Diabetes: 10-Year Health Plan

Baroness Altmann Excerpts

Thursday 26th June 2025 Lords Chamber

[Baroness Merron (Lab)]

The noble Lord, Lord Rennard, knows that it is always good that we hear about his own experience, because he epitomises the changes that are possible. I believe there is an understanding—not least because, as noble Lords will know, the Chancellor very recently gave the department a settlement that was, in large part, because of not just immediate need but looking to the future and the kind of NHS that is fit for the future we will see identified in the 10-year plan when it is published. Technology is certainly a huge part of that, which is why CGM and the hybrid closed loop system—the latter of which began to be rolled out in April 2024—are so important. There have been huge advances and they will be part of that NHS of the future that we seek to build.

[Baroness Altmann (Non-Afl)]

My Lords, I am delighted that the Government are producing their 10-year plan, and we look forward to seeing it. Following on from the question from the noble Lord, Lord Rennard, about protecting the labour force, can the Minister say something about fracture liaison clinics being rolled out across the country, to follow up on commitments made in the past that these clinics will be available across the country? These clinics can help boost productivity in the workforce; help older people, especially women, stay in the labour force; and prevent the fractures that so often force them out of work or cause accidents for older people.

[Baroness Merron (Lab)]

Fracture liaison services do an incredible job. I refer the noble Baroness to the words of the Secretary of State—I will not quote them because I do not have them to hand and there is nothing worse than misquoting somebody, particularly the Secretary of State—who has made his intentions quite clear on fracture liaison services. We certainly appreciate their value and the need to make that kind of provision available across the country.

NHS: Private Equity

Baroness Altmann Excerpts

Wednesday 25th June 2025 Lords Chamber

Asked by

[Baroness Altmann]

To ask His Majesty’s Government what assessment they have made of the potential risks to GP services and NHS costs presented by the takeover of Assura’s surgeries by private equity providers; and whether they plan to intervene to retain domestic control of such services.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, Assura’s portfolio of over 500 properties is leased to GPs and other NHS and private healthcare providers. Arrangements for leased properties and their ongoing healthcare are secured through lease arrangements. A change in ownership does not affect their legal status; leases will continue to be set out and protect the terms of occupation for GP surgeries and other NHS service providers. Officials are in dialogue with Assura and prospective purchasers—and will keep monitoring proceedings.

[Baroness Altmann (Non-Afl)]

My Lords, I thank the Minister for her Answer. Following Care REIT falling into foreign hands, the board of Assura was happy to sell out to KKR, risking an uncertain future for GP surgeries serving millions of people, rather than ensuring continued UK ownership to support NHS current and future infrastructure.

The dangers of allowing overseas takeovers and private equity buyouts are written in the wreckage of our care home sector. I have two questions. First, what power do the Government have to prevent further erosion of UK critical infrastructure? Secondly, do His Majesty’s Government recognise the damage caused by the FCA to so many such real estate investment trusts, and other investment trusts, which own and manage critical UK infrastructure? The exaggerated so-called investor costs have led to unwarranted under- valuation. Therefore, foreign bidders come in and take the opportunity to snap up our future infrastructure for short-term gain, denying those opportunities to pension funds, which are the ideal long-term investors for such companies.

[Baroness Merron (Lab)]

I understand the noble Baroness’s concern, but perhaps I could assure her and your Lordships’ House that it was decided this week by the board of Assura to recommend to shareholders an offer from Primary Health Properties, which is another UK real estate investment trust, similar to Assura, which is focused on primary healthcare premises. It is the case—or was the case, depending on how you look at it—that there was another bidder for Assura: KKR. As the noble Baroness said, KKR is an American private equity and investment company, but it seems very unlikely to be successful at this stage. The assurance I can give the noble Baroness is that a change in ownership does not affect the legal status of existing lease arrangements. I would also say that the ownership of the general practice estate is very much a mixed model in which GP practice buildings can be leased from a variety of landlords, including companies such as Assura, which actually constitute quite a small proportion of the overall estate.

--- Later in debate ---

[Baroness Merron (Lab)]

I thank the noble Lord for seeking that reassurance, which I can indeed give.

[Baroness Altmann (Non-Afl)]

I beg noble Lords’ indulgence. Will the Minister answer the second question I asked about how our infrastructure, such as these properties, is selling at hugely undervalued levels on the market because of a technical issue relating to regulations imposed by the Financial Conduct Authority?

