Integration of Primary and Community Care (Committee Report)

Baroness Armstrong of Hill Top Excerpts

Thursday 9th May 2024 Lords Chamber

[Baroness Armstrong of Hill Top (Lab)]

My Lords, I too felt very privileged to be a member of this committee and want to extend once again my sincere thanks to my noble friend Lady Pitkeathley. She worked tirelessly and used the knowledge and the commitment that she always shows, even on occasion in difficult circumstances with an unusually high turnover of staff working to her. However, I also want to thank the staff because they always worked in a professional way to support the committee effectively. I knew I could rely on the very good other members of the committee to be detailed about the report. It now seems quite a long time ago, but I do want to take therefore a slightly different approach to my speech, as it is meant to be fairly quick.

When I was chairing the Public Services Committee, particularly during Covid, I got to know National Voices, a charity that works essentially with people with long-term conditions, often more than one; and these are the people that an integrated care system should be measured against. I want to go back to what National Voices said when it worked with the patients it was seeking to represent about what they wanted from what we call an integrated system but what it calls a person-centred, co-ordinated care system. We have different definitions, and we like the sort of rhetoric of integration, but we must never forget what the real purpose of it is, because creating care that is co-ordinated around the needs of the individual, rather than the requirements of the health and social care organisations, seems as far away today as it has ever been.

National Voices asked patients what they wanted from the system—and I shall give noble Lords some quotes. They said:

“My care is planned with people who work together to understand me and my carer(s), put me in control, co-ordinate and deliver services to achieve my best outcomes”.


I do not think that that is an outlandish demand. However, it recognises that, while we may be trying to patch together different services and feel that we have succeeded when two organisations say that they are talking to each other, the end product of integration for service users is an outcome whereby they feel more in control of what is going on. The outcome of all this co-ordination means that they and their carers understand what they need to do to keep improving and help make things happen. They said that they wanted to be able to say:

“I was supported to set and achieve my own goals. Taken together, my care and support helped me live the life I want to the best of my ability. I was in control of planning my care and support. I could decide the kind of support I needed and how to receive it”.


I am afraid that we are still a long way away from getting professionals to talk to each other about the whole person they are meant to be helping. Even when we get to that, unless that collective voice of professionals puts the service user in control, we will not really get the outcomes that we need. How do service users want communication to take place? Again, they have some simple wishes. They always want to be

“kept informed about what the next steps would be”.

They want to be sure that “the professionals involved” have “talked to each other”, so that they can see that they have “worked as a team”. They want to be able to say:

“I had one first point of contact. They understood both me and my condition(s). I could go to them with questions at any time. That person helped me to get other services and help, and to put everything together”.


People with different needs know that they need different expertise, and they welcome that expertise—but first they want to know first that the professionals will talk to each other and that someone will put everything together.

These statements—and I could go on—are straightforward and moderate wishes. As I understand it, integration has been in the last three NHS plans. There was even an integration White Paper two years ago yet, last year, with all the new structure that the Government say we must wait to see, NHS England and the DHSC issued contradictory instructions to ICBs, ICSs and trusts. That means that, if they take any notice, they will revert to working in silos. We have to move away from the rhetoric and get on with delivering what patients need, when they need it and in the place they need it.

Maternity Services

Baroness Armstrong of Hill Top Excerpts

Thursday 25th January 2024 Lords Chamber

[Baroness Armstrong of Hill Top (Lab)]

My Lords, I enter this debate with some trepidation, having heard contributions such as the last from such a distinguished obstetrician, but I thank my noble friend Lady Taylor for introducing the debate.

