have training courses online so that communication can improve. A lot is being done, and the task force will push that forward further.

[Lord Jackson of Peterborough (Con)]

My Lords, the Minister will know that there is currently an imbalance between the resources available to the parents and guardians of children involved in end-of-life care—particularly time, money and legal advice—and that of public bodies such as NHS trusts. Compounding that issue is the routine use of secret transparency orders, which prevent scrutiny and oversight of court proceedings, particularly in the family court. Does the Minister agree with me in that respect: that secret justice is no justice at all?

[Lord Markham (Con)]

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

[Lord Allan of Hallam (LD)]

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

[Lord Markham (Con)]

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

[Lord Watts (Lab)]

My Lords, many families with critically ill children find it very difficult to access treatment because often specialist treatment is only available hundreds of miles away from where they live. That puts tremendous pressure on the family financially. Do the Government intend to do any more to help those families?

[Lord Markham (Con)]

Clearly, we would all agree that the families need to be the priority in these terrible cases. What we have tried to do—and I have also done my own research into this—is make available what I call independent funding requests for when there is a new course of treatment which might not be allowed generally by NICE to give opportunities in those instances as well. I will come back to the noble Lord on things such as travel support and other expenses.

[Baroness Altmann (Con)]

My Lords, I declare my interest in and my work with the Teenage Cancer Trust. In connection with the task force, will my noble friend let the House know what input charities that specialise in this kind of work with children and teenagers who, sadly, are in this position and their families will have into the task force? Will he join with me in commending the tremendous work done by this charity and the other charities which specialise in helping children and families going through this traumatic time?

[Lord Markham (Con)]

Yes, I am very happy to add my thanks for everything they do in this. It is clear in these circumstances that the more support we can give families, the better. I will speak to Minister Caulfield to make sure that input is properly there because my noble friend is correct that it should be there.

Smoking

Lord Markham Excerpts

Thursday 25th January 2024 Lords Chamber

[Lord Rennard]

To ask His Majesty’s Government what progress they have made towards the ambition of creating a “smokefree” generation by 2030.

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

Smoking is responsible for around 80,000 deaths a year in the UK, costs our country £17 billion a year and puts a huge burden on the National Health Service. That is why we will shortly introduce the tobacco and vapes Bill to Parliament in the coming weeks, to create the first smoke-free generation and further crack down on youth vaping. The Bill will be informed by our recent consultation, which we will publish soon.

[Lord Rennard (LD)]

My Lords, all parties have agreed on the need to reduce the prevalence of smoking in this country to below 5% by 2030, so the Bill to prevent young people ever becoming smokers is vital. Does the Minister accept that we need to do more to help the over 6 million people in this country who are addicted smokers, most of whom are struggling to give up smoking and want to? They are damaging their health and that of others affected by smoking. Does he agree that allowing integrated care boards to make further cuts to tobacco dependence treatment budgets will not help us to achieve this target?

[Lord Markham (Con)]

I thank the noble Lord. Actually, Khan recommended four major things to achieve that in his report Smokefree 2030. The first was to increase the anti-smoking spend that the noble Lord refers to. As part of this, we propose to increase that spend from £70 million to £140 million—so we are doing absolutely what the noble Lord suggests. The second was to increase the age of sale, which of course this legislation is all about. The third was to promote vaping to help quit smoking. Again, the legislation will do that. The fourth was to increase NHS prevention methods which, again, we will do from here. So it is very much a range of measures to stop people ever smoking but also to stop many who are currently smoking by helping them to quit.

[Lord Young of Cookham (Con)]

My Lords—

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[Lord Young of Cookham (Con)]

Further to the Question from the noble Lord, Lord Rennard, the Government commissioned the independent Khan review, which concluded that the Government would miss their smoke-free target for England by several years unless an additional £125 million a year was spent on prevention. Given the pressure on public expenditure, the Khan review instead suggested a levy on the profits of the tobacco industry, based on the polluter pays principle. Does that proposal not commend itself to my noble friend?

[Lord Markham (Con)]

As I say, we have tried to answer the four major points that Khan put forward, including doubling the spend from £70 million a year to £140 million. The levy was the one thing that was not so much favoured; there was a lot of modelling done on it and the thought was that the net increase would be only about £25 million or so. That is why it was thought better to look at taxes on tobacco itself as a way of raising revenue, and generally introducing the four major methods that Khan recommended.

--- Later in debate ---

[Baroness Blackstone (Lab)]

My Lords, I refer to my interests as set out in the register. Would the Minister agree that smoking in pregnancy has enormously damaging effects, leading to much poorer birth outcomes than for mothers who do not smoke? Would he also agree that incentives to pregnant women not to smoke have been very effective? In the light of this, could he give a guarantee that the existing scheme, which comes to an end this year, will be continued with adequate resources, so that it is not in any way disrupted?

[Lord Markham (Con)]

I totally agree with the noble Baroness on the importance of stopping smoking—always, but especially during pregnancy. In fact, we have a maternity debate coming straight after this, where this will be one of the things that we discuss. I hope, from showing that we are putting all this spend in place, that we are backing everything that works. As long as the anti-smoking in pregnancy measure continues to work, that will be one of the major features to make sure that we are continuing to stop all activity, but especially in pregnant ladies.

[Lord Patel (CB)]

My Lords, in the light of the last question, I will change my question. What assessment have the Government made of the long-term harm that vaping will cause, particularly to young people?

[Lord Markham (Con)]

The honest answer is that we do not know yet, and that is a problem. As we know, a number of these things take time to play through. That is why we want to make sure we take a precautionary approach. In this legislation, we aim to really stop anything that is targeted at young people in terms of vaping. We see vaping as an important tool to help people quit smoking, but we are equally sure that we never want anyone to start vaping. That is why we will also look at banning anything that targets young people, such as flavouring and packaging. We want to stop anything targeted at youth vaping.

[Lord Naseby (Con)]

My Lords, why are His Majesty’s Government ignoring the experience of New Zealand? That country has found the idea behind this Bill—it had a similar one—to be totally unworkable. Secondly, why are we undermining the existing scheme that has done so well, with under 2% of young people even bothering to take a taste of smoking? Does my noble friend not recognise that there are other, far more important health dimensions that need the resources that are to be wasted on this useless Bill?

[Lord Markham (Con)]

First, my understanding about New Zealand is that one of the biggest bones of contention was that it was looking to reduce the number of smoking retailers from 6,000 to 600; that is where their Bill came into difficulty. I am afraid I must disagree with my noble friend on the importance of this. It costs the economy about £17 billion a year and causes about 80,000 deaths, and 80% of people who have taken up smoking wish that they had never started. I think those are very strong reasons which I know the majority of this House is behind, and that is why I am delighted to be introducing that legislation shortly.

[Baroness Merron (Lab)]

My Lords, it has been reported that the decline in smoking has nearly ground to a halt since the pandemic, with many former smokers lapsing and many more young people now taking up smoking. Now that the smoking cessation drug cytisine is available, what is the Government’s assessment of how its availability will contribute or otherwise to the progress towards the smoke-free ambition by 2030? What plans are there to ensure its availability across the country, particularly among hard-to-reach groups of smokers?

[Lord Markham (Con)]

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

[Lord Allan of Hallam (LD)]

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

[Lord Markham (Con)]

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

[Lord Moylan (Con)]

My Lords, is my noble friend aware of the report published this week by University College London, in association with Cancer Research UK, which suggests that banning disposable vapes would lead to fewer adults giving up smoking? Will he give an assurance that any proposals brought forward by the Government will be based on clear evidence and common sense, and not unevidenced enthusiasm?

[Lord Markham (Con)]

I hope I could give my categorical agreement that everything is based on evidence and common sense; I will let people draw their own conclusions as to whether that is always the case. But, seriously, clearly anything we look at must be evidence-based. We will shortly be announcing the results of the consultation, which has a 28,000-strong evidence base, to show that we are really doing rigorous analysis.

