NHS Winter Pressures
Baroness Brinton Excerpts(1 year, 11 months ago)
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Lord Markham (Con)
I agree that we need a whole-system approach. Workforce is a key part of that, including the adult social care workforce. Again, as all noble Lords did, I welcome the advent of the agreement to do a workforce plan, which needs to take all these factors into account. We need to make sure that it is an attractive place to work, and that people see it as a career progression—and that it is modular so that you can start in social care and, if you want to, progress into other parts of the health service.
Baroness Brinton (LD)
My Lords, I declare my interest as a vice-president of the LGA and vice-chair of the All-Party Group on Adult Social Care. Nearly three years ago, the Government created Nightingale hospitals, which were much vaunted and had millions spent on them. Virtually all of them were useless because there was no staffing available for them at short notice. I listened to the question from the noble Baroness, Lady Merron, about the short, medium and long-term workforce plan. We are now in emergency time: there are 160,000 social care vacancies and 40,000 nursing vacancies, which includes those in social care. How is this unblocking of beds going to be staffed and by when?
Lord Markham (Con)
Obviously, prior to this, we were in touch with the adult social care sector to make sure that there was that capacity within the system for it. We have been assured that the capacity exists, but we wholeheartedly agree that we need to recruit the staff to fill those vacancies, which is why we have taken measures to recruit internationally as well as in the domestic recruitment programme. Those are all key components of the longer-term plan to solve this issue.
Hospital Beds: Social Care
Baroness Brinton Excerpts(1 year, 11 months ago)
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Lord Markham (Con)
I will happily write on the detail, but, yes, it includes everyone who could be provided a space, either in a care home or a mental health home, and those who are fit to go home but need domiciliary care.
Baroness Brinton (LD)
My Lords, Our Plan for Patients, which was published at the end of September, says:
“This winter, the NHS will open up the equivalent of 7,000 beds so that every hospital has space to see and treat patients more quickly.”
Winter is clearly here, so how many of those virtual beds are in operation now?
Lord Markham (Con)
I thank the noble Baroness. She is absolutely right that the target of 7,000 beds is a key part of this. All Ministers have been talking about it with every ICB over the last few days to see exactly where they are on the target for both real beds and virtual beds. I will happily provide exact information on the target, but I know that we are making good progress.
Food (Promotion and Placement) (England) (Amendment) Regulations 2022
Baroness Brinton Excerpts(2 years ago)
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Baroness Brinton (LD)
My Lords, it is a pleasure to follow the noble Baronesses, Lady Walmsley and Lady Merron. They have said practically everything I wanted to say, and as the Minister may find it depressing for me to say it a third time, I will not.
What I do want to focus on is the key role of Parliament, and in this case your Lordships’ House, in scrutinising statutory instruments. We all have to accept that the period during which Liz Truss was Prime Minister was a somewhat extraordinary, though very short, one. I note in parenthesis that the Minister was appointed on 10 October, after these incidents had happened, so I think we need to recognise that he is responding to something that happened before he was in post. He was, however, appointed by Liz Truss.
The key thing is the sleight of hand in turning something that was absolutely openly discussed during the passage of the Health and Care Bill, and which was only to be used as a very short-term emergency measure, into what has clearly become a highly political move. While I have perhaps been slightly harsh on the time during which Liz Truss was Prime Minister, her successor has chosen not to reverse this, which tells me that this is a move by the Government.
I have to echo the points made by the noble Baroness, Lady Walmsley, about the evidence to our eyes during the passage of the Health and Care Bill of those who had heard the lobbyists and were fighting hard against the amendments the Government wanted.
I have just a couple of questions. We do need to see the evidence. The Secondary Legislation Scrutiny Committee was right: it is not appropriate to ask Parliament to scrutinise something without the evidence. Where is it, when will we see it and why do claims about the cost of living contradict the Government’s own evidence in the impact assessment available at the time? It is important that Parliament sees the detail of the responses to the Government’s consultation from every sector—food and drink, supermarkets, health bodies, not-for-profit organisations and charities—and the public, in whatever way they responded. Do the Government plan to publish that consultation?
