Mental Health: Weight and Shape-related Bullying

Baroness Blackwood of North Oxford Excerpts

Monday 22nd July 2019 Lords Chamber

[Baroness Bull]

To ask Her Majesty’s Government what assessment they have made of the impact of weight- and shape-related bullying, criticism and teasing on long-term mental health.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, bullying in all its forms can have a serious effect on mental health. Children who are exposed to frequent, persistent bullying are at a higher risk of developing mental health problems; exposure to bullying is also associated with elevated rates of anxiety, depression, self-harm and suicidal thoughts, which can last into adulthood. The Government are providing more than £2.8 million of funding up to 2020 to support schools in tackling bullying.

[Baroness Bull (CB)]

My Lords, weight-related teasing is a form of weight bias, the consequences of which can include depression, anxiety, low self-esteem, substance abuse, eating disorders, obesity and suicidality. Weight bias is on the increase and is prevalent across the population. Research shows that even health professionals are not immune to negative stereotypes that connect character and capability with weight. Is the Minister confident that adequate social policies are in place to address and reduce the incidence of weight bias? Does she believe that there is sufficient provision in the law to protect all of us, young and old, from discrimination on the basis of size and shape?

[Baroness Blackwood of North Oxford]

The noble Baroness has a record of raising this important issue. The Government recognise that poor body image is not only a common problem but is associated with mental ill health. Approximately 70% of adolescent girls and 45% of adolescent boys want to change their body, weight or shape. As she rightly points out, in the most extreme cases, that can lead to eating disorders, depression or even feeling suicidal. The Government have delivered a broad programme of body image work over the past six years. We believe that more work can be done but we are working hard to make sure that we expand our eating disorder community care work for children and young people over the next few years. I welcome continuing the debate to see what more can be done.

[Baroness Wheeler (Lab)]

My Lords, the latest Barnardo’s report, Overcoming Poverty of Hope, showed that 69% of young people,

“feel they will have worse ‘overall happiness and mental health’ compared to their parents’ generation”,

with one young person saying that social media is “massive for mental health” because of the,

“unrealistically high expectations of body image and lifestyles”.

On top of that, the report found that,

“young people with additional life challenges, such as young carers and care leavers are more susceptible to the negative impacts of social media as they are more likely to experience social isolation”.

What are the Government doing to work with mental health charities, such as YoungMinds, and young carers to address this situation?

[Baroness Blackwood of North Oxford]

The noble Baroness is right that children exposed to persistent bullying risk experiencing these problems. This is related to the experience of face-to-face bullying, but exposure on social media can also cause the problem. That is why the Department for Education is providing over £2.8 million of funding between September 2016 and 2020 to four anti-bullying organisations—Internet Matters, the Diana Award, Anti-Bullying Alliance and the Anne Frank Trust—to support schools to tackle bullying. Of course, all schools must have in place an anti-bullying policy, which Ofsted regulates.

[Baroness Chisholm of Owlpen (Con)]

My Lords, we have already heard from noble Lords how important this problem is, but of course it is partly the responsibility of the Department of Health. I ask my noble friend whether we are also talking cross-departmentally. Surely schools have a role to play here, so are teachers being taught about the problems this can bring? Is DCMS being taught about online bullying, et cetera?

[Baroness Blackwood of North Oxford]

My noble friend is quite right. As I have already pointed out, DfE-funded anti-bullying work is ongoing. Work is also increasing to join up the provision for young people through the children and young people Green Paper, which will put in place early intervention provision to make sure that young people do not have to wait until they are ill before they can get support. This problem needs to be challenged right across government, which is why we have also brought in the online harms White Paper to make sure that social media companies play their part.

[Lord Laming (CB)]

My Lords, does the Minister agree that in recent years there has been a marked reduction in mental health counselling services for young people? Can the Minister tell us anything encouraging about the redevelopment of specialist mental health services for young people?

[Baroness Blackwood of North Oxford]

The noble Lord is absolutely right that we must make sure we invest in the services needed to respond to the increasing reports of mental ill heath in young people. That is why we have focused on increasing mental health funding. I am pleased to report that the amount spent on mental health will be £12 billion in the next year and that all CCGs will meet the mental health investment standard. We are also investing in particular in suicide prevention over the next three years—£25 million to support local suicide prevention plans to make sure that local authorities are able to have a multiagency suicide prevention response, which I think the noble Lord will agree is extremely important.

[The Lord Bishop of Ely]

My Lords, the Children’s Society has done quite a bit of research into the profile of those involved in bullying. Many have had very unhappy lives. Does the Minister agree that it would be a good idea, in policy formation, if we spent more time talking to the children themselves and getting their case put more fully before us? The Children’s Society advocates that the Government systematically measure children’s well-being and use this to inform policy-making. Does the Minister accept the potential merits of measuring children’s well-being?

[Baroness Blackwood of North Oxford]

As usual, the right reverend Prelate raises an important point. The fundamental principle of using lived experience to develop policy is an important principle within the Department of Health and across government. Most particularly, the experience of young people—those who are bullied and those who are bullying—should be taken into account. This is the only way we will get to the bottom of this problem and stamp it out once and for all.

[Baroness Brinton (LD)]

My Lords, as the co-chair of the APPG on Bullying, I have seen the reports that other noble Lords have referred to. It is good that more investment is going into mental health in the NHS, but schools still need front-line support for many bullied children. Over half of children report that bullying about their size and body image is the leading cause. What can the Government do to ensure that there really is access to front-line services for children in school?

[Baroness Blackwood of North Oxford]

As I have said, we are making sure that we bring the investment into the front line with this £2.8 million. In addition to that, all schools are legally required to have behaviour policies with measures to prevent all forms of bullying. They have the freedom to develop their own anti-bullying strategies to make sure that they are appropriate to their environment, but they are held to account by Ofsted. This is at the forefront of the Department for Education’s guidance to schools on how to prevent and respond to bullying as part of their overall behaviour policy.

National Health Service: Healthcare Advice

Baroness Blackwood of North Oxford Excerpts

Tuesday 16th July 2019 Lords Chamber

[Lord Patel]

To ask Her Majesty's Government what analysis they have conducted of the impact of the National Health Service introducing the use of devices such as Amazon’s Alexa for health care advice.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, digital technology will play a key role in making the NHS sustainable. The Secretary of State’s technology vision sets the foundation for a new generation of digital services focused on user need, privacy and security, interoperability and inclusion. The collaboration with Amazon simply connects people to medical information and is already freely available through the NHS website. This service does not provide advice or any form of diagnosis. More modes to access medically verified NHS information can only give UK citizens a better understanding of different medical conditions. The agreement with Amazon is convenient for those who rely on voice-activated technology, in particular blind and visually impaired people.

[Lord Patel (CB)]

My Lords, I thank the Minister for her response and might I say it was a good defence? While I have absolute confidence that Matthew Gould—our previous ambassador to Israel who leads on the project—will get it right, voice-recognition technology has its problems. It must recognise the correct phrase, word and accent. It might be interesting to hear the answers that the Opposition Chief Whip were to get if he asked a question with his accent. I asked five questions at the weekend; all health-related. One I repeated twice and got two different pieces of advice: one was to call 999 and the other was to go to bed and rest.

I know that it is not a diagnostic technology, but it runs the risk of a diagnosis being made, so the key questions are what trials are being carried out, what data protection do we have against Amazon collecting vast amounts of data, and what is the risk of misdiagnosis?

