Queen’s Speech

Baroness Blackwood of North Oxford Excerpts

Tuesday 22nd October 2019 Lords Chamber

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

My Lords, I am honoured to close this final day of debate in support of the gracious Speech. As ever, debate has been robust, largely courteous, but underpinned by the extensive expertise of this House. In this age of partisan rancour, our debate has been informed by a deeply held belief that in this place, regardless of political persuasion, we are bound together by a collective responsibility to use our roles here to improve the lives of our fellow citizens. That is something to be proud of.

The topics we have debated today—education, work and pensions, culture and health—make more difference than any others to the lived experience of people across this country. That is why the past seven hours have flown by for me as I have listened with pleasure to the important contributions of 61 noble Lords. It is because of the importance of these issues and the consensus on the need for action that the Prime Minister and his Government have prioritised them over recent months and, of course, in the gracious Speech, investing £14 billion in schools over the next three years, supporting the modernisation of pensions, accelerating access to broadband—perhaps even to the home of the noble Lord, Lord Aberdare—and three new health Bills, with a commitment to work towards a further two. It is an ambitious agenda and has been fully reflected in today’s wide-ranging debate.

I will now do my best to respond to the many important points raised today, but it will be necessary, I am afraid, that the relevant Minister might have to write on a few issues that I am not able to cover in the time that is available. I begin by focusing on education. I know that the whole House is passionate about supporting investment in education and the importance of ensuring, as the noble Baroness, Lady Massey, so clearly put forward, that all children, no matter their background, can benefit from an outstanding education. As the noble Lords, Lord Storey and Lord Berkeley, and the noble Baronesses, Lady Bull and Lady McIntosh, noted, there should be a broad and varied education. As a former musician myself, noble Lords are preaching to the choir when they emphasise the value of creativity to society and its role in preparing children for the future—even its role in preparing a recalcitrant Health Minister.

As has been mentioned, the Government have announced welcomed investment in schools. I can confirm to the noble Lord, Lord Watson, that, following the funding allocation statements issued by DfE last week, all schools will be better off in three years’ time.

The noble Lord, Lord Addington, raised very important issues around special educational needs, and the Government have announced an additional £770 million of investment in 2021 for SEND education. But the whole House will appreciate that providing the best possible education is not just about money. That is why the DfE has commissioned a review of SEND education to assess what further we need to do in order to support pupils with special educational needs, so I will put forward the specific points that he raised in order to ensure they are properly considered.

The Government have also set up a cross-government hub for all disability issues in the Cabinet Office to draw together a catalysed, more effective cross-government action on these points. The DWP has increased the size of Access to Work grants by £15,000 in the last year, driving forward a 7% increase in the volume of grants made in recognition of their importance. This will support those with disabilities and special educational needs in the workplace.

A wide range of noble Lords noted the critical role of further education, with my noble friends Lord Lingfield and Lord O’Shaughnessy, and the noble Lord, Lord Aberdare, and the noble Baronesses, Lady Blackstone and Lady Garden, all drawing attention to it. Further education is at the heart of the Government’s plans for an education system that works for everyone. That is why we have announced—as has been noted—an additional £400 million of funding and a focus on improving not only the quality of teaching and learning but also its status.

Many noble Lords have welcomed an investment as well of £290 million in 20 institutes of technology to deliver higher technical education as a clear route to high-skilled, high-wage employment, but they also sought more clarity on how this will work in practice. I shall ask for those points to receive an individual response as I cannot get through all of those right now.

The noble Lord, Lord Storey, and others also raised the response to the Augar review, which is awaited. I confirm that Ministers are considering this very carefully and will respond shortly. This is a policy area that would clearly benefit from close attention in the spending review that is coming up next year.

On essay mills, I can confirm that, in the first instance, the Office for Students will engage the sector in order to eliminate the use of such organisations, but the Government do not rule out further action.

Clearly, more progress needs to be made on apprenticeships, but much progress has been made: over 1.8 million apprenticeships have started since 2015, investment annually is over £2.5 billion and over 60% of apprenticeships are of the highest industry-desired standards. I recognise the need for progress, and we are working hard on it. That is why the Secretary of State has taken the portfolio of apprenticeships as his personal responsibility, in response to the point made earlier.

I turn to work and pensions. The noble Baronesses, Lady Donaghy, Lady Watkins and Lady Sherlock, and the noble Lord, Lord Willetts, all raised universal credit and concerns about in-work poverty. I think there is a consensus that work should always pay. Universal credit is a welfare system designed to help people into work, to support those who need help and to be fair to everyone who pays for it. The DWP recognises, however, the need to continually review and improve universal credit. This year alone, the DWP has committed to running a pilot on moving to universal credit to ensure the further and safe rollout of the advantages of universal credit. I noted the question about an update on that progress and I will ensure that a note comes to the noble Baroness about that. The department has announced that it will reduce the maximum single sanction that a claimant can face from three years to six months, and the number of those sanctions has also fallen. The department has instructed work coaches to use the flexible support fund to support parents with childcare costs. It is also providing £3 billion to support transitional arrangements for claimants moving over from other benefits. Noble Lords also raised concerns about the benefits freeze being extended. I can confirm now that it will come to an end by 2020.

The noble Baroness, Lady Bryan, and a number of noble Lords mentioned the pensions Bill. I genuinely feel that pensions is an area where there has been positive progress over the past decade. The Bill now goes a step further to improve both the options available to employers and accessibility for employees, so that they can track their pension as they would their bank account.

Our debate on DCMS was particularly robust, it is fair to say. I begin with broadband rollout, which was mentioned by the noble Lords, Lord Clement-Jones and Lord Aberdare. The Government have been clear in their commitment to delivering nationwide, gigabit-capable, reliable and resilient broadband—that is not easy to say at the end of a long debate—as soon as possible. That is why the gracious Speech included the telecommunications Bill, to ensure that millions of leaseholders are not left behind as we upgrade our communications network. I am conscious of the time but I am also aware that the Second Reading is imminent, so I am sure that many of the points made by your Lordships will be answered in letter form and that there will be ample time for detailed debate and robust scrutiny, which I am sure this House will provide.

