Health: RSV Immunisation

Baroness Bennett of Manor Castle Excerpts

Wednesday 17th January 2024 Lords Chamber

[Lord Markham (Con)]

As I say, we are looking to have an infant programme. It is vital in the first few weeks for babies, which is why we are doing this whole plan, thanks to the pressure and the medical evidence. I echo what has been said about the relentless campaign for it all by the noble Baroness, Lady Ritchie. We have got a tender in place. The intention is that we will be rolling it out from the autumn. I repeat that there is only one other public vaccination programme on this so far, in Galicia in Spain, so we really are at the forefront of this programme.

[Baroness Bennett of Manor Castle (GP)]

My Lords, as I discussed with the Minister last year, we have already had approval for private use of RSV for over-60s, so anyone who has up to £200 available has been able to get that RSV vaccination. That is for over-60s. We are talking about a public scheme for over-75s. Is data being collected on the effectiveness and overall health impacts on people who are having the vaccine privately, which might inform whether we should have a broader public programme?

[Lord Markham (Con)]

The JCVI process is similar to the NICE approach. They look through the quality-adjusted years framework and make sure that it reaches within that. That is how they came up with their calculations. So far it is only the older ones, 75-plus, that they think are enough of an at-risk group in terms of hospitalisations and mortality to justify that. But I will inquire further and get back to the noble Baroness I am sure that they are capturing the data so that we can check on the younger ages.

NHS Winter Update

Baroness Bennett of Manor Castle Excerpts

Thursday 11th January 2024 Lords Chamber

[Lord Markham (Con)]

I happily agree that we are investing record sums. The latest figures show that we are investing around about 11% of GDP in the National Health Service. I believe the figure in 2010 was somewhere in the 7% to 8% range—I am speaking from memory and so I will correct that if it is not quite right, but that is the sort of massive expansion we have seen. If I take one area as an example, the cancer workforce has trebled since 2010.

What we are seeing more than ever is a record level of investment in the health service but also a record level of demand. I was hoping to show in the Statement how we are looking to tackle that. I will freely admit the challenges, and that it is early days, but I believe we are showing signs of getting on top of it. As I have said many times, I really think that technology will be its future, and there will be lots more we can talk about when we show the profound changes it is going to make.

[Baroness Bennett of Manor Castle (GP)]

My Lords, one in seven UK-trained doctors has left the country to practise overseas. That is some 18,000 doctors, a figure which is up 50% since 2008. Last year, the General Medical Council did a survey of doctors departing the UK to practise overseas, and one of the key factors identified was that doctors were leaving to work in a place where they felt supported by the state and the employer. Does the Minister believe that the Statement—the Government’s general position—is sending a message to doctors that they are supported and cared for, and truly valued, by the UK Government, given that if we look at the financial valuation, junior doctors’ salaries are down 24% in real terms since 2009?

This is obviously an issue of money, but it is also an issue of attitude. Have the Government got their attitude to the junior doctors terribly wrong?

[Lord Markham (Con)]

I agree with the sentiment expressed by the noble Baroness. Clearly, we want to make sure that we minimise any loss to the profession. Retention is key. The long-term workforce plan was all about trying to put a long-term footing in place, one which looked at not just the recruitment of doctors but their retention, which, as I say, is key.

Money is an element of that, clearly. As I say, I have not heard or seen anyone suggesting that we should be paying the 35% increase. I do not think that is a reasonable approach; I have not heard any noble Lords come forward and say that. The correct attitude of the noble Baroness is key as well. We need to make sure that we get that right and I like to think that we are trying to do that. The Secretary of State has been very positive in terms of trying to do that as well. I absolutely agree that, at the end of the day, this is a key workforce and its members need to feel that they are key, rewarded and motivated by what they are doing. That is key to any profession.

Strikes (Minimum Service Levels: NHS Ambulance Services and the NHS Patient Transport Service) Regulations 2023

Baroness Bennett of Manor Castle Excerpts

Wednesday 6th December 2023 Lords Chamber

Moved by

[Baroness Bennett of Manor Castle]

As an amendment to the motion in the name of Lord Markham, to leave out all the words after “that” and to insert “this House declines to approve the draft Strikes (Minimum Service Levels: NHS Ambulance Services and the NHS Patient Transport Service) Regulations 2023 because they expose trade unions to liability of up to £1 million, make trade unions act as enforcement agents on behalf of employers and His Majesty's Government, and will add strain to industrial relationships when the National Health Service needs to protect them.”

