Integrated Care Boards

Baroness Brinton Excerpts

Monday 5th September 2022 Lords Chamber

[Lord Kamall (Con)]

During the debate on the Health and Care Bill, which became the Health and Care Act, one of the things on which we agreed across the House was that each integrated care board should have the appropriate mix of skills. I think that was thanks to an amendment by the Liberal Democrats. This particular issue shows that we need to ensure that we are considering all the important aspects of health. One of the things that will be very important is the parity of mental health with physical health. All these issues will be considered at the local partnership level.

[Baroness Brinton (LD)]

My Lords, one of the key elements of ensuring there is a good transition is the procurement process. Last month, three CCGs were fined for using considerable organisational bias to ensure that their contracts went to a preferred company. The fine must be paid by the ICB, and the staff from the CCG are now in the ICB. What are the Government going to do to ensure that this sort of practice is monitored and ruled out by the new bodies as they get under way?

[Lord Kamall (Con)]

I hope the noble Baroness will remember that, during the debate on the Health and Care Bill, there were concerns about private sector bias, as it were, in giving contracts. We agreed to an amendment suggesting that there should be no conflict of interest. I am afraid I am not aware of the specific cases that the noble Baroness raises, but I will look into them and write to her.

General Practitioners: Shortage

Baroness Brinton Excerpts

Tuesday 12th July 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

I call the noble Baroness, Lady Brinton, to make a virtual contribution.

[Baroness Brinton (LD) [V]]

My Lords, the Royal College of GPs reports that since 2019, GP clinical administration tasks have risen by a shocking 28%. GPs say that it would make a significant difference if hospital consultants could refer patients directly to other consultants, rather than patients having to come back to GPs and then be redirected. The back-office functions for repeat prescriptions take an ever-increasing amount of their time, and GPs are not in control of either of these processes. As a matter of urgency, will the Minister investigate how to reduce some of this bureaucracy so that GPs have more time to see their patients?

[Lord Kamall (Con)]

As part of the joint NHS England and NHS Improvement and DHSC bureaucracy review—there is such a thing—we have been working across government to reduce unnecessary bureaucratic burdens. There have been a number of key work streams, including a new appraisal process and digitisation of the signing of some notes, along with work to reform who can provide medical evidence and certificates and who can provide notes—nurses, occupational therapists, pharmacists and others. We are continuing to look through the process to engage with GPs to see how we can remove more such administrative burdens.

Health Improvement and Food Production

Baroness Brinton Excerpts

Thursday 7th July 2022 Lords Chamber

[Baroness Brinton (LD) [V]]

My Lords, I declare my interest as a vice-president of the Local Government Association. I thank my noble friend Lady Walmsley for securing and excellently introducing this important debate. This is a truly cross-departmental debate, but it rarely seems to go beyond any one of the core elements of health or food production. I also thank the Library for its excellent briefing, which covers so much. It rightly starts with the House of Lords Food, Poverty, Health and Environment Committee, which published its report, Hungry for Change: Fixing the Failures in Food, on 6 July 2020, almost exactly two years ago. This makes very significant recommendations.

The UK imports 48% of the food that we consume, and that proportion is rising. At the same time, many of our farmers, fishing and food-processing interests have lost a major part of their export markets following Brexit. For the last few months, Ministers have answered questions on the numbers of pigs slaughtered because our UK abattoirs and food processers cannot bring staff into the UK to do the necessary food processing. Fruit and vegetables are rotting in the fields because of a lack of staff.

At the same time, following Putin’s invasion of Ukraine, fertiliser and energy costs have rocketed. Farmers and fishermen are going out of business at exactly the moment when we need to be able to grow more food, not less.

The Government are keen to set trade deals that will encourage a further flood of cheaper food, often grown with lower welfare and other standards than we use here in the UK, and often much more full of UPF, as so helpfully outlined by other speakers.

The Government’s response to the Lords Select Committee is best summarised in its UK food strategy, published last month, which followed Henry Dimbleby’s independent review of the UK food sector, referred to by a number of noble Lords. I do not know if they felt this, but I found the Government’s response weak. Mr Dimbleby’s review was a bold approach to tackle a range of issues, but was also supported by experts in child poverty, food production and agriculture. As my noble friend Lady Walmsley outlined, the recommendation headlines are simple and clear, and worth repeating. They are to:

“Make us well instead of sick


Be resilient enough to withstand global shocks


Help to restore nature and halt climate change so that we hand on a healthier planet to our children


Meet the standards the public expect, on health, environment, and animal welfare”.


