Asked by
To ask His Majesty’s Government what additional funding is being
made available for the implementation of the Department for
Health and Social Care’s Major Conditions Strategy.
The Parliamentary Under-Secretary of State, Department of Health
and Social Care () (Con)
My Lords, the Government are providing additional funding of £3.3
billion in 2023-24 and £3.3 billion in 2024-25 to support the NHS
in England. The Government have not committed further additional
funding specific to the major conditions strategy. However, as
part of the strategy, we will be identifying innovative actions
to help alleviate pressure on the NHS and support improvement
within the current settlement, such as maximising the use of new
technology to screen individuals for conditions.
(Lab)
My Lords, the major conditions strategy has been well received in
both approach and content, particularly the focus on primary and
secondary prevention as part of a life-course approach, and
bringing together a strategic framework for the six major
conditions that drive over 60% of morbidity in England, including
cancer, heart disease and stroke. However, key stakeholders have
warned that, without adequate resources, NHS trusts and other
bodies will struggle to deliver, especially given their current
and future focus on trying to cope with ever-escalating waiting
lists. Do the Government acknowledge this and how will January’s
future strategy address it?
(Con)
We are investing about 11% of the economy—£160 billion—in the
NHS, and the conditions in the major conditions strategy account
for 60% of all the causes of death and long-term illness. What we
are really talking about is prioritising spend around prevention
and personalised care, as the noble Baroness said, and
channelling the money we are already investing towards those
aims, on which I think the whole House agrees.
(LD)
My Lords, in June, the Government announced a ring-fenced AI
diagnostic fund of £21 million to support the major conditions
strategy. Will the Minister update the House on progress with the
rollout of that fund? What other steps are the Government taking
to ensure that NHS patients in all parts of the country can
benefit from the latest developments in artificial
intelligence?
(Con)
AI is a key point. Take stroke, which is one of these conditions.
I saw a very good example in the Royal Berkshire the other day of
what we all know as the golden hour, and the results from it. The
Royal Berkshire has AI scans that go straight to the responsible
physician, who can say straightaway whether a thrombectomy, for
instance, is needed, the timing of which is critical. That is now
being used in that cluster of hospitals and will be one of the
six key technologies, the roll out of which we will encourage
across the board to others.
(Con)
My Lords, osteoporosis must surely be included in the major
conditions strategy, as fractures are the fourth-worst cause of
premature death and disability in the UK, with as many people
dying of fracture-related causes as lung cancer and diabetes.
Does my noble friend agree that the inclusion of osteoporosis in
the strategy would need to be backed up by investment in fracture
liaison services to make it effective? Would not a two-year
transformation budget of just £54 million to pump-prime universal
coverage of FLS in England, which would quickly pay for itself,
be a game-changer for patients, the NHS and the taxpayer?
(Con)
I thank my noble friend. I think that is covered by
musculoskeletal conditions, which is one of the six major
conditions we are looking at. Key to pathways is moving treatment
away from individual silos to patient-based treatment that looks
across the board. We know that 55 year-olds have, on average, at
least one condition, and that 80% of those over 85 will have one,
two or three of these conditions. We need to ensure that we look
at this across the board, rather than in silos.
(Lab)
My Lords, I understand the rationale for identifying these areas,
but how will the Government ensure that integrated care boards do
not deprioritise services for other clinical conditions, such as
eye health or kidney disease, for which there is huge demand in
the NHS, involving many patients?
(Con)
The strategy tries to provide a road map for how we want to do
this. It starts with prevention, which I think we are all agreed
on, then early diagnosis, quality treatment and then living or
dying well with that condition. It is a philosophy: the idea is
that we get it right in these six major areas with 60% morbidity,
and then we roll it out across the board in all other areas. It
is a way of treatment, really—a way of looking at the whole
problem, centred around whole patient needs, that we will roll
out to other conditions as well.
(LD)
My Lords, if this is to become a reality rather than an
aspiration it will require a huge increase in the number of
community nurses. How do the Government think that will happen
when the main incentives and career development for nurses lie
within the acute sector?