[Baroness Bennett of Manor Castle (GP)]

My Lords, in speaking after the noble Baroness, Lady Merron, I must respectfully disagree with and indeed correct her on one point. I do not now accept that your Lordships’ House does not have the responsibility, in exceptional circumstances that I have set out before, to act to stop statutory instruments that should not go through. However, your Lordships will be pleased to know that I will not rehearse all the arguments I referenced in my earlier speech.

I also correct the noble Baroness on her suggestion that there has to be a Labour Government to protect the rights of working people. We have to get rid of the Conservative Government, but other options are available. The see-saw of politics that we have had for the past century has not served this country well, and its people are increasingly aware of that fact.

I am aware of the desire to move quickly to a vote, so I will be brief, but I will pick up a point from the Minister. Again, it is important in this debate to reference the briefing from the Royal College of Nursing, which stresses that the regulations seek to make trade unions responsible for breaking their own strikes. As the Royal College of Nursing makes clear, the Government had claimed this is not about nurses, but there are nurses working for the services that we are now talking about. It seems so long ago that we were all standing on doorsteps clapping, cheering and banging pots for our nurses and other medical workers who were putting their lives on the line. Look where we are now.

The RCN briefing also makes the important point, as the Joint Committee on Human Rights noted, that the minimum service level requirements may impact more severely on certain protected groups—most obviously women in respect of nursing. This is a gendered attack on the freedom of members of the RCN. As the RCN says, and as others have said before, this whole approach makes strikes more likely, not less likely.

In a recent survey of RCN members, 83% of nursing staff said that the staffing levels on their most recent shift were not sufficient to meet the needs of patients safely and effectively. I, and I think all medical workers, strongly believe in minimum service levels. We need to have them every day, and the Government have not created a situation in which that is possible.

For the avoidance of doubt—we want to move on to other votes—I am not planning to divide the House on this but, in the meantime, to allow the debate, I beg to move.

[Lord Allan of Hallam (LD)]

My Lords, it is good that this instrument applies only to ambulance trusts in England. That is the last time I will use the word “good” in association with this statutory instrument, but it certainly reflects a lot of feedback, particularly by the noble and learned Lord, Lord Thomas of Cwmgiedd, and others, that we had during the debate on the primary legislation, when we felt we had to remind the Government that the health service is devolved and that it was inappropriate to seek to interfere too far. It was interesting to hear the Minister say that the Government have made an offer of assistance to the Governments in Wales and Scotland in respect of giving them these wonderful minimum service levels. I would love to be a fly on the wall for those conversations, which I am sure are very short.

I turn to the substance of the requirements. The people running local health services are like watchmakers looking after very complex mechanisms with many different moving parts. From time to time, we work with those professionals on health and care legislation that provides tools for them to tune and improve their services. What is before us today is not such an instrument but rather reflects that the Government have decided unilaterally to give local health authority managers a hammer, because that is what the Government think they need. Yet the feedback we have had from all those who work in the National Health Service, as cited by the noble Baroness, Lady Merron, is that they clearly believe that this is the wrong tool for the job. Given that feedback, it seems quite likely that many trusts will choose not to use the powers to issue work notices. If that is the case, perhaps little harm will ultimately have been done other than wasting parliamentary time on creating the law and the regulations.

But there is a worrying scenario, which we explored during the legislative process, that was not sufficiently addressed—where trusts that do not want to issue work notices nevertheless feel compelled to use them for legal reasons. I would like the Minister to come back to this today and provide some more compelling assurances. If an ambulance trust, after the passing of these regulations, wishes not to use this mechanism but instead to negotiate voluntary agreements, as the Minister said that he would like them to do, will it truly be free to make that choice? If politicians want to urge trusts to use the hammer of work notices that they have given them, that is one thing. They can deal with the political pressure. But if, by declining to use these notices, they will expose themselves to new legal risks, that is much more problematic. Trusts may then feel that they have to use the hammer, even where they believe it will cause more damage, because they cannot risk being sued for not doing so. Can the Minister give a clear guarantee that his department has looked into this thoroughly and determined that trusts will continue to be able to use their best judgment on what will cause least harm to the communities they serve?

Where a trust has exercised its judgment not to issue work notices and things go wrong, as inevitably may happen from time to time, for a variety of reasons, we need to know that the trust will not face action either from the department or from any other third party. Absent that assurance, the safe option may be to issue the work notices, for the trust to take the hammer to the watch, whether or not it thinks it is a good idea. This is the crucial point. If we are to believe the Minister’s reassuring words, that this will still create the scope for trusts to negotiate voluntary agreements and they will not have to issue these work notices, we need to know that the department has looked at this and can give us that kind of copper-bottomed guarantee, rather than simply saying it will not be a problem.