It was disappointing therefore to see a government food strategy that proposed not much more than business as usual.

The review’s focus on the holiday activities and food programme and the Community Eatwell programme is absolutely vital in helping those children and families who are struggling—even more at the moment—and have slipped into real food poverty that was unimaginable 20 years ago. I echo my noble friend Lady Walmsley’s question on why Dimbleby’s recommendations have not been fully accepted and implemented.

There are reports in the press this week that inflation is forcing schools to reduce healthier meals. A third of school caterers say they will serve more processed food in the coming months, and many have already changed their menus. In fact, 78% of school caterers say that higher prices have forced them to change their options for pupils as a result of rising prices, and 40% say they fear they will not be able to meet the Government’s school food standards if prices continue to rise. We have heard in this debate that those standards need to be raised. Most worryingly, 20% have said they have switched from British to imported meat because it is cheaper. This particularly matters because lunch, especially for those whose families are struggling financially, whether or not they are on free school meals, may be the principal meal of the day.

The noble Baroness, Lady Jenkin, referred to UPF and how these processed, nutritionally poor and addictive foods are growing in use. She argued very powerfully that our children’s diets have already been severely impacted by UPF, and why childhood obesity continues to grow in the UK at such a dangerous rate. The noble Baroness, Lady Bennett, echoed those comments, but also made the important point about science and agriculture not necessarily working towards the same objectives. She was also right to be concerned about the impact of processed foods from the US in the UK. The noble Baroness, Lady Jenkin, was also right in saying that we are losing the link between good food grown in our countryside.

In France, all children at primary school are given a free three-course lunch of healthy and—compared to our school catering—sophisticated foods. The French have always understood, which we still do not, that eating together is part of children’s social and emotional development, and staff sit and eat with the children rather than just monitoring them. In my mother-in-law’s village in rural south-west France, the elderly people who used to receive meals on wheels now join the children for lunch, which is not just enjoyable for all but strengthens the bonds in the community. There is no mass catering organisation purchasing, pre-cooking and sending frozen goods to schools; local cooks buy what is in season, and cook and serve it.

The OECD’s obesity update shows that in 2017 the UK adult obesity rate was 26.2%. In France it is 17%, despite its diet being high in fat. Its incidence of cardiovascular and other diseases is low; it is called the French paradox. Partly, it is to do with the right type of fat, but the broader French food culture is very different from ours: there is not a culture of snacking, and sitting down to eat as a family and as a class at school is regarded as very important. The quality of food is thought about not just by the person preparing the meal; it is considered carefully and commented on by everyone. A French friend of ours says that the English talk constantly about the weather and the French talk about food. Food is undoubtedly part of their cultural identity. In Japan, the obesity rate is just 4.2%. That is because almost all Japanese food tends to be low in calories and very low in fat. It is important to understand that it will take us time to change. France is worried that its rates have been going up, but we should all aspire to lowering our rates—perhaps it will take 20 or 30 years—towards where Japan is.

The noble Baroness, Lady Bennett, referred to the Dasgupta review, which echoes the many other reports that have been referenced by noble Lords. For me, his key comment is:

“Our unsustainable engagement with Nature is endangering the prosperity of current and future generations.”


The NFU’s The Future of Food 2040 report sets out the vital role of agriculture and horticulture in the UK and makes powerful reading. It too sees the importance of health becoming a key ingredient, requiring a change in what is grown as well as eaten. It recognises that our approach to diets needs to change, even talking about the use of insects in our diets. It highlights the socialisation of eating. Fewer families eat together in the UK than at any time. Eating together will help to change the cost and nature of how people eat. Will the Minister work with the NFU and some of the bodies mentioned in this debate in developing the Government’s land strategy? I also echo my noble friend Lady Walmsley’s concern about the overlapping and clashing schemes that cause real problems for farmers to make progress.

I turn to Henry Dimbleby and Jamie Oliver, and thank the noble Lord, Lord Kirkham, for referring to the latter and the Doncaster protests. The noble Lord was right to highlight that happiness does not resolve obesity or change dietary habits. He also made the vital point about the ability of people to pay for good, healthy food. The extraordinary @BootstrapCook, Jack Monroe, tried to help by putting cheap, nutritious meals on Twitter, but was misunderstood by others who assumed that this was patronising, whereas Jack was trying to help people who were really struggling. Jack says:

“If it’s inaccessible to the poorest amongst us, then it’s neither radical nor revolutionary.”


I ask the Minister: are this Government prepared to be revolutionary?

