NHS: End-of-life Care

Debate between Baroness Finlay of Llandaff and Lord Kamall

Thursday 8th September 2022 Lords Chamber

[Lord Kamall (Con)]

I return the favour by thanking my noble friend for the meeting, but also for the frequent conversations we have had about mediation, for example. I know my noble friend is a qualified and experienced mediator. We are quite clear that the review has to attach no blame. We want to hear from as many people as possible. It will investigate the causes of disagreements in the cases of critically ill children between providers of care and persons with parental responsibility. It will look at whether and how these disagreements can be avoided, how we can sensitively handle their resolution, provide strong evidence and inform future recommendations to support end-of-life healthcare environments in the NHS. As much as possible, it will promote collaborative relationships between families, carers and healthcare. We can see it from both sides: as a parent, just put yourself in the shoes of someone who has to make these difficult decisions. Sometimes they feel that the medical profession acts like God; on the other side, there are medical professionals who believe that the parents do not really understand all the details. Let us make sure that we get this right.

[Baroness Finlay of Llandaff (CB)]

My Lords, I too thank the Minister for having met me earlier in the week to discuss this issue. When parents receive devastating news, they are in such a state of shock that communication with them, however sensitively undertaken, risks being misunderstood. Parents are unaware of the limitations on their ability to request interventions or transfer for their child, unlike when the child is at home. So will the Minister confirm that the review will take direct, in-person evidence from parents who have been in this terrible situation and who wish to contribute from their experience—not to apportion blame, but to improve care for others?

[Lord Kamall (Con)]

I thank the noble Baroness, Lady Finlay, for the conversations we have had since the passage of the Health and Care Bill. My officials have been incredibly appreciative of her bringing her expertise to this field and, in fact, for educating them—and me—on some of the sensitive issues that people have to deal with in these environments. We want the review to be as wide as possible; we do not want to cut it off; probably the only thing we want to avoid is blame. We want to do this in a sensitive way; we want to hear from the families; we want to make sure it is a balanced review, and we hope to take evidence for the review from as many people as have a view on this. That is why we are taking our time; we have to publish it by 1 October 2023.

Defibrillators

Debate between Baroness Finlay of Llandaff and Lord Kamall

Wednesday 15th June 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Baroness raises an important point: while we require defibrillators to be purchased when a school is refurbished or built, one of the things we are looking at is how we can retrofit this policy. We are talking to different charity partners about the most appropriate way to do this. What we have to recognise is that it is not just the state that can do this; there are many civil society organisations and local charities that are willing to step up and be partners with us, and we are talking to all of them.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare that I am patron of CRY, a charity that looks at cardiac arrest in the young. Of the 270 children who die each year, 75% of them would still be alive if a defibrillator had been readily available. Do the Government recognise that, as well as having a defibrillator in a school, one must also be on the sports ground because many of the cardiac arrests occur during athletic activities? Therefore, having only one in a school is inadequate. Will the Government consider asking Ofsted to ensure that there is a defibrillator on every sports ground specifically as well as centrally in every school?

[Lord Kamall (Con)]

As the noble Baroness rightly says, it is important that we get these defibrillators out as widely as possible, including in sports grounds, for the reasons she mentioned. We are looking at how we work with partners in this area; for example, the Premier League announced that it will fund AEDs at thousands of football clubs and in grass-roots sports grounds. Also, Sport England is working with the Football Foundation on this. The defibrillator fund will see AEDs in a number of different sports grounds. We are also looking at other locations and working in conjunction with Sport England and the National Lottery fund. Not only do we have to put defibrillators in place, but people have to know where they are and how to use them.

St George’s Hospital: Patient Deaths

Debate between Baroness Finlay of Llandaff and Lord Kamall

Wednesday 18th May 2022 Lords Chamber

[Lord Kamall (Con)]

I understand the premise behind the assertion and the Question but, as I explained to the noble Lord yesterday, a number of issues are ongoing—the coroner’s inquest, an employment tribunal and a number of other reviews—which, sadly, I am not allowed to comment on. However, I can say at the moment that we are committed to improving the standard of patient safety investigations. We have set up the independent patient safety investigation service and HSSIB to look at this, as the noble Lord will know from the Bill, and we have a number of independent investigations guidance for standard operating procedures by NHS England and Improvement for teams to use.

[Baroness Finlay of Llandaff (CB)]

In the light of the criticisms levelled by the coroner over the structured judgment review in particular, will the Government undertake to require the royal colleges and the new bodies set up to look at the procedure used? Although it looked at case notes, it included neither full oversight of previous medical history nor direct observation of clinical procedures, surgical technique—including anaesthesia—and post-operative nursing, all of which have an impact on outcomes. We all know that clinical opinion varies; the point at which a procedure is judged as high risk versus futile varies from centre to centre and can vary within them from one surgeon to another.