[Lord Faulkner of Worcester (Lab)]

My Lords, many Members of your Lordships’ House have received lobbying from tobacco companies over the years. Is the Minister aware that the Daily Telegraph reported last week that Philip Morris had threatened legal action against the Government over the consultation to which he referred in his first Answer. Can the Minister give an assurance that, if this lobbying is undertaken by tobacco companies, the Government will ignore it and go ahead with their very sensible and welcome plans?

[Lord Markham (Con)]

Yes, I am aware of the moves, and I am sure there will be many more. I was advised that it was a fairly unusual legal challenge on consultation, which I believe was withdrawn quite quickly. Yes, there will be opposition, but we are determined, because of the importance of what we are trying to do.

Maternity Services

Lord Markham Excerpts

Thursday 25th January 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 Taylor, for enabling us to have this debate and I am grateful for all the contributions from Members here with their vast experience and expertise. I too was moved by the words of the mother mentioned by the noble Lord, Lord Patel. The noble Baroness, Lady Merron, put it well when she spoke of the thousands of mothers who have their thanks to give to the noble Lord. I am not sure that there are many fathers who would thank to the noble Lord, Lord Allan, for his advice, but I will take it, should I be in that situation again and I may not take photos of the scenery.

I want to reassure the House that we are committed to ensuring that all maternity services provide safe and compassionate care. As many Members have mentioned, most women have a positive experience of NHS maternity and neonatal services, and outcomes have improved, with over 900 more families welcoming a healthy baby each year compared with 2010 figures. However, all women should feel confident that they and their baby will be cared for safely and, where tragedies happen, that they will be well supported and treated with compassion. We therefore acknowledge that there are unfortunately times when the care provided is not enough.

Recent independent reports by Donna Ockenden on maternity services in Shrewsbury and Telford, and by Dr Bill Kirkup on maternity and neonatal services in East Kent, and previously in Morecambe Bay, set out many examples of poor care over the years. The review into maternity care at Nottingham University Hospitals chaired by Donna Ockenden commenced in 2022, and we expect that report to be published at the end of September 2025. We take those investigations and all elements of maternity safety incredibly seriously. We understand the immeasurable impact that poor care and adverse outcomes can have on a family, and remain committed to supporting trusts to deliver safe, compassionate care and addressing the unacceptable disparities for women and babies.

While maternity services must always seek to learn and improve, I want to recognise the dedication and commitment of the vast majority of the maternity workforce. I know that everyone who joins the healthcare profession sets out to deliver safe and compassionate care, and I acknowledge the efforts and ability of the many maternity professionals who work tirelessly for the women and babies they care for.

The Secretary of State last week announced that improving care during and after pregnancy will be one of her top priorities in implementing the women’s health strategy in 2024. A key tenet of this is continuing to deliver NHS England’s three-year plan for maternity and neonatal services. The plan sets out how NHS England will make maternity and neonatal care safer, more personalised and more equitable for women, babies and families. Since 2021, we have invested an additional £165 million a year to improve maternity and neonatal care. That will increase to £186 million a year from 2024-25.

The Government have also set a national maternity safety ambition to halve by 2025 the 2010 rates of stillbirths, neonatal and maternal deaths, and brain injuries that occur during or soon after birth, alongside a further ambition to reduce the rate of pre-term births from 8% to 6% by 2025. In answer to the question from the noble Baroness, Lady Taylor, on progress to date, there has been a 23% reduction—so it is progress, but I fully admit that it is not enough.

At this stage, I want to address a lot of the points that have been made. Many noble Lords, including the noble Baronesses, Lady Taylor and Lady Warwick, talked about staffing. The noble Lord, Lord Patel, offered to come and help once more, as did the noble Baroness, Lady Watkins—I am sure she is bright enough to do it as well.

We recognise the importance of staffing. There has been a 14% increase since 2010—and, unlike other areas of the health service, the birth rate has remained stable during that time. So that is a real-time increase, for want of a better word. But I completely accept the points made about the importance of training and retention, and the point the noble Baroness, Lady Warwick, made about understanding what numbers are required to make sure we have the right provision going forward. Of course, that is what the long-term workforce plan is all about. On the retention agenda and the points made by the noble Baroness, Lady Watkins, about sabbaticals, loan repayments and smart stuff such as using technology for flexibility, and staff apps, should all be part of the toolkit. Again, I have seen some very good examples of that in places such as Milton Keynes. I am talking more generally about staff here—using a staff app to allow exactly that sort of flexibility. If we want to be a modern employer competing in a modern world, enabling sabbaticals and that sort of flexibility is, I agree, key.

Turning to the noble Baroness, Lady Taylor, and her local services, my understanding is that, hopefully, the Bronte birth unit will open again in April 2024. However, I accept that some issues have arisen there.

I say to the noble Baroness, Lady Cumberlege, that I absolutely believe in continuity of care as a key tenet in what we are trying to do. I accept that that needs to be built into the long-term workforce plan and some of those allocations. As the noble Baroness, Lady Watkins, says, it is vital that we listen not just to the mothers—that the staff are taught to listen not just to the mothers—but the partners as well.

The point made about access to interpreters is a very good one. Among the many things I shall write back on, I shall be pleased to come back on that too. An excellent point was made about ensuring that staff understand the needs of mothers with learning difficulties. That is very important, and I shall come back on the detail, particularly regarding passports.

I absolutely agree with the point the noble Baroness, Lady Donaghy, made about the long-term relationship with staff. You have to avoid a situation of winners and losers, asking, “Did we win the last battle?” All you are doing is creating bad feeling for the next battle.

I turn to the many points made regarding safety, which is key to this whole debate. The noble Baroness, Lady Armstrong, said that that time and how the birth took place defines much of a mother’s relationship with the child. As many noble Lords said, including the noble Baronesses, Lady Armstrong, Lady Gohir, Lady Bennett and Lady Thornton, the disparities experienced by ethnic minorities and those with learning difficulties are a key issue. I remember my conversation in that regard with the noble Baroness, Lady Thornton, very well.

The Maternal Health Task Force is meeting regularly; it met last September and is meeting again next week. It is chaired by Minister Caulfield and is a fundamental tool in this regard. The point made, particularly by the noble Baroness, Lady Gohir, about ensuring that we have the necessary data and analysis is vital. I shall come back to the points made about NHS Resolution. Having said all that, I would not be surprised to discover that it does not show that there are more disputes from people from ethnic minorities, because they may not feel confident enough to use NHS Resolution. There is probably quite a lot to unpack in all that, but I shall come back in writing and make sure that we also cover the point about learning difficulties.

I share the concerns raised by the noble Baronesses, Lady Merron and Lady Taylor, and others around the CQC reports. We are seeing an increase in levels of concern—50% or so—about inadequacy or need for improvement. That is clearly not a good situation.

To respond to the point from the noble Lord, Lord Patel, that it is the action that really counts, I know that the NHS has an implementation plan for each trust where there are inadequacies to make sure that they are being addressed. I have made sure to ask that I can see and understand all those and I have asked for a report in six months’ time on progress, which I am willing to share with all noble Lords here.

On the questions of whether we should be having an inquiry and further work on this and, as asked by the noble Baroness, Lady Donaghy, what would inform my view on that, I personally think that it is about whether we are really seeing progress. I am very aware, as mentioned by noble Lords, that every time you kick off a new inquiry, it can take a long time. If the action and improvement plan is put in place, I will be satisfied that we are on the right track—but, to be very open, my view will change if I do not believe that the plan is there. As we have the benefit of the noble Baroness, Lady Watkins, being an NHS board member, I say to her—I am sure it is something that is happening—that I think this would be an excellent topic for the NHS board to cover as well, because it is on the front line in all this as well.