Given the concern expressed by everyone who has spoken this evening, and indeed the Secondary Legislation Scrutiny Committee, and the evidence of our own eyes in your Lordships’ Chamber during the passage of the Health and Care Bill, it might be helpful if Ministers could publish all the meetings that all Ministers have had with food and drink industry members this calendar year, which about ties in with the beginning of the passage of the Health and Care Bill—at least, the first consultations prior to legislation arriving here in your Lordships’ House.
Finally, I suspect this may be slightly beyond the power of the Minister, but I do hope he will go back to the usual channels and seek guarantees that this sleight of hand will not be used again, especially given the delay on advertising HFSS products on TV and online before the provisions are due to come into effect on 1 January 2023. We absolutely must have that 21 days to decide whether we want to pray something in aid and bring forward regret Motions. However, there is a bigger issue here: the reputation not just of your Lordships’ House but of the Executive, and the power of the Executive just to ignore the systems that are in place. We need to make sure that scrutiny can be done effectively.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
My Lords, I thank the noble Baronesses, Lady Merron and Lady Walmsley, for securing this important debate to discuss the Food (Promotion and Placement) (England) (Amendment) Regulations 2022. I also pay tribute to the Secondary Legislation Scrutiny Committee for its 15th report of the 2022-23 Session, which considered the amendment.
I thank noble Lords for their constructive and thoughtful contributions to the discussion on tackling the significant challenge of obesity. From this debate and our previous discussions, the good news is that we are all agreed on the need to take action. We are all aware of the stats: 40% of kids are overweight when they leave primary school, 25% are obese and, as the noble Baroness, Lady Walmsley, said, there is a huge impact on the economy of £58 billion per annum and a huge impact on the NHS of £6.5 billion. That is notwithstanding the huge impact on individuals’ personal health and well-being as well.
We are also all agreed on the strategy that we need to take: reducing overconsumption of food and drink high in calories, sugar, salt and fat. I think we all know the main levers available to achieve that but, to paraphrase the OECD, there are four key steps: information/education, increasing healthy choices, modifying costs and restrictions on promotions and product placements. We have made good progress on each of those. We have extensive education programmes and traffic-light labelling on food, we are working with industry to reformulate food recipes, we are putting calories on menus to signal healthy choices and we are ensuring a healthy start to life through nutritionally balanced school recipes. Furthermore, the sugary drinks tax levy has had a huge impact, with a 47% decrease in sugar.
Finally, the introduction of restrictions on product placement has had a high impact on the look and feel of our supermarkets. It is early days but a year-on-year change in the consumption of these types of products—two months into this, I guess—shows an 8% fall in sugar content, a 5.7% fall in salt consumption and a 6.4% fall in fat, which shows that these restrictions on product placement are working. Furthermore, analysts calculate that the steps we have taken here will account for 96% of the reductions in calorific intake. I repeat: the actions that we have taken, thanks in large part to all of us in the House, account for 96% of the projected reduction in calories. The early signs from the evidence that I gave show me that those actions are working.
I turn to the 4% and the thing we have not done, the subject of the regret Motion tonight: the delay to the ban on promoting foods high in fat, sugar and salt—the so-called BOGOF, or “buy one, get one free”, promotions. I emphasise that this is just a delay to the ban to give people time to adjust. I am delighted to say that Tesco and Sainsbury’s, accounting for 42% of the market, have already voluntarily banned BOGOFs of these types of food products. I am confident that the rest of the market will voluntarily follow, whether they are supermarkets following the lead of Tesco and Sainsbury’s or food companies reformulating their recipes to reduce fat, sugar and salt to avoid the so-called BOGOF ban.