The noble Lords, Lord Clement-Jones and Lord Griffiths, and a range of Peers noted the challenge of online harms and how to regulate and respond to digital technologies that can change and evolve rapidly. The online harms White Paper was published in April. It set out the Government’s plan for world-leading legislation to make the UK the safest place in the world to be online. The public consultation has closed and the Government’s response will be published in the coming months. We will then publish a draft Bill for pre-legislative scrutiny. Let me be clear: the Government recognise that this is one of the fundamental challenges facing our society in the coming years and they are determined to address it.

I want explicitly to recognise the strength of feeling expressed by the noble Baronesses, Lady Benjamin and Lady Howe, the noble Lords, Lord Clement-Jones and Lord McNally, and other noble Lords on the issue of age verification and the pace of reform. I will confer that back to the department. The Government are clear that protecting children is at the heart of our online reform agenda and is key to wider government priorities. The issue here is making sure that those reforms are as effective as possible and do the job that they are intended to do.

Moving on to health and social care, my department was delighted to begin the year by publishing the clinically led NHS long-term plan and by securing £33.9 billion to support its implementation. On the point made by the noble Lord, Lord Smith, the plan focuses not on funnelling ever-greater funding into the health service but on ensuring sustainable and substantive reform that can support what we all want to see in the health service. As my noble friend Lord O’Shaughnessy noted, there are delicate balances to be struck on integration versus accountability, which the upcoming NHS long-term plan Bill is intended to address. That has also been clinically and NHS-led.

I follow the noble Lord, Lord Hunt, who is not in his place—

[The Earl of Courtown (Con)]

Yes he is. He is over there.

[Baroness Blackwood of North Oxford]

Sorry, he is in a different place. I follow the noble Lord in paying tribute to the noble Lord, Lord Patel, and his colleagues on the Long-Term Sustainability of the NHS Committee, which he chaired, because many of its proposals were replicated in the long-term plan.

The noble Baronesses, Lady Greengross, Lady Walmsley and Lady Massey, and my noble friend Lord Young raised the importance of prevention, primary care and tackling inequalities. These are all important agendas for the Government and for my department, which is why the Government have committed more than £4.5 billion of additional funding to support GP services and will recruit an additional 20,000 staff to work in practices.

It is also why the Government have published their prevention vision, which sets out an ambitious agenda in order to put public health at the heart of everything the department and the NHS do, including aggressive action to tackle obesity such as the sugar tax, which has proved to be a great success. I am happy to reassure my noble friend Lord Young of Cookham that this will continue to be right at the heart of our agenda. Moreover, the department is addressing the real and valid concerns about health inequalities. We have just recently finished consulting on how to improve the health of people living in the poorest communities. Reducing inequalities is a key part of the long-term plan and will be a requirement as part of our PCMs.

We have also worked closely with Defra on the introduction of the clean air strategy, which was noted by the noble Baroness, Lady Walmsley, and on antimicrobial resistance, which no one noted but I do so now, and with Henry Dimbleby on his food strategy. On this last point, while I cannot commit the Leader of the Opposition to continuing commitment on this agenda, I can certainly reassure the noble Baroness, Lady Boycott, of the Government’s ongoing commitment and I thank her for both her expertise and her work on this agenda because it is essential.

The noble Baronesses, Lady Greengross, Lady Meacher, Lady Hollins, Lady Watkins, Lady Sherlock, Lady Campbell, Lady Wheeler and Lady Bakewell, along with my noble friend Lord Young, the noble Lord, Lord Hunt, and the right reverend Prelate the Bishop of London also raised the critical issue of social care. As my noble friend Lord Willetts said, we must just get on with it, and I do not think that I can improve on what the noble Baroness, Lady Bakewell, said: “Ageing is not an option”, and nor is substantial reform in this area.

The Prime Minister was clear on the steps of Downing Street about this Government’s determination to fix the crisis in social care to ensure that every older person has dignity and security and that no one needs to sell their home to fund their care. He wants this to be a bold, once-in-a-generation reform and I can reassure the House that officials across government are working, probably at this moment, on developing ambitious proposals on top of the £17.1 billion invested in the past financial year. However, I will strongly reiterate to the Secretary of State and to the Prime Minister, as I often do, the very strong mood in this House that the time for action is now. I will also confirm that the department will consider carefully the recommendations set out by the Independent Living Strategy Group, led by the noble Baroness, Lady Campbell, and those of the Intergenerational Fairness Committee, of which the noble Baroness, Lady Greengross, is a member, as part of those considerations.

The noble Baronesses, Lady Jolly, Lady Donaghy, Lady Janke and Lady Watkins, along with the noble Lord, Lord Patel, raised the issue of NHS staffing. Having the right staff is crucial to delivering the aims and objectives of the long-term plan. To address this, we are recruiting more staff than ever before with, for example, a 25% increase in training places for medical students. We have also given a significant pay rise to more than 1 million staff and my noble friend Lady Harding is currently preparing for publication the people plan, which will set out a range of ambitious options for what more we can do to improve the situation. In answer to the noble Baroness, Lady Watkins, this will specifically consider the whole range of potential financial incentives which could support recruitment and retention. At this point I will follow other noble Lords in putting on the record my department’s deep appreciation of the noble Baroness, Lady Emerton, for her wonderful work as a champion of the nursing profession.

The noble Baronesses, Lady Jolly, Lady Hollins, Lady Sherlock, Lady Featherstone, and Lady Tyler, and my noble friends Lady Verma and Lord Kirkhope, along with the noble Lord, Lord Watson, noted the importance of getting mental health right, the reform of the Mental Health Act and the care of those with disabilities. This is not only a crucial issue but a complex area, so it is important that we get the reform right. I recognise the impatience of noble Lords to go further faster, but there is real progress to report. The Government have already accepted a number of the recommendations made in the independent review. We will publish a White Paper by the end of the year and we will set out in detail our legislative and non-legislative response. To address the immediate service challenges, the Government are also investing record amounts in NHS mental health care as well as in care for those with learning disabilities and autism. I can also report that capital will not be overlooked. Since 2017, we have recruited more than 3,000 additional staff to put in place a wide range of measures to ensure that care is provided closer to home.