[Lord Kamall (Con)]

The noble Baroness clearly draws on her own experience of this. First, we have to wait for all the coroners’ inquests to finish; I think 36 have been completed at the moment. There will then be reviews, to which there is a statutory guideline on when they have to be responded to. However, it is also important to recognise the differences between the coroners’ inquests and the work of the independent mortality review, which was not undertaken to determine the cause of death in individual cases or attribute blame to individual clinicians—it was looking at a number of procedures.

Folic Acid Fortification

Debate between Baroness Finlay of Llandaff and Lord Kamall

Wednesday 6th April 2022 Lords Chamber

[Lord Kamall (Con)]

I think the noble Baroness is being a little unfair. It is quite clear that some of the delay has been due to elections, particularly when it has been necessary to consult across the devolved Administrations. Let there be no doubt. The Government are not against this; we are in favour of it. We are having to cover a number of issues—for example, the level of folic acid fortification to ensure that we add an appropriate amount without the side-effects that have been found in older people. We need to standardise the minimum levels of the existing four fortifications—calcium, iron, niacin and thiamine—and to consider exemptions from fortification for products that have minimal amounts of flour. Provisions have to be made for flour used to manufacture ingredients. We have to consider potential exemptions, for example, for micro-businesses and heritage millers. This consultation will start in earnest once the Northern Ireland elections are out of the way.

[Baroness Finlay of Llandaff (CB)]

My Lords, do the Government recognise that the early MRC trial and all subsequent trials have shown that folic acid must be taken before a woman becomes pregnant? Giving supplementation once someone is pregnant is too late because of the formation of the neural tube. Now, with modern haematological techniques, the problem of pernicious anaemia and the confusion with B12 deficiency does not apply nearly as much, because it is easy to measure the levels.

[Lord Kamall (Con)]

In the brief which I received yesterday the recommendation is for a daily supplement of 400 micrograms of folic acid during the first 12 weeks of pregnancy. I am told that this advice will remain. Certain women with a higher risk of an NTD-affected pregnancy are advised to take a higher, 5-milligram supplement. This is why we have to get the right level. Increasing folic acid in flour alone will not solve the issue.

Ockenden Report

Debate between Baroness Finlay of Llandaff and Lord Kamall

Wednesday 30th March 2022 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for her points. I will take this opportunity to elaborate a bit on multidisciplinary training in the maternity workforce. Some £26.5 million of the £95 million invested in maternity services last year will allow training aimed at how multidisciplinary teams work together. There is a new core curriculum for professionals working in maternity and neonatal services—this is being developed by the maternity transformation programme, in partnership with professional organisations, clinicians and service users, to address variations in safety training and competence assurance across England. A single core curriculum will enable the workforce to bring a consistent set of updated safety skills and continue to learn. It is important that we have collaboration and close working relationships between midwives and obstetricians because that obviously benefits the mothers and babies within their collective care. The noble Baroness has already said that this has to be mother-centred and patient-centred.

I also thank my noble friend for highlighting the fact that the Royal College of Midwives and the Royal College of Obstetricians and Gynaecologists have been clear that the professions must work together collaboratively. We expect all maternity services to act on the recommendations.

We also have to make sure that staff feel able to and confident about speaking up, as my noble friend said. The Government have taken this issue seriously. In response to a recommendation from Sir Robert Francis’s Freedom to Speak Up review, we established the independent national guardian, to help drive positive cultural change across the NHS and, in addition, to provide support to a network of local freedom speak-up guardians. We will have to see how that works, what can be done better and how we can improve it. Putting in one measure will not solve all these problems. There is no silver bullet, but one of the reasons to put this in at local level is to see where it works and where it does not, and what we can learn from that.

[Baroness Finlay of Llandaff (CB)]

My Lords, I also thank the Minister for the very sensitive way in which he has dealt with this Statement and, like others, commend those parents who have fought for years to be heard. I also commend Donna Ockenden for an outstanding report that makes really harrowing reading.

To follow up on the question asked by the noble Baroness, Lady Bottomley, about training, it has struck me for many years that the competition between midwives and obstetricians is extremely damaging. It was there when I was a medical student and it has not changed. The bullying culture on the wards has I think been almost endemic and right across the system. I hope that the colleges will look at training jointly from day one, not just after qualification, because that team building needs to happen very early. The way the midwifery tutors and the obstetric tutors deal with their trainees must be integrated from day one and then follow on into continuous professional learning. So my first request is that that message goes back very clearly to the schools of midwifery and to the obstetric training courses.

My second point relates to the CQC, which has done a great deal to raise the quality of care across the NHS and is often to be admired. However, it is worrying that it took so long for it to realise that there was a problem. That would suggest that, internally, its benchmarking of what was normal was at a level that is actually unacceptable. I hope the Minister will be able to go back to the CQC and that the CQC itself will be supported to radically rethink the way that it looks at maternity services. I hope that it will be prepared to have some extremely difficult inspections, consultations and conversations with staff in some units that were previously thought to be doing well, but where it might discover that there is bullying and, particularly, this closed-ranks culture that was so evident in the way people responded to the report. But, overall, I think we are all grateful for the openness of this report and the openness with which the Minister has brought it to our notice.