By working with the food industry, we have taken action to address 96% of the problem, and we are working collaboratively with industry to implement the remaining 4%. Those figures probably give the best answer for the delay, though I concede that maybe I say that as a data analyst—and it was before my time.
I agree with the noble Baronesses, Lady Merron and Lady Brinton, that the so-called sleight of hand clearly was not great. I am pleased to take that from this debate, and I commit to doing better for as long as I am here.
The noble Baroness, Lady Walmsley, asked about the benefits challenge. The action that we have taken is focused on 96% of the forecast decrease in calorific intake, which again shows that we have acted where the benefits are most likely to accrue. My rough maths says that, if 42% of the market—Sainsbury’s and Tesco—voluntarily introduce this, we are now looking at addressing about 98% of the calorific intake that we had forecast to reduce. By any measure, that shows very strong analytical evidence of good reasons for doing so, and for giving people time to adjust and make the other changes.
On the 21-day rule, a consultation on this instrument was conducted between 3 and 17 August 2022. This was a short consultation shared with key stakeholders, including trade industry bodies and organisations, non-governmental organisations and enforcement officers. We sought views on the proposed text of the instrument. A summary of the outcome of the consultation was provided in the published Explanatory Memorandum. We explained that the consultation received 11 responses, including from organisations that represent over 50 health organisations, and industry trade bodies that represent manufacturers and retailers. All proposed changes suggested as part of the consultation were considered in the light of ensuring that this instrument served the intended purpose of delaying the implementation of the volume price promotion restrictions by 12 months.
Baroness Brinton (LD)
My question was whether the detail of the consultation responses would be published in the future. I appreciate that the Minister may not be able to answer that now, but even though there may not have been responses from many people—and it sounds as though there were not—it would still be useful for us to see that to do our job. Can he take that back? It is the normal convention that the results of public consultations are published; if not word by word, there is certainly more of a summary provided than there was in the Explanatory Memorandum.
Invasive Group A Streptococcus and Scarlet Fever
Baroness Brinton Excerpts(2 years ago)
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Baroness Brinton
To ask His Majesty’s Government what assessment they have made of their guidance to doctors and to parents in light of the increase in Strep A, iGAS and Scarlet Fever cases.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
The UK Health Security Agency has declared a national standard incident to co-ordinate the public health response. It is working with schools and GPs where there are outbreaks to provide information on scarlet fever and iGAS. A rapid surveillance report and communications to the health system have been published to ensure heightened awareness among front-line clinicians. We are also putting out key messages for parents to understand the trigger points for urgent referrals of children with more serious cases.
Baroness Brinton (LD)
My Lords, UKHSA has reported today that, in the last 10 weeks, it has received 4,622 notifications of scarlet fever, compared to an average of 1,200 for the same period over the previous five years—that is more than three times. Parents with very sick children report being turned away from hospitals or GPs not prescribing antibiotics. Local directors of public health are talking to schools and GPs, but can I ask the Minister what else can be done to ensure that all cases of potential strep A and scarlet fever are tested for, and treated as appropriate at the earliest moment, to avoid serious illness and death?
Lord Markham (Con)
I thank the noble Baroness for bringing this important issue before us today. To give context and answer the point, there were about 850 cases in the latest week, compared with about 186 in previous years. Generally, in peak years such as 2018, we had as many as 2,000 cases per week. We are not at those levels at the moment, but we seem to be seeing an earlier season: we normally expect levels to be higher in spring. At the same time, it is essential that we are alert. We have given instructions to doctors that they should proactively prescribe penicillin where necessary, as it is the best line of defence, and that they should be working with local health protection teams to look at whether to sometimes use antibiotics on a prophylactic basis where there is a spread in primary schools, which we know are the primary vector.
NHS Dental Contract
Baroness Brinton Excerpts(2 years ago)
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Lord Markham (Con)
I agree, and I understand the problem. I also agree that we need to look at a broad range of measures. I was delighted that we passed the statutory instruments on water fluoridation recently, and we should look at new ideas. I was also delighted to see oral health advice included in the new family hubs being set up. We are willing to look at measures that work elsewhere as well, such as free toothbrushes in Scotland.