The noble Lord, Lord Rennard, and my noble friend Lord O’Shaughnessy raised Brexit and the health service. In any Brexit scenario my department is committed to maintaining the very highest standards of regulation and I can assure the noble Lord, Lord Rennard, and my noble friend Lord Young of Cookham that we will remain a world leader in the regulation of tobacco and of prevention, as we have laid out in our prevention vision. Our preference remains close co-operation with the EMA as well as with our other long-term friends and partners such as the Commonwealth, as my noble friend Lord Howell mentioned.

The importance of patient safety was also raised by a number of Peers in relation to the upcoming Health Service Safety Investigations Bill. I am very much looking forward to its Second Reading next week, when I am sure we will have plenty of time to debate it and I will be held to account in every possible way—so I shall not go into detail on that now.

I will say just a word about innovation, raised by the noble Lords, Lord Patel, Lord Kakkar and Lord Bassam, who raised the importance of life sciences and innovation. We have a very strong record in this area. I am afraid I do not recognise the picture presented in the IPPR’s recent report. Turnover and employment in UK life sciences have grown notably over the last decade, and the life sciences strategy sets out a powerful vision for action, which we are delivering against assiduously. This has included £1 billion of government investment and £3 billion of leveraged industry investment. We now have substantially better partnership between the NHS, academia, government and industry, but I agree with the noble Lord, Lord Kakkar, that we have to improve on our rate of progress between ideation and adoption. Part of that is better working between all those agencies engaged in trying to deliver against that objective.

I also noted strong support from the noble Lord, Lord Patel, and others on the fast-track visa for top scientists. I will take away the sensible suggestion from the noble Baroness, Lady Bull, that this be expanded to include the cultural and creative sectors.

Finally, the noble Baroness, Lady Deech, raised the storage of gametes. I agree on the importance of this, as I think she knows, and have continued to push this matter within my department. To that end, I hope to have a positive update in the coming weeks.

I am mindful that I have only a short amount of time and the clock is counting down. In closing, I reiterate my thanks to noble Lords for their many and varied insightful contributions. Responding to a debate such as this is a challenge, given the breadth of issues we have covered, but it is also a pleasure, giving me the opportunity to engage on many issues that I do not regularly come across in my brief. As has been pointed out, we debate the gracious Speech in unprecedented political times, but my commitment to this place on behalf of the Government and the departments for whom I speak today is that we will continue to strive day in, day out to improve the lives of and the services available to people right across the United Kingdom. I know that is an ambition to which all your Lordships here today will join me in being committed.

Motion agreed nemine dissentiente, and the Lord Chamberlain was ordered to present the Address to Her Majesty.

Specific Food Hygiene (Regulation (EC) No. 853/2004) (Amendment) (EU Exit) Regulations 2019

Baroness Blackwood of North Oxford Excerpts

Wednesday 16th October 2019 Grand Committee

Moved by

[Baroness Blackwood of North Oxford]

That the Grand Committee do consider the Specific Food Hygiene (Regulation (EC) No. 853/2004) (Amendment) (EU Exit) Regulations 2019.

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

My Lords, I thank noble Lords for their consideration of the regulations. I am confident that we have the shared intention to ensure that the high standards of food and feed safety and consumer protection we enjoy in this country are maintained when the UK leaves the European Union. This instrument, and the original instrument that it amends, seek only to protect and maintain these standards. Changes are limited to minor drafting amendments to ensure that the legislation is operable on exit day. No policy changes are made through these instruments and we have no intention of making any at this point. This amends a previous EU exit SI, the Specific Food Hygiene (Amendment etc.) (EU Exit) Regulations 2019. Further clarity was required in setting out the authorisation process for products that can be used to remove surface contamination from products of animal origin. The clarification will ensure that the process is robust and can be applied clearly in assessing the risk of new products.

This instrument was made on 9 September under the urgent, made-affirmative procedure, which was considered appropriate to meet the deadline for the European Commission’s third country listing vote on 11 October. It needed to be in place to support the UK’s application for third country listed status with the EU. Third country listed status guarantees that the UK can continue to export animals and animal products to the EU after exit. The application was voted on by the European Commission on 11 October, and I am pleased to report that the vote was indeed in favour of accepting the UK’s application for third country listed status for products of animal origin.

I shall now talk a little about the specific detail of the minor and technical changes made by the instrument. The new instrument makes clear that the responsibility to approve substances that may be used to remove surface contamination from products of animal origin rests with the Secretary of State for Health and Social Care and the appropriate Minister in each of the devolved Administrations. Lack of clarity may affect implementation and has the potential to undermine the responsibilities for authorisation; the instrument therefore rectifies this. The measure introduces no substantive policy changes to what was successfully passed and made in Parliament in March 2019. 

Food business operators are not permitted to use any substance other than potable water or, where permitted, clean water, to remove surface contamination from products of animal origin unless this has been approved. This relates to business establishments that handle products such as meat, eggs, fish, cheese and milk and do not supply to final consumers. Currently, approval for such substances is given by the European Commission, but after EU exit this responsibility will be carried out by Ministers. The amendment to Regulation (EC) 853/2004, made by the specific food hygiene SI, is being further amended to make it absolutely clear that Ministers will be responsible for prescribing the use of any other substances and the process of consulting the Food Safety Authority is retained. That decision will be made based on rigorous, evidence-based and independent food safety advice from the FSA and the FSS.

If, after EU exit, any additional substances are proposed to be approved for this purpose, they will be subject to risk analysis by the FSA, which has established a rigorous and transparent risk analysis process for assessment and approval of any such new substances. Any requests for substance approval would be subject to thorough scientific risk assessment and risk management before being put to Ministers for the final decision. The advice provided to Ministers, and the analysis and evidence on which that advice is based, will be publicly available. All decisions to approve the use of substances to remove surface contamination from products of animal origin will be implemented by means of legislation, thus also providing opportunity for parliamentary scrutiny.

Let me be clear that neither this instrument nor the instrument it amends introduce any changes for food businesses in how they are regulated or run, and nor does it introduce an extra burden. The overall changes to the food hygiene regulations will ensure robust systems of control that will underpin UK businesses’ ability to trade both domestically and internationally.