--- Later in debate ---

[Lord Markham (Con)]

I thank noble Lords. In keeping with other comments, I will be brief in my response. We genuinely see a situation where, as the noble Baroness, Lady Bennett, said, we all agree that we want minimum service levels every day. As the noble Lord, Lord Collins, said in the previous debate, no one is against minimum service levels. All we are talking about here are the tactics to how we achieve that. I also totally agree with the point made by the noble Baroness, Lady Merron, that using the language of conciliation has to be the right approach in disputes. However, all these SIs are designed to do is to provide that safety net. To address the point of the noble Lord, Lord Rooker, there have been other circumstances where there was a genuine concern that strikes would not enable those minimum service levels to be fulfilled. That is what we are talking about today.

In response to the point made by the noble Lord, Lord Allan, I agree that it will be up to the ambulance’s trust, or the other trust when we come to other parts, to use its best judgment on how to achieve those minimum service levels. It is at management level, but it is then our job as the Government to hold them to account. Clearly, if during these strike actions the trust was not achieving minimum service levels, and there were certain standards which put patient safety at risk, in those circumstances I would be expected, as would any Minister, to ask the relevant trust why that was the case and perhaps to reconsider, because its judgment call did not bear fruit on that occasion. This is all about trying to give the trust part of the toolkit to ensure what we all want, which is minimum service levels. We are not compelling it; we are giving it the choice to do it. We hope that it is never needed but we believe it is an important part of the toolkit.

[Baroness Bennett of Manor Castle (GP)]

My Lords, I note that no Tory Back-Benchers are speaking in favour of the Government in this part of the debate. I note also the comments made by the noble Lord, Lord Rooker, who came at it in a different way to how I did. The House is again and again butting against the question “If not now, when?” We have the power to act. Not acting is as much of a choice as acting is. I am sorry to disappoint the noble Lord, Lord Rooker, but I am aware of the time and the pressure to move on to more votes, so I beg leave to withdraw the amendment.

Baroness Bennett of Manor Castle’s amendment to the Motion withdrawn.

Ultra-processed Food

Baroness Bennett of Manor Castle Excerpts

Thursday 26th October 2023 Lords Chamber

Asked by

[Baroness Bennett of Manor Castle]

To ask His Majesty’s Government what is their assessment of the impact on public health of ultra processed food; and what steps if any they will take to reduce the amount of ultra processed food consumed.

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

Observed associations between ultra-processed food and health are concerning, but it is unclear whether these foods are inherently unhealthy due to processing or their nutritional content. A diet high in processed food is often high in calories, salt, saturated fat and sugar, which are associated with an increased risk of obesity and chronic diseases. This continues to be the basis of our dietary guidelines and policies to tackle obesity and poor diets.

[Baroness Bennett of Manor Castle (GP)]

I thank the Minister for his Answer, which reflects what he said yesterday in our debate, that the House did not agree on whether processed food per se is bad for you. Common sense has long suggested that food that, to quote the Washington Post, is

“refined, pounded, heated, melted, shaped, extruded and packed with additives”

is bad for you. These dreadful food-like substances do not just contain a terrible balance of nutrients; there is also a problem with the process. The science increasingly demonstrates that. Yesterday I referred to a study based on the French NutriNet-Santé study by Chantal Julia et al; I supplied the Minister with the link. Will he commit to asking the department to look closely at that study, which demonstrates that nutritional quality and ultra-processing are correlated but distinct issues in diet? Will the department provide a substantive response to the study?

[Lord Markham (Con)]

Obviously, I am always happy to look at all the research because this is a vital area. This is the fifth time we have discussed it in the last three and a half months, so I apologise for any repetition. We are ever vigilant on this area but, as the contributors to yesterday’s debate showed, the research is mixed. The key things to get behind are the bad features of ultra-processed foods that are high in sugar, salt and saturated fat.

Children’s Health: Ultra-processed Foods

Baroness Bennett of Manor Castle Excerpts

Wednesday 25th October 2023 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, I thank the noble Baroness, Lady Jenkin, for securing this short debate and for her excellent introduction. Since very soon after I came into your Lordships’ House, I have been working on a project: to get a Minister to say “ultra-processed foods”. I have hope that we may see that project delivered today, as that is the subject of the whole debate.