[Lord Kamall (Con)]

I begin by thanking the noble Baroness, Lady Finlay, not only for her questions today but for the advice she has given me over a number of months since I started in this post. I have learned so much from the noble Baroness, especially from her courage to speak about her own professional experiences and admit where there are issues that need to be addressed. I am very grateful for that.

I completely take the point about working together from day one because, if you do that, you embed that culture of collaboration from day one, rather than just training people and then saying, “Oh, by the way, don’t forget to work collaboratively”. I think that has to be bred into the system and it is something we have to understand.

The other principle, which all noble Lords discussed in debates on the Bill, is the concept of a safe space. In an ideal world, we would find out who was responsible and they would be held to account, but what is really important is that we learn from that and the system learns from its failures. We have to encourage the ability to have a safe space where people feel confident about speaking up. We saw incidents where people felt bullied into not speaking up or where they withdrew their statements. If we can get this through the SHA and throughout the culture of the new HSSIB, this would be a really important first step. I thank noble Lords who, during the debate, pushed for the removal of certain bodies in order to make sure people felt comfortable coming forward.

On the CQC, there are real questions about the inspections in 2014 and 2016 and why it did not recognise safety concerns at the trust. Subsequently, the CQC did recognise the issues and place the trust in special measures. There was some progress made by the trust following this, and there were two subsequent visits. As a regulator, the CQC holds providers to account and makes clear where improvements must be made, but I think it recognises that there are lessons to be learned. There are lessons to be learned not only in government but across the health and care sector. It is important that we look systemically at how we work together and address some of those concerns.

Care Homes: Evicted Residents

Debate between Baroness Finlay of Llandaff and Lord Kamall

Thursday 10th March 2022 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Lord for raising this issue. I am sure he will recognise, from when we have worked together on a problem, that the first question I ask officials is: what is the problem and what are we doing about it? When I asked this question, I found that my colleague Gillian Keegan, Minister for Care and Mental Health, has met relatives and residents’ associations to hear directly about their experiences and focus on how we could strengthen the CQC role. In addition, in the Living with Covid-19 strategy, we are reviewing a range of measures in place for homes, including visitor restrictions. The updated position will be set out in guidance by 1 April. We are encouraging representatives, patients and patients’ groups to come forward and feed into that.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my role as chair of the National Mental Capacity Forum. There are many people with impaired capacity in care homes, whose mental state is deteriorating through lack of stimulation, inability to be taken outside and lack of general overall mental activities. Does the CQC have any idea of the number of people with impaired capacity still subject to restricted visiting by their relatives?

[Lord Kamall (Con)]

The noble Baroness has identified a potential issue that we have to address, which is drilling down into detail. One of the things that the CQC does is to look at aggregate numbers of complaints and concerns. Of course, there is a Local Government Ombudsman who looks at this issue as well. We are looking at ways where that works and where it does not work, and at how we could improve the system. This is all part of the ongoing review to build up a better, integrated health and care system.

Integration White Paper

Debate between Baroness Finlay of Llandaff and Lord Kamall

Thursday 10th February 2022 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, before I ask my question, perhaps I might formally apologise to the House for an error I made last night in Committee on the Health and Care Bill in responding to the debate on my Amendment 287 on dispute resolution and children’s palliative care. I had missed email correspondence from Together for Short Lives prior to the debate, in which the organisation had offered to discuss my amendment with me. I hope the House can accept my sincere apologies and regret at my inaccuracy. I have had helpful correspondence with the charity today.

I turn to today’s Statement. In my role as chair of the Mental Capacity Forum, I welcome the mention in item 5.14 of training in mental capacity, because there is a tremendous need for training at every level.

I also welcome the concept of personalised care, but I am concerned that the paper before us just does not go far enough. We need to document what matters to a person, and that needs to be an ongoing dialogue, not a tick-box exercise. If we know what matters to a person, that can inform best-interest decisions if the person loses capacity, and it is important for informal carers and family members to know that beforehand. Personalised care must include emotional care.

I am also concerned that there is nothing here about training the unpaid carers. They do not just need training in physical aspects of care; they need emotional training and training in how to de-escalate their own emotional stress, particularly when dealing with mental health issues in the person that they are caring for. There is nothing here about child carers and how information goes to a school that a child is a carer and may be under tremendous stress—or it may be that I have missed it in the documentation.

I hope the paper will stress the importance of people being listened to, which will inform decisions when deterioration happens. I would welcome the Government’s comment on how they are going to train enough people and instigate training across the board, both in sensitive listening skills and in achieving the high aspirations that I think the paper has attempted to set out.