It is also important to note that we have engaged positively with the devolved Administrations throughout the development of this instrument, and this ongoing engagement has been warmly welcomed. The Welsh Government have provided their consent and the Northern Ireland Civil Service has given its acknowledgement of this instrument. FSA officials have also been in close contact with the Scottish Government regarding these regulations. They have not yet had the opportunity to give their agreement, due to the necessity of having these regulations in place by 11 October, but we expect that to continue in a positive direction. I stress that we are still committed to the intergovernmental agreement accompanying this Act not to normally make EU exit regulations without the agreement of the devolved Administrations where the policy area is devolved in competence. However, as I explained, this is a very minor drafting change to a regulation the Scottish Government have previously agreed.

Finally, I draw noble Lords’ attention to the fact that, in line with informal communications that the FSA has had with the Joint Committee on Statutory Instruments, the agency will, in accordance with the terms of the free issue procedure, be making this instrument available free of charge to those who purchased the earlier exit SI. The Government accept that this instrument should have been made available under the free issue procedure when it was first made, but that did not happen due to an oversight. I apologise to noble Lords for that oversight and confirm that it will be corrected. The Food Standards Agency will be taking action, together with colleagues in the National Archives, to ensure that anyone entitled to a free copy of the instrument under that procedure will, where appropriate, be able to apply for a refund, or otherwise obtain a free copy of this instrument on request, in accordance with the usual terms of that procedure.  

This instrument constitutes a necessary measure to ensure that our food legislation relating to food safety continues to work effectively after exit day. I urge noble Lords to support the amendment proposed to ensure that we continue to have effective food safety and public health controls. I beg to move.

[Baroness Thornton (Lab)]

I thank the Minister for introducing these regulations. I also thank my noble friends Lord Rooker, Lady Jones and Lady Wheeler for carrying the bulk of the food standards instruments that we dealt with before the summer, when we seemed to do a great many of them. As the Minister said, these are important regulations because they address the process for approval of substances that may be used to remove surface contamination from products of animal origin.

As the noble Baroness confirmed, this SI was discussed earlier this year, but a great deal has changed since then, as we all know. We have a completely new Government, though I am pleased to see that the noble Baroness has remained in her job. What has not changed is the uncertainty over whether the UK will leave the EU in the next 15 days or so, with or without a deal, and the impact that could have. For the record, once again, we find ourselves back debating necessary statutory instruments and having to spend time and money putting through legislation in case of a no-deal Brexit.

We all agree that the safety of our food is of the utmost importance to our health and well-being. We have been fortunate to lead the world in food safety, in some areas. We have also had to learn some very hard lessons from our own food scares. We know that food safety must be protected at all costs. Therefore, I share the Government’s commitment to ensuring that there is no change in the high-level principles underpinning the day-to-day functioning of the food safety legal framework. Ensuring continuity for business and public health bodies is of the utmost importance and in the interest of the public. This has been the protection that the EU regulatory framework has afforded us in the UK.

While the Minister assures us that there is no substantive policy change, I need further reassurance. Paragraph 2.7 of the Explanatory Memorandum states:

“Following further policy deliberations, a revised approach to describing the process for approval of substances which may be used to remove surface contamination from products of animal origin is felt to be desirable”.


What does that revised approach consist of if it is not a policy change?

Why was this SI not among those we took through in March? What would have happened if we had left in March and this SI had not been on the statute book? What would have happened to this regulatory framework?

I am not convinced that the SI does not give some leeway for Ministers to approve substances that can be added to our food. I shall be interested to hear how confident the Minister is that the high standard of food safety will be maintained. What additional substances could be approved by Ministers if needed? How will that impact food safety? The safety of our food is hugely important and we cannot get this wrong, so I have made these very brief comments. I do not want to delay the Committee, but I welcome interventions from other noble Lords. We will, of course, not oppose this statutory instrument and I look forward to the Minister’s response.

--- Later in debate ---

[Baroness Blackwood of North Oxford]

I thank noble Lords for what has been, as ever on the issue of food safety and the FSA, an informed and very expert debate. While I would never dare to call the noble Lord “Grandpa Nanny Rooker”, I assure him that the value and expertise of the FSA are under no question from the Department of Health and Social Care and the Government. Experts are very much in vogue in our department, and the importance of the FSA on exit day is very much understood. That is why we have taken such care in bringing forward the statutory instruments that, as he recognised, have been crafted to ensure the highest standards of food safety on exit day, no matter what the nature of the deal. I entirely agree with him that we should ensure that we continue to value the FSA and to communicate that value publicly and privately. I should expect no less than to be held to account by him on this issue every time I come into the Chamber. His expertise shone out during his speech.

I thank the noble Baronesses, Lady Thornton, Lady Jolly and Lady Kingsmill, for their support for the statutory instrument. I shall answer some of their questions, and I welcome their commitment to join the Government’s commitment to the very highest standards for food and food safety, represented in the statutory instrument.

I reassure the noble Baroness, Lady Kingsmill, that this instrument will not have a sunset clause for the specific reason that it amends retained EU law, so any future changes, as with the other statutory instruments, will be subject to parliamentary scrutiny and control in the normal way. It is in the event of no deal, so, should the Government reach a deal with the EU, as we very much hope they will, we will repeal or amend it in accordance with that outcome. It is being put forward to reassure rather than to create any concerns, so that we can ensure that we have in our legislative framework very clear processes for the cleaning of products of animal origin.

In response to the question put forward by the noble Baroness, Lady Thornton, this issue was not missed in the original statutory instrument. It was dealt with, but it was felt that the drafting needed to be clearer. It was brought forward in a swift and made-affirmative way because we wanted to make sure that, when we went forward to the vote on the third country listing, this was part of our statutory instrument programme at that point. That is why it went through quicker than it would otherwise have done. There was no intent to be underhand or sneak it through; we just wanted to make sure that it was part of the package at that stage. That is why we are having this debate now, after the fact. With this statutory instrument, we wanted to ensure that we clarified further the process for making decisions on the approval of substances to remove surface contamination from products of animal origin, and to move beyond doubt that the decision on approvals was for Ministers and a statutory instrument, so that there would be a double question of scrutiny on the basis of clear scientific and risk advice from the FSA.

A very clear process has been set out. Currently an applicant makes a request to the European Commission following agreement from representations with member states, which will refer the application to EFSA. EFSA will carry out a scientific evaluation of both the safety of the substance and the efficacy of its use. Following the issue of EFSA’s opinion, the member states will then vote on whether the substance will be approved by the European Commission Standing Committee meeting. After EU exit, we will have a similar process, with just the Ministers, or the devolved Administration representatives, replacing the European Commission, but we will have just as strong an emphasis on scientific advice and transparency.