Regarding maternal deaths, which we all agree is something of serious concern, the Secretary of State has commissioned urgent work on that. I think we all understand that it is a more complex situation; factors such as age, obesity and diabetes all make the underlying situations more complicated. I do get into the data and, just so noble Lords have all the facts, the recent increase that we saw translates to about 35 extra deaths in the period. I note—and I am just giving the data; I am not using it as an excuse at all—that Covid was responsible for 38 deaths. Covid is a big component in all this, but I do not for one moment suggest that that is the only reason. As the noble Lord, Lord Patel, said, analysing thrombosis, for example, which is a leading cause, is vital in this. The introduction of the 14 maternal medicine networks, which are specialist units set up to look at where there are complications and at likely need for things such as thrombosis, is a vital part of this. Again, seeing action on that in the report back will be key.

To respond to the noble Baroness, Lady Donaghy, I look forward to seeing the Birth Trauma Association report. Obviously, we will respond further after that.

On the points made by the noble Lord, Lord Allan, and the noble Baroness, Lady Merron, I see data as having an important role; use of the app to allow mothers to take control of their own health and data is vital. I had a meeting just yesterday to make sure that the baby red book is brought into the app as well so that, from day one, mothers can have access by proxy. I am mindful of the time, so I will cover that in detail in my letter. I will also pick up and write on the other points raised, but I again thank noble Lords. For me, the benefit of having so much experience is that we can hear these sorts of points in debates. I, for one, have found it useful, so I thank the noble Baroness and everyone else for the work they do in this space.

Dementia

Lord Markham Excerpts

Thursday 18th January 2024 Grand Committee

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

I add my thanks to my noble friend Lady Browning not only for bringing this debate but for her commitment generally in this area. I also thank all noble Lords for their contributions. These sorts of debates are always a pleasure, and one thing I have learned in the almost 18 months that I have been involved in the Lords is that it does not matter what the subject is; you always find expertise and learn about colleagues’ experience, such as that of the noble Baronesses, Lady Greenfield and Lady Murphy. I always find having the power of that knowledge around the table a real asset for the Lords and a real contribution to these types of debates.

My noble friend Lady Browning quite rightly said in her introduction that the statistics are gobsmacking, if I can use that word. I note the fact about one in 11 of those over 65. The one that really resonated with me—noble Lords have heard me mention it many times—is the fact that 25% of our beds are occupied by people with dementia. There is a real feeling that not only is that not the right place for them but it is not a good use of money. I therefore totally agree with that sentiment.

We see virtual wards and hospices at home as part of the answer to this. I have seen some good technological advances: at the light end of the scale, for want of a better word, we could look at people’s electricity usage, for example, and start to learn their patterns. For a lot of people, there is a surge at 8 am when they put on the kettle, so if that surge suddenly is not there, that is an early warning that perhaps there should be a call because something is wrong. There are also motion detectors around the house to start to understand their patterns. To my mind there is a spectrum of those sorts of virtual wards from the very heavy intervention ones to just trying to make sure that people are generally fine and going about in their normal way or, if they are not, it can be an early warning.

I will come on to staffing, but a key part of that in the home is dom carers. It is a point that the noble Lord, Lord Allan, made well. We have made a lot of progress in what we are trying to do with career progression, but I want to be assured that we have really got this area right.

My noble friend Lady Browning mentioned the fundamental need for a care plan in all that. In preparing for this, my noble friend Lord Evans said that that was what he needed in his recent situation with his mother. That is what ICSs should be starting to do now. I take the point made by the noble Lord, Lord Allan, that there is probably no better example of trying to learn how they are working than using this as a case study. My general experience of ICSs—of course it is early days, even now I think we are only 18 months or so in—is that, as ever with these things, there are some very good examples and probably some which need to do a bit more work. I am quite happy to take that away to try to find some test cases that we can try to learn from. The NHS has set out best practice guidance that it expects all ICSs to follow. My understanding, which I will check on, is that part of that is having a dementia lead, which my noble friend Lady Browning mentioned.

As the noble Baronesses, Lady Ritchie and Lady Donaghy, and other noble Lords mentioned, diagnosis is key. The target is two-thirds. We are getting quite close to that, but we have been behind, so there has been an investment of £17 million to catch up. I accept the point about whether two-thirds is enough and whether we would accept that in other areas and let one-third go undiagnosed, but step one is making sure that we hit that two-thirds.

The noble Baroness, Lady Ritchie, asked what sort of resource we are putting behind this. CDCs already have the equipment, in terms of scanners, and the ability to do that, but I accept the point made by the noble Baroness, Lady Murphy, that it is probably more about the people. It is less the equipment than making sure that people are trained to do that. I will come on to staffing later, but I take that basic point.

What is the point of diagnosis? First, it is to make sure that people get the right care. Secondly, it is so that we can start to deploy some of these new treatments. Again, it is great to have the expertise of the noble Baroness, Lady Greenfield. In answer to the question from the noble Baroness, Lady Ritchie, we are expecting NICE approval of the drugs to slow dementia down in early summer, and we expect to then roll that out during the summer period. However, we all know that they are only on the nursery slopes, and that is why there is a commitment to research of £160 million per year.

To fuel the moon shot, I am really excited about the power of the data that we own. I was recently on a fact-finding mission to Boston and they were talking about a major $250 million investment that a private venture group had made into the 9 million hospital records in Mayo Clinic. They were saying, “You don’t realise what you have in the UK. You have 50 million records in England, and you have primary care as well”. The whole problem around dementia is that we do not know what we are trying to tackle, in terms of the early causes. The reason we were so good at tackling Covid was that we knew exactly what we were going after. Right now, in things such as dementia and Alzheimer’s disease, it is still a case of shots in the dark.

However, regarding the 50 million records we have, if we look at people who have dementia today, wind back 15 years and ask what they were visiting their GP about then, and throw that all at AI, we can get some of those early-warning indicators. I know some of the anecdotal ones. For instance, as mentioned, urinary tract infections are often an early indicator of dementia because people do not understand that they are there. Throwing all that at AI and making sure that that data exists is a real way to fuel the moon shot so that we know where we should be putting our research efforts to try to find treatments.

On the funding of social care, as I said, the £8.1 billion investment over two years is a major investment. I learned a lot from my noble friend Lady Berridge. I did not realise that being committed under the Mental Health Act is a main way to get there. On the question from the noble Baroness, Lady Wheeler, about CHC transparency, I do not know the answer off the top of my head, but I will come back on that because it is a good point. As ever, I will try to come back and cover it more fully in writing.

The reform plans that we have announced are about making sure that we have the proper staffing to do this. As I mentioned in answer to the earlier Question today, we are starting to turn a corner, although it is early days. On career progression and training, I believe that what we announced last week is a key part of making this a real profession that people will want to stay and progress in. I agree with the point made by the noble Lord, Lord Allan, that paid progression has to come along with those qualifications; otherwise, you will not get people wanting to enter it.

I understand, as a few noble Lords have mentioned, including the noble Baronesses, Lady Wheeler and Lady Pitkeathley, that the role of the carer is vital and often overlooked. As noble Lords know, I have had personal experience of that as a carer. Quite honestly, all I can say is that we are making some early steps in trying to get some of the funding, but I freely accept, from personal experience, that there is a lot more that could be done in that space.

I have tried to give a flavour—before my throat totally gives way—of what we are trying to do in this area. As ever, I will respond fully in writing, but I hope there is an understanding from the Government’s side, as echoed by all noble Lords, that this is something we do take seriously.

[Lord Warner (CB)]

I am sorry to test the Minister’s vocal cords, but he mentioned that there was good practice guidance issued to ICSs. My experience as a Minister is that the department is extremely good at sending out guidance but extremely bad at checking whether anyone ever follows it. What arrangements has the department got to see if that good practice guidance is put into operation?

[Lord Markham (Con)]

The noble Lord makes a very good point, and it is one I have some personal experience of as well. The hope, when setting up 42 ICSs, was that this would be the right size for them to pool resources and take a holistic view, and that 42—while still a lot— would be a manageable number. As Ministers, we have divided those up into seven each that we can get to know, and live and breathe and understand; we also have dashboards that we can use to monitor progress in these areas. That is the way we plan to do that. I freely admit, again, that it is early days; I accept the noble Lord’s point that you can give out guidance until you are blue in the face—and they will receive a lot—but it is the follow-up that really matters.