The NFU advocates for a food re-think. It is right that we need a new approach to food, moving away from high-fat, high-carb, very cheap food, which, as we have heard from noble Lords, often contains the wrong sorts of fat, to a position where we grow much more of our food for our own needs, where our young people learn from their earliest experiences to love food and be curious about it, and where the public realm ensures that the poorest in our community are not priced out of eating good, nutritious local food.

Above all, good health and good food production is a joint venture which needs to be led by government. It is a joint venture of the people, of food producers, of cooks and others involved in food processing and of our welfare state to help protect the poorest people from food poverty. I look forward to hearing the Minister’s response.

Thyroid Patients: Liothyronine

Baroness Brinton Excerpts

Wednesday 6th July 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

The noble Baroness, Lady Brinton, will make a virtual contribution.

[Baroness Brinton (LD) [V]]

My Lords, what assessment has been made of the T3 Prescribing Survey Report, which was published on 13 May, and of the reported failure by clinical commissioning groups to follow NHS England’s national guidance, Prescribing of Liothyronine, published in 2019, which shows that 58% of CCGs are still not complying with the national guidelines? Can the Minister intervene? This seems to be a ridiculous situation.

[Lord Kamall (Con)]

I have had prior notice from other noble Lords about this issue and have organised meetings with my officials in the past on this—I am always happy to do so. Given the concerns about the lack of commissioning for people who have tried the first-line treatment and now want the second-line treatment, NHS England intends to revise its guidelines. It is sorry about the process, but it must consult before it can change those guidelines.

Paramedic Services

Baroness Brinton Excerpts

Monday 4th July 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, we have a virtual contribution.

[Baroness Brinton (LD) [V]]

My Lords, when Sandra Francis of Oswestry had a cardiac arrest a few months ago, her son had to do 35 minutes of CPR waiting for an ambulance delayed in handovers at A&E. Sadly, she died. Her son said:

“An ambulance should be a way of getting someone to hospital. It shouldn’t be a waiting room sat at the hospital.”


He is right. Ambulance delays are the very visible part of the A&E crisis and the wider shortage of hospital beds, doctors and other healthcare professionals. Again, I ask the Minister: what are the Government doing to remedy this much wider emergency that is causing preventable deaths right now?

[Lord Kamall (Con)]

The noble Baroness will be aware that there are a number of things going on with the 10-point plan. Maybe I will go through some of the points now. We are supporting 999 and 111 services, making sure that the appropriate person answers the call; supporting primary care and community health services to manage those services; making more use of urgent treatment centres; and providing more support for children and young people. Sometimes people ring 999 but do not need emergency treatment and they can be redirected to another clinician, who can speak to them and that takes pressure off. We are recruiting more staff and looking at more prevention and looking at different rules which prevent the appropriate workflow through the system.

Mental Health: Advertising and Body Image

Baroness Brinton Excerpts

Thursday 30th June 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

We have a remote contribution from the noble Baroness, Lady Brinton.

[Baroness Brinton (LD) [V]]

My Lords, the Children’s Society’s Good Childhood Report 2021 shows that one in seven girls and one in eight boys is particularly unhappy about their appearance. Young people who are not happy with their lives at 14 are more likely than others to have symptoms of mental health issues by 17, including instances of self-harm and suicide attempts. Despite the Government’s promises of future funding for mental health support for schools and CAMHS, it is clear that young people are not getting that initial front-line support that they need now. How soon will there be mental health counsellors in every secondary school?

[Lord Kamall (Con)]

When we look at mental health in children and body image, we see that it varies not only among age groups but within age groups. We have identified concerns about poor body image as a risk factor that leads to mental health conditions, but it is not necessarily a mental health condition in itself. We have to look at how much of this was already present in the playground before the age of social media, with people being called nicknames for their appearance. However, that has been amplified by social media. We are working with social media companies and others to find the most effective solution.

Draft Mental Health Bill

Baroness Brinton Excerpts

Tuesday 28th June 2022 Lords Chamber

[The Deputy Speaker (Lord Duncan of Springbank) (Con)]

My Lords, the noble Baroness, Lady Brinton, is taking part remotely.

[Baroness Brinton (LD) [V]]

My Lords, from these Benches we would also like to thank Sir Simon Wessely for his report. We welcome reform to the outdated Mental Health Act and we are pleased to see that the Wessely review is finally being implemented by the Government, even if they are not accepting all the recommendations. The Liberal Democrats pledged in 2019 to implement all the recommendations of Sir Simon’s review, including bringing forward the necessary investment to modernise and improve patient settings and ambulances. We will apply the principle of “care, not containment” to mental health, while ensuring an emergency bed is always available if needed. Sadly, that has not been the case in recent years.