I echo what the noble Lord, Lord Patel, said: what happens in maternity services should be seen as a bellwether for the rest of the NHS. The CQC reports on maternity services that Members have referred to are really quite shocking. We know that for women who are pregnant, this period forms their view of the confidence they can have in the services that they are relying on during pregnancy. There is more than one: it is not just a midwife, it is the GP, it is whoever they see in community services, it is all the other services that prop up their eventual delivery, and the post-delivery services, that are under the microscope here. During my period of chairing the Public Services Select Committee in this House, in virtually every inquiry, we came across women who felt that their relationship had almost been defined by this during their pregnancy: if it had been a poor experience, that introduced anxiety, concern and just a little trepidation about how they would make sure that their health and that of their family was looked after in future. I wanted to intervene in this debate to tease that out a little more.

I thank all the myriad organisations which have written to us about this debate, but also the Library. We are really privileged to have such high-quality research and attention paid to us. Too often, we take it for granted and forget to say thank you to the Library staff for doing that.

All the reports and briefings highlighted staffing and leadership, as the Public Services Committee did. For me, they underpin this whole thing. There is a crisis in staffing and in the skills mix there needs to be to ensure a happy and successful pregnancy for mother and baby, and there is certainly a crisis in leadership. Far too many of the good leaders have left, partly over Covid and partly because of additional pressures. The workforce plan on its own is not the answer. As the noble Lord, Lord Patel, said, you can have plan after plan and review after review, but without adequate implementation they will be just glorified bits of paper on the shelf.

I know well the chief executive of the Maternal Mental Health Alliance, because I worked with her in a charity that I chaired before she took up this role. I have heard from her over the past two to three years about the challenges in this area. I thank her team for their work and their briefing, from which I have benefited over many months rather than just for this debate. They are now working much more on the inequalities highlighted by most speakers today. In the Public Services Committee, we looked at what Covid revealed about our public services. It was absolutely clear that virtually none of them had understood the depth of the inequalities in how they responded to different racial and ethnic groups in our society.

We still have not got hold of what we need to do there. As the Minister knows, I have been anxious about this in terms of our preparation and trials of vaccines and how far they include ethnic minorities, because there are different genetic and cultural needs. Unless the workforce is sensitive and knowledgeable about that—practitioners must be enabled to be aware of it through their education and training, so that they can be sensitive to it when they are working with women from different cultural or ethnic backgrounds from their own—inequalities will be virtually inevitable. The Government have not been significantly sensitive to that in their approach, and that really concerns me.

Others have mentioned the stark reports from Embrace UK, which talk about not just the numbers but the effect on the women of their experiences. Others have talked about the numbers so I will keep my bit short, but, in looking at the care of black and white women whose babies have died, Embrace UK says:

“In around 1 in 2 baby deaths, the care assessed was poor. If care had been better it may have prevented the baby from dying … For around 3 in 5 mothers, care after their baby died was assessed as poor. If it had been better, it may have meant bereaved mothers were likely to have been better supported in their physical and emotional health”.


For both white women and black women—I will leave Asian mothers to the noble Baroness, Lady Gohir, as I am sure she will speak about them—the report assessed their care as good in only around one in five of the deaths reviewed. This is about basic care, not necessarily medical knowledge. Honestly, I am ashamed that we cannot do better and support our workforce so that it does better. Those disparities are huge.

On attitudes, another charity, Five X More, identified that the use of offensive and racially discriminatory language and being dismissive of their concerns was too often the experience of black, Asian and minority-ethnic women. Significantly, there was also a poor understanding of the anatomy and physiology of black women and of the clinical presentation of conditions in babies of black women. Then there were the racially based assumptions about the pain tolerance, education levels and relational status of black women. These are all issues in the basic care and attitudes experienced.

Most shockingly, mental ill health is the most common complication of pregnancy in the UK. At least one in five women experiences a mental health problem during pregnancy and after birth, and suicide is the leading cause of maternal death in the post-natal period. Again, this is honestly shocking. We need to be able to intervene much more appropriately. Midwives are ideally placed to ask sensitively about mental health in their routine contacts with women, but too often that simply does not happen.