I thank the noble Baroness again for the debate. I hope there is a feeling that we understand and that we are trying to give the parity of esteem that this deserves, and I look forward to following up more thoroughly in writing.

Committee adjourned at 4.56 pm.

National Immunisation Programme

Lord Markham Excerpts

Thursday 18th January 2024 Grand Committee

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

I too thank the noble Baroness, Lady Ritchie, for allowing us to have this debate today. To my mind, this is the right way to do business—for want of a better word. We have smart people who know about the subjects as well as people who have personal experience, and we are having a good conversation about how we can learn the lessons from the situation, make improvements and make sure that we are up to speed with the latest that is going on. Again, I thank the noble Baroness and all the contributors to this debate. I hope that I respond in the right vein.

As many have mentioned, we have a good track record in terms of the standing of the immunisation programme. NIHR is a fundamental piece of that. As mentioned on a few occasions, the horizon scanning by the JCVI is obviously a key part as well. I want to talk later about some of the Covid dividends that I am starting to see in terms of point-of-care medicines, with Moderna and BioNTech using messenger RNA. That goes right to what the noble Baroness, Lady Merron, said about the need to look at the new delivery mechanisms.

The JCVI is key to it all. This debate gave me the opportunity to understand more about the process that it goes through in trying to do that horizon scanning and make sure that we understand what is coming through in the pipeline, what differences it will make and how we evaluate that quickly. We have also commissioned the National Immunisation Schedule Evaluation Consortium to undertake policy research, going upstream even further, looking at the use of different vaccines and schedules.

As I mentioned before, probably the best thing we are doing in terms of the heritage is putting in place the new agreements, which I very much call a Covid dividend, knowing that we will be spending hundreds of millions a year on Covid vaccines for the foreseeable future. Let us make a benefit out of that necessity and get both BioNTech and Moderna to invest in the infrastructure in the UK so that we can do more of this research going forward. That is what I mean by the Covid dividend, as the noble Baroness, Lady Twycross, mentioned. It means looking at the point of care for some cancers, which is particularly exciting. It looks at a person’s particular cancer and cells and then alters and gives personalised treatment. I am sure we are all familiar with some of this. The beauty is that a person’s own body attacks the affected cells, without the blunt instrument of chemo, which kills lots of cells around the cancer as well.

The challenge—this goes right to the point made by the noble Baronesses, Lady Ritchie and Lady Merron, who asked how we deliver and whether the infrastructure is right for doing these sorts of things—is that all of our sudden you are moving from a model of mass production of vaccines in a big factory to individual, tailored creation of vaccines, and often some of the substances are very unstable. In one example I was given, you have only 20 minutes to use it. In that environment, you need to look much more at the real point of care and have a point-of-presence delivery that is not a big factory but where the capability is very close to the patient, whether in a GP or hospital environment, to produce and then deliver those sorts of drugs. In terms of our main learnings, that will be a major dividend from Covid and will transform the whole way in which we deliver our medicines. I hope that, in time, we will see the replacement of chemo in a lot of places with much more specific, delivered medicines.

As I said, I will write about anything I may have missed—as noble Lords will be able to hear, I am very croaky, and I have another debate after this one. In reply to the noble Baroness, Lady Ritchie, I would indeed be interested in hearing the GSK results from the round table. I hope that I have given some reassurance on the infrastructure, but I will give more detail on that as well.

The key point is that, while we can talk about all the sexy stuff in terms of the innovation and treatments, the point made by the noble Baroness, Lady Twycross, from her own experience of issues around MMR, really shows the importance of this. As I mentioned in the debate the other day, I spoke to Chris Whitty specifically about this. It is the most infectious disease out there. We all got used to R rates of 1.1 and 1.2 during Covid. That is a really big R rate, where you know it will be exponential. Noble Lords heard me mention that the R rate on measles is 13, which is massive. One in 1,000 people suffer from brain damage from it, so I completely agree with the noble Baroness that the idea of chickenpox parties is very outdated. I remember them from my childhood. I know that they are reviewing the chickenpox vaccine as we speak.

As I said, we are gearing up on the RSV process. The tender is going out as we speak, and we are looking at delivery this autumn. As I mentioned the other day, it is a different process depending on whether it is for maternal or baby use, or for the over-75s, but we are going through that process.

I will come on to some of the other questions. Thank you for the research; I agree on Steve Russell. The main point made by the noble Lord, Lord Allan, was about user-friendliness. I had my own experience of this when, knowing that I had these debates coming up, I asked the team to get me a schedule of everything that the JCVI has approved. They gave me a list of all these vaccinations, and I had to go back with my tail between my legs and ask, “Can you tell me what all these things are for?”. The noble Lord mentioned AF—I like to think that, similarly, I know quite a few of the abbreviations these days, but I needed them to give me the Noddy guide. The language for those using the app is vital. It is a critical piece to help inform people, especially when they are looking at their records. As the noble Lord is probably aware, the records are currently forward-looking: we need to start getting them to go back historically, and that is something I see a real utility in; it is not there today but it needs to be. The beauty of that is it can be optimised for the target audience. On the question of how we increase uptake in those hard-to-reach areas—as the noble Baroness, Lady Merron, mentioned—the most effective way of doing that to date has been ringing up the parents of under-5s, and then moving on to under-11s and under-25s. Doing that through the app will clearly be more effective in terms of time and money, so that must be the way forward.

The role of community pharmacies is a vital part of delivering point-of-care medicines. I was really interested to hear on one of my trips that GPs in America are really struggling as a profession these days. They cannot recruit them; I asked why not, and they said the problem was that many of the routine things that GPs were making money from had been mass-industrialised by the likes of CVS and Walgreens. This really resonated when the noble Baroness mentioned the app; we need to make sure these vital medicinal and well-being hubs are thriving, and that we do not repeat the American experience. That is why Pharmacy First is a very positive thing for promoting community pharmacies as a place for patients to get care and as a way of improving the finances and commercial viability of these places that I see as key assets.

The question about the AMR benefits of these vaccines was interesting; I do not know the answer off the top of my head, but I will take it away and try to come back with a detailed answer. To conclude—

[Baroness Ritchie of Downpatrick (Lab)]

I thank the noble Lord for giving way. In the fullness of time—I know time is short today—could he give some thought, along with his ministerial colleagues, to the acceleration of the NIP programme so that it is possible to get other vaccines on to it, because of the infrastructure, the funding, the investment and the staff in it, so that we can use the good practice we have to benefit our economy, health and patients generally?

[Lord Markham (Con)]

Yes, I must admit that I need to write to the noble Baroness on the NIP programme because I do not have the detail, but I undertake to do that.

In conclusion, I thank noble Lords; these informed debates have real value. I will take up those points about the use of clear language and acronyms, and make sure that we are accelerating those basic vaccines, which is a vital part of this.

Care Home Staffing

Lord Markham Excerpts

Thursday 18th January 2024 Lords Chamber

[Baroness Pitkeathley]

To ask His Majesty’s Government how they are planning to address current staffing levels in care homes, and any connected delayed discharges from hospital wards and the impact on NHS waiting times.

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

We estimate that the number of adult social care filled posts increased by 70,000 in the last 18 months. The Government remain committed to the 10-year vision to put people at the heart of care, making up to £8.1 billion available over two years to strengthen adult social care provision and discharge. Funding is enabling local authorities to buy more care packages, help people leave hospital on time, improve workforce capacity and reduce waiting times.