The Statement talks of the Mental Health Act 1983 and how it was designed to protect those who presented a risk to themselves or to others, but it has long been unfit for purpose, with some practices adding more distress to those already struggling with mental health conditions. I am sure most of us have seen that with our families and friends, because everybody knows somebody who has had mental health problems. For too long, people from ethnic minority groups, as well as autistic people and those with learning disabilities, have been unfairly detained under this Act and it has caused huge distress and damage, not only to the individuals themselves but to their families too.

Shockingly, black people are more than four times more likely to be detained under the Act and more than 10 times more likely to be subject to a community treatment order. The noble Baroness, Lady Merron, said it is important to eliminate racism in mental health and criminal justice system interventions for those with mental health problems. This is long overdue. It is or has been, frankly, institutional racism, and it is time that it is dealt with very quickly.

That people with learning disabilities and those who are autistic are being detained under the Act even when they do not suffer from any mental health conditions is appalling. The Statement says that the Bill will change this, but can the Minister assure us that the Government are serious about tackling these issues and will have no cause to delay this Bill again? While pre-legislative scrutiny is important, it should not lead to further delays in getting the Bill on the statute book next year.

It is good that the Statement announces £150 million over the next three years to bolster mental health services, especially to support people in crisis and avoid their having to attend A&E, which is not good for them and not good for A&E either, but I ask the Minister, since it is not clear from the Statement: is this entirely new money, or is it coming out of the mental health budget that was announced?

It is good that patient safety will be enhanced, but what is being proposed to bring much of the elderly and decrepit mental health building stock up to date and suitable for the 21st century? Some of the buildings are not just unsafe; they are actually not very pleasant places to be either.

The cost of living crisis continues to have a significant impact on families and the demand for mental health services for parents with young families is increasing, but the support to deliver these services is simply not keeping pace with demand, with nurses reporting cuts to funding and staff shortages. What plans does the Minister have in place to improve access to mental health services for new parents?

The Statement mentions the important proposals to give patients more control over their care and treatment. This is vital. We in the disabled community say that there should be nothing about us without us, and that is true too for those with mental health issues. The proposal for the nominated person to be chosen by the patient is a great step forward too, but that may well be hard for family members not selected as the nominated person, who may be excluded from any information about their family member’s mental health or progress, or as my honourable friend Daisy Cooper MP said yesterday, may not even know which part of the country their family member is staying in. This is part of the navigation of a future which is important to get right for the patient, while making sure that close family members who are worried about their loved ones are not cut out of the information loop entirely. Perhaps the Minister can give us some indication of how this trickly situation could be navigated.

The Government have said that they are accepting most of the recommendations of the Wessely review, but I add my concern to that expressed by the noble Baroness, Lady Merron: why have some not been accepted? Having said that, we accept the Wessely review and look forward to the pre-legislative scrutiny and the opportunity to discuss this Bill in detail when it comes into Parliament.

Pharmacy (Responsible Pharmacists, Superintendent Pharmacists etc.) Order 2022

Baroness Brinton Excerpts

Tuesday 28th June 2022 Lords Chamber

[The Deputy Speaker (Lord Brougham and Vaux) (Con)]

The noble Baroness, Lady Brinton, will be taking part remotely and I call her now.

[Baroness Brinton (LD) [V]]

My Lords, I thank the Minister for his introduction to this Order and the noble Lord, Lord Hunt of Kings Heath, for explaining his amendment. First, as others have said, it is important to recognise the contribution pharmacists in our health service have made for many years—long before the NHS was created. Too often we talk about clinical and health care professionals and do not raise the vital contribution made by pharmacists. Covid-19 has really demonstrated in a number of ways that they are not only a cornerstone of the NHS and our healthcare system. In the pandemic, and lockdown especially, they also stepped up, took on extra responsibilities and became a new frontline service for people concerned about minor symptoms that they would normally have taken to their GPs, while their GPs were overrun with many more serious cases, including Covid cases.

I too thank the PSNC for the pharmacy advice audit it sent through earlier this week. We now know that nearly a quarter of a million consultations a week—that is 65 million informal healthcare consultations a year—are still being carried out in community pharmacy because patients are unable to access another part of the healthcare system. We should not forget, either, that the pharmacy database was used as the basis for the NHS app because it already had direct links with GP records, prescriptions and vaccinations that were delivered by pharmacists in their pharmacies.