[Baroness Blackwood of North Oxford]

The noble Lord makes very important points. It is important to understand that this is not a technology to offer advice or diagnosis. NHS Digital and NHSX have built an interface to connect the NHS website so that other organisations can make NHS information available on their own sites. That is so that a greater number of people can access NHS information. It has already been made available through a number of other examples such as NHS Go, which is designed to inform young people, accuRx and eConsult. No health data is collected by Amazon. No money is exchanged via this route and all data protection laws, such as GDPR and the NHS data protection rules, still apply. Data protection is still required to protect data through this system.

[Baroness Thornton (Lab)]

My Lords, it is exciting to contemplate the new world of communication technology and how it might help in all kinds of ways, but the noble Lord, Lord Patel, has raised some important points. The NHS-Alexa partnership has to be seen in the context of Amazon’s ambitions for our wider healthcare industry. I seek assurance. I am sure that at the moment the data is being protected, but I want to know what will happen in the future. If Amazon collects yet more data on patients raising medical concerns, what use might be made of that in the future?

I do not know how other noble Lords are getting on with their Alexa in the corner of the sitting room, but ours regularly joins in with conversations and tells us very bad jokes. My granddaughter thinks it is wonderful because she knows what noise a unicorn makes, so I am not sure, as the noble Lord said, how that plays if one is trying to have a serious discussion about a medical condition.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for that. I would be interested to know what jokes she has heard from Alexa in her family conversations. However, patients look on well-known search engines for medical advice and at the moment they may receive advice from all sorts of untested sources. NHS.uk is clinically based advice which has been approved by NHS England. The purpose of making that advice more available through the Open API, which is available through the developer system, is to ensure that that clinically based advice is more widely available and more readily searchable for patients. A reasonable point has been raised which is to ensure that the right advice reaches patients and that patients go through the right triage system, whether it is 111 or another system, but that is the intention of the programme. It will be carefully monitored and managed by NHSX, NHS England and the department.

[Lord Fox (LD)]

My Lords, there is a wider principle here. Even if effective, anonymised data is gathered and generated, where does the value lie in that data? Can the Minister tell us whether the Government have discussed and agreed with Amazon where the value lies and who gathers that value? On the overall principle, can the Minister tell us that when this data generates value, it is the NHS that benefits and not the private sector?

[Baroness Blackwood of North Oxford]

Amazon is not sharing any of the information that it gathers from third parties. It is not selling products or making product recommendations based on health information, nor is it building a health profile on patients. It has strict technical and operational safeguards in place so that Amazon employees will not have direct access to information that can identify any person or account. As I have already said, it does not have access to any health data based on this contract. No health data is being shared between the NHS and Amazon. Just yesterday we launched some new data-sharing principles which are designed to improved clarity around health data-sharing between the NHS and private companies so that we can improve public and clinician confidence on this issue.

[Baroness McIntosh of Hudnall (Lab)]

The Minister has just given a very eloquent explanation of her view of the relationship with Amazon, but does she agree that it is a bit counterintuitive to assume that a company as big and commercially successful as Amazon is not getting some value from the relationship with the NHS? Can she explain what that value is?

[Baroness Blackwood of North Oxford]

Amazon is seeking to ensure that it provides a service to its customers. In this instance, we have ensured that we have provided an open API: any company that chooses to develop a service linking to the information on the NHS website is able to do so. This is not an exclusive contract with Amazon. As I have already said, other companies are able to do so and some already have done. It is not a specific benefit for Amazon. It is something that other companies have already availed themselves of and is of benefit to the NHS and NHS patients.

NHS: Automation

Baroness Blackwood of North Oxford Excerpts

Monday 15th July 2019 Lords Chamber

[Baroness Seccombe]

To ask Her Majesty’s Government what steps they are taking to increase the use of automation in the National Health Service.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the Topol review, published earlier this year, outlines recommendations for preparing the health and care workforce, through education and training, to adopt new technologies such as artificial intelligence and robotics. It is clear that the use of AI will not replace clinical staff but instead allow them to be more human. The use of new technologies will ensure that patients receive safer, more productive, more effective and more personalised care. The recommendations of the Topol review have informed the interim NHS people plan, which sets out how we prepare the workforce to build an NHS that is fit for the future.

[Baroness Seccombe (Con)]

My Lords, the success of any organisation is dependent on the people within it. I believe that the most precious asset that the NHS has is its human resource of dedicated staff, but in these days of sophisticated IT, and now artificial intelligence, can my noble friend tell the House what developments can be safely and securely harnessed by the NHS?

[Baroness Blackwood of North Oxford]

Tremendous innovations are being introduced, including in robotics and AI-based automation, particularly in diagnostics, which have the potential to transform how healthcare is delivered in the NHS, but the role of automation to carry out basic administrative and repetitive functions, and of robotics in surgical operations in particular, is due to increase over the next decade. The main purpose of this automation in health is not to replace staff with machines or to reduce the role played by humans in providing care but, rather, to enable staff to spend more time delivering personalised care. But it is also to improve the productivity of health services and systems so that we can ensure that the NHS becomes more sustainable in future.

[Baroness Thornton (Lab)]

My Lords, the noble Baroness, Lady Seccombe, made a valid point about the need for human beings to be involved in the delivery of healthcare, but the use of AI and other technology is also very exciting, as is the fact that it features so largely in the long-term plan. Are the experiments in automation taking place across the country, where are they taking place, when will we see the results and who is delivering automated healthcare and AI? Is it the NHS or are private contractors being commissioned to do this work? I accept that the Minister may not be able to answer all those questions in detail, but if she cannot, I would appreciate a letter being placed in the Library.

[Baroness Blackwood of North Oxford]

The noble Baroness is absolutely right: this is a very exciting area of ongoing work and a key part of the grand challenges which we put in place as part of the life sciences strategy, part of which is the AI and early diagnosis initiative, which aims to transform the prevention, early diagnosis and treatment of chronic diseases. NHSX’s work across government is to deliver that mission, creating an ecosystem of safe and effective development of AI and the regulatory infrastructure so patients and clinicians can be reassured that where it is introduced, it will be safe. There will be lots of research and development of those innovations. We are at an early stage of implementing them, but there are five centres of excellence across the country. I will be very happy to place a letter in the Library updating the House on progress with the AI mission and these exciting developments.

[Baroness Brinton (LD)]

My Lords, while the delivery of automation and AI has much to commend it to the NHS, CyberMDX reported last week that anaesthetic machines can be hacked and controlled from afar, including silencing alarms that would alert anaesthetists to danger. Four months ago in Israel, a cybersecurity firm demonstrated that computer virus malware could add tumours to images of scans. What protections, such as digital signatures and encryption, does the NHS now put in place, following the malware alarm two years ago, to ensure that automation and digital services cannot be attacked by malevolent forces?

[Baroness Blackwood of North Oxford]

The noble Baroness is correct to say that patients and clinicians have a right to expect their data to be held securely. Since the WannaCry attack in May 2017, we have taken steps to ensure that NHS security measures are of the highest standard. This includes £60 million to improve cyber resilience in local infrastructure, support for NHS organisations to update their Windows operating systems, procuring a new cybersecurity operations centre, and boosting the national capability to prevent, detect and respond to cyberattacks. We are also committed to achieving much greater operational visibility across all NHS digital systems. This is one of the ways in which we can respond to attacks. Lastly, we expect the highest ethical standards from all data-driven systems and that is why we have introduced the code of conduct for data-driven health and care technology. That is how we will ensure that we have some of the best AI and data-driven technologies.

[Viscount Ridley (Con)]

My Lords, does my noble friend agree with one of the key points made by Professor Topol that one of the benefits of artificial intelligence is the “gift of time”, as he has put it? In other words, patients can spend more time with their doctor if certain more routine things are automated. Will my noble friend make sure that that is one of the key aims of bringing automation into healthcare?