Baroness Brinton (LD)
My Lords, the British Dental Association has proposed four simple emergency measures—changes which could be made to the dental contract that would make an enormous difference. The Minister referred to the regulations. Regulations in respect of the workforce will make significant changes too. They were in Forthcoming Business and then removed. When will they be heard in this House? This reform is urgently needed.
Lord Markham (Con)
As mentioned, the new package of measures, which is all about encouraging dentists into the NHS space, will be brought forward next year. The workforce plan is now under way. However, central to all this is not the budget but making sure that it is fully utilised. As the noble Baroness said, that will happen by having more NHS dentists. We currently have 3,500 in training, which is working towards that, but, clearly, we need to work further.
Care Homes: Severely Disabled People
Baroness Brinton Excerpts(2 years ago)
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Baroness Brinton (LD)
My Lords, the Minister just referred to mental health funding and referred earlier to the increased funding to cover delayed discharges and get more people coming out of hospital into social care. Neither of those affects severely disabled adults; funding for them from central government to local government has not been increased. I repeat the question of the noble Baroness, Lady Pitkeathley: does the Minister think that the provision and arrangements for this particular group of people are broken?
Lord Markham (Con)
No—it is for local authorities to decide how best to use the funding we have put in place, as I said. That means looking at the needs of local people and how best they will put this in place. The 22% increase in funding can be channelled to exactly these types of places and people if a local authority believes that that is in the best interest.
Covid-19: PPE Procurement
Baroness Brinton Excerpts(2 years ago)
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The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
I thank the noble Baroness, and I commit to write with the precise figures. To put it into context, we should remember that this was at a time when unprecedented action was required. Of the 38 billion PPE items ordered, 98% were delivered and just 3% were unfit for purpose. Within that, clearly there is action that needs to be worked on and action is being taken to pursue those damages. I will put those in writing, so that the noble Baroness can understand them all. As I say, it is good if noble Lords recall that the priority at the time was clearly getting equipment to help protect and save lives, and that was what was done. Were mistakes made? Of course. Are we seeking to address those now by going back to take action against those people? Yes, of course we are, but we need to keep it in the context that the undoubted priority was to buy PPE and protect lives.
Baroness Brinton (LD)
My Lords, from these Benches we echo the questions that the noble Baroness the Leader of the Opposition has asked. We note that at least 71 PPE deals were awarded to firms, of which at least 46 were put into the VIP lanes by Conservative Ministers and officials during the Covid pandemic, as well as by some MPs and Peers, before a formal eight- stage due diligence and checking process was put in place. There were also deals made not for PPE during that period, including for testing and some non-health ones.
I think we all agree that the wastage and profiteering should never happen again, but we warned from these Benches, as did other Members across the House, in the early stages of the pandemic that all the right contracting arrangements, protocols and scrutiny needed to continue. The Minister has said that the pandemic posed problems, so will he push for a separate, independent-led inquiry able to examine the whole procurement process, including the VIP lanes, and analyse forensically the bids, profits, wastage and catalogue of links to Ministers, MPs, Peers and others who had influence on them?
Lord Markham (Con)
I thank the noble Baroness. My understanding is that there have already been three NAO reports and three PAC reports on this, so it has been covered in depth. I think people have accepted that mistakes were made and that the high-priority lane, so to speak, should not have been on the basis of referrals but more burden of proof should have been put on the applicants, so we could get more information and sift it that way. Again, to put it all into context, there were 19,000 applicants at the time. This was led by officials, and they put the high-priority lane in place to try to sift those. Also, of the 430 that went into the high-priority lane, only 13% actually ended up in contracts. Are there lessons to learn from this? Of course, but the NAO and PAC reports have outlined those lessons.