Again, I come back to the fact that this is the time in women’s lives when they will have the most interactions with healthcare professionals, so it is the time to make sure that mental health becomes a normal way of working with women when they present to healthcare professionals—I do not see pregnancy as an illness—in whatever sense. Attention to mental health must be part of how they are handled.

I am really trying to say that there are lots of things that we know the Government must do. They need to get on and do them rather than continually doing reviews. Here I disagree with some other speakers; we need to get on and improve the services in the way that so many of us have been told they need improving.

National Health Service: Key Targets

Baroness Armstrong of Hill Top Excerpts

Tuesday 16th January 2024 Lords Chamber

[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.

Cancer Research UK Report

Baroness Armstrong of Hill Top Excerpts

Tuesday 5th December 2023 Lords Chamber

[Baroness Armstrong of Hill Top (Lab)]

My Lords, the problem that the Minister faces is that things may well be getting worse. Because of the extensive waiting lists, one major cancer centre in London is saying that the number of people referred to the cancer pathway has rocketed, because of a large number of people on other waiting lists. Among those that it is now seeing for the cancer pathway, only 2% actually end up having cancer. At one level we can celebrate that, but we know that it is not because the numbers with cancer are reducing. People are being referred into the pathway because it is the only way that they will be seen at the moment.

[Lord Markham (Con)]

No, I do not believe that is why people are being referred; it is to give them peace of mind. People know their own bodies and, if they are concerned about having cancer, they know that we want to put their minds at risk. I am familiar with that statistic. I had heard that 95% of people who go to these referrals, thankfully, do not end up with cancer but, boy, do they have peace of mind since we are able to give them that assurance.

Emergency Healthcare (Public Services Committee Report)

Baroness Armstrong of Hill Top Excerpts

Thursday 20th July 2023 Grand Committee

Moved by

[Baroness Armstrong of Hill Top]

That the Grand Committee takes note of the Report from the Public Services Committee Emergency healthcare: a national emergency (2nd Report, HL Paper 130).

[Baroness Armstrong of Hill Top (Lab)]

I thank the noble Baroness for being here to chair this debate; I know that this is an area in which she, too, has a strong interest. I apologise to her and to other members of the Committee, in that more people who were members of the Public Services Committee at the time of the report are not here. There is a rail strike today, which indicates that the House needs to look again at hybrid proceedings when there are events such as this at the end of the week that make it really difficult for Members from outside London to be here. If we want free speech and free expression, we should do whatever we can to enable as many people as possible to participate.

It seems a long time ago since we did this report. It is not that long, but I am now involved with others who are here in another Select Committee, which is looking at integration of primary and community services in the health service. All of that is relevant to today’s debate, but I will not go down that route today.

The Public Services Committee began this inquiry last September. It was the end of the summer, when things are supposed to be easy in the NHS, and everything was going wrong. The reports of what was happening were just horrendous, and the committee wanted to look in a more holistic way at might happen. Inevitably, NHS organisation, reorganisation and turmoil took precedence, but we did look at some of the work of services such as the fire service and police service. Both said that how they could help effectively needed to be clarified, and that they should not be expected to do mainstream health jobs. We had some fascinating discussions with fire service operatives, and some good examples were given from around the country—for example, the Hull district fire service providing a full service—but they need their terms of reference, which the Government are considering, to clarify what they can and cannot do. I hope the Government will take account of that. Of course, the police have now largely said that they will not do mental health crises emergency call-outs, which is raising all sorts of questions among community health services about what will replace that intervention.

As I say, we wanted to look at things holistically, but that ended up being quite challenging, and I know that the Government find that difficult, so I will concentrate mainly on the NHS. We looked at all the obvious things and the barriers people face when they seek to access A&E. One is ambulance response times, which I will say a little bit about later. Ambulance response times were longer than we had known before. The average in June 2023 was just under 37 minutes; this is a significant improvement on last year, but it is still twice what the standard should be. There has clearly been progress, but it is not good enough. Worryingly, this year, the figure in June was higher than in April and May. I am sure that the Government are thinking about that—they need to.