I have a helpful diagram, provided for me by the Food Standards Agency, which I hope it is acceptable for me to display and which I am happy to put in the Library. It demonstrates the process the FSA will go through in ensuring that there is a transparent process for gathering scientific evidence. There are several points of publication of the evidence, which would then be presented to the Minister and then be available as part of the scrutiny process for statutory instruments. I hope that this is reassuring and that there would be no question of undermining the expert advice provided to Ministers. I will place this in the Library of both Houses for assessment by your Lordships.

In answer to the question from the noble Baroness, Lady Kingsmill, regarding farmed salmon—I did not know this, so it is a helpful, educational moment for me—there will be no policy change in this area, as in any other. The treatment of farmed salmon will follow the rules as now: either clean water or seawater could be used to surface-wash salmon. I hope that is reassuring for the noble Baroness.

On chlorinated chicken, the current situation will remain. No substances other than potable water are approved to remove surface contamination from chicken carcasses, and there is no intention to change this when we leave the EU. Any change to this would have to go through the application process, which I have outlined, and would be clearly transparent to Members of this House and members of the public. It would be open to scrutiny, so I hope that is reassuring.

The noble Baroness, Lady Kingsmill, rightly raised the important issue of animal welfare in the context of chlorinated chicken. That would be considered with an application, as it is an important concern. Scrutiny would be available not only through scientific consideration and the FSA’s consideration, but also through public and parliamentary consideration. The retention of current law helps us promote the good welfare standards we already have, so I hope that is a reassuring answer.

Finally, I turn to the important question from the noble Baroness, Lady Jolly, regarding the potential for different food and feed safety standards to emerge across the UK after exit. The FSA has considered this and discussed it closely with the devolved Administrations as we have prepared very carefully with the Administrations in Scotland, Wales and Northern Ireland for the—albeit unlikely—potential no deal. There is a commitment from all the devolved Administrations to a common approach across the UK, albeit with the potential for evidence-based divergence. We are confident that, in practice, it will be possible to make arrangements to operate a framework for food and feed safety regulation across the UK. It is one of the policy areas set out in the UK Government’s published provisional policy analysis, which is subject to detailed discussions between the UK Government and the DAs to explore what common framework arrangements are needed after we have exited the EU. Officials across the different devolved Administrations have already been working over recent months and years to make sure that this is implemented effectively, so there is confidence in the FSA and FSS that this can continue effectively. I hope I have answered all the questions asked.

[Baroness Jolly]

The Minister has not answered one question; it may be that she does not have the answer at the moment. I have not seen her diagram with blobs on, but can she indicate whether there would be any element of public consultation if the Secretary of State were to consider a change?

[Baroness Blackwood of North Oxford]

The noble Baroness asks an important question. There is the opportunity for formal consultation as necessary, depending on the nature of the change. This is point 10 in the diagram and, yes, I have just been told that it is there in the SI, depending on the nature of the change that comes forward. Given that any formal advice would be available for public scrutiny, it would be evident and open should there be any need for public consultation. Given that there are implications for industry, this would be carefully managed. It is notable, and important to take into account, how carefully the FSA has managed its statutory instrument programme. It carried out a six-week consultation to prepare for its 16 SIs and managed its engagement very carefully. The impact assessment was very carefully managed, and I think this is an indication of its intention going forward. I beg to move.

Motion agreed.

Sexually Transmitted Infections: England

Baroness Blackwood of North Oxford Excerpts

Thursday 5th September 2019 Lords Chamber

[Lord Black of Brentwood (Con)]

My Lords, I beg to move the Question standing in my name on the Order Paper. In doing so, I declare an interest as a trustee of the Bloomsbury Network and patron of the Terrence Higgins Trust.

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

My Lords, we are seeing a mixed picture in relation to trends in sexually transmitted infections. There have been increases in some infections such as syphilis, gonorrhoea and chlamydia, but diagnoses of first-episode genital warts have fallen. We are also seeing a steep decline in new HIV diagnoses among gay and bisexual men. Condoms remain the most effective way of reducing the risk of STDs.

[Lord Black of Brentwood]

I thank my noble friend for that Answer. While the news on HIV is obviously very welcome, is it not the truth that other STIs are now on the rampage, with rates of increase for gonorrhoea, syphilis and chlamydia sky-rocketing ferociously? Does my noble friend agree that what is needed is a cross-sector sexual health strategy and some vision and ambition for what we, as a country, want to achieve around sexual health? Can my noble friend, who I know cares deeply about these issues, tell us exactly what yesterday’s spending announcements mean for sexual health funding, which has been cut by £700 million in the last few years, with appalling consequences?

[Baroness Blackwood of North Oxford]

I thank my noble friend for his Question and I congratulate him on his important work in this area. He is absolutely right that the Health and Social Care Committee recommended a new sexual health strategy and we will respond to its report shortly. In addition to that, the Green Paper consultation on prevention sought views on priorities for a possible new strategy and we will consider those responses very carefully. As he rightly says, the spending review yesterday announced 1% real-terms growth for the public health grant, which I know will be very welcome because it means that local authorities can continue to invest in prevention and essential front-line health services, including sexual health services.

[Lord Cashman (Non-Afl)]

My Lords, I remind your Lordships that I intervene as a non-aligned Member of this House and declare my interest as a patron of the Terrence Higgins Trust. I thank the Minister for her response to the Question. What progress has been made towards PrEP being routinely commissioned for all who need it before the end of the trial in 2020? Does she agree that PrEP needs to be made available as part of routine sexual health services from April 2020 and that no gay or bisexual man should be discouraged from being placed on the PrEP impact trial?

[Baroness Blackwood of North Oxford]

The noble Lord will agree that this Government have shown significant commitment to the roll-out of PrEP since the start of the PrEP impact trial in October 2017. Over half of the 26,000 places have been filled, which is welcome progress. The trial is scheduled to continue until autumn 2020 and work is now starting to consider future commissioning for PrEP after the trial has ended.