[Baroness Pitkeathley (Lab)]

I thank the Minister for that reply, but I am not sure that I find it very reassuring. Your Lordships’ House will know that delayed discharges and long waiting times are largely the result of shortcomings in the care sector, especially the shortage of staff in care homes, where international recruitment has been a lifeline. It was therefore a surprise when the Government elected to put further pressure on this sector by increasing the minimum annual salary required for employees applying for a visa, banning them from bringing dependants to the UK and requiring care firms to be regulated by the CQC if they are to sponsor these visas. Far from being broadly relaxed about these proposals, as the Secretary of State for Health claimed, the care sector is most alarmed about how this will affect recruitment, especially as no consultation at all took place before the policy was announced. Will the Minister please further explain to the House how the Government intend to ensure that there are enough staff in the care sector to cover the enormous and growing need?

[Lord Markham (Con)]

The whole point of the title People at the Heart of Care is the recognition that staffing is critical to this. While it is early days, I believe the 70,000 increase in staff over the last 18 months, as I mentioned in my Answer, is a positive step. We had a very positive announcement just last week about the care pathway, setting out a career structure, which has been welcomed. For instance, ADASS, the Association of Directors of Adult Social Services, said that these are

“positive steps to help make adult social care a real career choice now and in the future”.

We really are making advances in this space.

[Lord Allan of Hallam (LD)]

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

[Lord Markham (Con)]

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

[Baroness Manzoor (Con)]

I welcome the additional care staff that my noble friend mentioned, but there are some real pressures in rural areas where people cannot get carers to come and work. Can he say what is being done about that? Also, because he mentioned it previously, can he give an indication of whether there is a greater number of community hospitals that patients could be discharged into?

[Lord Markham (Con)]

I thank my noble friend for the question. The whole point of trying to develop the career structure that we talk about is to make sure that it is a career that people want to go into across the board, be it in urban or rural areas. Part of that is putting in place about 100,000 training places—this is the first place in the world that has been set up—to try to set up a real career structure. We are starting to see early signs of it working. The number of beds blocked has decreased by 10% in the last few months. It is early days, but it is beginning to work.

[Baroness Murphy (CB)]

My Lords, does the Minister not agree that, while the increase of 70,000 people is very welcome, it is in the context of a turnover of nearly 400,000 every year in care because of the poor career structure? I understand and appreciate that £70 million has been put into training and a care workforce pathway, but does he not agree that it is profoundly inadequate compared with the £11 million a day that is put into NHS nurse training?

[Lord Markham (Con)]

The 70,000 increase is a net increase, so it takes into account the turnover of staff, many of whom rejoin somewhere else in a social care setting. Notwithstanding that, I agree with the noble Baroness that a turnover rate of around 28% is too high in any sector. For about 20% of employers the turnover is only 10%, so clearly some know how to develop a career structure and have motivated staff who will stay there. The intention behind the programme and the career pathway we are trying to set up is to try to get more of that across the system, because retention is key.

[Baroness Wheeler (Lab)]

My Lords, the Minister told the House on Tuesday that hospital discharges have recently been reduced by 10%. However, he knows that this figure goes up and down as some people leave hospital while more come in at the other end, and it depends on which period of time is measured. From July to November last year there was in fact a steady rise, so we need to be specific about dates when we talk about making progress. On the care settings that patients are being discharged to—care homes—how are the Government keeping track of how the extra funding allocated to deal with chronic local staff shortages has supported the discharge process? Will it continue in the longer term?

[Lord Markham (Con)]

The noble Baroness is correct that the numbers are a result of flow. We are seeing thousands more people hospitalised through A&E, so the fact that we have managed to reduce the back end indicates a positive way forward. To measure precisely what the noble Baroness asked about, we have now set up a kind of flight control system for each integrated care board, as I have mentioned, which looks at data across the system to monitor the number of hospital beds and places needed on a case-by-case basis. The noble Baroness is absolutely correct that having that data is key.

[Lord Kamall (Con)]

My Lords, my noble friend the Minister mentioned the importance of a career structure to encourage people to work in the care sector. On the question from the noble Baroness, Lady Pitkeathley, about visas for carers, one issue that has not been addressed is that of personal carers. It is very difficult to sponsor or get a personal carer for individuals, and therefore there is a massive shortage. Can my noble friend the Minister say what the Government are doing to make sure that we can have more personal carers, whether from a domestic workforce or through immigration?

[Lord Markham (Con)]

My noble friend is correct that the recruitment of personal carers is harder. I know that this is close to his heart. I can probably serve him best by giving him a written reply setting out the details of what we are doing.

[Lord Turnberg (Lab)]

My Lords, to make this an attractive job for a care worker, we have to not only give them a pay rise above the national living wage, which is their basic pay, but make this into a profession. If they are professionals, they will then have a career structure that is recognised nationally. Will the Minister encourage that development?

[Lord Markham (Con)]

Yes, I totally agree. That is why we announced this career pathway last week, to try to do exactly what the noble Lord is talking about. It has been welcomed; I quoted from ADASS, but a number of other bodies have welcomed what we are trying to do. We aim to do what the noble Lord said: to make it a profession that people really want to join. There are qualifications for it, advancement and apprenticeships, which are all part of setting up a career structure.

[Lord Swire (Con)]

Does my noble friend the Minister not agree with me that there is still massive potential with the 500 or so community hospitals we have in the United Kingdom? Many are extremely well supported by their local community, and many still retain beds.

[Lord Markham (Con)]

Yes. I have seen a number of really good examples of the kind of step-down care that my noble friend is talking about, or intermediate care that can be used as interim measures. We are trying to bring more of them on board, as well as the very good virtual wards. We have set up 11,000 virtual wards, and they are making a difference as well.

[Lord Watts (Lab)]

My Lords, the Government say that they have done an assessment on the effects of the visa changes. Can he tell us how that was done if the Government did not discuss it or consult with the sector?

[Lord Markham (Con)]

It was a Home Office impact assessment, so I freely admit that I do not know exactly who was consulted; I will happily get back to the noble Lord on that. I know that the assessment looked at all the different parts, including the salary cap and the impact on dependants. For instance, it was not thought that the restriction would have much impact on dependants because not many people come with dependants in the care sector. It looked into each bit, but I will happily let the noble Lord know more in writing.

NHS: Drug Shortages

Lord Markham Excerpts

Wednesday 17th January 2024 Lords Chamber

[Lord Dubs]

To ask His Majesty’s Government what is their response to the reported shortages of NHS drugs.

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

Medicine supply chains are highly regulated and complex. Supply disruption is a common issue that affects countries all around the world. The department has a range of well-established processes and tools to help prevent and mitigate risk to patients. Most supply issues can be managed with minimal disruption to patients. We work closely with industry, the NHS and others to prevent shortages and resolve any issues that may arise.

[Lord Dubs (Lab)]

My Lords, I am sorry to say that I find that Answer very complacent. We are talking about drugs for the treatment of cancer and comments from the pharmaceutical industry that the situation is the worst it has ever been, with cancer patients and others seriously at risk. Surely the Government should do something to ease the anxiety of people who are seriously ill and depend on these drugs for their lives and their safety.

[Lord Markham (Con)]

I assure the noble Lord that a specific team, the medical supply team, works to manages this across the piece. It is a complex area, as we have said. There are 1,000 notifications a year about supply shortages—that has been consistent over the last so many years—that the team works to resolve. I am sure that, as this debate progresses, we will talk about some of the issues, including getting the MHRA to expedite regulatory approval, working with alternative suppliers, buying internationally where needed—we did that very well last year on strep A—and, where really necessary, introducing serious shortage protocols. It is an issue that we take very seriously, and we are managing it.

[Lord Naseby (Con)]

My Lords, “may” is the wrong word; there is a shortage at this point in time, certainly from the inquiries I have made. Is it not time that we had another look at the existing procedures on recompensing drug manufacturing and maybe producing a new version of the PPRS, which worked extremely well in its time?

[Lord Markham (Con)]

Actually, we recently reached a new agreement with the drug suppliers on this. I think we were all pleased to do that, and it will ensure we continue to get continuity of supply. I have quizzed the team at length on this and asked it to sit down with the British Generic Manufacturers Association, which produced these figures, specifically to understand where there are differences, because I must be honest: the team does not recognise those numbers. We did not see an increase over the last few years. Where there are specific instances, such as ADHD, which I worked with the noble Baroness, Lady McIntosh of Hudnall, on recently, remedial actions are in place to ensure we can manage through the supply issues.