I have thrown out a large amount of what I was going to say, because I want to directly respond to the noble Lord, Lord Krebs, for whom I have the greatest respect. However, I entirely disagree with a large part of what the noble Lord said. We know that there are significant problems with the peer-reviewed research process. We know this from what happened with big tobacco and pesticide companies. We have a huge problem with commercial interests in the research process. If you look behind where most of the attempts to challenge and question the NOVA classification system comes from, you do not have to look very far to find commercial interests.

As one of example of that, just last month in London the Science Media Centre hosted an event questioning whether there was any problem with ultra-processed foods and if they are all absolutely fine. The Guardian looked into this and discovered that three of the five participants on the panel had either received financial support from UPF manufacturers or hold key positions in organisations funded by them. They include companies such as Nestlé, Coca-Cola, Pepsi and Unilever.

I point the noble Lord, Lord Krebs, to a specific recent study. The noble Lord suggested that we were talking about either the nutritional content or whether food was ultra-processed. This is a study that covers both areas. The study is by Julia et al in the European Journal of Nutrition. It is based on the French NutriNet-Santé cohort study, so it is an observational study. The conclusions say that

“nutritional quality and ultra-processing should be considered as two correlated but distinct and complementary dimensions of the diet”.

So, yes, the amount of fat, lack of micronutrients and nutritional quality is a problem, but ultra-processing is a problem too. This is a very solid 2023 study demonstrating that.

Very briefly, I want to focus on young children, as the noble Baroness, Lady Jenkin, has pointed us to. We have a huge problem with the diet of young children in the UK. That is now demonstrably obvious in all the health dimensions, whether obesity or height. We are not giving children the chance to develop in the way they should.

I will pick out one deeply shocking figure. Think about the size of child between a year and a half and three years old—quite small. Some 65% of one and a half to three year-olds in the UK drink, on average, one adult-sized can of soft drink a day. One of the things that has not been focused on enough is that, as has been said, this is nutritionally attractive and, arguably, addictive—the paper is strong on that. But you are filling a child up with empty calories or, if the drink is low calorie, with no calories at all, and there is no space for the child to eat the vegetables and fruit that they should.

As others have said—I was going to major on this more—look at all the products in supermarkets directed at children, with cartoon characters all over them, and with messages about health directed at the adults. We are profoundly misleading parents about what their children should be eating—by “we” I mean the multi- national food companies, which are making massive profits from making our children ill.

[Lord Evans of Rainow (Con)]

My Lords, I ask noble Lords to keep note of the four-minute speaking time, please. We still have to hear from the Front Benches and the Minister.

Domestic Violence and Brain Injury

Baroness Bennett of Manor Castle Excerpts

Monday 23rd October 2023 Lords Chamber

[Lord Markham (Con)]

The noble Baroness makes a very good point; it is often the hidden side of domestic violence. The problem is that there is not much information on this, but a US study shows that as many as between 30% and 74% of women who suffered domestic violence had suffered from traumatic brain injury. It is about making people aware that this is not an edge case; this is something that unfortunately is all too familiar. As the noble Baroness mentions, every strand of society needs to be aware of this and to act on it.

[Baroness Bennett of Manor Castle (GP)]

My Lords, the Minister reflected that many victims of intimate partner abuse sometimes do not report until weeks, months or years later. Will the Minister ensure that there are services available that recognise this medical issue when they may not present primarily as a medical case, making sure that all the support that is available to victims of domestic violence is aware of this issue? In responding to the noble Lord, Lord Hunt, the Minister said that we will wait for the research. I think there is already clearly enough evidence in what we have heard today, and the fact that 3% of dementia in the community is attributed to traumatic brain injury. We need to act now, not wait for research.

[Lord Markham (Con)]

It is a good point, and there are already some very good examples, such as in Cambridge, where the ICB has a single front door to make sure that all facilities, whether it is neurologists, psychologists, physios or speech therapists, are there and available. The noble Baroness is correct: there are lessons we can learn and roll out straight away, and we are looking to do that.

Adult Social Care (Adult Social Care Committee Report)

Baroness Bennett of Manor Castle Excerpts

Monday 16th October 2023 Lords Chamber

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a great pleasure to follow the noble Baroness, Lady Finlay. Her phrase about services that empower is an excellent one which I may well adopt.