[Baroness Blackwood of North Oxford]

My noble friend is right. One of the key recommendations is that by automating routine analyses such as radiology, diagnoses and pathology and routinely bringing in AI to sequence bed management, we will reduce the burden on clinicians so that they are able to see more patients. The review makes specific recommendations to help the workforce become more digital ready, which means increasing capacity and capability, and building the right environment. That is exactly what we have embedded into the NHS people plan and all that we are working on through NHSX.

[Lord Ravensdale (CB)]

My Lords, I declare my interests as set out in the register. Robotic process automation—RPA—is an emerging software technology that can undertake repetitive tasks in place of human workers. Many industries are seeing the benefits of using this technology and thus releasing people to do more value-added work. I believe that it has been used in a small number of NHS trusts. Can the Minister say whether there are any plans to deploy this technology more widely across the health service?

[Baroness Blackwood of North Oxford]

The noble Lord is right to say that technologies such as this offer the most potential to reduce repetitive work and transform how our healthcare is delivered. This is what we are focusing on to ensure that we can give health and care staff the ability to spend more time delivering personalised care in medicine while also ensuring that we improve systems to make them more efficient and productive.

Childhood Obesity

Baroness Blackwood of North Oxford Excerpts

Monday 15th July 2019 Lords Chamber

[Baroness Jenkin of Kennington]

To ask Her Majesty’s Government what action they are taking to combat childhood obesity.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, we are delivering a world-leading plan to tackle childhood obesity. Later this summer, we will set out further action through a prevention Green Paper. In addition, the Chief Medical Officer is reviewing what more can be done to help us meet our ambition of halving childhood obesity by 2030. The review, due to report in September, will consider the approaches taken internationally, regionally and across the country, and will make a series of recommendations.

[Baroness Jenkin of Kennington (Con)]

My noble friend will have seen coverage in the weekend’s press of food companies which are continuing to breach the government advice that a child should not be weaned until six months of age. They are also still failing to reformulate infant foods. For example, one portion of baby porridge contains 9.4 grams of sugar in a 24 gram portion. That of course leads to further childhood obesity, dental decay and addiction to sugar. Can my noble friend tell us what conversations and discussions the Government are having with food companies, in particular Heinz, Danone and Nestlé about reformulation and the age at which infants should be weaned?

[Baroness Blackwood of North Oxford]

My noble friend is a great champion on this subject and has been an expert in it for a long period. Through the prevention Green Paper, which is due to be published this summer, we are determined to look at a range of further options to tackle obesity. We have publicly committed to taking action on infant and baby food. She will know that we are making progress on the reformulation section of the obesity strategy. However, we have further to go, and I am grateful to her for her Question on this issue.

[Lord Bird (CB)]

Is it possible to consider something very clever? Rather than accepting that the poorest among us are the ones who deal with obesity, why do we not give them a Waitrose lunch and dinner and subsidise it, and stop having to pay further upline in the NHS? Why do we not start thinking globally rather than just a bit at a time?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his question; I hope that we can occasionally think cleverly in government. He is absolutely right that obesity is strongly correlated with socioeconomic deprivation, and that is why chapter 2 of our plan tries to target those areas that are most affected by delivering a childhood obesity trailblazer programme, working with local authorities to address this. They have been provided with £100,000 in the first instance to try to improve the impact of the childhood obesity plan. We shall see how that goes, but I am very happy to pass on his suggestion.

[Lord Dubs (Lab)]

My Lords, the Minister will no doubt be aware that the British-Irish Parliamentary Assembly some time ago produced a report on childhood obesity. Does the Minister agree, dipping into that report, that we need not only a national strategy but—as demonstrated to the committee in Amsterdam—a local strategy, where the local authority can take the initiative, and there can be education and pregnant mothers can be helped to see their way through their own diets and therefore to help their children? Does she agree that we need a local strategy as well, and can the Government initiate that with local authorities?

[Baroness Blackwood of North Oxford]

The noble Lord is quite right that the national plan must be implemented locally. Public Health England works with local authorities to do that and has set up a number of tools, such as the Change4Life plan, which includes food scanners that have been downloaded several million times to help parents and families make better food choices. We have more to do on this, and we very much welcome proposals to do it. I know that the Amsterdam model has been particularly effective; indeed, my noble friend raised this with the previous Public Health Minister, and I am sure she will continue to raise the issue.

[Lord Addington (LD)]

My Lords, does the Minister not agree that activity is an important part of tackling obesity? We have had some wonderful examples of sporting success in women’s football, cricket, netball and other activities at the moment. What are we going to do to make sure that these examples of sporting success are fed down to children and made available on free-to-air when possible?

[Baroness Blackwood of North Oxford]

We should all be incredibly proud of the sporting achievements over this weekend; we should not hesitate to do whatever we can to promote them throughout our schools and make the most of the moment. The noble Lord is absolutely right that regular physical activity has been linked not only to improved physical health but to improved mental health and academic achievement. That is why the Chief Medical Officer has recommended 60 minutes of physical activity every day. We know that only one in five achieve this; that is why the money from the sugar levy is going into schools activity. But we have more to do. We have announced the national plan and now need to implement that effectively, and I hope that the noble Lord will hold us up to the mark in delivering it.

[Baroness Bull (CB)]

My Lords, notwithstanding the importance of anti-obesity guidance in supporting the long-term health of the general population, is the Minister aware of the concerns of eating disorder specialists about its unintended consequences on those for whom “Eat less, exercise more” is not an appropriate message? Clinicians are reporting an increasing number of young people citing anti-obesity guidance to justify excessive behaviours in exercise and diet restriction. Does she agree that, while anti-obesity policy is vital, it needs to be sufficiently nuanced that it does not cause unintended collateral damage to these vulnerable groups?

[Baroness Blackwood of North Oxford]

The noble Baroness presents a sensitive and sophisticated point: the whole point of the obesity message is that children should be eating a healthy, balanced diet and exercising in an appropriate way.

[Earl Attlee (Con)]

My Lords, does the Minister agree that obesity will break the NHS model if we do not do something about it?

[Baroness Blackwood of North Oxford]

I absolutely agree with my noble friend. Obesity is a crisis that will not only create misery for those who will then experience increased risk of tooth decay and of diseases such as cancers, diabetes and other severe illnesses, but it will also create significant unsustainability within our health service, which we are able to prevent. Since we know the tools that we have to prevent it, we should all be working together to make sure we do.

[Baroness Thornton (Lab)]

My Lords, we know—and the noble Lord, Lord Bird, made this point—that it is the poorest children who are obese. This is largely because their parents buy food which is high in fat, sugar and salt, because it is cheaper than fresh food. It may or may not be from Waitrose, but the noble Lord makes an important point there. I have two questions for the Minister. First, is it true that two-thirds of the deadlines of the plans that have been put forward for the obesity strategy have been missed? Secondly, what is the Government’s strategy for dealing with summer hunger—those children who will not get proper meals during the summer break?

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right to raise inequalities. This is exactly why chapter 2 of our plan is focused on childhood obesity trailblazer programmes, where we have identified areas of highest deprivation to provide specific support to local authorities in those areas. We have also recognised this issue around school holidays: around 50,000 disadvantaged children will be offered free meals and activities over the upcoming summer holidays, funded by £9.1 million from the Department for Education. That follows a successful programme last summer, which saw improvement, with football play sessions and cooking classes for more than 18,000 children across the country. However, the noble Baroness is right to recognise that this is a real challenge that we need to address.