Turning to the SI, which clarifies the governance of, and sets out the roles of, responsible pharmacists and superintendent pharmacists, the brief summary by the Secondary Legislation Scrutiny Committee raises some key issues. The Minister is right: although there are only three paragraphs, its report is certainly worth reading. It says in paragraph 14:

“several proposals were not popular with respondents to the consultation exercise on the grounds that they may reduce patient safety, particularly provisions allowing Superintendent Pharmacists to cover more than one firm and Responsible Pharmacists to cover more than one pharmacy or to operate remotely. We also note significant levels of distrust from the profession that the regulator, the General Pharmaceutical Council … would be able to set standards and rules appropriately.”

Worryingly, the committee goes on to say:

“We found the response of the Department of Health and Social Care … to these concerns, as set out in the Explanatory Memorandum, unconvincing.”


In the next paragraph, it says:

“In supplementary material, DHSC told us that to counter the concerns the GPhC will be required to consult on any proposed rules, which will provide the profession with an opportunity for scrutiny and comment. In addition, any changes to professional rules made … would need to be made by a statutory instrument following the negative resolution procedure in Parliament.”


Although this extra information to the Secondary Legislation Scrutiny Committee is reassuring, I still want to ask the Minister what the timescale is likely to be before such an instrument is laid before Parliament for scrutiny, explaining those concerns outlined by the committee and how they will be alleviated.

I thank the General Pharmaceutical Council for its briefing, which sets out the safeguards in the draft order to consult on the rules and report back. I know we look forward to seeing the detailed responses to the consultation and how they might affect the resulting resolution. With any change in responsibility, trust is absolutely critical, and this is on top of the increase in community consultations and referrals to other parts of the healthcare system that pharmacists throughout the UK are now carrying out. This is the real change already happening in our primary care system that Ministers say we should be looking for, and the public have taken to it.

The All-Party Pharmacy Group notes that the new demands on pharmacists have been coupled with a real-terms decrease in funding over the last eight years. Despite their desire to help, many pharmacies have had to limit or reduce their offerings and, as the noble Lord, Lord Hunt, has said, some pharmacies are closing. It is in this context that the noble Lord has brought forward his amendment, asking your Lordships’ House to consider that

“the Order does not make provision about the wider workforce challenges facing the community pharmacy sector”.

Diabetic Prevention Programme

Baroness Brinton Excerpts

Thursday 23rd June 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

The noble Baroness, Lady Brinton, is contributing remotely.

[Baroness Brinton (LD) [V]]

My Lords, the observational study by academics of the 2018-19 wave of the NHS diabetes prevention programme, published by BMC Health Services Research, observed disengagement within sessions when patients reported that information was difficult to understand, and when there were very large group sizes and problems with session scheduling. This is all before Covid. Problems with the course will inevitably make patients more likely to drop out but 50% is shocking. Now that this diabetes prevention programme has been rolled out across England, have these specific problems been addressed?

[Lord Kamall (Con)]

The noble Baroness makes an important point about what we have to learn from these programmes. In many of these programmes we are in a process of discovery. You try things—some will work and some will not. Those which do not work, we want to learn the lessons from. Clearly, the length of the programme, nine months, has put some people off and led to the dropout rate. We are looking at shorter programmes, digital access and self-assessment, and at community-led initiatives rather than top-down government initiatives. To give another example, I met someone at a meeting yesterday who told me that his mosque in Accrington was running healthier-diet programmes for worshippers. We need to see a lot more of those programmes as well.

Social Care: Adults

Baroness Brinton Excerpts

Wednesday 22nd June 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

My Lords, the noble Baroness, Lady Brinton, is participating remotely.

[Baroness Brinton (LD) [V]]

My Lords, I go back to the previous question: this ADASS survey shows that almost 170,000 hours of homecare a week could not be delivered for the first three months of this year, because of a shortage of care workers. This is a sevenfold increase on the previous year. The changes proposed to the social care system will not increase the rates of pay for social care workers, at the moment, to make it attractive to others, who can work in hospitality. But there is a dire need for people now. What will the Government do right now to help solve this crisis?

[Lord Kamall (Con)]

As the noble Baroness will acknowledge, some of the problems have been in evidence for a long time. Sometimes, we are tackling the legacy of this neglect of the social care system. At the same time, we have to remember that many social care providers are not run by the state; they are private providers. Following the People at the Heart of Care White Paper, we want to make sure that, first, we encourage better conditions for workers. We also want to make sure that local authorities determine a fair rate of pay based on local market conditions. We have seen an increase in the national living wage, which means care workers will get an increase. But we are looking at all this as part of the overview of the social care landscape.