[Baroness Merron (Lab)]

I fear I am not able to answer in the detail that the noble Baroness would like, but I would be delighted to write to her.

NHS Pensions

Baroness Altmann Excerpts

Thursday 3rd April 2025 Lords Chamber

[Baroness Merron (Lab)]

I certainly agree with my noble friend. This runs across all public service pensions. Indeed, it is not just the issue of pensions but the administration and support given. To the point raised by both my noble friend and the noble Baroness, Lady Watkins, I should add that the NHS Business Services Authority and the department are in regular contact with the Pensions Regulator on delivery.

I can certainly give the assurance to my noble friend that we are working cross-government to ensure that these difficulties are corrected as soon as possible. I absolutely recognise the inconvenience, uncertainty and potential distress that have been caused to individuals. As I say, this has a root in it being discriminatory from 2014-15. That said, it falls to us to put that right.

[Baroness Altmann (Non-Afl)]

My Lords, does the noble Baroness agree that at the heart of this problem is the complexity of our pension system and the tax rules, which have undermined the generosity of public sector pensions, which are meant to be a really generous benefit but have turned into a hugely unwelcome cost for our most senior medical staff and nursing staff, as well as others in the public sector? Is she looking, at the same time as trying to correct some of these errors, at finding other ways of improving the problems in the scheme, which will remain even after the statements are issued, such as doctors and nurses themselves having to go on to an HMRC tool to retrospectively adjust their annual allowances for the various tax years going back all those years? Will there be consideration of addressing the cost of scheme pays? Has consideration been given to providing independent financial advice for senior members of the scheme, who would then have some comfort that what they are frightened of—and is driving early retirement or stopping overtime—is either unnecessary to worry about or can be dealt with in another way?

[Baroness Merron (Lab)]

I very much value the noble Baroness’s expertise in this area, so I particularly value her acknowledgement of the complexity of the scheme. Certainly, in our efforts to support the workforce, we consider all matters to make working for the NHS better and simpler. There has been talk—the noble Baroness did not quite say this—that pension issues are impacting NHS activity. There is no evidence of that. Nor is there any clear evidence from NHS payroll data that pension tax rules limit the activity of, for example, the consultant workforce overall. All that said, I, as ever, will be pleased to take away the suggestions that the noble Baroness makes and to have them looked into.

Health Research

Baroness Altmann Excerpts

Wednesday 12th February 2025 Lords Chamber

[Baroness Merron (Lab)]

Yes, very much so, because it is by doing so that we will improve prevention and make the move from sickness to prevention. I can tell your Lordships’ House that the Government are continuing to support commercial clinical research delivery, including through new NIHR commercial research delivery centres that work with industry and other research infrastructure. I was pleased to visit one of them in Leicester, meet patients and hear how they were very engaged in doing exactly what the noble Lord is referring to.

[Baroness Altmann (Non-Afl)]

My Lords—

[Lord Hannan of Kingsclere (Con)]

My Lords—

[Captain of the Honourable Corps of Gentlemen-at-Arms and Chief Whip (Lord Kennedy of Southwark) (Lab Co-op)]

Let us hear from the noble Baroness.

[Baroness Altmann (Non-Afl)]

My Lords, will the Minister join me in acknowledging and applauding the work of charities in health research, particularly those such as Wellbeing of Women, Teenage Cancer Trust, many of the cancer research charities and Alzheimer’s Research UK? I declare my interest, but these are such a cost saver to the NHS.

[Baroness Merron (Lab)]

I certainly associate myself with the noble Baroness’s generous comments about the role of charities. Much of the work that we do in research and innovation is in partnership, including with the third sector, and I thank all those charities for the role that they play.

Carers and Poverty: Carers UK Report

Baroness Altmann Excerpts

Thursday 21st November 2024 Lords Chamber

[Baroness Merron (Lab)]

I thank my noble friend for that and can assure her that I will be discussing that very point with ministerial colleagues and am happy to return to her on it.

[Baroness Altmann (Non-Afl)]

My Lords, particularly today, will the Minister join me in paying tribute to all carers and care workers, paid or unpaid? Does she agree that, with an ageing population, it is long past time to stop treating care as some kind of second-rate service and to give it parity with the NHS? It saves the NHS significant amounts of money, and carer’s allowance is extremely low. Following the recent Budget, care charities will still have to fund the extra national insurance costs, even though NHS workers are exempt.