[Lord Kamall (Con)]

I thank the noble Baroness for her clarification and for notifying me earlier about the issue that she apologised for. One of the issues for us is that we want to make sure that if all the parts of the healthcare and social care systems are talking to each other, and there are accountable people, we hope that people will not fall through the cracks and that there is a multi-agency approach. It will be difficult to be overly prescriptive here, because what would work in one area might not work in another.

The point that the noble Baroness makes about training is critical. In many debates in this House, we have understood that we need to take the social care workforce seriously and give support to unpaid carers of whatever age, whether they are children or family members. Sometimes they are doing it because they do not want their loved ones to go into a home and sometimes they just need a bit of respite. We are looking at a number of issues around carers—first, unpaid carers but, secondly, making sure that being a carer is a rewarding career and is not seen as being at a lower level than, say, a nurse in the health service.

One reason for having a voluntary register, for example, is to understand the landscape and then put in place proper and different educational pathways, and other pathways, into care. Having national qualifications at levels 4, 5 and 6 and so on will show parity of esteem and that this is a worthwhile career. We have the Made with Care campaign to start to encourage more people back. We are looking at a number of different ways to make sure that carers are not just forgotten. If they work in care homes, that is fine, but we want to make sure that there is a real career structure for them, and also that they can move between health and social care, both ways. There may well be nurses or doctors who want to move across. We have to make sure that going from one place to another is not seen as disadvantageous in any way and that the system is truly joined up.

Of course, this is all top level and shows our ambition to integrate. We do not want to be overly prescriptive; decisions have to be made at place level.

Covid-19: Lateral Flow Tests

Debate between Baroness Finlay of Llandaff and Lord Kamall

Thursday 10th February 2022 Lords Chamber

[Baroness Finlay of Llandaff]

To ask Her Majesty’s Government how many COVID-19 lateral flow tests are awaiting approval under the Medical Devices (Coronavirus Test Device Approvals (Amendment) Regulations 2021; how many have been approved; and how many that already hold Medicines and Healthcare products Regulatory Agency approval will fall if not re-approved by the extended deadline of 28 February.

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

As of 3 February 2022, 87 lateral flow devices were in the CTDA approval process, and none have been approved—

[Lord Kamall (Con)]

I am sorry, this is a 2.45 am hang- over. Lateral flow devices from 20 CTDA applications are currently included on the temporary protocol. If we interpret the phrase “Medicines and Healthcare products Regulatory Agency approval” as CE marking, we are currently considering proposals to ensure the continued supply and usage of tests beyond 28 February and will announce plans once a decision has been confirmed.

[Baroness Finlay of Llandaff (CB)]

I am grateful for the Minister’s response despite the late hour of last night’s debate. I am concerned that the information I have is that there are still 200 tests waiting, 46 have been assessed and validated at Porton Down, and the process is not well-aligned with the MHRA processes. What is being done to bring those processes back in line? What is being done to bring forward applications from devices that provide a differential diagnosis between Covid and influenza? These are already being used in Europe, but I understand that none are available in the UK because they have been held up in the validation process.

[Lord Kamall (Con)]

I should perhaps start with some background on this and why we have reached the situation we are in. Her Majesty’s Government began the large-scale procurement of Covid-19 test kits at the height of the pandemic. To ensure supplies for the universal testing offer, Porton Down assesses tests offered to Government. It found that three-quarters of those offered failed to meet their stated performance in their instructions for use. For most testing technology, the manufacturer needed only to do self-assessment to meet the CE marking rules, but clearly, when they were tested, they were not meeting those standards. We considered that the current standard was insufficient and did not keep bad tests off the market. That is why we had a public consultation in April that showed strong support for a more rigorous regime. In terms of avoiding a cliff edge, as it were, if they have not been validated, we are looking at solutions.

Vaccination: Condition of Deployment

Debate between Baroness Finlay of Llandaff and Lord Kamall

Thursday 3rd February 2022 Lords Chamber

[Lord Kamall (Con)]

I hope that the noble Lord will forgive me, but I had a lot of meetings on the Bill today. When the questions came in and I saw the original answer, to be perfectly frank, I was not content with it and I pushed back, which is why I need more time to answer the question.

We are completely clear. We intend to revoke the requirement in its entirety for both care homes and the health and wider care sectors. The care home requirement has been in force since 11 November, but the requirement for health and wider social care was not due to come into force until 1 April. This means that first doses would have been needed by today in order for people to be fully vaccinated by 1 April. We wrote to the sector to clarify how the 3 February deadline would be impacted by the Government’s intention to revoke the regulations. While this particular question was specific to wider social care settings, not care homes, the letter was clear that we intended to revoke them for both care homes and wider social care.

