Sodium Valproate

Lord Patel Excerpts

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

The noble Baroness is correct. In terms of data, it is vital: first, that we have a register of all the people who are taking valproate so that we can be sure that the information is there; secondly, that we then keep a record of where patients have signed the annual acceptance; and, thirdly, that we are gaining data on testing. The latest suggestion is that we should also be looking at males taking valproate because there is evidence that it can, through their sperm, cause difficulties in pregnancies. On all those factors, data is central and we should make sure we collect it.

[Lord Patel (CB)]

My Lords, we have known for decades that sodium valproate, particularly when given in early pregnancy, causes 1% of babies to be born with deformity and as many as 10% to be born with learning disabilities. Despite the guidance issued two years ago, last year 250 babies were born to mothers taking high doses of sodium valproate. Does the Minister agree that we need to make the guidance much stricter, particularly about the appropriate contraception to use, and that when advising women who might be planning a pregnancy, sodium valproate should stop being prescribed for them?

[Lord Markham (Con)]

The noble Lord is absolutely correct. Everyone taking sodium valproate who is of childbearing age should be on a pregnancy prevention programme to make sure that those sorts of incidents do not happen. It is vital, when it is necessary for people to take it, that they really understand the risks and do everything to avoid pregnancy.

NHS GP Surgeries: Purchase by US Companies

Lord Patel Excerpts

Monday 5th June 2023 Lords Chamber

[Lord Markham (Con)]

This is absolutely the work that the Treasury is doing at the moment. Noble Lords have asked, many a time, when it is coming out. I think people will understand that part of the delay is making sure that, when the plan does come out, it really does work.

[Lord Patel (CB)]

My Lords, what does the Minister think is the main reason that general practitioners might be leaving the NHS to work in the private sector?

[Lord Markham (Con)]

My understanding is that it is a range of issues, clearly including workload, pay and conditions. We are trying to address those; I think the change in the pensions rule has been generally welcomed in terms of encouraging more doctors to stay on in place. But it is a range of those measures—again, all things we are hopefully addressing through the new training and skills programmes, and the long-term workforce plan.

Cancer Referral Targets

Lord Patel Excerpts

Monday 5th June 2023 Lords Chamber

[Lord Allan of Hallam (LD)]

My Lords—

[Lord Patel (CB)]

My Lords, I interrupt to say that, while the new test shows promise, it is nowhere near perfection. The sensitivity of the test is extremely low and false positive rates are high. This is cell-free DNA testing, including machine learning. It may be the promise of five years to come that we detect cancers at an early stage, which would be the holy grail, but we must not hype the test at this point and raise false hope.

Pharmacies: Medicines at Home

Lord Patel Excerpts

Wednesday 17th May 2023 Lords Chamber

[Lord Markham (Con)]

As noble Lords are aware, I hold the technology brief, so, if there are automated ways, I am absolutely all for them. As I learned while researching this Question, this is a complicated area, given the number of permutations of pills that can be there in each circumstance. I have not seen those solutions, but I will look into them.

[Lord Patel (CB)]

My Lords, medicines reconciliation —the right drug to the right dose at the right time—is an important part of managing diseases, particularly for patients who are on multiple medications. Blister packs were seen as one of the solutions to reduce risks, as 10% to 15% of older people on multiple medications end up in acute medical wards. If blister packs are not the solution, what solution does the Minister propose to reduce issues with medicines reconciliation?

[Lord Markham (Con)]

I am sorry: I will try to be clear to make sure that I am fully understood. There are many, many people for whom a blister pack is absolutely the right solution. Basically, what has been put in place here is a structured medicine review, so that, in each case, it will be the responsibility of the pharmacist to make sure that they have the right solution for the patient. What I am saying equally is that blister packs are not a blanket solution, and it needs to be done on a case-by-case basis.

Life Expectancy: Pensions, Health and Insurance

Lord Patel Excerpts

Wednesday 26th April 2023 Lords Chamber

[Lord Markham (Con)]

As ever, there are multiple factors at play. That is what the Office for Health Improvement and Disparities is all about: making sure that we are tackling this in exactly the holistic way the noble Lord mentioned, going back to all the major conditions that are causes of death and tackling each one by one. The 10 million cancer screenings save 10,000 lives a year, and our breast cancer screenings save 1,300 lives. There is a lot to do but a lot that we are doing already.

[Lord Patel (CB)]

My Lords, in his introductory remarks, the Minister quoted the Government’s ambition to extend healthy life expectancy by five years by 2035. Can he put some numbers to it? What age are we talking about?

[Lord Markham (Con)]

My understanding is that people are predicted to live a healthy life until around age 63. It is about looking at that aspect as well; it is not just about the length of life but how well we live it.

Long Covid

Lord Patel Excerpts

Tuesday 25th April 2023 Lords Chamber

[Lord Patel (CB)]

My Lords, two things are important in the long-term management of patients with long Covid. The first is epidemiological studies, and I am glad that the Government are backing with £50 million the NIHR to do such studies. The second is finding cures. Interestingly, the molecular studies carried out by Oxford show that there might be mitochondrial dysfunction, which leads to a loss of energy production and therefore fatigue. A drug that has entered its phase 2 trial sounds promising, so we must also support molecular science to find a cure for this condition.