[Lord Cunningham of Felling (Lab)]

My Lords, will the noble Earl please focus—

[Lord Cunningham of Felling (Lab)]

I am sorry; will the noble Lord please focus on pancreatic cancer and say whether he is satisfied with the performance of the National Health Service and others in respect of research into and finding solutions to what in many respects is apparently becoming a notifiable disease and a sentence of death?

[Lord Markham (Con)]

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

[Lord Allan of Hallam (LD)]

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

[Lord Markham (Con)]

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

[Baroness Manzoor (Con)]

My Lords, the drug Ozempic has been described as a super-drug for the use of diabetic patients, in order to help them reduce weight. My noble friend the Minister will be aware that diabetes costs the NHS 10% of the budget—approximately £25,000 to £30,000 a minute—with 80% of that money spent on treating diabetic complications. Therefore, can my noble friend the Minister say why Ozempic can be prescribed privately but is not available easily to NHS patients as a result of demand and constraints in manufacturing? How can the Government address this?

[Lord Markham (Con)]

My noble friend is correct that this so-called off-label use of these diabetes drugs for weight-loss-type treatments is causing some of the shortages she mentions. That is exactly what we have been tackling, and we have been making sure that the only way you can get the Wegovy weight-loss drug is actually on a very tightly controlled weight management programme normally run through hospitals, and not through normal GPs, exactly to get on top of that issue.

[Baroness Merron (Lab)]

My Lords, there are reports in the media today of pharmacists having to deal with frustrated and worried customers who are faced with shortages of medicines including HRT and the drugs for ADHD, diabetes and cancer. Can the Minister indicate what action is being taken to support and gather feedback from pharmacists who are dealing with such an unsatisfactory situation? What steps are being taken to ensure that, in the future, the supply system is able to cope as soon as demand for medicines increases?

[Lord Markham (Con)]

We find that each one is a different case in point. HRT is an example: we actually saw a 50% increase in demand for it over the last year, so suddenly that is quite a dislocation for the market, and you need to gear up very quickly in terms of the supply chain issues. Strep A was the example last year that we will all be familiar with; normally, it does not come until later in the year, but suddenly there was a very early outbreak in October, which caused the demand there. You find that every single drug tends to be a different case in point. There is a range of tools that they work with; it is working with the NHS, MHRA suppliers and pharmacists, and it is case by case. As I say, sometimes it is the MHRA expediting medicines to get new supply in; sometimes it is working on alternative suppliers; sometimes it is buying internationally—that is what we did in the case of strep A—and sometimes you do have to go as far as the serious shortage protocols, finding substitutes or, in extreme cases, changing doses. There is a range of programmes on it, which by and large are managing to tackle it.

[Earl Russell (LD)]

My Lords, can I ask the Minister specifically about the continued lack of supply of ADHD medication? The department said that the supply shortages would continue until April, when previously it had indicated that this supply issue would have been resolved by now. Do the Government understand the serious impacts that these shortages have, and the impact that the inability some people are facing to get any medication at all is having on their daily lives?

[Lord Markham (Con)]

There are 78 medicines for ADHD, 10 of which are particularly affected. We have put export restrictions in place on that, and we are working it through so that we can hopefully get it resolved by April. It is something we are working very closely on, because we know the importance.

[Lord Bellingham (Con)]

My Lords, I understand the Minister’s department has a cap on total allowed sales of branded medicines to the NHS. I think it will be a 4% cap over the next five years. Is this making the problem worse? Is it exacerbating the problem? Is it something he could look at with his ministerial colleagues?

[Lord Markham (Con)]

I think the cap my noble friend is referring to is actually in terms of the price negotiations on the VPAG and how the rebates kick in. It is not my understanding that is something that is at issue here. We are talking about where there are specific ranges. A study was produced by the Pharmaceutical Research and Manufacturers of America looking at supply issues across lots of countries over the 10 years from 2012 to 2021. The UK was consistently in the top three. Yes, there are some issues that we are working through, but by and large we are consistently in the top three of supply.

Health: RSV Immunisation

Lord Markham Excerpts

Wednesday 17th January 2024 Lords Chamber

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government what steps are being taken to ensure that appropriate funding is in place to deliver immunisation programmes for respiratory syncytial virus by the 2024/25 winter season, and when an implementation plan will be published.

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

The Government published a prior information notice on 27 November 2023 outlining the market’s intention to tender against its requirements for infant and adult RSV programmes in 2024. Following the tender and the confirmed potential budget implications, a final decision on programme designs will be taken alongside an implementation plan for autumn 2024.

[Baroness Ritchie of Downpatrick (Lab)]

My Lords, I thank the Minister for his Answer. For the avoidance of doubt, can he explain to your Lordships’ House what funding has been allocated to the national immunisation programme for the 2024-25 winter season; what proportion of that funding has been allocated for immunisation programmes for adult, infant and neonate RSV; and what conversations have been held with NHS England regarding readiness to implement the RSV immunisation programme, as advised by the JCVI?

[Lord Markham (Con)]

First, I thank the noble Baroness. She has been a tireless campaigner on this issue and very good—quite rightly—at holding our feet to the fire. The exciting news is that the new vaccines that are coming along for both mothers and infants, as well as the over-75s, are now cost effective; that was recognised in the JCVI’s analysis. As part of that, we have plans to fund the programme, as mentioned. I would rather not go into the details of the actual budgets, because they depend on the tender and I do not want to give that information out to the market—but I can reassure the noble Baroness that plans are in place.

[Baroness Manzoor (Con)]

My Lords, RSV is a leading cause of infant mortality globally. Sadly, as my noble friend the Minister will know, 20 to 30 such deaths occur in the UK. I am pleased to hear about the progress that the Government are making to roll out the programme in the UK, but my noble friend will know that rolling out this programme will significantly reduce costs to the NHS by reducing GP visits, reducing attendance at A&E and reducing the 20,000 hospitalisations of infants aged under one year. Can my noble friend the Minister say, as we move towards autumn 2024 and the rollout of the vaccination programme, what the Government are doing to ensure that mothers and families know about the programme so that they can take up this vaccination when it is available?

[Lord Markham (Con)]

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

[Lord Allan of Hallam (LD)]

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

--- Later in debate ---

[Lord Markham (Con)]

A DHSE team is working closely with the NHS, because that needs to be rolled out. Again, it depends on whether we go for the maternal option or do it via a different process with infants. The final answer on that will depend on the groups that are chosen; likewise, vaccinating the over-75s will more likely be in a primary care situation. When we finalise all those things, there will be a very clear plan, but there is a team in DHSE that is responsible and accountable for this.

[Baroness Merron (Lab)]

My Lords, over the past decade, we have seen the take-up of immunisation decrease. Particularly worrying is the great disparity between white Britons receiving the flu vaccine, where coverage is 83.6%, and black Britons at just 52.2%. In anticipating the RSV immunisation programme, how do the Government plan to address vaccine hesitancy, particularly in the black community?

[Lord Markham (Con)]

The noble Baroness is absolutely correct. This applies to the take-up of a whole range of vaccinations—MMR is another example, as is polio. Inner cities, including London and cities in the West Midlands, seem to be examples where take-up is quite a few percentage points lower, not just because of ethnic minorities but more because those areas have larger migrant populations, who often have not been part of the vaccination programme. Specifically to that aim, we are now publishing information in 15 languages and are trying to reach out to some harder-to-reach groups, such as ethnic minorities, the Traveller community and Orthodox Jews. There is a programme for all this, because it is a challenge. We all know that, during Covid, we talked about an R rate of 1.5. Would you believe that, for MMR, it is 13? That is just to give noble Lords an idea. It is very, very infectious.

