General Medical Council: Internal Guidance

Lord Sandhurst Excerpts

Tuesday 17th October 2023 Lords Chamber

[Lord Cormack (Con)]

My Lords—

[Lord Sandhurst (Con)]

My Lords—

[Baroness Williams of Trafford (Con)]

My Lords, my noble friends should come to a gentlemen’s agreement on who is going first.

[Lord Cormack (Con)]

My Lords—

[Lord Sandhurst (Con)]

My Lords—

[Noble Lords]

Oh!

--- Later in debate ---

[Lord Markham (Con)]

I think the noble Lord makes the point very well. I do not think I have anything to add, apart from basic agreement.

[Lord Sandhurst (Con)]

My Lords, the GMC may be independent but it is a creature of statute and should remember that. Parliament can change its statutes at any time. Are we to anticipate that, if the doctors’ regulator —this creature of statute—refers to its female staff, by which I mean women, as chest feeders or people with cervixes, the Minister will make it plain that this language from the medical regulator is unacceptable?

[Lord Markham (Con)]

I am quite happy, as mentioned previously, to talk to the GMC about its use of language, the importance of the use of correct language and the clear feelings of all of us in the House today about women who are women and mothers, and men who are male and fathers. I will leave it to the GMC as to how it deals with staff matters, but I will be very clear on medical issues and the belief of all of us here in this House.

Gender Identity Services: Children and Young People

Lord Sandhurst Excerpts

Wednesday 19th April 2023 Lords Chamber

[Lord Markham (Con)]

I feel I am probably outgunned to some degree by the noble Lord. I would like to make sure that I answer that in the proper way and give him a detailed written response. I am happy to follow up, because I want to make sure that I am answering in completely the right way.

[Lord Sandhurst (Con)]

My Lords, the Times of 23 February reported that GIDS patients were still receiving puberty blockers. What arrangements are in place—as recommended by Dr Cass in her report—to monitor patients who receive treatment, both during it and in subsequent years by way of follow-up, to ensure a proper longitudinal study of the effects?

[Lord Markham (Con)]

My noble friend is absolutely correct: one of the main findings from the Cass review was that more research has to be done in the whole space of puberty blockers. The NHS is moving on that as we speak. At the same time, I can assure the House that, from now on, no puberty blockers can be prescribed unless they are part of that research programme, because it is vital that that does not happen as a matter of course until we understand far more about this subject.

GP Appointments

Lord Sandhurst Excerpts

Thursday 23rd February 2023 Lords Chamber

[Lord Markham (Con)]

As mentioned, we are increasing the number of doctors. We have 2,000 more versus 2019. The House will be pleased to know that that is a key part of the workforce plan for recruiting and retaining more doctors. As to comorbidities and deprived areas, clearly that is the role of the integrated care boards. They are set up very much to understand the needs of their areas and to make sure that they are looked after properly. In a lot of cases that means investing in primary care. We all know that a lot of the reason why we have a lot of people in A&E is that they cannot get GP-type services, so getting upstream of that issue and investing in primary care is the direction in which we need to go.

[Lord Sandhurst (Con)]

My Lords, it is often forgotten that general practitioners, unlike salaried NHS doctors, are self-employed contractors under contract to provide services. What plans, if any, do the Government have to review the existing GP contract to ensure that new terms are imposed to require better delivery of services by general practitioners?

[Lord Markham (Con)]

My understanding is that the new GP contract is part of live conversations with the BMA that we are about to get into—I think it is over the summer that those negotiations will start to take place. Within all of that, we will be looking at all those sorts of things in terms of how we want to see the GP service evolve. At the same time, we will be talking openly to the BMA about what it wants for its doctors, so that we get an outcome that works well for both sides.

Osteoporosis: Early Detection

Lord Sandhurst Excerpts

Thursday 19th January 2023 Lords Chamber

[Lord Markham (Con)]

I thank the noble Baroness for bringing this to my attention. Clearly a 28% reduction is impressive and something that we should take seriously. If she can give me the reference, I will definitely take it up and write back.

[Lord Sandhurst (Con)]

My Lords, is not exercise when growing as an adolescent, particularly impact exercise, important for stimulating bone growth? Should more not be done to encourage impact exercise among children and teenagers, particularly among girls, who do not always want this—in other words, running, jumping on the spot and so on?

[Lord Markham (Con)]

As a player of rugby, which probably has far too many impacts, I agree with the sentiment that exercise is always a good thing, whatever stage of life one is at. Also, we all know that vitamin D is a vital part of helping against bone weaknesses. Things as simple as spending more time in the sun in summer or taking vitamin D supplements in the winter are vital prevention methods. I agree about exercise, but all these measures should be rewarded and promoted.

Health and Care Bill

Lord Sandhurst Excerpts

2nd reading
Tuesday 7th December 2021 Lords Chamber

[Lord Sandhurst (Con)]

My Lords, I add my congratulations to the noble Lord, Lord Stevens of Birmingham, on his very uplifting maiden speech.

I shall direct my remarks to Clause 4. This inserts a new provision into Section 13A of the National Health Service Act:

“The objectives that the Secretary of State considers NHS England should seek to achieve which are specified in subsection (2)(a) must include objectives for cancer treatment defined by outcomes for patients with cancer, and those objectives are to be treated by NHS England as having priority over any other objectives relating to cancer”.


This is a very specific and important mandate. Henceforth, successful management will be judged by “outcomes for patients”: how many survive and for how long.

Let me explain why this is important. For the first time, cancer survival rates from the date of diagnosis will be given priority over other objectives in the treatment and management of cancer. Hitherto in respect of cancer this country has focused for too long on targets, such as the two-week wait to see a specialist after a referral and the 62-day wait from referral to first definitive treatment. Those targets are not irrelevant or unimportant, but they are only part of the picture and have distorted the way we have managed cancer. They have had too much priority as measures for achieving funding support. They have not resulted in better results.

Over the last 20 years, there has been only limited evidence of cancer survival rates catching up with international averages in other prosperous countries. Professor Sir Alex Markham, the founding chief executive of Cancer Research UK, has observed that

“comparable health services abroad continue to outperform the NHS in terms of cancer survival. They all remain focused on cancer outcomes and the UK would be foolish not to do likewise”.

This clause should put that right.

When it comes to treatment after diagnosis, I understand that the NHS largely performs as well as other comparable health services. However—this is the important thing—it is not as good at catching cancers in their crucial earlier stages. If the new commissioning bodies under the Bill have to focus on outcomes, they will monitor survival from date of diagnosis. They will have to collect that data, identify dates of diagnosis and match outcomes. This will show which places are doing better than others. Researchers can then establish what the more successful places do and how they differ from the less successful ones. That way, routes to success may be identified. Improvements can and should follow. That is true evidence-based medicine.

Hitherto, data collection and data transparency have not been a strength. As Bowel Cancer UK told the APPG on Cancer, the priority should be to

“improve the quality and use of data”

produced. Indeed. Another point is that data on the less common cancers are not used consistently throughout the NHS. The focus to date has been on the so-called big four: breast cancer, prostate cancer, bowel cancer and lung cancer. Yet it is a fact that the other less common cancers, taken as a whole, constitute more than 50% of cancer cases in England at any one time.

The new statutory obligation addressing outcomes for all cancer treatment would ensure that such data are collected across the range of different cancers. This new provision will provide the springboard for long-overdue improvement in cancer detection and cure. I commend it to the House.