In June 2023, 108,000 people waited 12 hours or more in A&E; that is 8% of people going to A&E. That is better than last year, when it was more than 120,000, but it is substantially worse than the years leading up to that. In 2021, the number was just over 60,000; in July 2020, it was less than 10,000. I will say something more about the 12-hour wait later.

We became convinced as we did the report that patient flow was in fact the key issue. If you look at the demand side in GP services, in May, just under 18% waited for two weeks for their GP appointments. In mental health services, there is still a real problem, with too many people ending up in A&E needing constant attention, with no beds available. Users of community mental health services felt that they had not been able to see community services sufficiently in the last 12 months, and almost one third said that they had not seen mental health services often enough.

I will now turn to public health funding. We all know the problem: in too many areas of the country—including the north-east, the area I used to represent down the corridor—funding of public health services has been so significantly reduced that many local authorities feel that they are not fulfilling their potential. It has been cut by 26% in real terms since 2015-16.

There are real challenges in elective treatment. I could give many examples of people who are looking to be in hospital but, because their case is not an emergency, their treatment has been delayed or cancelled. I suspect that members of the committee have very real, live examples of that, as have I in my own family. It means that people turn up in emergency services because they cannot access other services.

We also outlined lots of supply challenges. The biggest, I suspect, are the discharge challenges. Far too many patients remain stuck in hospital longer than necessary, not getting discharged even if they are ready to be. The Government have announced a range of things, including a recovery plan for A&E generally in January this year. The NAO tells us that it is still too early to know whether that discharge plan is effective; it will be towards the end of year before we know that.

Social care is in the midst of this but, tragically, the long-awaited workforce plan—I have given the Minister a hard time before about how long we have waited for it—does not mention or deal with social care. A social care organisation, which I accept is a lobbying organisation, reported last week that there were fewer employees in social care last year than before. We should be increasing their numbers and the work they can do alongside the NHS in improving discharge and stopping people ending up in hospital.

We highlighted that the number of acute beds in hospitals has more than halved over the last 30 years. The Government now recognise that they need to increase bed numbers by 5,000, but this is still a huge challenge. We do not yet know how it will happen and, therefore, whether it will.

There are real accountability and governance challenges. There is also a lack of central vision. This is crucial. The Government do not seem to have a plan, other than to say, “We’ve now got the new ICBs and they will sort it for us”. None of the evidence we heard convinced us of that. ICBs must do their job, but they need to know what the expectations are and what they will be held to account for nationally. Our committee argued that this lack of vision meant that what a good emergency service looks like and what its major components would be was unclear.

We heard different stories about and from ICBs. The interim deputy chief executive of NHS Providers said that many people saw the solutions lying with ambulance care, but that sits outside ICBs at the moment. You need to be able to pull all the levers to have an effective outcome. We got a real feeling of risk aversion—A&E services refusing to accept patients from ambulances due to the number of patients in A&E, and care homes and schools calling for ambulances when they were not needed. There was a real mishmash of people’s expectations and how they were being responded to. There was very much a risk-aversion approach, such as 111 services escalating calls to ambulances when alternative care would have been more appropriate. Risk aversion is also an issue for NHS hospitals putting people back into the community, for obvious reasons.

So there is an opportunity to take that more systemic view through ICBs. However, this lack of clarity about the power of ICBs to make services take action means that it is still unclear who the person responsible for identifying an issue will be; also, ambulance services will work with and report to multiple ICBs, which therefore presents them with another huge challenge. The NHS gave us a fairly confused picture, but again, I do not really have time to go into that, because I want now to turn to the workforce.

There are serious shortages in emergency healthcare and ambulance care, and in other sections of the infrastructure which supports and enables good emergency access. I welcome the fact that the Government have now published the workforce plan, which addresses some of the issues we raised in our report. However, there is further still to go, and the Government need to focus on implementing the plan alongside social care.