[Baroness Finlay of Llandaff (CB)]

My Lords, I am most grateful to the Minister for the way in which he has answered these questions, because he has done so in a very nuanced way and this is a difficult topic to deal with. Can he reassure me that there will be no let-up in the effort to understand the fears behind why people are vaccine hesitant, particularly when they are working in these settings, so that they can change their mind without any sense of losing face? Will the general infection control measures that have been put in place, such as handwashing, social distancing and ventilation, be maintained? It is not only Covid that is transmitted from one person to another; there have been thousands and thousands of cases where patients have acquired a nosocomial infection in hospital. One of the most important measures—particularly for something like MRSA—has been handwashing in between treating every patient. Any let-up in these procedures could well mean that we would slip back to the bad old days of multiple wound infections on surgical wards.

[Lord Kamall (Con)]

As ever, the noble Baroness is absolutely right. Once again, I thank her personally for her frequent advice and questions, based on her years of experience. This gives me the opportunity to be quite clear: just because we are intending to revoke VCOD does not mean that we should let up in the fight against this virus. We need to continue to be vigilant, to wash hands, to respect space, and we hope that many people will continue, as in this Chamber, to wear face masks in crowded places and to ventilate areas, particularly when you are with people that you do not know and do not normally associate with. We should not give up on those; in fact, some of those measures, especially handwashing and others, are good common sense anyway, whether we have a virus or not. We hope that one of the lessons from this whole Covid experience has been the need for better hygiene and for us to be more aware. We cannot yet let up. We may have revoked VCOD, but it is really important that we continue to battle against this virus.

On the first question, about understanding the very real concerns, as the noble Baroness said earlier, I do not think we should simply categorise people as anti-vaxxers or pro-vaccine and virtuous; I think we need to understand their reasons. I had conversations this week when I was chairing the round table with local community organisations and I made the point to them that we want to learn from them. It is all very well for me, as a Lords Minister, to say this, but they understand much better in the community. Sometimes, it is a lack of trust. Sometimes, there are historical trust reasons. Sometimes, it is people’s personal experience. Noble Lords will have heard the recent story about the police, for example: it does not exactly engender trust in figures of authority within certain communities. It just shows the spillover effect of all these issues—discrimination, racism, but also lack of trust—and we have to be quite clear that we understand individual communities. Sometimes, even though they are in the same ethnic community, they may live in different parts of the country and respond in quite different ways. It is very easy to group people and say, “Oh, all BME, all Asians or all disabled people feel this way.” These people are individuals, and we need to understand their concerns.

Ambulance Queues: Health Outcomes

Debate between Baroness Finlay of Llandaff and Lord Kamall

Thursday 13th January 2022 Lords Chamber

[Lord Kamall (Con)]

As the noble Lord will be aware, when the charge was initially announced it was intended to help with social care, which has been neglected for a number of years under successive Governments. Given the pressures of the backlog, the NHS has decided to divert some of those resources to help tackle it. We have invested money in social care in the short-term winter plan, and in the longer term we have announced extra investment to ensure that social care is an attractive career and offers real prospects.

[Baroness Finlay of Llandaff (CB)]

My Lords, does the Minister recognise that his response, saying that this involves a small number of trusts, does not address the data from NHS England for the seven days to January 2, which showed that 23% of all arrivals by ambulance had delays of half an hour or more—that is over 19,000—and that some 10% of patients waited more than an hour to be handed over? This meant that those ambulances were also unable to deliver first aid and first implementation of treatment to people who were waiting. Therefore, when patients arrived at emergency departments, they were even sicker than necessary, and it may be that some lives were lost.

[Lord Kamall (Con)]

The noble Baroness makes an important point. In anticipation of the winter crisis, last year we published the Urgent and Emergency Care Recovery 10 Point Action Plan to look at the direct pressures on not only A&E but the call centres, and at some of the wider system issues. For example, when people cannot get access to their doctor, they tend to go to A&E. At other times, they cannot get the replacement medication they want and have to call an ambulance to go to A&E and get it. We are looking at some of the wider system problems to make sure we address the backlog.

Care Workers: Professional Register

Debate between Baroness Finlay of Llandaff and Lord Kamall

Monday 10th January 2022 Lords Chamber

[Lord Kamall (Con)]

As the noble Baroness will appreciate, many people who work in social care are employed by private care home owners and other bits of the sector. If she looks at the minimum wage, there has been an announcement of 6.6%, effective from 1 April, which means that workers will be paid more, but one of the bases of some of the additional funding that we have announced is to convince local authorities to put pressure on private care home owners and others to make sure that they pay staff more.

[Baroness Finlay of Llandaff (CB)]

Given that the Government have clearly expressed the view that social care must be adequately valued, which is to be welcomed, and the comments about pay scales, what is the Government’s attitude to those employers in the private sector who do not hand on pay at time-and-a-half on bank holidays and so on, to their front-line staff? These front-line staff feel exploited and do not receive any pay or reimbursement for travel time between clients, even though they may spend quite a lot of time on the road. They are paid only while they are actually in somebody’s home in the community.