Adult Social Care
Baroness Brinton Excerpts(2 years ago)
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Lord Markham (Con)
Obviously, the central grant is raised through general taxation and so is distributed and raised in the way we all know. We can all have a question as to what the balance should be between the two. At the same time, I think we all believe in localism and we all believe, as part of that, that local authorities are the best placed to make decisions. That means that they have some of those fundraising abilities, so they can put more funds into the area where it is required. Whether we have the balance right is something we need to keep under control, but right now the most pressing thing is putting in more money for next year and the year after, and I am very glad—and I hope the whole House will welcome—that we have committed to do that. We put our money where our mouth is to create 200,000 new care packages.
Baroness Brinton (LD)
My Lords, surely the most pressing thing is the emergency winter fund to help remove and reduce delayed discharges this year. The Secretary of State for Health has said that he wants to reduce the bureaucracy, so why are the rules for accessing the emergency winter fund so complex that the Health Service Journal is full of local authority and senior NHS staff saying that they do not understand why the Government are insisting on this bureaucracy?
Lord Markham (Con)
Believe me, I am no fan of complexity. At the same time, I want to make sure, as I am sure we all do, that the funding goes to the places of most need and is really being spent on the areas that it is being spent on. Having said that, I will take away those comments at face value and will look into the complexity because, clearly, that is in no one’s interest.
NHS: Waiting Lists and Increased Spending
Baroness Brinton Excerpts(2 years ago)
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Lord Markham (Con)
I thank the noble Lord. For the record, there are 29,000 extra nurses since 2019-20, so we are well on course for the 50,000 increase. At the same time, we do need to recruit from overseas, and that is very much part of the plan. Again, this will go into the workforce strategy, but I completely agree that we should be looking to recruit from around the world, which we are. I am delighted that we are adding more and more people to the essential workers list, so to speak, to enable us to do that, because we all know that the workforce plan will show that we need to recruit people and retain them.
Baroness Brinton (LD)
My Lords, the last time the figure of 92% of patients being seen within 18 weeks was achieved was in 2016. Since then, the numbers who are waiting have doubled: it is now 7.1 million. What does the Minister say to the 16 year-old in Shrewsbury who has just been told that he has to wait nearly three years for a first appointment at his local hospital? The hospital says that it has recruitment problems. When will we see the details of this workforce plan, particularly for rural areas?
Lord Markham (Con)
I thank the noble Baroness. As I say, we have committed to that workforce plan, and it will be detailed. We will look at every place in every part of the country because we understand that that is needed, and it is part of the critical plan to get on top of the 7.1 million waiting list. As I think we have accepted, it is not a quick win; it will get higher before it gets lower again. Clearly, however, we need to get on top of it, and we are focused on it. It is very much about the plan and the new spending plans that we put in place to address it.
NHS Waiting Times
Baroness Brinton Excerpts(2 years ago)
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Lord Markham (Con)
I agree with the noble Lord that cardiovascular is one important area in which, over the last few years, patients have not received the number of check-ups that we want, so it is an area on which we want to focus—not just through checks in GP centres but in the community. We all know that it is very easy to take blood pressure and have blood pressure machines. As a team, we are looking at precisely those kinds of measures to make sure that we can get the preventive screening in up front, so we can identify these people before problems occur.
Baroness Brinton (LD)
The Minister referred to the worst-performing hospitals and ambulance trusts, but news from the Health Service Journal today has shown that the longest waiting times are mainly in rural, deprived areas, with an elderly population that is much higher than in the rest of the country. Can the Minister say what special resources will be provided for those areas—rather than just using words like “worst”, which punish them unnecessarily?
Lord Markham (Con)
I thank the noble Baroness. If I have used a poor choice of words, I apologise. What we are looking at is identifying the areas where we most need to focus resources to solve wait times. That might be because it is a rural area or it might be, candidly, because it is not performing so well. The point that I was trying to make is that there is targeted support. We spent £150 million on ambulance performance and new facilities last year, and it is something that we will continue to do if those rural areas and other areas need the spend.