Turing to the positives, on transparency, I would like the Minister to tell us how far the Government have got on the 12-hour wait. As he knows, we picked up that there was no real honesty with the public about the 12-hour wait, and the Government promised to rectify that and make clear exactly how long people were waiting. I wonder where that has got to now. There are important opportunities for collaboration and there is some really good practice, but how will the Government make sure that that is extended?

I thank everybody who worked on the report. The committee staff—Tom Burke, Claire Coast-Smith, Aimal Fatima Nadeem, Sam Kenny and Suzanne Mason—all made very important contributions and supported us enormously.

This is a life-threatening issue. We heard some terrible stories, and we need to know that we are going into this winter with more hope and preparedness, so that the public do not have to go through what they went through last year and we can assure them of a better service from the National Health Service and the Government.

--- Later in debate ---

[Baroness Armstrong of Hill Top (Lab)]

My Lords, I thank everyone who has been involved today. There are lots of issues that have come up, but I hope that the Minister understands that we saw this as a national emergency. I do not meet anyone now, who, if they begin to talk to you about the health service, does not talk about this as a crisis—being able to see their GP, or getting access to any professional care and reassurance. I could now go into a whole raft of things which he has not mentioned about what we did on “frequent flyers” 15 years ago, and with the group that is the most prevalent: homeless people. We had very clear ways forward, which have all gone.

So, there are issues and lessons in the past. However, the thing the Minister did not address, which I hope he will think about, is whether the Government and Ministers are thinking about what we mean by good emergency care. What should it look like? What should the public therefore expect, and what should the health service—the ICBs, or whatever the structure—be responding to in terms of what good emergency care should look like?

There are huge issues here. This is essentially about the ability of the public sector in its largest window to respond to people’s concerns about whether they will get care when they need it, at the time they need it, and where they need it.

On that basis, I am grateful to everyone for their contribution and I beg to move.

Motion agreed.

Urgent and Emergency Care Recovery Plan

Baroness Armstrong of Hill Top Excerpts

Thursday 2nd February 2023 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend and agree that the GP service is the backbone. As per the earlier comments, a lot of the issues and challenges we have with A&E are because people are not getting their appointments in the GP space, and fundamental to that is having enough doctors. I did not quite recognise the figures. I am aware of an increase of over 2,000 GPs since 2019. That is not to say that that is enough, and so, again, the workforce plan will be key to making sure that we are building for that long-term future. However, we are also looking to retain them. We had a very good debate in the House about pensions and what we need to do in that space, and we will make sure that everything we do—including, I hope, the primary care plan—will show that primary care is key to the solution.

[Baroness Armstrong of Hill Top (Lab)]

My Lords, I am sure the Minister has taken note of the House of Lords Public Services Committee report on emergency access to healthcare, which came out two weeks ago. Many of its recommendations have been taken up by the Government. I thank the Minister in particular for the one on the 12-hour waiting list. We found out to our shock that that was not honest, as the witness said to us when they came to talk about it. I am pleased that the Government have done something about it. Our previous report was on workforce, and I urge him to read that too. Any report or plan is worth the paper it is written on only if it will and can be delivered. We were promised the outline of the workforce plan last September—we have had nothing yet.

Can the Minister help me on what I see as a major problem this week? As he has said today, a major part of the plan is increasing capacity. As others have said, you need the staff to do that. However, the Government, having said on Monday this week that increased capacity was really important as part of the emergency plan, wrote on Wednesday to Lincolnshire ICT to say, “You have a deficit. In order to deal with that deficit, you must cut beds”. What are people there to think when on one day the Government say, “We will sort emergency access by increasing capacity and beds” for one thing, and then two days later say, “Oh, you have a deficit—cut the beds”?