NHS Dentistry Services

Baroness Blackwood of North Oxford Excerpts

Thursday 11th July 2019 Lords Chamber

[Baroness Gardner of Parkes]

To ask Her Majesty’s Government what assessment they have made of the availability of National Health Service dentistry services.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, nationally, access to NHS dentistry remains high, with 22 million adults and 7 million children seen by a dentist in the 24 and 12-month periods ending 31 December 2018 respectively. However, we know that there are areas of difficulty and more work remains to be done. NHS England, in its role as commissioner, is responsible for commissioning NHS dental services to meet local need and is actively looking into dental access issues.

[Baroness Gardner of Parkes (Con)]

That is rather a disappointing Answer, although it certainly ties in with my experience: it was declared in Manchester that no children could have operations done under general anaesthetic because all slots were taken for the clearance of baby teeth. When I saw that, I wrote to the Mayor of Manchester, who has great experience in the field of health from when he was in the House of Commons. I did not even get an acknowledgement, so after a time I wrote again, saying that perhaps my letter never reached him so I was resending it, but to this day I still have not had an acknowledgement. The press reports get worse and worse about the shortage of these possibilities.

[Baroness Blackwood of North Oxford]

I am very sorry to hear of my noble friend’s experience with the Mayor of Manchester. Children’s oral health is now better than it has ever been, with more than 75% of five year-olds in England being decay-free, which we welcome. However, the number of children requiring tooth extraction remains a concern. It fell slightly between 2016 and 2017-18, which we welcome; however, we recognise that there is much more to do. That is why the NHS outcomes framework is working to ensure that we perform better, with much work being done to target improved oral health of young people, with the Starting Well core framework and Starting Well pilots in the 13 areas of greatest deprivation.

[Baroness Thornton (Lab)]

My Lords, in Portsmouth there are 20,000 patients without a dentist, due to the closure of three practices. In Cornwall, 22,000 people are on the waiting list, having to wait an average of 529 days before they get an NHS dentist. The noble Baroness is quite right that there are some serious problems to address here about access to NHS dentists. I should like to know exactly how those areas in desperate need, such as Portsmouth, will be tackled. Secondly, how many of the babies, children and young people included in those numbers currently have no dental care whatever?

[Baroness Blackwood of North Oxford]

As I said in my previous answer, children’s oral health is better than it has ever been. This is not to say that there is any complacency or acceptance of where we are. We recognise that while access has significantly improved, there are still areas where NHS England needs to do more to meet local need. NHS England is responsible for helping patients who cannot find a local dentist. Those in that situation should contact NHS England’s customer contact centre for assistance. Things that are being done to improve this include the introduction of new nationally flexible commissioning, which can help national commissioners commission a wider range of services from dental practices, and the testing of a new, reformed dental contract, which we think will make the profession more attractive for new dentists.

[Baroness Benjamin (LD)]

My Lords, patients’ dental fees in England have been increasing at an unprecedented rate. These charges are discouraging patients from seeking treatment; they are made to think twice before treatment. Delayed treatment means that they end up seeking free help for dental pain from their GPs and the local A&E, piling huge pressures on other parts of the NHS. Will the Government take urgent action and start proper investment in NHS dentistry to end these extortionate dental fee increases?

[Baroness Blackwood of North Oxford]

The noble Baroness raises an important point. Patient charges are an important contribution to the overall costs of the NHS, and they were driven by some really difficult financial circumstances in the NHS, but she is right that it is critical that no one be deterred from seeking care by the cost. As part of this year’s uplist, the Government and the department have committed to looking further at evidence as to whether patients are being adversely impacted so that this can be taken into account in next year’s—and any future—decisions.

[The Countess of Mar (CB)]

My Lords, the Care Quality Commission recently published a pretty damning report on dental care for people in residential care and nursing homes; most of these people do not have access to a dentist. What are the Government doing to ensure that people in residential or nursing home care get regular dental treatment?

[Baroness Blackwood of North Oxford]

My friend the noble Countess, Lady Mar, raises a vital area. Overall care for those in care homes, whether healthcare, mental health care or dental care, must be provided in a suitable manner. This is being considered in the social care Green Paper.

[Lord Tomlinson (Lab)]

My Lords, I declare an interest as a former chairman of the British Fluoridation Society. Does the Minister agree that prevention is much better than cure, and that you can prevent the need for dentists through a substantial increase in the use of fluoride in our water supplies? Is she satisfied with the progress being made on fluoridation of water? If not, what plans does she have to encourage it?

[Baroness Blackwood of North Oxford]

The noble Lord is quite right: prevention is always better than cure. That is why the programme for oral health improvement in both the NHS long-term plan and the dental contract being tested focuses on a more preventive approach to oral care. Water fluoridation is obviously a very effective way of improving oral health, particularly for children. According to the 2012 Act, it must be a local decision supported by Public Health England in the lead. We want to see more decisions. PHE’s guidance on delivering better oral health sets out clear expectations on this, but there are also other ways in which fluoride can get to children. One is through fluoride in toothpaste, which is now at effective concentrations; the other is that all dentists are expected to deliver fluoride to teeth directly, at clinically appropriate intervals, to all children in their care.

[Lord Clark of Windermere (Lab)]

Is it true that more than a million people were unable to get a dentist under the health service last year?

[Baroness Blackwood of North Oxford]

I do not have that figure in my briefing pack, but I am very happy to write to the noble Lord to confirm or deny whether that is the case.

Restaurants: Calorie Labelling

Baroness Blackwood of North Oxford Excerpts

Tuesday 9th July 2019 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, we welcome the ongoing commitment of Diabetes UK, including the Food Upfront campaign, which, together with its encouraging support for our proposals, makes a valuable contribution to improving the nation’s diets. The impact assessment published alongside our consultation last year estimates the number of businesses that will be affected under the various policy options considered. An updated impact assessment will be published when the Government publish the outcome of the consultation later this year.

[Baroness Thornton (Lab)]

I thank the noble Baroness for that Answer. It is a shame that the consultation, which ended in December, has yet to be published. Diabetes UK tells us that three out of four people want to see calorie information on restaurant, café and takeaway menus, and that nine out of 10 say that clearer food labelling will help them make healthier food choices. Diabetes UK is worried that the Government intend to limit compulsory calorie labelling to companies with 250 employees. If that is the case—I would like to know whether it is—only 520 businesses would be included out of the 168,000 eligible, rendering this meaningless. What are the Government doing in this regard and when will we see the results of the consultation?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her important question. She will know that we remain committed to delivering the actions we set out in chapter 2 of the childhood obesity plan, which included the consultation on calorie labelling in the out-of-home sector. We will publish it shortly. She will also know that our ability to introduce changes to the labelling system depends on EU legislation. We are committed to exploring whatever additional opportunities we can to have food labelling in the UK display world-leading, simple nutritional information, as well as information on origin and welfare standards. We will bring that forward as soon as possible.

[Baroness Walmsley (LD)]

My Lords, I was alarmed to read the Public Health England report about unacceptably high levels of sugar in baby foods, even some labelled as being healthy. What steps are the Government taking to ensure that such products give parents the information they need to make healthy choices for their children?

[Baroness Blackwood of North Oxford]

I know the noble Baroness has raised issues around baby food on several occasions. The reformulation programme taking place under the obesity plan takes account of sugar in a number of different products. So far, I do not think baby food has been one of these, but the Secretary of State has commissioned the CMO to urgently review what can be done to help the Government meet their ambition of halving childhood obesity by 2030. The report is due for publication by September and I will pass on the noble Baroness’s comments.