[Baroness Merron (Lab)]

I, of course, join all noble Lords in paying tribute to care workers, whether paid or unpaid. On paid care workers, that is one of the reasons why, as we move towards a national care service, we have for the first time laid legislation to ensure that there will be a fair pay agreement. On national insurance contributions, I can assure the noble Baroness that the Chancellor considered all the implications of the measures that were announced in the Budget when settlements were made. Further details of those will be announced in due course.

NHS: Dementia Commission Report

Baroness Altmann Excerpts

Thursday 22nd February 2024 Lords Chamber

[Lord Markham (Con)]

Again, everything that can add to our knowledge has to be a good thing.

[Baroness Altmann (Con)]

My Lords, with an ageing population it is inevitable that this illness is going to increase in prevalence across the population. Do the Government have any intention of building into their strategy for caring for dementia the support, perhaps in the workplace, that might be needed, particularly for older women, who tend to be predominantly carers, maybe via insurance in the workplace for respite and for carer’s leave, in order to ensure that this is not such a strain on both the families and the public purse?

[Lord Markham (Con)]

There is recognition in all these things that the workplace has a role here. I have looked at treatments and outcomes in the G7 countries, and Japan is often a good example of having care in the workplace, as my noble friend is aware. As so often, it is about making people realise that this is everyone’s problem to deal with. I will do more work to understand what we are doing to arm employers for that, and I will come back to my noble friend.

NHS: Fracture Liaison Services

Baroness Altmann Excerpts

Monday 5th February 2024 Lords Chamber

[Lord Markham (Con)]

I believe that the latest number is 57%, but the general point stands that that leaves 43% which are making other types of provision. The work we are doing right now is trying to understand the success of those versus what we see as prudent with that 57%. That is the case we are making and the case that Minister Caulfield was referring to as well. I believe personally that it is a strong case, so it is something that, as I say, we are looking to work further on.

[Baroness Altmann (Con)]

My Lords, I apologise for adding to the pressure on my noble friend, but half of all over-50s women will suffer fractures due to osteoporosis, and this affects 50,000 working-age women each year, yet too often this disease is just stereotyped as affecting old women. The menopause increases fracture risks for women in their 50s, when many are in the prime of their life. Might such mistaken stereotyping about old women explain the near total absence of osteoporosis from the Government’s laudable women’s health strategy? Will we perhaps see women’s health hubs referring women to fracture liaison services, with further progress in the forthcoming Budget?

[Lord Markham (Con)]

Again, the use of hubs and their importance for getting people back to work is recognised. That is why in 2023, in the major conditions strategy, we announced the £400 million workforce programme to get 100,000 people with employee support back into work. It is absolutely recognised that what we can do with fracture liaison clinics is a major help. We are also looking at digital therapeutics—the app is close to my heart—that can help with MSK as well. There are a range of measures.

Care of Critically Ill Children

Baroness Altmann Excerpts

Monday 29th January 2024 Lords Chamber

[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.

National Health Service Pension Schemes (Member Contributions etc.) (Amendment) (No. 3) Regulations 2022

Baroness Altmann Excerpts

Wednesday 11th January 2023 Lords Chamber

We have a real problem here for getting the NHS back on track. We need to retain senior staff, and, unless the Government accede particularly on the need to have an effective and efficient system for dealing with the index mismatch—and, especially, on taking into account negative pensions growth—we will continue to have those difficulties.

[Baroness Altmann (Con)]

My Lords, I congratulate the noble Lord, Lord Davies, on highlighting a really serious issue in terms of the workforce situation within the National Health Service. I commend him on his clarity and ability to explain an incredibly complicated situation. I also congratulate my noble friend and welcome him to his position. I know that he is in listening mode and that the Government really want to sort out the problem; it has been hanging over the National Health Service for a number of years.

Small changes have been made to try to address different parts of the problem, but we are left with a situation where, partly because of the legacy of unexpected tax bills that hit senior staff and lowered morale at points over the past three or four years, we currently face a new problem that did not exist before and which has added to the difficulties faced by NHS staff: inflation. The NHS Pension Scheme, as with other public sector pension schemes, is an excellent scheme; the benefits provided for the majority of members are generous and of extremely high value relative to the salaries of most of the workforce. More than 1 million members are in that scheme, and the Government, in their new regulations, have commendably sought to widen the membership of the NHS Pension Scheme. Again, I commend the recent consultation measures that have been put forward; for example, bringing in more primary care network staff so that they do not have to keep opting in but can be automatically included.