Like everyone else, I wish to thank the noble Baroness, Lady Andrews, and her committee for this brilliant report and for her compassionate, caring instruction. The focus on co-production with experts by experience is a crucial phrase. Given the lack of representativeness of your Lordships’ House, that should really be adopted by all your Lordships’ committees—particularly given that, the way politics is heading, it seems that the nature of this House is unlikely to change anytime soon. Our society is increasingly coming to recognise the importance of those experts by experience.

I would like to pick up the point made by the noble Baroness, Lady Andrews, by reflecting on the disappointment that the Government have essentially rejected all the recommendations of this report. If not now, when? The noble Baroness, Lady Fraser, said that we do not seem to be turning the dial, which was a similar reflection; she also noted that neither of the two largest parties’ leaders spoke about social care at their party conferences.

I am going to put a challenge to all the Front-Benchers who will be speaking shortly. I am well aware that they are not able to make up a social care policy on the Floor of the House, but I am going to challenge them to make a commitment that they will take into the election a social care policy that they plan to take forward—because surely this is so clearly desperately needed. As the noble Baroness, Lady Andrews, said, the delay in debating this report has not made it one iota less relevant because we have not made any meaningful progress.

In the interests of living up to what I am asking others to do, I am very happy to set out the framework of the Green Party’s social care policy that we will be taking into the next general election. It is free social care for all adults who need it in England. That policy was decided democratically at our conference in 2021, led by members who were affected by the need for social care—more experts by experience. This calls for all social care support and independent living services to be free at the point of use and fully publicly funded.

The guideline for this comes from—I ask any Front-Bench spokespeople who might like to respond if they acknowledge these standards—the UN Convention on the Rights of Persons with Disabilities. That should set the standards of what is available. The Green Party says that this should be

“accountable to local democratic bodies with a secure national framework of laws, guidance and funding … the services should be designed and delivered locally and co-productively, involving disabled adults, councils, the NHS, carers and unions”.

With that, I will raise a point that is implicitly referred to in the report, but developments have happened since it came out. Skills for Care, the workforce planning body for the sector, has noted that an estimated 70,000 people took up care jobs in England after arriving in the year to March 2023. That was after visa changes, and there were a further 30,000 to 40,000 people arriving between April and August. Despite that fact, the vacancy rate in the adult social care sector is still nearly 10%.

The noble Baroness, Lady Fraser, referred to difficulties in Scotland. I would point to the fact that Scotland, despite having about 8% of the UK population, took up only about 2.5% of those care visas. That reflects the fact that both Scotland and Northern Ireland have slightly raised the rate of pay already. Scotland is planning next April to raise the rate of pay to £12 per hour. In Scotland, carers are also employed by the local authority, unlike in England where authorities are forced to take legal responsibility for a market in care. Would the Minister acknowledge that the market as a model of providing care is one of our underlying structural problems?

National Health Service: Major Conditions Strategy

Baroness Bennett of Manor Castle Excerpts

Monday 18th September 2023 Lords Chamber

[Lord Markham (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.

[Baroness Bennett of Manor Castle (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?

MMR Vaccine

Baroness Bennett of Manor Castle Excerpts

Thursday 20th July 2023 Lords Chamber

[Lord Markham (Con)]

As mentioned, there are outreach programmes, particularly for home-schooled children or children who are not there. There are also programmes in community centres, with the idea of trying to pick them up in as many places as possible. Obviously, there is concern about certain communities that are harder to reach than others. That is particularly the case in London, as I mentioned earlier. That is where we are trying to specifically target those community centres with outreach work.

[Baroness Bennett of Manor Castle (GP)]

My Lords, in April the UK Health Security Agency’s director of public health told the Health and Social Care Committee in the other place that the workload for delivering vaccines now falls disproportionately on general practices—particularly after the 2012 NHS reforms—and that this is one of the weaknesses we are trying to put back together.

In that context, the Minister may be aware of the issue around the quality and outcomes framework payment to GPs. GP practices in deprived areas are missing out on payments for delivering vaccines that could help them deliver more vaccines because it is extremely difficult for them to register the patients whom they have tried to contact multiple times when those patients do not respond. So, the GPs are missing out on payments they need to be able to reach those difficult-to-reach patients.

[Lord Markham (Con)]

I am sorry, I am not quite sure what the question was there. Clearly, we need to make sure that the system is working in terms of making sure that the payments are there so the doctors can follow up. If the noble Baroness would like to follow up with me, so that I can fully understand it, I will get her a response.