[Lord Kamall (Con)]

Issues such as the way private care home owners treat their staff are all part of the consultation that we launched on 6 January. We are working across government and with the devolved Administrations to seek views on the proposed criteria on which the profession should be regulated, whether there are regulated professions that no longer require statutory regulation, and whether there are unregulated professions that should be brought into statutory regulation. The consultation will run for 12 weeks until 31 March, when we will look at the results before taking further action.

Hospital Beds and Social Care

Debate between Baroness Finlay of Llandaff and Lord Kamall

Thursday 6th January 2022 Lords Chamber

[Lord Kamall (Con)]

We have been looking at different pathways out of hospitals, and one of the discharge pathways is step-down care. One issue that the task force has looked at is how we improve and increase accessibility to appropriate step-down care when a patient is unable to go straight to their home.

[Baroness Finlay of Llandaff (CB)]

I will follow on from the question from the Labour Front Bench. Who is taking responsibility for actively recruiting staff so that any step-down beds can be staffed and managed? We have a workforce problem; without actively recruiting back into the workforce people who have experience but currently have left, we will not bridge that gap in manpower and womanpower provision.

[Lord Kamall (Con)]

All noble Lords will appreciate the work and dedication of all our social care workers, especially in these challenging times and with the extra pressure that omicron has brought. Throughout the pandemic, we have provided different types of funding. In December 2021, we announced an extra £300 million to support local authorities working with care providers to recruit and retain staff throughout the winter. This funding is in addition to the £162.5 million announced in October 2021. We recognise the issue, and it is about working with local authorities and others to make sure that this money gets into the system and achieves what it is intended to do.

Breast Screening

Debate between Baroness Finlay of Llandaff and Lord Kamall

Tuesday 14th December 2021 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for raising the importance of co-ordination and sharing information across the devolved Administrations. I have meetings scheduled with health Ministers from the devolved Administrations, and I will make sure that my office puts this on the agenda.

[Baroness Finlay of Llandaff (CB)]

My Lords, following on from the question of the noble Baroness, Lady Ritchie, will the Minister tell us how the stage of presentation of breast cancer has altered over the past two years? How many women presenting with stage 3 and stage 4 cancers had never been screened?

[Lord Kamall (Con)]

I thank the noble Baroness for giving me advance notice of the question, and so giving me the chance to get some information. Data on cancer stages is currently published only annually, and NHS Digital is publishing the data from 2019 on Thursday 16 December. The latest data from 2018 shows that nearly 86% of breast cancers were diagnosed at stages 1 and 2, meaning that about 15% were diagnosed at stages 3 and 4, but this was pre-pandemic. I will make sure that I get the updated data as soon as possible.

Medical Schools: Training Places

Debate between Baroness Finlay of Llandaff and Lord Kamall

Monday 13th December 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Lord raises an important question, but the fact is that we are training more doctors, and we are recruiting internationally where it is ethical to do so. On retirements, we are looking at a scheme that lasts until 2024 to allow doctors to come back without it affecting their pension.

[Baroness Finlay of Llandaff (CB)]

My Lords, I should declare that I am a fellow of the Royal College of Physicians. Do the Government accept the report from that body, Double or Quits, which has shown that we need 15,000 medical school places annually? Doubling the number of medical school places to that number would cost £1.85 billion, which is only one-third of what hospitals currently spend on agency and bank staff. Therefore, an increase is an investment to save.

[Lord Kamall (Con)]

I thank the noble Baroness for that question and for the advice and expertise that she has passed on to me in my short time in this place. As part of the expansion, we have opened five new medical schools across England, in Sunderland, Lancashire, Chelmsford, Lincoln and Canterbury. Sometimes we have the training, but it is difficult to find doctors in certain locations. We have tried to move training as close to those locations as possible.

NHS: Elective and Cancer Care Backlog

Debate between Baroness Finlay of Llandaff and Lord Kamall

Tuesday 7th December 2021 Lords Chamber

[Lord Kamall (Con)]

The Government have announced the NHS long-term plan. We have had a budget increase. We are focusing on a number of different issues. One of the challenges over recent years has been the ageing population. That should be a positive thing and we want to make sure that we look at the new health challenges that we face for the future.

[Baroness Finlay of Llandaff (CB)]

My Lords, do the Government recognise that one-fifth of patients with cancer are diagnosed in emergency departments across the country? When patients are diagnosed late, the nature of cancer and its progressive metastasising behaviour means that, by the time they are diagnosed, the treatment burden is greater and the cost to the NHS goes up. Early diagnosis becomes the only way to tackle the overall problem.

[Lord Kamall (Con)]

The noble Baroness makes a very important point—as did the noble and gallant Lord—about how we reconfigure our healthcare system to make sure that we catch these diseases much earlier in the system rather than waiting for secondary referral. This is not only in primary care but lots more self-diagnosis with more technology now in the home and elsewhere.