I also welcome the attempts to attract back some of the people who have retired early from the NHS or left it for a number of reasons over the past few years. Were they to come back under the old rules, they would face extra penalties; however, those penalties are being removed. I again offer my noble friend and the Government my full support on trying to get people to come back flexibly, take partial pensions and make new contributions and to remove the limits on the number of hours worked—all of which is to be welcomed in allowing retired staff to rejoin the pension scheme.

There is also an attempt to address the inflation calculation problem, whereby the base for calculating the end-of-year inflation is being moved to 6 April so that it will take a base at a similar level of inflation to the previous year. However, that is a one-year fix, so it is not going to solve the long-term issue.

Given the cost to taxpayers of unfunded public sector pensions and, in my view, the right of public servants to expect good pensions, we need to recognise that there is a real problem for some groups of members for whom something which is supposed to be a brilliant workplace benefit has turned into a workplace penalty because of illogical tax rules. More senior and long-serving earners—and now even middle earners, not just the highest earners—are finding that their supposedly tax-free pension contributions are causing them to receive huge tax demands that can even exceed the extra earnings that they may make from taking on an extra shift or doing some overtime, so they are effectively paying to work for the NHS. That is not intentional; the rules in theory are having unintended consequences in practice. The tax system rules that the Treasury has devised are intended to limit the extra tax-exempt pensions so that taxpayers do not have uncapped, extra-large bills going forward, but, in practice, there is complexity, a lack of transparency and perhaps inappropriateness in applying rules that might work for defined contribution pension schemes to defined benefit pension schemes—as well as in trying to limit not only the amount of money going into the scheme each year but the amount built up over the long run. Surely, if you limit the amount that goes in on an annual basis, you should not need to punish people if they have a big pension at the end—is that not the point of building up pensions? I urge my noble friend perhaps to meet a group of interested Peers and representatives from the Treasury to try to work through how we can fix some of the illogical tax rules.

I have identified four elements of the pension scheme that are not working: the annual allowance itself; the tapered annual allowance, on which the Government have gone quite a long way to try to ensure that the increased level at which that bites in the NHS has taken some of the sting out of what was a problem lower down the scale before; the lifetime allowance; and the 20-times pension calculation, regardless of whether you take early retirement. The latter means that it will be advisable for many people to retire in their 50s—as soon as they can—if they are just coming up to the lifetime allowance, because the 20-times calculation will be applied to the pension at that stage, rather than to stay on, work longer, wait until they have a bigger pension and slip over the limit.

There is the inflation calculation, as the noble Lord, Lord Davies, has mentioned, the index mismatch and the failure to have any offset for negative growth. Again, if we were to be able to change Sections 234 and 235 of the Finance Act 2004 to better allow the total pension calculation that accrues above inflation, that would at least address some of this issue.

A final element that I would like to highlight is that there is the possibility for members who face tax charges to have those charges paid by the pension scheme. It is called “scheme pays”, and effectively it means that you get a lower pension later on because the pension scheme has paid your tax bill today. But what we need to do is to take away the punitive interest rate charged for the calculation made for the “scheme pays” amount. Right now a member is charged CPI plus 2.4%, effectively 12.5% to borrow money from their pension scheme, meaning that they get a lower pension later on.

Children in Care: CAMHS Waiting Times

Baroness Altmann Excerpts

Monday 5th December 2022 Lords Chamber

[Lord Markham (Con)]

I agree. Arguably, if you are being home schooled, you probably need a lot of help. As the noble Lord will be aware, a lot of the services are related to social prescribing, where often people with mental disorders can be helped by involving them more in community activities. Clearly, those who are home schooled are much more likely to be isolated.

[Baroness Altmann (Con)]

My Lords, I congratulate my noble friend on his previous answer about triaging so that those in care can get urgent mental health support. Does he have any targets in mind as to the proportion of children in care with mental health needs who could be seen within, let us say, six months rather than the current waiting time of up to two years?

[Lord Markham (Con)]

I thank my noble friend. The NHS has recently set out a national framework for the practical pathways that it expects ICBs to follow in terms of getting diagnoses. To be very open with my noble friend, given demand, setting targets in this space is probably not the wisest thing to do, but we understand that we need to get on top of this.