[Baroness Neville-Rolfe (Con)]

Does my noble friend agree that two other policies on obesity are not adequately focused on? The first is helping parents to teach self-control and good eating habits. The second is increasing physical activity—for example, through the daily mile and school sports. I was horrified to learn from the Diabetes UK briefing that only 18% of children in the UK reach the recommended target for physical activity so vital to lifetime health.

[Baroness Blackwood of North Oxford]

I thank my noble friend for her question; she is absolutely right that increasing physical activity is a key part of the childhood obesity plan. That is exactly why the revenue from the soft drinks industry levy is being invested in improving childhood health and well-being in this way, including doubling the primary PE and sport premium to £320 million a year. This has included a commitment to every school in the country including the daily mile, or something similar. We are particularly pleased about that, but we also believe that work needs to be done in supporting parents, and PHE is working on that.

[Lord Mackenzie of Framwellgate (Non-Afl)]

My Lords, parents carry some responsibility. What disturbs me—I would like to know whether the Minister agrees—is that I often see parents with young children who have a scooter. The child will stand on the scooter and the parent pushes the child all the way to school, so the child gets no exercise whatever. It seems to defeat the whole purpose. Are the Government doing anything to remedy this by means of advertising?

[Baroness Blackwood of North Oxford]

The noble Lord has asked a most innovative question, to which I do not have an immediate answer in my notes. I hazard a guess that scooters offer some balance benefits, but I shall get back to him on that.

[Baroness Young of Old Scone (Lab)]

Are the Government losing their grip on this issue? We were promised the Public Health England sugar reduction data in April, when it did not appear, and then “in late summer 2019”. Can the Minister tell us how late summer will be this year?

[Baroness Blackwood of North Oxford]

Based on the weather, I cannot really answer that, but I absolutely reject the premise that the Government are losing their grip on this issue. We have seen some real successes since the publication of the 2016 plan. The soft drinks levy has resulted in the equivalent of 45 million kilograms of sugar being taken out of soft drinks, which is a genuine success. Some products in the sugar reduction programme have exceeded their first-year targets: a 6% reduction in sugar in yoghurts has been achieved. As I mentioned, significant investments are being made in schools to promote physical activity and healthy eating. We accept, however, given the obesity crisis, that much more needs to be done and the noble Baroness will be glad to hear that the Secretary of State has, as I said, commissioned the CMO to urgently review and drive this agenda forward, which is exactly what we intend to do.

[Baroness Boycott (CB)]

My Lords, I urge the Government to follow up on the point of the noble Baroness, Lady Thornton, about how many of these places are small companies. When I ran the London Food Board, we did research in Tower Hamlets and I found one single takeaway where a portion of chips—a large one, admittedly—was 1,800 calories. That is completely insane, and parents and children do not know about it. I would be grateful to hear the Government’s view on how we might publicise that fact.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her point. As I said, we remain committed to exploring what additional opportunities leaving the EU presents for food labelling. At the moment, we have some world-leading simple nutritional information, but we want to work with the devolved nations and Administrations to explore the potential for common approaches. Obviously, the consultation on mandated calorie labelling has received a high level of interest—there were over 1,000 responses—and that is partly why we are in the process of going through that at the moment.

NHS Pensions: Taxation

Baroness Blackwood of North Oxford Excerpts

Tuesday 9th July 2019 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I beg leave to ask a Question of which I have given private notice.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, we will be consulting shortly on proposals to make NHS pensions more flexible for senior clinicians in response to evidence that shows that pension tax charges as a result of the tapered annual allowance are having a direct impact on retention and front-line service delivery. These proposals aim to maximise the contribution of our highly skilled workforce, who are crucial to delivering the NHS long- term plan.

[Baroness Finlay of Llandaff]

My Lords, I declare my interest as a past president of the BMA. Can the Government state exactly when the consultation will begin, how long it will run for, how it will be organised and when it will report? Do they recognise that, of 4,000 consultants recently surveyed, 60% said that they would retire at or before 60 years of age, and over half of those cite the sudden unexpected tax bills as a reason? This is particularly urgent because in August we have new graduates starting, who need additional supervision as they begin to get used to working in the clinical arena, yet we are already seeing consultants dropping sessions, which will adversely impact on clinical services. Doctors seem to have only two options now: to retire or to leave the NHS pension scheme, and until they can do that, they are financially penalised for working. One paediatric intensivist I was talking to said that he is £300-plus out of pocket by working a weekend.

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her important Question, which she has asked before. Retaining and maximising the contribution of our highly skilled clinical workforce is crucial to the delivery of patient care. We are preparing to provide pension flexibility that appropriately balances the benefit of new flexibilities with their affordability. We have listened, and we are discussing the issue with the Treasury. As a first proposal, the consultation will set out a potential 50:50 option, offering 50% pension accrual and halved contributions. The BMA requested this as an option earlier this year and has welcomed it as a step in the right direction. The consultation will be an opportunity to listen to a range of views and will be genuinely flexible and open; we will bring it forward as a matter of urgency. I hope that that is a reassuring answer for the noble Baroness.

[Baroness Thornton (Lab)]

The briefings that I have received from the BMA and other places say that the 50:50 solution may not prevent the problem. How many people will have to wait longer for their operations before the Minister’s colleagues, the Chief Secretary to the Treasury and the Secretary of State for Health and Social Care, concentrate on their day jobs—that is, getting together and talking about how to solve this problem instead of campaigning for whoever they are campaigning for to be the leader of her party? Surely their time could be better spent sorting this problem out.

[Baroness Blackwood of North Oxford]

The noble Baroness knows that I cannot answer for the Chief Secretary to the Treasury, although I know that this issue has been raised with the candidates as part of the leadership campaign and that they see it as a priority. As I said in my Answer to the noble Baroness, Lady Finlay, we recognise that the 50:50 flexibility option does not provide unlimited flexibility for clinicians to target their own personalised level of pension growth. Other options, such as additional pension accruals to purchase individual units alongside a pension, may be considered as part of the consultation. The message going out to the sector is that we want as much flexibility as possible to try to find the right solution to meet the complex needs of the system.

[Lord Naseby (Con)]

My Lords, is my noble friend aware that this issue was raised on the Floor of the House? I was one of those who contributed; I hastily declare an interest as a trustee of the Parliamentary Contributory Pension Fund. Against the background of what was raised some three weeks ago and the evidence that was already in the field, I do not blame any particular Minister, but is there not a pensions section in Her Majesty’s Treasury that must know what options are available to Her Majesty’s Government in coming to a decision that will ensure that the consultants affected will not be forced to retire when they reach 60? That evidence must be there by now; surely, we can have some fast decisions on this major issue.

[Baroness Blackwood of North Oxford]

I absolutely share my noble friend’s desire for a speedy response. He is right that the evidence has come forward and that the issue is affecting front-line services, which is why we are keen to bring the consultation forward as quickly as possible and resolve it. He is also right that those in the Treasury will have seen the evidence and it is right for them to consider it. It is important to understand that the consultation is about the implementation of tax policy, not changing it. That would be a separate question for the Treasury team.

[Baroness Jolly (LD)]

My Lords, the Nuffield Trust found that two-thirds of GPs are retiring early for tax reasons, and because of burnout, the level of extra training required and stress. The Secretary of State is reported as saying that this tax issue is the area that concerns him most about the GP workforce—and well he might worry. Given the Minister’s earlier reply to the noble Baroness, Lady Finlay, when will we see the figures on the decline in GP early retirement?