[Baroness Davidson of Lundin Links (Con)]

My Lords, I am grateful to the noble Baroness for raising a very important issue. Getting the new RSV immunisation programme up and running correctly will undoubtedly save lives and, to ensure that it happens, it is really important that we learn all that we can from areas of success and failure in recent vaccine rollouts. The latest was the shingles general immunisation programme, which was introduced for all over-70s in September. Can the Minister give some indication of what data capture of rollout, uptake, demand, delivery and efficacy has been instituted and how those learnings can be applied to a future RSV programme?

[Lord Markham (Con)]

My noble friend is quite right. If we take the shingles one, we see quite a disparity. The 70 to 75 element of the programme has a 74% take- up while the 65-plus element has only a 41% take-up—so there is a huge difference. We are starting to collect the data so that we can understand those disparities and then, as I mentioned in answer to the previous question, make sure that we have an action plan to address those groups.

[Lord Blunkett (Lab)]

My Lords, I congratulate my noble friend Lady Ritchie on her tenacity and declare a selfish interest in that I have had this wretched virus two winters running. I will be able to buy the vaccine later this year if it is not available otherwise, but millions of people, including those supporting infants, will not. That is a disgrace, is it not?

[Lord Markham (Con)]

As I say, we are looking to have an infant programme. It is vital in the first few weeks for babies, which is why we are doing this whole plan, thanks to the pressure and the medical evidence. I echo what has been said about the relentless campaign for it all by the noble Baroness, Lady Ritchie. We have got a tender in place. The intention is that we will be rolling it out from the autumn. I repeat that there is only one other public vaccination programme on this so far, in Galicia in Spain, so we really are at the forefront of this programme.

[Baroness Bennett of Manor Castle (GP)]

My Lords, as I discussed with the Minister last year, we have already had approval for private use of RSV for over-60s, so anyone who has up to £200 available has been able to get that RSV vaccination. That is for over-60s. We are talking about a public scheme for over-75s. Is data being collected on the effectiveness and overall health impacts on people who are having the vaccine privately, which might inform whether we should have a broader public programme?

[Lord Markham (Con)]

The JCVI process is similar to the NICE approach. They look through the quality-adjusted years framework and make sure that it reaches within that. That is how they came up with their calculations. So far it is only the older ones, 75-plus, that they think are enough of an at-risk group in terms of hospitalisations and mortality to justify that. But I will inquire further and get back to the noble Baroness I am sure that they are capturing the data so that we can check on the younger ages.

[Lord Kamall (Con)]

My Lords, a number of noble Lords referred to the fact that there were disparities between different communities in the take-up of previous vaccines. My noble friend the Minister acknowledged that. Given the experience of previous vaccine rollouts, what specific lessons has his department learned that it will put into practice to make sure that it reaches some of those hard-to-reach communities in the rollout of those vaccines?

[Lord Markham (Con)]

You have to have the data and the records so that those who you know have not been vaccinated you have to go and get specifically. In London we have been running an under-fives programme, calling all those who have not been vaccinated to come and get a vaccine. That will be rolled out to under-11s and even up to under-25s, having learned precisely those lessons.

National Health Service: Key Targets

Lord Markham Excerpts

Tuesday 16th January 2024 Lords Chamber

[The Lord Bishop of St Albans]

To ask His Majesty’s Government what plans they have in place to ensure the National Health Service meets its key targets.

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

The NHS has made progress against its targets, especially given the challenges of recovering from Covid-19, the changing demography and winter pressures. The Government recognise that there is still a way to go and are working non-stop to support the NHS to do better. I take this opportunity to thank all NHS staff for their hard work to improve performance this winter.

[The Lord Bishop of St Albans]

My Lords, I would like to join in thanking NHS staff, who are doing a fantastic job. There are some structural problems here. In particular, I am concerned about ambulance response times, which are causing a great deal of concern despite the Government having increased the category 2 call response times from 18 minutes to 30 minutes. Category 2 calls deal with such life-threatening events as strokes and heart attacks, so this is deeply worrying. What are His Majesty’s Government doing to reduce the response time? Will they consider returning to the 18-minute response time for category 2 calls?

[Lord Markham (Con)]

I agree with the basic point, as I am sure all noble Lords will, that ambulances are on the front line and are the most important service in all of this. That is why we have invested in 800 new ambulances, with over £200 million of funding. It is early days, but that is starting to take effect. Regarding the category 2 issue, we have managed to halve the time it takes since last year, but it is still too long and we absolutely need to make more progress in this area.

[Lord Bird (CB)]

Does the Minister agree with me that, if you really want to hit the targets for the NHS, you need to deal with the fact that 50% of people who present themselves at the NHS are suffering from food poverty? Why do we not concentrate on lifting the great weight on the NHS by doing serious work on getting rid of poverty?

[Lord Markham (Con)]

I agree with the noble Lord that prevention is key. About half the number of people who turn up at A&E do not need to go to A&E and can be seen in other settings. I completely agree that all the elements in terms of prevention and getting ahead of the problem are key, including where there are issues around food.

[Baroness Browning (Con)]

My Lords, following on from the question from the right reverend Prelate and his reference to stroke patients, given that there is a three-hour window for stroke patients during which, if certain treatments are given, the outcome is so much better, what have the Government done to ensure that, adding on the ambulance time to the time when the patient then arrives at hospital, more patients are being treated within that window? Is there a target specifically for stroke patients? It makes such a difference.

[Lord Markham (Con)]

My noble friend is absolutely correct, and strokes have been a major focus. I am glad to say that was one of the first areas where we rolled out AI everywhere, with the result that we were able to improve treatment times so much—and I will get the precise figures to my noble friend—that the recovery rate has increased by two-thirds as a result. It is absolutely right that this is an area of top focus.

[Baroness Armstrong of Hill Top (Lab)]

My Lords, the Government keep telling us—and I understand why and congratulate them on it—that the number of people employed as doctors and nurses has risen in recent years. Can the Minister explain why productivity over the same time has reduced by 4%?

[Lord Markham (Con)]

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

[Lord Allan of Hallam (LD)]

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

[Lord Markham (Con)]

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

[Lord Winston (Lab)]

My Lords, the Minister well knows that we have raised the issue of primary care again and again in this Chamber. Would he be kind enough to tell the House how the Government feel they are doing with regard to the retention of very highly qualified general practitioners at the height of their career, who are currently leaving early? Up to about 50% are considering retirement before the retirement age. Will he comment on how he feels that is going?

[Lord Markham (Con)]

Staff retention, particularly of GPs, is vital. That is why we listened to the number one reason they were retiring, which was the feeling that their pensions were being adversely affected. We changed the rules in the last Budget to try to address that; it is early days, but I hear that that is starting to make progress. Primary care is the front line. That is why I am pleased that we have increased the number of appointments by more than 50 million, ahead of our manifesto target. But it absolutely needs to be a key focus.

[Lord Kakkar (CB)]

My Lords, I draw attention to my registered interests. The long-term—and, indeed, the short and medium-term—sustainability of the NHS is critically dependent upon active engagement in research and the adoption of innovation at scale and pace. Is the Minister content that His Majesty’s Government are doing enough to ensure that the NHS is resourced to support that research and innovation agenda?

[Lord Markham (Con)]

It is key, and I think we are all aware that a couple of years ago—this was a result of the report of the noble Lord, Lord O’Shaughnessy—we were not doing as well as we needed to be in the clinical trials area. I am glad to say that, since then, there has actually been a lot of progress towards it, so we are now hitting similar levels to comparative nations. Innovation is at the heart of everything we have done. We have some very good examples of that; I mentioned the stroke AI treatment earlier. We have just set a similar thing in terms of AI for looking at chest cancers, but it is absolutely something we need to make sure we continue to progress.

[Baroness Merron (Lab)]

My Lords, the King’s Fund has highlighted a delay to the release of additional funding to help NHS and social care services prepare for winter, which will of course only worsen the situation of missed targets and wait times for patients. Can the Minister tell the House what the reasons are for this delay and what steps are being taken to unblock the money to get it to where it is needed?