[Baroness Jolly (LD)]

My Lords, as the noble Lord, Lord Black, said, there is good news. Walking into the House this morning through Lambeth, I saw posters telling us that HIV is on the way out, but to be aware of STIs. What proportion of the Chancellor’s money announced yesterday will be allocated to local authorities delivering public health and what guidance is given to local authorities on developing sexual health services by Public Health England?

[Baroness Blackwood of North Oxford]

We will need to confirm the distribution of the grant in due course. I am sure that will be the subject of questions as we go forward. As for the guidance that comes from Public Health England, in developing its plans, local systems work in close partnership with directors of public health to respond to local health needs and deliver on the commitments for the long-term plan. Public Health England works very closely with those directors of public health.

[Baroness Masham of Ilton (CB)]

My Lords, do the Government agree that drug resistance to some of these STIs is very serious and a strategy would help to make people more aware of the problem?

[Baroness Blackwood of North Oxford]

The noble Baroness is expert in this area and often raises this issue. She is absolutely right that antimicrobial resistance among some STIs is a growing concern. Public Health England has a world-class surveillance system to enable early detection and management of antimicrobial resistance. It is particularly an issue when it comes to gonorrhoea, and it uses that intelligence to advise the national gonorrhoea treatment guidelines. We will continue to keep on high alert when it comes to these matters.

[Baroness Manzoor (Con)]

My Lords, the number of reported gonorrhoea cases has increased by 176.6% among multi-race persons over the last six years. How exactly is the issue being tackled in this community and what funding will be made available for it?

--- Later in debate ---

[Baroness Blackwood of North Oxford]

My noble friend is absolutely right that increases in particular STIs are worrying and we need to make sure that we drive forward our response to that. Some BAME groups are at particularly high risk of STI acquisition, particularly those from a black Caribbean background possibly due to a higher number of sexual partners. PHE’s reproductive, sexual health and HIV innovation fund is spearheading new, innovative, community-led interventions to support those at increased risk of infection and we will continue to look for new ways to respond to these challenges.

[Lord Winston (Lab)]

My Lords, it is very unwise to group all STIs together and the organism that I should like to concentrate on for the moment is chlamydia. We may not be diagnosing chlamydia in the right way. Given that the NICE guidelines now mean that we hardly ever do laparoscopies, we cannot show whether people have tubal damage, which is said to be an important part of chlamydia. In my view, that is greatly overestimated. What does the Minister think about research into whether chlamydia really does cause infertility and other problems with conception?

[Baroness Blackwood of North Oxford]

The noble Lord is of course an expert in where we should target our research. The NIHR is a £1 billion fund which is not targeted specifically. However, it is right that we should target research into STIs to ensure our response to the challenges. We know that STIs are increasing so we should include research into them.

[Baroness Finlay of Llandaff (CB)]

My Lords, how much is the Department of Health and Social Care doing with the Department for Education to ensure that in schools young people are aware of the emergence of antimicrobial resistance among STIs and to make the use of condoms more fashionable? Many young people feel that they are not the things to use, when they are actually the best form of protection.

[Baroness Blackwood of North Oxford]

The Government have made it clear that we want all young people to be happy, healthy and safe, especially when it comes to relationships. That is why we are making relationship and sex education compulsory for all secondary-age pupils from September 2020. That is intended to equip young people with the skills to maintain their sexual health and overall well-being. The noble Baroness is absolutely right that that will be effective only if it is cool and works well in terms of communication with young people.

Brexit: Medicine Supply and NHS Staffing

Baroness Blackwood of North Oxford Excerpts

Thursday 5th September 2019 Lords Chamber

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

My Lords, we recognise that leaving the EU could affect a wide range of areas across the health and care system. We are doing everything possible to prepare, and our plans should help to ensure that the supply of medicines remains uninterrupted. We continue to monitor staffing levels, and we are working to ensure that there will continue to be sufficient staff to deliver the high-quality services on which the public rely.

[Baroness Thornton (Lab)]

I thank the Minister for that Answer. I suspect that this Question is an appropriate one, given the debate we are going to have later. Given that the majority of the House is trying to save the Government from their foolishness of crashing out of the EU, these are very important questions because they affect people’s lives and their futures.

I have two questions. What is the department doing to sort out the fact that the Home Office is still completely failing to deliver how settled status can be offered? We are losing European staff from the NHS, including senior and experienced doctors, at a huge rate, which will mean enormous problems. Secondly, on medicines, what measures have the Government put in place to ensure that the shortage protocol does not negatively impact patient safety, and how are the Government going to prevent the UK from becoming a third-tier market for medicines and ensure that we can access medicines and new drugs in a timely fashion if we crash out of the EU?

[Baroness Blackwood of North Oxford]

I thank the noble Baroness for her comprehensive questions. Regarding the EU settlement scheme, we are very pleased that there are now record levels of EU nationals working in the NHS and the social care system. We hugely value their contribution. We need them, and we want them to stay. EU nationals working in the NHS can obtain their long-term status in the UK through the EU settlement scheme, and we are supporting NHS Employers in promoting the EU settlement scheme. On 15 August, the Home Office said that 1 million people had been granted settlement status. Where there have been challenges to working through that, there is support to address it. The EU settlement scheme statistics confirm that not a single person has been refused the status that they applied for. About three-quarters of people receive that status without the Home Office needing to ask for additional evidence on the length of residence; we are checking that is working as it should.

When it comes to medicines, we continue to implement a multi-layered approach to minimise any disruptions of medicines and medical products in a no-deal scenario to ensure that patients will have access to the medicines they need. There are about 7,000 prescription-only and pharmacy-only medicines, and we have been working very closely with suppliers, asking them to hold at least six weeks of stock. The shortage protocol will be led by clinicians, to ensure that patients can access the medicines that they need and are not put at risk. Any decision about this will be made between the patient and their clinician, to ensure that it is appropriate for the care of the individual patient in question.

[Lord Deben (Con)]

My Lords, the Government have claimed that they have done a detailed account of what would happen if we were to leave the European Union, as far as the health service is concerned. Why have they not published that detailed account, why do we not know any of those details and why is the whole country being kept in the dark on all these issues? The Minister has the facts. Can we please have them now, so that we know what we are debating about?