[Lord Markham (Con)]

I thank the noble Baroness for her question and her recognition of the 12 hours. In all these spaces, data is always the way that you give a backdrop to better services, and 12 hours is part of that. As regards capacity, I totally agree that we need more of it. I was surprised by what she said—I will find out some more about it. However, the absolute direction is a recognition that, with Covid and flu, what might have been the right number of beds a couple of years ago is not today. That is why we are committed to the 5,000 extra beds and, just as importantly—potentially more so—the 50,000 in virtual wards, because that is using technology to look at how we can expand supply, and absolutely critical to that is having the workforce.

NHS Winter Pressures

Baroness Armstrong of Hill Top Excerpts

Tuesday 10th January 2023 Lords Chamber

[Lord Markham (Con)]

First, I declare an interest in this space. As many noble Lords will know, I set up a Covid testing company which never did any business towards the Government; I am very pleased to say that it served only the private sector. I am disposing of it as part of my obligations as a Minister. As the question relates to testing, I am quite keen to put that on the record.

Secondly, I would say “absolutely”. Dare I say it, but the reason my company was so successful is that we set the very highest standards according to the regulators. That is why we were able to win the crème de la crème—the Formula 1s and Wimbledons of the world. I cannot speak for other companies which may not be taking that high level of support, but there is absolutely a role for the regulator to make sure that only effective tests are marketed and those which are not effective should not.

[Baroness Armstrong of Hill Top (Lab)]

My Lords, I wonder whether the Minister—I hate to say this—will recognise that, too often, it feels that the Government have no institutional memory, have no ability to learn from what has happened in the past and keep trying to reinvent the wheel while the wheels are spinning away long before they get anywhere near. The King’s Fund recently published a report on how the last Labour Government brought down waiting lists. That report shows that you do not just have to shout about it; you have to put in place all the different steps, including the right financial flow.

From all that has been said today, it is clear that the right flow is to encourage more people into social care work and encourage and enable them to do more serious, high-level work like urine testing. The Government have not even begun to think about this. Until financial support for the whole flow and the financial incentives to change the things the Government need to change are there, and that is understood by Ministers, we will not get it. It is not enough to say, “We’re putting another £15 million or £50 million into this, that or the other”, without making sure that you know how it is going to be spent and that people are going to be there to deliver it.

[Lord Markham (Con)]

I have said before in this Chamber —and I will say it again—that we should be learning all lessons. I like to think that, three months into my role, I am learning some of those lessons. The noble Baroness will see that we have taken some backwards steps on the use of the independent sector, which, again, was pioneered 15 or 20 years ago, but hopefully we will move forward again. I unashamedly say that we can learn from those things. I have spoken to some colleagues from the noble Baroness’s side of the House, and will continue to, because I will adopt anything that works, and I agree that payment by results is one of those things. We can speak after these questions; my door is definitely open on those matters.

Draft Mental Health Bill

Baroness Armstrong of Hill Top Excerpts

Tuesday 28th June 2022 Lords Chamber

[Lord Kamall (Con)]

I start by paying tribute to all the work the noble Baroness has done in this area, and for educating me more on this issue when I was a relatively new Minister. All I can say at this stage is that patients who have a co-occurring mental illness as well as a learning disability or autism may well be detained under the Act, but we want to make sure that there is support in the community. This is one of the big debates we have seen on a number of issues—for example, on social care. How much of social care will be in homes and how much will be in the community? Does technology improve that? Does constant online communications technology, sensors and the ability to speak to somebody online almost immediately change that equation? A lot of that will be discussed as we debate the Bill and by the experts who, we hope, will be on the pre-legislative scrutiny committee.

[Baroness Armstrong of Hill Top (Lab)]

My Lords, I chair the Public Services Committee and we are currently concluding a report on workforce in the public sector. I hope the Minister will be able to read it and think about it over the recess to make sure that he takes account of it. In my work with women with complex needs, particularly those who have been groomed, it is absolutely clear that their sexual exploitation has led to significant trauma. The NHS will never be able to be the first body they interact with, or able to train enough people in the next 10 years to look after the wide range of people who we know now need mental health care. That means the Bill must link to the work of the voluntary sector and how we address trauma in people first approaching a public service, or any service. I am concerned that the Government think they can do it just by training more people, which will take a long time. They need to be working in a pathway that starts at a very different level.