[Lord Markham (Con)]

I thank the noble Lord and applaud the research work that has been done. As I said, we have invested £50 million on top of the £118 million for Covid research. Just as we were one of the front-runners in developing the Covid vaccine, with AstraZeneca, it is very much our ambition to be a front-runner in developing cures for long Covid.

Stroke Rehabilitation and Community Services

Lord Patel Excerpts

Wednesday 22nd March 2023 Lords Chamber

[Lord Markham (Con)]

My Lords, that is a very important point. Two things have really struck me. When people are in hospital, they lose 10% of their muscle mass per week, which is clearly key in their ability to have an active lifestyle and look after themselves outside. At the same time, they need constant support and reminders to keep up that active lifestyle. It is very much at the front of our mind.

[Lord Patel (CB)]

My Lords, we know that rehabilitation at the appropriate level is key to the best outcome for stroke patients: some 10% will not have any residual disability, 25% will have a minor disability and 40% will have a moderate disability, but without rehabilitation, 80% will have a major disability. Would it be a good idea to carry out a country-wide audit of what services for the rehabilitation of stroke patients are currently like?

[Lord Markham (Con)]

I thank the noble Lord. I believe that this is what the national integrated community stroke service is all about. It is the responsibility of each ICS to make sure that there is sufficient capacity in their area. At the same time, it is always good to make sure that that is happening, so I will follow up with the NHS to see what plans are in place to make sure that we really are getting that uniformity of service.

Patient Deaths: Ambulance Waiting Times

Lord Patel Excerpts

Tuesday 14th March 2023 Lords Chamber

[Lord Markham (Con)]

My noble friend is absolutely correct: with responsibility for these things comes accountability, and it is the job of us all to hold people to account where performance is not where it should be. I know each Minister has their own set of ICBs— I have a particularly close relationship with seven; other Ministers have the same—so that we can bear down on exactly these sorts of differences and hold people to account.

[Lord Patel (CB)]

My Lords, does the Minister agree that the junior doctors’ representative at the BMA and the Department of Health should get round the table and negotiate the end of the doctors strike before more harm is done to the patients? To express a personal view, as a doctor, I would never withdraw my services from patients.

[Lord Markham (Con)]

I thank the noble Lord for his contribution, as ever. Yes, absolutely; these things always have to be resolved around the table. As I say, I am pleased that we are making good progress with nurses and ambulance workers, and I hope we can get around the table and make more good progress with GPs as well.

Physiotherapy: Rehabilitation Services

Lord Patel Excerpts

Thursday 23rd February 2023 Lords Chamber

[Lord Markham (Con)]

I agree with the noble Lord’s point; our estimate is that over half of all physiotherapy takes place outside the hospital environment. Clearly, all sorts of settings, including swimming pools and gyms, are vital for that. The work we have done with the Energy Bill and the caps has been a vital help to those leisure centres, and, thankfully, we are now starting to see bills come done and so these places are on a better financial footing.

[Lord Patel (CB)]

My Lords, I was previously a trustee of the Stroke Association and the chair of Chest Heart & Stroke Scotland. Every five minutes, a person suffers a stroke. Their outcome depends on two crucial factors: first, the so-called golden hour during which they should receive treatment—if they do not, their outcome is poor—and, secondly, the rehabilitation they get over the next three to six months, including training on speech, mobility and dealing with daily life. Sending these patients to care homes or their own homes without that kind of support decreases their outcomes considerably. Currently, 10% of these patients end up in nursing homes for ever; if these services are not available, that number rises to 30% to 40%. So, despite the positive response from the Minister, there is a degree of urgency for integrated care boards to address the issue of rehabilitation for stroke patients.

Maternity Services

Lord Patel Excerpts

Thursday 9th February 2023 Lords Chamber

Asked by

[Lord Patel]

To ask His Majesty’s Government what steps they intend to take in response to the Care Quality Commission’s Maternity Survey 2022, published on 11 January.

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

My Lords, we are committed to continuing our work to ensure that all maternity services provide safe and compassionate care. We will continue to closely monitor progress in improving the standard of maternity care across the country. We have made significant investment into maternity and neonatal services, with £127 million announced in 2022 to go into the maternity system to help to increase the NHS maternity workforce and improve neonatal care.

[Lord Patel (CB)]

My Lords, I thank the Minister for his Answer. The Ockenden report on Shrewsbury and Telford, the Kirkup reports on East Kent and Morecambe Bay, the current report of the CQC, the fact that the CQC fined a Nottingham hospital the maximum amount—£800,000—for a baby death, and the fact that we are now paying out in maternity litigation costs over £1 billion per year all point to one thing: a question of safety in our maternity units. Mothers and babies should not die in our maternity units without care and compassion, but that is what is happening. I am glad that the Minister, the honourable Maria Caulfield, met Dr Kirkup last week, which is a great improvement and progress. I hope the Government will now take seriously the need for zero tolerance of mothers dying in our maternity units and zero tolerance of normally formed babies dying or being damaged in childbirth. I shall keep pursuing this until we get that.

[Lord Markham (Con)]

I welcome the noble Lord’s pursuit because that is absolutely the right thing to do. I think we all agree with that, and we would all say that what happened in East Kent and the other examples from the Ockenden report are clearly not something that we are happy with or that we should put up with. The Kirkup and Ockenden reports gave us a north star, a way forward. I am pleased to see that we are making progress on that, but I expect the noble Lord to hold us fully to account because I am holding the department to account on this.