Health and Social Care

Debate between Baroness Finlay of Llandaff and Lord Kamall

Monday 6th December 2021 Lords Chamber

[Baroness Finlay of Llandaff (CB)]

My Lords, I should declare my interest in relation to medicine, the BMA and the Royal College of Emergency Medicine, and I would like to ask about emergency medicine. The winter flow data from the Royal College of Emergency Medicine has data from 40 sites across the UK. They are reporting that, in November, there were 275,596 attendances. Their long hospital stays had increased by 13% to more than 48,000 patients. Their 12-hour stays in emergency departments were twice as high as they had been in the previous year, and that was equivalent to 7.3% of all attendees. Their four-hour performance is incredibly low, at 62%. I know from one department that was built for 28 patients that, on a Monday in November, it had 108 patients in. This becomes unsustainable, and the overcrowding is a danger in terms of Covid and infection. It is also a danger to the welfare of staff because, in this particular department, even the staff toilets were not flushing, so the staff had to leave the department just to excuse themselves.

The estate takes time to rebuild and be repaired. What is being done with projects now to create additional space for emergency departments to manage this overcrowding? Is there targeted money going to make sure that the departments are in a good condition of maintenance for the staff? Separate, but related, to that, is the pension block, which has stopped doctors from returning from retirement and has pushed some doctors into early retirement, being addressed in the long term? It is important that doctors who have retired because their pension pot has reached its limit can be incentivised to come back to take pressure off in GP surgeries and in hospital departments, particularly out-patient departments, by seeing patients where their long-term experience and wisdom can contribute to the clinical services.

[Lord Kamall (Con)]

I thank the noble Baroness for the points she makes. We are doing what we can to support the dedicated NHS staff in healthcare services. This year alone, we have invested over £15 billion on top of the existing NHS annual budget, and that includes funding to help get patients out of hospital, freeing up beds and supporting hospitals to manage Covid-19. In addition, we are looking at how we can tackle capacity issues on NHS 111 and A&E. We are giving NHS 111 £98 million to boost capacity, help people avoid unnecessary ambulance trips to A&E and take pressure off hospitals. We realise that NHS 111 is often the first port of call to provide urgent medical advice quickly and book time slots for people at their local A&E or appointments at alternative services. We are also delivering the largest ever seasonal flu vaccination programme, so we hope to tackle it on that basis. A number of CCGs and others are having conversations about how we can tackle the pressures on A&E.

The noble Baroness makes the point about staff who, during Covid, went way beyond the call of duty, and we managed temporarily to address those concerns. We are very grateful to staff who had retired and returned, and we are looking at whether that can be a long-term solution. We need to make sure that no one who is willing to come back is disincentivised. I do not have the details at the moment but I commit to write to her.

NHS: Primary Care Surgeries

Debate between Baroness Finlay of Llandaff and Lord Kamall

Wednesday 24th November 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for that important question. International engagement remains crucial to tackling the pandemic and ensuring future resilience. In my first few weeks in the job, I have had a number of meetings, at bilateral, G7 and other levels, to make sure that we are fostering international health partnerships. “It is also really important that we understand the contribution the private sector can make towards making the NHS better for all of us.” Those are the words of Alan Milburn, also a former Labour politician.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare that I am a fellow of the Royal College of General Practitioners. Do the Government recognise that, with an increasing number of GPs working salaried and part-time, it is essential that they have security in their contracts? There is a tension when commercial providers need to provide profits to their shareholders, which can work in the opposite direction to the needs of the community, as the medical staff should be working as a co-operative to improve services locally.

[Lord Kamall (Con)]

I am sure that we all want to pay tribute to the work of GPs, who are at the front line and, quite often, are the gateway to many services across the NHS and the wider healthcare system. It is important that we recognise some of the pressures they are under, but also work out how to help them and, indeed, patients. As I have said in the past, I will be a champion of patients and it is important that patients have access to their GPs, as a gateway to further services.

Covid-19

Debate between Baroness Finlay of Llandaff and Lord Kamall

Monday 15th November 2021 Lords Chamber

[Lord Kamall (Con)]

I apologise if I have misled the House: I have booked my booster jab but I have not had it yet. I was able to book it in advance but I cannot have it until—perhaps I should not make this public, but they have given it to me one day before the six months is up. This will be all over the front pages tomorrow, it will be a huge scandal and noble Lords will be calling for my head. I understand that.

On the serious point, I share the frustration of all noble Lords who have brought this issue up. I was hoping to be able to announce a date today, but it was scratched at the last minute. I think there was some technical reason, but we hope to have good news soon. I know that will be as frustrating to many noble Lords as it is to me. Believe me, I would rather have good news than to be seen to be avoiding answering the question.