(Con)
My Lords, the noble Baroness is absolutely correct. That is set
out in the long-term workforce plan: a move much more upstream to
prevention and primary care, of which community nurses will be a
key part. The recruitment is in place for it all. Yes, a lot of
people might see the action as being in the acute sector, but a
lot of people really enjoy working in the community as part of
their lifestyle. The hope and expectation is that it will appeal
to a lot of people in those areas as well.
(CB)
My Lords, less survivable cancers such as pancreatic cancer are
often characterised by vague, non-specific symptoms, making them
hard to diagnose. Will the major conditions plan include making
funds available for symptoms awareness campaigns to ensure that
these signs of deadly cancers are not missed? Will it also cover
increased funding for research aimed at increasing survival rates
for pancreatic cancer, which is the deadliest common cancer?
Survival rates have hardly changed in the past 50 years, whereas
for leukaemia there has been a surge in survival rates following
an increase in funding for research.
(Con)
This is all about prevention—letting people understand when there
is something not right within themselves and trusting them to
know that. That is why the self-referral part of this is so
important, rather than always having a GP as a kind of gateway to
it all. Most people know their bodies better than anyone else
does. If we can arm them with awareness and give them the ability
to self-refer to these centres, we can get them diagnosed that
much quicker.
(Lab)
Does the Minister agree that in the broadest sense, this strategy
would be aided by the Powers of Attorney Bill that passed in this
House last week and will shortly reach the statute book? With the
indulgence of the House, I pay tribute to my friend and colleague
Stephen Metcalfe, the Member for South Basildon and East
Thurrock, who steered the Bill through the other place, my noble
friend and the noble
and learned Lord, , both of whom are in their
places, for getting government and opposition support. I thank
the officials at the Ministry of Justice who worked for years to
make it possible. Does the Minister agree that lasting powers of
attorney as applied to health will make a difference to the
better?
(Con)
Absolutely. The Government, and in particular my noble and
learned friend on behalf of the whole MoJ
team, fully support the noble Viscount’s remarks on the Powers of
Attorney Bill and warmly thank him, and all the others for
their efforts on the Bill.
(Con)
My Lords, I congratulate the Minister on concentrating on the
importance of person-centred care, particularly for people with
long-term conditions. I declare an interest as chief executive of
Cerebral Palsy Scotland. Cerebral palsy is a good example of
this, because we actually have very good NICE guidelines for the
treatment of adults with CP but there seems to be nothing we can
do to ensure that integrated care boards around the country
follow those guidelines. Can the Minister explain why?
(Con)
My noble friend is absolutely correct, in that we are setting out
the whole emphasis of what we are trying to do here. It is really
ingrained in those pathways. It is about culture and behaviour as
a whole, rather than a silo-based scheme, looking at the whole
patient. Once we have got those pathways set up properly, it is
Ministers’ job—I have mentioned before that we each look after
six or seven ICBs—to hold them to account and make sure they are
following those pathways.
(GP)
My Lords, on that whole- patient approach, in 2021 when the
Office for Health Improvement and Disparities was launched, the
then Secretary of State said that the Department of Health would
be co-ordinating activity across government, looking at the wider
drivers of good health—employment, housing, education and
environment—lack of which often drives many major conditions. Can
the Minister tell me how that co-ordination is going?
(Con)
As mentioned, this is about looking at the whole patient, and
that is why the ICB role in this, working with local authorities,
is key. The environment in which people live is also key, as is
tailoring our part of the jigsaw puzzle—health—towards this. One
of the major elements that noble Lords have heard me talk about
before is mobile lung cancer screening, which goes into
neighbourhoods where it is known to be a problem, often the old
mining communities or places where there are high levels of
smoking and deprivation. That mobile screening technology has
meant that instead of reaching only 60% of people by stage four
of cancer, we are capturing 75% at stages one and two. This is
about working with local authorities on whole health needs to
ensure that our efforts are targeted in the right places.