[Lord Kamall (Con)]

I could not agree more with the noble Baroness. One thing we must be well aware of is that, although there are pressures and we are asked for more funding, the Government alone cannot do all this. Sometimes officials, be they from local or national government or from another state organisation, are mistrusted by vulnerable people. Local civil society groups, voluntary organisations and, often, those who have suffered the same problems themselves and then been inspired to set up their own organisation to support others—who can empathise with the situation many of these poor women are in—are sometimes the best first point of contact. As the Government spend more on this, we must make sure that we are not squeezing out the voluntary sector or local civil society, but working in partnership with them.

NHS: Gambling Treatment Services

Baroness Armstrong of Hill Top Excerpts

Monday 28th March 2022 Lords Chamber

[Lord Kamall (Con)]

I am very happy to take two questions at once; I will even take three, if noble Lords want, and try to answer them.

The important point that a number of noble Lords are making is that many want to see a polluter pays principle. In economics, this goes back to negative externalities, where you attack things that are considered bad. Some people call them bad; others call them negative externalities. However, when you say that the polluter should pay, who is that? People sometimes say that it should be users but, if you do that, users will end up paying more. Others say that it should be the industry, but will the industry then pass on those costs to users and put those people into even more distress? This is why we want to look at this issue in a joined-up way. Yes, it is about the gambling industry, and this may well be the option we land on, but we want to make sure that we tackle the issue in a completely holistic way.

[Baroness Armstrong of Hill Top (Lab)]

My Lords, I welcome the Government saying that there needs to be a range of treatment and not just the hard-end clinics. I declare my interest, as in the register, having recently become a trustee of GambleAware; I did that because I want those people who are scared of going for treatment and frightened of the stigma to be able to access early intervention, which means much more work for the voluntary sector. Can the Minister commit to the Department of Health ensuring that the pathway is very clear and will involve early intervention, particularly for women, so that they do not have to end up in heavy-end treatment?

[Lord Kamall (Con)]

The noble Baroness makes a very important point: people must be treated as individuals—they will have come to addiction from different pathways. We have been engaging with the Department for Digital, Culture, Media and Sport on a number of issues. Additionally, the Office for Health Improvement and Disparities regularly engages with NHS England working-level counterparts, including recently on the establishment of a joint task and finish group on integrating the gambling treatment pathway. Referring directly to the question asked by the noble Baroness, there is no one simple pathway into gambling, and there is a stigma. By putting it at the forefront of some NHS services, we are showing that we are taking it seriously, and that it is not just an affliction but an addiction. We recognise that we must do more to tackle that.

Health and Care Bill

Baroness Armstrong of Hill Top Excerpts

Lords Hansard - Part 1 & Report stage
Tuesday 1st March 2022 Lords Chamber

[Lord Shipley (LD)]

My Lords—

[Baroness Armstrong of Hill Top (Lab)]

My Lords, I apologise; when there are so many amendments in one group I can never work out just when people who are moving subsequent ones further down the line, as it were, ought to rise.

I will speak to Amendments 63, 65 and 67, and begin with an apology that I was not able to be here to speak to those in Committee. I too had a positive test, although I have to say that I had no symptoms. None the less, I was self-isolating, and therefore was not able to be present in the Chamber.

I welcome the amendments tabled by the Government. I chair the Public Services Committee in this House. In our first report, we looked at public services through the mirror of Covid. We noted and reported, and indeed debated in this Chamber, the significant uncovering or rediscovery of the extent to which inequalities in our society affect people’s health. I am pleased that the Government are responding with some of their own amendments.