Emergency Healthcare (Public Services Committee Report)

Baroness Bennett of Manor Castle Excerpts

Thursday 20th July 2023 Grand Committee

[Baroness Bennett of Manor Castle (GP)]

My Lords, it is a pleasure to follow the noble Baroness, Lady Morris of Yardley, and to join others in thanking the noble Baroness, Lady Armstrong of Hill Top, for this report. I share the reflection that it is a great pity that there is no capacity for people to participate remotely, particularly given that there is a speakers’ list here, so it would be very easy, logistically, to facilitate. This debate does not have the potential difficulties of when there is no speakers’ list. I also join in with the comments about how long it has taken us to get a debate on this.

As others have said, the report came at a point of absolute crisis in emergency services, but there is no real evidence that the crisis has in any way abated. I did not originally plan to, but I will speak from a different perspective that might at first be surprising: the environmental impact of emergency care. The context is that yesterday, my office launched a policy briefing entitled, Eco-directed and Sustainable Prescribing of Pharmaceuticals in the United Kingdom. It was written by my interns, Julze Alejandre and Emily Stevenson, working with Paul-Enguerrand Fady. I acknowledge the financial support of the British Society for Antimicrobial Chemotherapy for that work.

I must admit that, in thinking about the report and the environmental impact of pharmaceuticals and medical devices, I have mostly thought about chronic conditions and treatment in the community and the great deal of discussion about the alternatives of using social and green prescribing—issues that do not apply to emergency care. However, I was absolutely inspired at the launch event yesterday by one of the attendees, a critical care consultant from a foundation trust in the north of England. They said, “Each day, I consider the environmental impact of the treatments that I give my patients in the ICU”. The doctor set out that that meant three steps, or principles: first, choosing the most environmentally friendly route for medical care, which means acknowledging that intravenously administering drugs requires more plastic packaging; secondly, minimising the amount of PPE used by opening only the PPE that is needed; and thirdly, demedicalising by trying to shorten the length of hospital stays where possible, which means less PPE and generally lower consumption of resources in hospital. The consultant told us that these environmental considerations are included in the doctors’ notes and discussed by the healthcare team during the patient handover.

That approach addresses something that we are starting to get some attention and focus on: the fact that, in England, 4% of our total greenhouse gas emissions come from the healthcare sector. There is the impact of plastics, which is increasingly acknowledged, and the pharmaceuticals going into the water supply.

Another of yesterday’s inspiring speakers was Sharon Pfleger from the One Health Breakthrough Partnership in Scotland, a partnership of the NHS Highland, the University of Highlands and Islands, the Environmental Research Institute and the University of Nottingham, which has a £100,000 UKRI Medical Research Council grant. This picks up the point that the noble Baroness, Lady Morris, made about joining up all the issues and all the healthcare bodies, as well as those not immediately related to healthcare, that collectively make up part of our healthcare system. We cannot afford to think, “Here’s the NHS that does healthcare, and everybody else does other things”. This applies in the case of the environment as well as in other things. Looking at the overall aims of the One Health Breakthrough Partnership, I see that it

“seeks to facilitate new knowledge sharing across organisational boundaries, raise awareness of the environmental impact of medicines, and develop novel and robust solutions to complex sustainability issues”.

That joined-up, complexity-systems thinking is an example of what we need to do.

I was reminded of an interview I did recently on LBC. We had been talking for some time about what might be described as the social determinants of health, and how environment helps determine people’s health and whether they will need the emergency care that is now so stretched—meaning everything from mouldy, cold homes to air pollution and all those other issues—when the presenter said to me, “I realised that I invited you on to talk about environmental problems, but you are talking about social problems too. They are all interrelated”. I thought, “Bingo! We have just had a moment of understanding”.

The point I really wanted to make is that, when we talk about healthcare and environment, emergency medicine probably looks like the most distant part—the part where it is hardest to think about the environmental impact. You have an emergency situation in front of you and you have to care for this patient. I think, however, that I have just shared with the Committee a really inspiring example of where individual leadership is really showing a way of operating differently. This is what we need to encourage and evolve. Consultants are, perhaps, seen to have the power to do something like that on their own ward; we need to empower people right across the healthcare system and more broadly to take the steps needed.

To pick up the point made by the noble Baroness, Lady Morris, there are so many good pilots. One of the great institutional problems in the UK is that we have funding for pilots, systems for funding new ideas and people who really clearly see the problem, and who can maybe make a difference in their local trust in their local area, but it does not get rolled out further.

We are the most centralised polity in Europe. Power and resources are concentrated in Westminster and Whitehall. We need to move to a system where the power and resources are held vastly more locally to create circumstances that work for local conditions.