[Baroness Blackwood of North Oxford]

The noble Baroness is right that this is an important aspect of the recruitment and retention of GPs in particular, which is why we are bringing forward the consultation. As I said, we have been working closely with representative bodies, including the BMA and others. When we brought forward the five-year contract for general practice, announced in January, part of that was to provide greater certainty for GPs to plan ahead. Part of the work we have done is looking at other aspects that will ensure recruitment and retention. This includes, as we have discussed before, funding towards 20,000 extra staff working in practices, remaining committed to recruiting an extra 5,000 GPs and looking at targeted enhanced recruitment schemes, which include a £20,000 salary supplement to attract doctors into GP specialty training. The noble Baroness will understand that it takes a little time for these policy changes to be reflected in the data, but she can have no doubt that this is a policy area in respect of which the Government are absolutely determined.

[Lord Patel (CB)]

My Lords, there is currently a disparity in pension arrangements between clinical academics and NHS consultants. Can the Minister confirm that any discussions the Department of Health and the Treasury have will include the university sector? Otherwise, a disparity between pension arrangements will be created, which might affect the recruitment of clinical academics.

--- Later in debate ---

[Baroness Blackwood of North Oxford]

The noble Lord raises an important point. I am afraid I do not have the specific details about NHS clinicians and academics within the university sector. I will ask about this and write to him.

[Baroness Kramer (LD)]

My Lords, the BMA makes it clear that the Defence Medical Services are the most impacted group of medics. Will the Minister confirm that we are today sending medics out to battlefields such as Afghanistan, who work all hours to serve their wounded comrades and are having to call home to tell their families to take out a second mortgage to pay an unexpected £20,000 to £40,000 tax bill, which hits them because of the peculiar pension consequences? Will this be remedied immediately?

[Baroness Blackwood of North Oxford]

I can confirm that it has been made absolutely clear that NHS clinicians have been impacted by these reforms, and front-line care has been impacted. This is unacceptable and that is why we are bringing forward the review to find a solution as quickly as possible. The noble Baroness is right to raise the issue and we are determined to resolve it.

[Baroness Altmann (Con)]

My Lords, I am sure the Minister agrees that this was an unintended consequence of changes to the tax system. The reality is that the cliff edge of the taper is forcing consultants to pay tens of thousands of pounds for doing one small extra shift, sometimes voluntarily. Could she look at offering financial advice to each individual consultant who may be affected? They will not all face this tax charge, but they are all frightened that they might, so they are not undertaking the extra shifts we need them to undertake. Can she also note to her departmental colleagues that high-paid people potentially affected by the taper in other areas of the public sector received some assistance and mitigating measures from their departments, whereas it has been almost impossible for consultants to plan ahead? We are now seeing the problems occurring belatedly.

[Baroness Blackwood of North Oxford]

My noble friend speaks with particular expertise on this issue. As the whole House will appreciate, NHS consultants are often asked to take on additional shifts at short notice and they face peculiar challenges when calculating the consequences for their pensions. This is one of the reasons why the BMA has put up its calculator. However, the pension rules we are discussing today mean that some who take on extra work may find they have inadvertently incurred a substantial tax charge in moving into the taper. This is why we have brought in the consultation. It is obviously important that those facing pension charges should seek advice. NHS England is considering this issue closely at its most senior levels and working with the department to better understand the impact on clinicians, but also on NHS performance, and we are determined to resolve the situation to get it right.

National Health Service: Bullying

Baroness Blackwood of North Oxford Excerpts

Wednesday 3rd July 2019 Lords Chamber

[Lord Clark of Windermere]

To ask Her Majesty’s Government what assessment they have made of the level of bullying, harassment and abuse in the National Health Service in England.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, the NHS staff survey shows that the level of bullying, harassment and abuse in the NHS is too high, so we are tackling these issues through the national Social Partnership Forum’s collective call to action; the interim people plan, which, through its new offer for our people, will create a healthy, inclusive and compassionate culture where bullying, harassment and abuse will not be tolerated; and our alliance of healthcare organisations, which is promoting civility and respect throughout the NHS.

[Lord Clark of Windermere (Lab)]

I thank the Minister for her Answer. As she said, the latest survey shows that over 25% of NHS staff had personally experienced bullying from fellow employees in the previous 12 months. Does she agree that that is appalling and intolerable, and that in most other organisations it would simply not be tolerated? I accept that the problem is exacerbated by the chronic staff shortages, but bullying can be reduced by firm and proper management practices. That is within the Government’s power, so will they get on with the action of reducing the intolerable level of bullying in the NHS?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his question, which is a follow-up to a recent Question on this. This is exactly why the Government have brought out a manifesto commitment to tackle violence and abuse against staff, including legislation that has already brought forward one conviction. NHS Improvement and NHS England have reviewed what central support arrangements should be provided to support NHS organisations in their responsibility to protect staff from unacceptable violence and abuse. In addition, we are bringing forward a plan that will pilot and evaluate the use of body-worn cameras by paramedics, who experience the worst of the violence and abuse, so that we can ensure that they have evidence for prosecutions that is sadly often lacking for convictions where they are appropriate.

[Baroness Jolly (LD)]

My Lords, as we have heard, levels of abuse and bullying are unacceptably high in the NHS, and whistleblowing is not a universally trusted or successful route to resolution. The Scottish Parliament is investigating using the Scottish Public Services Ombudsman to investigate unresolved NHS whistleblowing cases. Does the Minister consider the use of the English Parliamentary and Health Service Ombudsman a sensible route for English NHS whistleblowers? If not, what would she recommend for frustrated NHS whistleblowers?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for that proposal; I shall certainly look into it. A number of measures have been put in place to enable a safe space for whistleblowers to come forward, including a number of regulations ensuring that they are protected and that non-disclosure agreements do not inhibit them from coming forward, but I will certainly consider her proposal.

[Lord Dobbs (Con)]

My Lords, does my noble friend accept that the rights that we all enjoy with the National Health Service also come with commensurate responsibilities: the responsibilities of patients not to abuse staff and to turn up to their appointments, and the responsibilities of staff to ensure that the National Health Service is being used honestly and responsibly? Does she agree that the BMA’s recent announcement that charging health tourists is “fundamentally racist” is not only bonkers but financially disgraceful, and deeply damaging to the people and the patients the National Health Service was set up to protect?

[Baroness Blackwood of North Oxford]

I certainly agree that charging those who come from other countries and use the National Health Service is perfectly sensible and appropriate, and by no means racist. I also believe that, as the call for action on bullying says, it should be perfectly straightforward to get out messages on safety from senior leaders and staff voices. It should be a positive message about how it is a natural extension of the social contract between the NHS and those who use it.

[Baroness Masham of Ilton (CB)]

My Lords, if a member of staff is being bullied by their senior, who should they go to for help?

[Baroness Blackwood of North Oxford]

The noble Baroness asks an important question. There are structures built into the NHS to enable those people to speak up. There is a “freedom to speak up” champion and a system of champions, so that it is perfectly clear to those experiencing bullying by senior managers who they can speak to.

[Lord Hunt of Kings Heath (Lab)]

Does what the Minister suggests apply to the actions of Ministers? She will recall, from when he was Secretary of State, Mr Jeremy Hunt’s practice of insisting on a weekly Monday morning meeting with the key national regulators, at which the sacking of chief executive officers was often discussed. Bullying starts at the top. If Ministers take a bullying attitude towards the NHS, they can hardly be surprised if that behaviour is followed at local level.