[Lord Markham (Con)]

One of the key learnings from last year, which goes back to the whole question about planning, was actually that if you put social care moneys in too late, you do not get nearly as effective spend. That is why we brought forward the £600 million discharge fund much earlier—actually, into the summer—so that local authorities and care providers could plan on that money. It is starting to make a difference. A key thing that noble Lords have heard me talk about is bed-blocking. Actually, we have seen a 10% reduction in bed-blocking since these measures have come into effect in the last few weeks. It is early days, but we are actually making progress.

[Lord Jackson of Peterborough (Con)]

My Lords, the number of over-85s is due to double over the next 30 years. Would my noble friend the Minister give some consideration to government funding for extra care facilities and at-home treatment, such as physiotherapy, in order that pressure be taken off acute district hospital beds in respect of older people?

[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.

NHS Winter Update

Lord Markham Excerpts

Thursday 11th January 2024 Lords Chamber

[Lord Allan of Hallam (LD)]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

--- Later in debate ---

[Lord Markham (Con)]

The noble Lord is correct; London is always our most challenging place. I have found that across the board, funnily enough. He is right in terms of Covid and flu vaccinations, but it is also the case for the take-up of all sorts of different services. We see technology as a key enabler; in fact, the number of people who have booked their vaccinations and follow-up through the app has multiplied significantly. I do not have the precise figures in my head, but they really have gone up. A lot of that is through people seeing their reminder through the app as well. It is recognised that London in particular needs more targeted action—in fact, noble Lords will see an advertising campaign come out in the next couple of weeks or so. We are really trying to promote usage of the app, which is a tool for all these sorts of things as well.

[Baroness Finlay of Llandaff (CB)]

My Lords, I should declare that I am a registered doctor with the GMC. I live in Wales, but I do not want to get into data-hurling over Wales, but I do have a comment to make. I would like to follow up on the question from the noble Lord, Lord Allan of Hallam, about virtual wards. The Minister may be unable to tell us now, but how many of those patients were actually terminally ill; how many of the virtual wards were providing 24/7 effective cover for these patients; and what is happening across the whole country in relation to 24/7 palliative care cover? All the evidence that is emerging is that it really is grossly inadequate. Families are left unable to access the care and support they need.

Ten years ago, NICE recommended that every area in England should have a helpline so that families can phone if there is a crisis, 24/7, when they are looking after someone with palliative care needs at home; yet the Marie Curie report Mind the Gaps—I should declare that I am a vice-president of Marie Curie—which has been developed with the Cicely Saunders Institute—again, I should declare my interest there as an international adviser—has shown that only one in three areas has such a helpline available. Two-thirds of the country has nowhere for people to phone.

Is the Minister prepared to meet me and others from palliative care to mirror what is happening in Ireland now? From this February, the Irish Government will be funding 100% of hospice clinical services, because they have recognised the inadequacy of relying on voluntary sector funding. We know that good care costs less than poor care. We know that where there is good palliative care in place, with 24/7 support, the number of emergency admissions goes down, the pressure on acute beds goes down and inappropriate transfers drop. Although I am not expecting an answer today, I hope the Minister will seriously consider looking at that situation.

I shall just make a comment from Wales and point out that in Wales, paramedics are now being trained specifically in palliative care. Some consultant paramedics are now attached to palliative care teams and are able to administer palliative care drugs out of hours as required.

My other question for the Minister is on what discussions he has had with the GMC over retention. Those doctors who were temporarily registered have received notice that, as from March, for those who had retired, their temporary registration because of Covid will cease. I just wonder, with the figures we have seen come out today, whether it would be wise to negotiate with the GMC, first, for that to be deferred and, secondly, for all those doctors to be contacted and asked directly how they would like to contribute to improving some of the services. There is a lot of skill there which is currently being unused and underutilised. Again, I guess I should declare an interest because my husband is a dermatologist and has been in that position but has never been called up and would have been quite willing to go and help with clinics. Those are some of my questions for the Minister.

[Lord Markham (Con)]

I thank the noble Baroness for those points. Absolutely, I will need to come back on some of the detail on the virtual wards and how they are being used. One thing I will say about them, though, from my knowledge, is that the ability of people to communicate on a regular basis is one of the key advantages. On the point she makes about palliative care and the ability to have 24/7 communication, the beauty of the virtual wards is that they have that inbuilt, for want of a better word—they have that advantage. As noble Lords know, I am always eager to learn from practices all around the world, so I will very happily meet people and learn from them.

On retention, absolutely, we all know that the supply of doctors and medics is the key thing that we need, so I personally feel that we need to look at every avenue to make sure that we can maximise that supply. Again, it is something that I will inquire into as a result of that, and maybe when we have our meeting we can discuss that further.

[Lord Hunt of Kings Heath (Lab)]

My Lords, I too thank the Minister for the Statement and his response, but it takes the biscuit in terms of the Government really seeking to exploit the plight of the NHS by putting so much emphasis on the industrial action being taken. As the noble Lord has said, even before Covid the Government were way off meeting any of the core targets. In 2010, they inherited a health service that was running very well and met all the targets. They threw away that inheritance. When Covid hit, the health services were already running so hot that there was just no headroom at all to cope with the pressure that then came, with—my noble friend is right—hugely dangerous occupancy rates. There was simply no headroom.

Looking at the funding, from 1948 to 2019-20 the NHS received funding of 3.6% real annual growth, on average, per annum. The coalition Government slashed it to 1.1%. The May and Cameron Governments gave it 1.7%. Only with the Covid expansion were resources over that 3.6% average. It is no wonder that the health service is tackling such a momentous challenge. We need to hear from the Government some real plans to get investment back in the health service, to give it the kind of headroom it needs to start meeting the targets that are so important—would the Minister agree?

[Lord Markham (Con)]

I happily agree that we are investing record sums. The latest figures show that we are investing around about 11% of GDP in the National Health Service. I believe the figure in 2010 was somewhere in the 7% to 8% range—I am speaking from memory and so I will correct that if it is not quite right, but that is the sort of massive expansion we have seen. If I take one area as an example, the cancer workforce has trebled since 2010.

What we are seeing more than ever is a record level of investment in the health service but also a record level of demand. I was hoping to show in the Statement how we are looking to tackle that. I will freely admit the challenges, and that it is early days, but I believe we are showing signs of getting on top of it. As I have said many times, I really think that technology will be its future, and there will be lots more we can talk about when we show the profound changes it is going to make.

[Baroness Bennett of Manor Castle (GP)]

My Lords, one in seven UK-trained doctors has left the country to practise overseas. That is some 18,000 doctors, a figure which is up 50% since 2008. Last year, the General Medical Council did a survey of doctors departing the UK to practise overseas, and one of the key factors identified was that doctors were leaving to work in a place where they felt supported by the state and the employer. Does the Minister believe that the Statement—the Government’s general position—is sending a message to doctors that they are supported and cared for, and truly valued, by the UK Government, given that if we look at the financial valuation, junior doctors’ salaries are down 24% in real terms since 2009?

This is obviously an issue of money, but it is also an issue of attitude. Have the Government got their attitude to the junior doctors terribly wrong?

[Lord Markham (Con)]

I agree with the sentiment expressed by the noble Baroness. Clearly, we want to make sure that we minimise any loss to the profession. Retention is key. The long-term workforce plan was all about trying to put a long-term footing in place, one which looked at not just the recruitment of doctors but their retention, which, as I say, is key.

Money is an element of that, clearly. As I say, I have not heard or seen anyone suggesting that we should be paying the 35% increase. I do not think that is a reasonable approach; I have not heard any noble Lords come forward and say that. The correct attitude of the noble Baroness is key as well. We need to make sure that we get that right and I like to think that we are trying to do that. The Secretary of State has been very positive in terms of trying to do that as well. I absolutely agree that, at the end of the day, this is a key workforce and its members need to feel that they are key, rewarded and motivated by what they are doing. That is key to any profession.