[Baroness Blackwood of North Oxford]

I do not believe that the noble Lord is presenting an accurate picture of the case. We have been very clear with the public, and a lot of information has been published on the MHRA website, on GOV.UK, on nhs.uk and in a number of other places, regarding the information about the analysis of the impact of no deal on patients and on the NHS. We have been very clear about the risks that we think there may be to the supply of medicines due to temporary disruption at the border and the mitigating measures that we have taken to ensure that the supply will continue uninterrupted to patients and to the healthcare system. If the noble Lord wishes to have more information, I am sure that he would be very happy to write to me, and I will place a copy of my reply in the Library.

[Lord Clark of Windermere (Lab)]

My Lords, the noble Baroness is aware that virtually every pharmacist and every GP is experiencing dire shortages of certain medicines already. If the Government have such a good alternative plan for a no-deal Brexit, why do they not bring forward those plans to deal with the shortage that patients are facing today?

[Baroness Blackwood of North Oxford]

At any given time, there are about 100 to 150 medicine shortages within our system. There is a team specifically set up in the Department for Health and Social Care to deal with these shortages. There is no evidence whatsoever that the shortages within the medicine system at the moment are related to Brexit. I work to respond to those shortages every day. The system that we have set up to respond to the potential risks of no deal—which we do not want to happen—is prospective. We are confident that it will be able to respond to any potential border disruption on the short straits.

[Baroness Jolly (LD)]

My Lords, what proportion of our pharmaceuticals are manufactured in the UK? Have Brexit deal negotiators discussed pharmaceutical supplies and, if so, what was the outcome? How many people will be immediately affected if a no-deal Brexit is the final outcome?

[Baroness Blackwood of North Oxford]

I do not have the data for the proportion manufactured in the UK, but I can tell her that there are 7,000 prescription-only and pharmacy medicines with an EU touchpoint which we believe we need to import into the UK at the point of no deal. We have been working very closely with those suppliers, asking them to hold a six-week stock, over and above the usual buffer stock that they hold in case of a potential shortage, which they always hold a risk of. We have also put in place a number of other multi-layered mitigation measures, which include securing capacity for re-routing freight. We have also put in place a number of other measures, such as providing assurance of readiness for logistics and supply chains to meet new customs and border requirements. We have been working to ensure that we communicate that to all those along the supply chains, in the NHS system and in the pharmacy chain.

Personal Healthcare Budgets: Sheffield

Baroness Blackwood of North Oxford Excerpts

Wednesday 4th September 2019 Lords Chamber

[Lord Blunkett]

To ask Her Majesty’s Government what was the difference in the number of people covered by personal health care budgets or Independent Living Fund payments in Sheffield between (1) January and June 2019, (2) January and June 2018, (3) January and June 2017, and (4) January and June 2015.

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

My Lords, the department does not collect the data requested in the specified format. However, the number of people with a personalised health budget is calculated on a quarterly basis within each financial year, which ends on 31 March. Currently, 53,143 people benefit from a personal health budget nationally. I shall write to the noble Lord this afternoon with a full breakdown of all the data that we collect in relation to Sheffield and place a copy of the letter in the Library.

[Lord Blunkett (Lab)]

I am grateful to the Minister. Can she help me with a very practical question relating to the county council’s publication last week, and that of the Institute for Government today, in respect of the funding of social and the interim grant that was due to run out at the end of March next year, which constituted a third of government spending? Can we presume that the amount announced by the Chancellor of the Exchequer this afternoon is in addition to renewing that temporary grant? If it is, is it not a strange paradox that it is half a billion pounds less than the amount that he announced in respect of a no-deal arrangement with the European Union?

[Baroness Blackwood of North Oxford]

The noble Lord has asked a very important question and I am pleased that the Prime Minister has followed through on his commitment to improve the situation for local authorities and for social care, not only by increasing funding for social care by £1 billion today but by increasing funding for local authorities. This is a welcome change for local authorities, which need to ensure that they can fund the commitments that we have. In addition to the letter that I shall place in the Library, I shall be happy to follow up on the specific challenge that the noble Lord raised regarding Sheffield following Questions.

[Baroness Jolly (LD)]

My Lords, personal healthcare budgets and payments from the Independent Living Fund can offer an individual freedom and choice, but will the Minister tell the House what advocacy support accompanies these payments, so that members of the public can be well informed and choose the best providers for their needs?

[Baroness Blackwood of North Oxford]

Personal health budgets play a really important role, not only in supporting individuals to have personalised care but by making sure that we can seek support from social prescribing and community care, just as the noble Baroness mentioned. These plans are designed not only between the general practitioner and the supporter, but with the patient; therefore, the right information is provided to the patient in an open and transparent manner so that they can ensure they get the right care. It is important to note that those in receipt of this care have an 87% satisfaction that they are receiving the care they want in a much more effective way than they were before.

[Baroness Wheeler (Lab)]

My Lords, NHS continuing healthcare is supposed to provide a lifeline when older people and their families are at their most vulnerable and face sky-high costs as the result of chronic health conditions. However, this system is confusing and the rules arbitrary, resulting in a significant postcode lottery. Since 2015 more than 4,000 adults have died while awaiting a decision on their care to be made. What action are the Government taking to ensure that every person in need gets the support they need promptly, regardless of where they live?

[Baroness Blackwood of North Oxford]

One of the actions we have taken today is increasing funding to local authorities to relieve some of the pressures on them, increasing real-terms spending on public health, and also £1 billion for social care. In addition to that, there is a clear impetus from the long-term plan to increase personal health budgets, which are a very important aspect of the solution, because it will lead to an integration of spending and an integrated assessment of NHS care and social care. This is a real gap within the solutions for those who receive this support, which is why we want to make sure that we roll this out much faster than we have before. There is a commitment to have 200,000 people on personal health budgets and we are ahead of our ambitions on that.

Adult Social Care

Baroness Blackwood of North Oxford Excerpts

Thursday 25th July 2019 Lords Chamber

[Baroness Wheeler]

To ask Her Majesty’s Government what assessment they have made of the Association of Directors of Adult Social Services Budget Survey 2019 on the state of adult social care.

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

My Lords, we recognise many of the issues highlighted by ADASS. People of all ages are now living longer, sometimes with complex care needs. Social care funding for future years will be settled in the spending review, where the overall approach to funding local government will be considered in the round. Meanwhile, we have given local authorities access to up to £3.9 billion for more dedicated funding for adult social care this year, and a further £410 million is available for adult and children’s services.