[Baroness Blackwood of North Oxford]

I am afraid I do not recognise the characterisation set out by the noble Lord. One of the key characteristics set out by the former Secretary of State in his leadership was that the NHS should be open and not have a culture of blame, and that people should feel free to speak up, so that when mistakes are made they should be corrected.

[Baroness Hussein-Ece (LD)]

My Lords, the NHS is the biggest employer of people from black and minority ethnic backgrounds. They face bullying and harassment from within—from co-workers—but also from members of the public and patients. There is considerable anecdotal evidence that some patients refuse to be treated by a clinician or a nurse from a minority ethnic background. What is being done to protect these workers and ensure that the NHS has a much more inclusive environment and culture?

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right. Bullying faced by those in the BAME community is more significant, and data supports that. That is why the NHS is implementing the workforce race equality standard, which is a requirement for NHS commissioners and healthcare providers—including independent organisations with an NHS contract —to track and ensure that employees from BAME backgrounds have equal access to career opportunities and receive fair treatment in the workplace, and to ensure that this is properly recorded and published. This will drive through the improvements she seeks.

Asthma

Baroness Blackwood of North Oxford Excerpts

Wednesday 3rd July 2019 Lords Chamber

[The Earl of Clancarty]

To ask Her Majesty's Government what support they are giving to people suffering from asthma, including on access to medicines.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, respiratory disease, including asthma, is a clinical priority in the NHS Long Term Plan, which aims to improve outcomes for patients through earlier diagnosis and increased access to treatments. Pharmacists in primary care networks will undertake medicine reviews for asthma patients. This will include education on inhaler use and uptake of dry powder and smart inhalers where clinically appropriate. Finally, the NHS will build on the RightCare programme to implement respiratory initiatives in 2019-20.

[The Earl of Clancarty (CB)]

My Lords, Asthma UK finds that, of the 2.3 million people with asthma in England who pay for their prescriptions, more than three-quarters struggle to afford them, let alone follow an essential treatment plan. Does the Minister agree that prescription charging sends out entirely the wrong signals to the whole community about the seriousness of the condition which causes the deaths of many young people? The great tragedy is that most of those deaths are avoidable. Should we not as a priority look again at the exemptions list?

[Baroness Blackwood of North Oxford]

I thank the noble Lord for his question. I have met with Asthma UK on this issue. As an asthmatic myself, I understand the challenges of keeping up with medication, especially when in the middle of an exacerbation. At the moment, we do not intend to review the prescription charges list. However, there are some exemptions in the prescription list, and we have committed to work with Asthma UK to ensure that those who are eligible for low-income exemptions and for the pre-payment charge are accessing them and to look at any other ways in which we can help those who need life-saving medication.

[Baroness Wheeler (Lab)]

My Lords, I am sure that the Minister will know about the recent shocking report from the BMA describing the UK health system as complacent about the risks of asthma. It comments on and documents some of the tragic deaths of young children who would still be alive if their chronic asthma had been properly cared for. It shows a sorry litany of absence of a proper asthma plan across primary and secondary care and failure to refer children suffering repeated attacks to a specialist respiratory team or to optimise medical management of the condition. Some clinicians and staff are unaware of national treatment guidelines, prescribing advice or recommendations from the national review of asthma deaths. What is the Government’s response to this? Why has only one of the NRAD recommendations been implemented since 2014? Why are the remaining 18 still to be acted on to try to stop these unnecessary and untimely deaths?

[Baroness Blackwood of North Oxford]

The noble Baroness will have heard in my opening remarks that we have put treating asthma and respiratory diseases as a key priority within the NHS Long Term Plan precisely because we recognise that we need to improve our performance on respiratory diseases. Working with Asthma UK, we have identified that one of the key challenges in improving performance has been the identification of those with severe asthma and providing them with an appropriate care plan. That is exactly why we are pleased that a new NICE quality standard, QOF and the RightCare programme are in place; these should help to improve referrals and outcomes for patients as is desperately needed.

[Baroness Manzoor (Con)]

My Lords, as the Government roll out the early diagnosis centres, including for lung-health checks, across the country, will they be looking to implement recommendation 1e of the lung task force as part of their strategy, so that air pollution is monitored and the NHS can provide advice when pollution levels are high?

[Baroness Blackwood of North Oxford]

I thank my noble friend. She is right that we need to improve our response to those at high risk of respiratory illness. That is partly why we are improving our offer on mobile lung-health screening, specifically as part of the national targeted lung health checks programme. It is also why we are offering smoking cessation advice and treatment as part of that service. We offer the general population and vulnerable groups advice via the daily air quality index, but she is right: we need to improve our monitoring of air pollution if we are to make progress on this issue. It is something that I will take up with the department.

[Lord Brooke of Alverthorpe (Lab)]

In view of the gravely damaging effect of asthma on children, does the Minister agree that the abolition by the former Mayor of London of the west London zone for congestion charging has increased the amount of air pollution in London over recent years? Many children have died and many people have suffered as a consequence. Will she ask the candidates for the Tory leadership whether they are prepared to reintroduce such a zone in London?

[Baroness Blackwood of North Oxford]

The noble Lord is asking me to step in and comment on matters that are slightly outside my brief. However, I am pleased that we have brought in the clean air strategy, which is a significant step forward. He is also asking me to commit the Mayor of London rather than leadership candidates to a policy area. We do need to move further and faster on air pollution; that is what I expect to see in the prevention Green Paper which will be published shortly.

[The Lord Bishop of Carlisle]

My Lords, given the recent report of an upsurge in acute asthma attacks among schoolchildren at the start of each school year, and given that—as we have already heard—there are three deaths per day from asthma in the UK, many of them preventable, what plans do Her Majesty’s Government have for encouraging better health education regarding the seriousness of this disease?

[Baroness Blackwood of North Oxford]

As ever, the right reverend Prelate is insightful on this matter. Children going into school with identified respiratory illnesses should have care plans to assist the school in caring for them. Asthma UK has indicated that many children are slipping through the net and remaining on long-term oral steroids in primary care. This results in repeated trips to A&E with no referral to specialist centres. We are working with NHS Improvement and others to ensure that we support them with training in the use of medication and improving the use of smart inhalers, which can track the management of their care and reduce referrals to secondary care.

[Lord Rennard (LD)]

My Lords, I am grateful to the NHS for the fact that as a diabetic I do not pay prescription charges, but other people in England with long-term conditions have to pay such charges. In Scotland, Northern Ireland and Wales, all prescription charges have now been scrapped. Is this not somewhat anomalous? Is it not unfair that the 2.3 million adults with asthma have to pay these charges?

[Baroness Blackwood of North Oxford]

The noble Lord will already have heard me answer his question in reply to the opening Question. I have already met Asthma UK on this issue and discussed its concerns about the balance of prescription charges. We are not in a position at the moment to review prescription charges as a whole, but I will be working with that organisation to make sure that the system works as effectively as possible for asthma patients and that they get access to the exemptions that are in place.

Academic Health Science Centres

Baroness Blackwood of North Oxford Excerpts

Tuesday 2nd July 2019 Grand Committee

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Blackwood of North Oxford) (Con)]

My Lords, I thank the noble Lord, Lord Butler, for raising this question on AHSCs. I pay tribute to his work as the former chair and now non-executive director at the King’s Health Partners AHSC and to his speech setting out some of the achievements that have been delivered. This has been a supremely expert debate, so I feel somewhat cautious in summing up. I thank noble Lords who have spoken this afternoon about their work in AHSCs, notably the noble Lords, Lord Kakkar, Lord Patel and Lord Darzi, and my noble friends Lord Prior and Lord O’Shaughnessy, who have been so instrumental in developing the system to where it is today. This is a timely debate because, as many noble Lords said, we are developing policy options for AHSCs going beyond the current designation. As noble Lords know, it is due to end in December this year. I acknowledge that this is a tense time for AHSCs, which will now be thinking about planning their future strategy. I am grateful to the noble Lord, Lord Willis, for making the point that this is a cross-party issue and that there is wide agreement across the Chamber about the importance of AHSCs. I will say at the front that there is also consensus about the need to go forward to designation; the question is how we do that.