[Baroness Finlay of Llandaff (CB)]

I shall follow up on the question asked by the noble Baroness, Lady Tyler, in relation to pregnant women in particular. There were maternal deaths early on. It would be most helpful if we could have the data on the number of such women, the pattern of vaccination and the pattern of maternal deaths from Covid and severe infection. Women are still worried and hesitant because there was a failure to vaccinate early on, because the data on safety was not there. Having data on the drop in the number of deaths will help to persuade women of childbearing age to pursue being vaccinated, whether they are already pregnant or not.

[Lord Kamall (Con)]

The noble Baroness raises a very important point and I apologise for not spotting it and answering it earlier. Many noble Lords will be aware of the very sad story of a young lady who died because she felt that the vaccine was not safe; her mother is encouraging other pregnant women to have the vaccine. For that reason, we want clearly to communicate that the vaccine is safe and will not affect fertility, so getting the vaccine is the best way to protect yourself. Pregnant women are more likely to get seriously ill from Covid-19, and we know that vaccines are safe for them and make a huge difference. In fact, no pregnant woman who has had two jabs has needed hospitalisation with Covid-19. We need to make that clearer, and I will take this back to the department and the Government to make sure that we communicate more clearly. We all share the same will to share that message more widely.

Smoking Cessation: Prescription of E-cigarettes

Debate between Baroness Finlay of Llandaff and Lord Kamall

Tuesday 2nd November 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend for pointing that out, and I will investigate. Not being a user of e-cigarettes or cigarettes, or of any sort of narcotics or alcohol, I am afraid that I am not really an expert myself. I will look into that and write to my noble friend.

[Baroness Finlay of Llandaff (CB)]

Can the Minister confirm that the nicotine levels will be looked at, given that the nicotine level in some e-cigarette products is very high and that nicotine is the addictive substance both in cigarettes and in the continued use of e-cigarettes? The commercial incentive for tobacco producers to produce flavoured, palatable and highly addictive products should not be pandered to.

[Lord Kamall (Con)]

The noble Baroness raises an important point about nicotine itself being a very addictive substance. I am sure that the MHRA will be looking at the guidance, but if the noble Baroness would like to write to me, I can confirm that.

Alcohol Duties

Debate between Baroness Finlay of Llandaff and Lord Kamall

Tuesday 2nd November 2021 Lords Chamber

[Lord Kamall (Con)]

The noble Lord makes an important point in looking at the various factors that have to be balanced up. Clearly, we want to encourage consumers or drinkers to move towards low-alcohol and no-alcohol products, while balancing that against the wider economic climate and the hard two years that the hospitality sector has faced, which is why we announced the freeze to some alcohol duties. On encouraging people to go out and drink alcohol, I am afraid I am the wrong person, because I am teetotal.

[Baroness Finlay of Llandaff (CB)]

My Lords, I declare my interest, having chaired the Commission on Alcohol Harm. Our report published last year cited the data, then 10 years old, which showed that the cost from alcohol to the NHS was £3.5 billion a year, while the Home Office’s own estimates were that the cost to society was £21 billion a year. In the decade since then, the number of alcohol-related hospital admissions has risen by 19%, and there has been a rise, too, in alcohol-related hospital admissions and deaths, which increased by 20% last year alone. Given the rising cost to the NHS, what contingency plans have the Government made should this drop in duty fail to decrease alcohol harms, and what other methods do the Government plan to use to decrease alcohol consumption?

Health: Chronic Fatigue Syndrome

Debate between Baroness Finlay of Llandaff and Lord Kamall

Tuesday 12th October 2021 Lords Chamber

[Lord Kamall (Con)]

I thank my noble friend—my predecessor—for his warm words and his offer of advice to me, as I find my feet and find myself swimming at the deep end, if you like, in this job. Usually, when I get a question like this, I say, “I will ask my predecessor” but clearly, he has a question for me.

My noble friend is absolutely right that we have to be concerned about how we help those who are suffering from ME and chronic fatigue syndrome, but he will recognise that there is a range of views on this issue. If we want these guidelines to be widely accepted and respected, it is important that we get as many stakeholders around the table as possible. NICE has agreed to this round table; hopefully, we can then move forward.

[Baroness Finlay of Llandaff (CB)]

My Lords, I too welcome the Minister to his post. I declare that I have been vice chair of the NICE committee that produced the revised guidelines on ME/CFS over the past three years, through consensus agreement in the committee. This was fully compliant with NICE’s rigorous processes. Will the Government work with commissioners to ensure that appropriate specialist services for patients with ME are developed and continue, and that services monitor accounts of harms as well as benefits?

[Lord Kamall (Con)]

I thank the noble Baroness for her warm welcome. I am new to this and, as you can imagine, I am still learning the ropes and learning about NICE and its processes. However, I agree with the noble Baroness: it is really important that we address the issues she raises and if she writes to me, I will ask for some advice and respond to her.