[Baroness Wheeler (Lab)]

My Lords, the ADASS survey results provide yet more evidence of the ongoing crisis in social care caused by persistent underfunding and a fragile and failing care market. As the report says, there are planned cuts of £700 million to adult social care budgets in the current financial year and there have been cumulative cuts of £8 billion since 2010. On the last day of our current Session, can the Minister update the House on the timing of the social care Green Paper, which has been delayed six times and is now two years overdue? Given this inexcusable delay and the widespread consensus across social care about what needs to be done, why can the Government not commit to publishing a White Paper with actual proposals? Has the Lords Economic Affairs Committee report calling for £15 billion of extra funding, to include free personal care for people needing basic washing and dressing support, not done the Government’s job for them?

[Baroness Blackwood of North Oxford]

I share the noble Baroness’s impatience on this issue and I agree with the overall conclusions of the ADASS report that older and disabled people need dignified, high-quality care and support. When properly resourced it does work, and as a nation we must make this an immediate priority. That is why I very much welcomed the incoming Prime Minister’s statement that,

“we will fix the crisis in social care once and for all with a clear plan ... To give every older person the dignity and security they deserve”.

He will make it a priority of the incoming Government and there will be an imminent announcement from the incoming Health Secretary. As I do not know whether I will be part of the department, I am afraid that I cannot commit to this, but I am sure that whoever is in this place when that comes forward will be very happy to do so.

[Lord Forsyth of Drumlean (Con)]

My Lords, I welcome the statement by the incoming Prime Minister. However, does my noble friend share the concern about the unfairness of the current system? People suffering from dementia or motor neurone disease are not given access to free care, whereas people suffering from cancer are. People who choose to be looked after at home do not get free care until their assets have been run down to £23,500, but their home is not taken into account. However, if they go into residential care, their home is taken into account. As my noble friend indicated, what we need now is not another White Paper; we need the Government to write a cheque. We need to move away from a system where local authorities are asked to fund this out of business rates, which results in a postcode lottery and differences in care throughout the United Kingdom.

[Baroness Blackwood of North Oxford]

I thank the noble Lord for the work he has done on this issue. It is very much welcomed. He will know that, as one of his first statements, the Prime Minister said that his job was to,

“protect you or your parents or grandparents from the fear of having to sell your home to pay for the costs of care”.

This was one of the first points he made. The noble Lord will also know that one of the Government’s long-term principles is that there must be a level of personal responsibility for social care in England, as well as the safety net that supports significant numbers of people today. However, we accept that there will need to be a significant amount of funding as part of the spending review commitment. That is being considered at the moment and will be coming forward imminently.

[Baroness Jolly (LD)]

My Lords, the sustainability of adult social care is at severe and immediate risk. We too welcome the Prime Minister’s words yesterday. Could the Minister confirm that he will commit to continuing with the precept, and the social care grant or the improved better care fund after 2019-20? Otherwise, how can councils plan their finances for 2020-21? What assurances do councils have that any future funding will be protected for the adult social services budget and not be part of the overall spending at the councils’ discretion?

[Baroness Blackwood of North Oxford]

The noble Baroness is quite right that the better care fund has been considered a great success. It is an important part of the integration proposals between health and social care, which the Government and the NHS are committed to. It is under review to see how it can work better. That will conclude later this year so that certainty can be given to local councils, which I hope she welcomes. On market instability, I reassure her that the overall number of social care beds has remained more or less constant over the past nine years. There are also over 3,700 more home care agencies now—so, while there will inevitably be some exits from the market, we are more reassured than we would otherwise have been.

[Baroness Pitkeathley (Lab)]

May I take the noble Baroness back to her reference to personal responsibility? There is a great deal of agreement across the House and elsewhere that personal responsibility is important as far as social care is concerned, but does personal responsibility extend to subsidies for those on local authority placements in nursing homes? Those paying for themselves privately are actively subsidising those places because local authorities cannot afford adequate rates.

[Baroness Blackwood of North Oxford]

The noble Baroness has got to the nub of the challenge, which is how we get the balance right. This is why we have brought forward the work we have been doing to make sure that, while we have the safety net in place and an element of personal responsibility, it becomes fairer. That is why the Prime Minister and the Secretary of State have made it clear that they are determined to drive this work forward faster and with more urgency than has been done until now. That has been put forward as a key priority of the incoming Cabinet.

[The Lord Bishop of Ely]

My Lords, we have heard, properly, about the needs of the elderly. Will the Minister assure us that the needs of people with learning disabilities will be better addressed in any action the Government are likely to take, particularly since some 41% of the helpline calls to Mencap in April were from people very concerned about the loss of community care?

[Baroness Blackwood of North Oxford]

The right reverend Prelate has pointed out something very important: a significant portion of those accessing adult social services are actually those of working age and those with learning disabilities. It is very important that does not get lost in the debate. Anything that comes forward as part of the social care solution must address the concerns of that part of the community in a much more effective and joined-up way. Integration of social care and NHS budgets, and effective delivery, will be core to that delivery.

[Baroness Greengross (CB)]

My Lords, last week, with the Salvation Army the charity the International Longevity Centre UK, which I head, published a report on the funding gap in social care, in particular for older people living in rural areas. The report summarised it very well by saying that there is not just one crisis but lots of crises and that local leadership alone cannot overturn the inequalities. As co-chair of the All-Party Group on Adult Social Care, I hope that the Minister can assure me that Her Majesty’s refreshed Government will now prioritise this issue in the way I have suggested.

[Baroness Blackwood of North Oxford]

The noble Baroness phrased that very elegantly—I shall use the term “refreshed Government” myself. I will make the gentle point that the funding available for adult social care has increased by 8% in real terms from 2015-16 to 2019-20, which is a step in the right direction. However, there is a recognition that, to put it on a sustainable footing for the future, there needs to be a settlement in the upcoming spending review. That is recognised. On the point she made about rural areas, which is important, a lot of this hinges on workforce recruitment and retention, which can be more challenging in rural areas. That is why the Government have invested £3 million in the Every Day is Different national adult social care recruitment campaign, to encourage more people to apply to work in the social care sector and to raise its profile. This has had some success already, which is an encouraging picture. We need to work harder on that.

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.