First, in response to some of the wider points that were made in the debate, I say that the Government recognise the critical role that health research plays not only in fuelling the life sciences sector, which is one of the most productive within our economy, but in driving up the quality of diagnosis, treatment and care in the NHS. We are committed to creating the best environment for clinical research and to achieving the ambition set out not only in the life sciences strategy but in the sector deals. This is the only sector to have two sector deals, and that is because of the quality of the sector and the relationship between research, industry and the NHS, which has developed into an outstanding ecosystem in the past few years. We have to pay tribute to the role that the NHS long-term plan will play in that, due in no small part to the leadership role of my noble friend Lord Prior.

This country is a world leader in health research, with a world-class science base and three of the top 10 globally ranked universities. As my noble friend Lord Prior said, we have an extraordinary life sciences sector, and we must be as ambitious as we possibly can be in driving it forward. We are investing more than £1 billion per year through the NIHR to fund research, skills and facilities to enable high-quality research. I can answer the noble Baroness, Lady Donaghy: about £100 million of that was invested in a range of training programmes, and we have also created the NIHR training academy so that we can think about how we link that to international training.

We must ensure that we protect the valuable collaborations that we have because that ensures that we have the highest quality clinical research in the world. The commitment to increase our R&D investment from 1.7%, which has quite frankly not been good enough, to 2.4% and beyond that to 3% was hard won from the Treasury. I know that because I was one of the first to campaign on this as chair of the Science and Technology Select Committee some time ago. I will be one of the first to join noble Lords across the Committee in campaigning to drive further and faster, as we must not only have this commitment from our leadership candidates—and I am sure that others will join us in that—but keep driving forward blue-sky investment and further investment through the people, programmes, centres of excellence and the NIHR. That is how we will have an integrated health and research system which is one of the best in the world, designed to transform scientific breakthroughs into life-saving treatments.

The noble Baroness, Lady Donaghy, is right that we should be proud of what we have already achieved. Between them, the existing AHSCs cover health research and education in a wide range of clinical disciplines including mental and physical healthcare, cancer, cardiovascular and inflammatory diseases. It would not be right it we did not pay tribute to some of that today. Noble Lords have already done that. While we do not fund the AHSCs specifically, of the 20 NIHR biomedical research centres, 12 are at the heart of these six AHSCs, representing more than £700 million of NIHR investment over five years from April 2017. This significant NIHR-funded research infrastructure is key to enabling its engines for world-class excellence in early translational biomedical research.

The existing AHSCs were designated based on recommendations made by an independent panel, which we heard about from the noble Lord, Lord Darzi. On the regional spread, I am afraid that the noble Baroness, Lady Masham, will be disappointed that they can be designated only in England, not in Scotland, but it is open to the new designating committee to consider the regional spread as that goes forward.

Over the past 10 years, the six AHSCs have facilitated the strategic alignment of some of our leading NHS providers and their university partners in world-class research and health education, leading to improvements in patient care and playing an important role in driving economic growth through partnerships with industry, including life sciences companies, which is one of our key priorities. It is through this strategic alignment that these partners have secured funding. An example is the £10 million funding from UKRI for a new centre for medical imaging and AI at King’s Health Partners as part of the industrial strategy challenge fund. The noble Lord, Lord Kakkar, spoke about the success of UCL Partners, which has, among many things, been leading on the adoption of a learning health system to standardise data entry. This has allowed seven CCGs to trial and support interventions into early detection of atrial fibrillation, which is a key priority of the long-term plan, and for primary care networks. Specific examples are the ways that we are going to change healthcare for individuals. Imperial AHSC has supported North West London STP’s integrated care record to bring together the health and social care information of 2.3 million patients in the sector, enabling the identification of patient cohorts and the evaluation of service developments.

London’s three AHSCs are collaborating through the MedCity initiative to grow the life sciences cluster of London and the greater south-east, working with the Oxford and Cambridge AHSCs. In Manchester—not in the south-east—the AHSC is working with the AHSN to align research and education into the health and social care priorities of the Greater Manchester population. A single blood test-driven decision aid for patients presenting with chest pain at the emergency department is being rolled out. Since June 2016, more than 7,000 patients have been treated using this tool and the diagnosis of acute myocardial infarction was ruled out in more than 99% of cases, with patients returning home within hours of their arrival in the emergency department. This is evidence of how the AHSCs have changed clinical practice on the ground. Additional data published today by the NHIR clinical research network shows that NHS trusts which are part of the six AHSCs have undertaken more than 3,600 clinical studies and recruited 148,495 participants in 2018-19.We know that other academic health science partnerships have formed, further strengthening the health research and health education interface in London but, as my noble friend Lord O’Shaughnessy said, we must ensure that the deep research base that we have in this country is matched by a health system that embraces innovation and translates research funding into improved patient care, so that innovators can develop, test and deliver those products that patients and clinicians need and so that examples such as those I have just given can be adopted.

We know that in the past the system has been too fragmented, too complex for innovators to navigate and too slow to adopt promising technologies. That is why last summer, at my noble friend’s instigation, the department undertook an innovation landscape review, which identified the need for a system which was more joined up between healthcare partners, and for improved support for late-stage evidence and a better strategic alignment of priorities, such as how we support emerging technologies, including AI, drug discovery, mentioned by the noble Lord, Lord Kakkar, and precision medicine.

As my noble friend Lord Prior pointed out, it is also important to recognise the role of collaboration between NHS, industry and academia. During the landscape review, we found huge appetite for change and more ambition within the healthcare stakeholders who need to implement it. That is why the sector deals, the NHS long-term plan and the tech vision have all begun the process of transforming a significant part of strategy within government policy. Through the establishment of the accelerated access review and NHSX, as has been mentioned, we have started to build the necessary infrastructure effectively to support health innovation in this country. Under the expert leadership of the noble Lord, Lord Darzi, the AAC brings together senior leaders from the key government, NHS and industry partners with patient and clinician representatives to promote innovation within the NHS. Already, the AAC has made significant progress in supporting uptake.

We must agree that AHSCs and other structures must work hand in hand with AHSMs and wider innovation infrastructure to ensure that this is wired into the ARCs and will be in AHSCs. This is why I have asked the AAC to consider AHSCs, to ensure that the whole system is joined up, because that is what it is leading on. It is important that we give the AAC and the noble Lord the opportunity to build a cohesive health, research and innovation ecosystem that meets the challenges that we have set and the ambitions that we need our life sciences sector to deliver. That is why I have asked the AAC to consider AHSCs’ role within the health system as part of the boost agreement. That will ensure that the future designation of AHSCs complements the innovation support landscape, rather than adding further complexity. The AHSCs will therefore support the AAC in achieving its new objectives, including commitments to establish globally leading testing infrastructure, improving the system’s capacity to adopt innovation.

We plan to extend the existing DHSC AHSC designation until March 2020 to enable that new designation process to be held. We will announce the timescales soon. I appreciate that is not necessarily the answer that noble Lords want, but I hope that the strategic vision, the need for ambition and the purpose, which is to deliver innovation for patients which changes their quality of care and the ambition of our life sciences ecosystem is understood as the reason for that change.