PPE Expenditure

Baroness McIntosh of Pickering Excerpts

Wednesday 25th January 2023 Lords Chamber

[Lord Markham (Con)]

Again, I would take issue with the words “useless material”. It was bought based on a projection of how the pandemic could progress and what would be required. The fact that it did not progress that far was thanks a lot to the work we did in being the quickest country to vaccinate in the world. So, we did not need that level of PPE; that was a good thing. We bought for a worst-case scenario and, thank goodness, we did not require it because of the action we took to get on top of it all. Now, we are dealing with the surpluses bought for that worst-case scenario and quickly disposing of them.

[Baroness McIntosh of Pickering (Con)]

My Lords, can my noble friend tell us the amount of this stuff in UK warehouses, and how much that costs daily?

[Lord Markham (Con)]

As I mentioned before, the daily cost is roughly £700,000.

Streptococcus A: Antibiotics

Baroness McIntosh of Pickering Excerpts

Thursday 15th December 2022 Lords Chamber

[Lord Markham (Con)]

Absolutely—clearly, we always need to learn in such circumstances, so we will be happy to do that.

[Baroness McIntosh of Pickering (Con)]

My Lords, I remind the House of my interest with the Dispensing Doctors’ Association. Can my noble friend give reassurance that dispensing doctors, pharmacists and others will be reimbursed for the full cost of the increased price of antibiotics?

[Lord Markham (Con)]

My understanding is that there are measures in place to ensure that the people supplying in those circumstances are not losing out because of profiteering. The most essential message today is that that supply is available to anyone who needs it, so I will take that back.

Invasive Group A Streptococcus and Scarlet Fever

Baroness McIntosh of Pickering Excerpts

Monday 5th December 2022 Lords Chamber

[Lord Markham (Con)]

I thank the noble Lord. At this point, I put out the general message that, if parents are aware that their child is unwell, particularly drowsy or dehydrated, that is when they should look to seek medical advice. They should start by using paracetamol and ibuprofen. Clearly, if there is no response, they should be particularly concerned and absolutely making sure that they are getting access to the surgery—to a nurse, as well as a doctor, in this case. This is clearly a priority area. We need to make sure that there is access for those people.

[Baroness McIntosh of Pickering (Con)]

Following on from the question by the noble Lord, Lord Hunt, if the child presents symptoms after 6 o’clock at night or over a weekend, they will clearly be dependent on out-of-hours service. What is the department recommending that they do? Should they go to A&E in these circumstances? It is obviously absolutely vital that, if the child has meningitis or scarlet fever that may develop complications, they should be attended to and given medical assistance as soon as possible.

[Lord Markham (Con)]

I can probably draw on a personal illustration. In answer to a question a couple of weeks ago, I mentioned how I used 111, and in this case I think the advice would be to use 111. In that instance, I was able to get access to a doctor. On that basis, if the symptoms are there, to take that example, a doctor can arrange for a prescription to be sent to an out-of-hours pharmacy. The most important thing in these circumstances is to get antibiotics quickly. The first thing I would say is to use 111. Obviously, A&E is always there, but a more effective route would be through 111.

Covid-19: PPE Procurement

Baroness McIntosh of Pickering Excerpts

Wednesday 30th November 2022 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, will my noble friend pay tribute to Industrial Textiles & Plastics of Easingwold which, together with Barbour and Burberry, submitted an application to the Cabinet Office for a number of gowns, and are still waiting for a reply? They donated these gowns free at the point of use to local hospitals. I believe that they should have had a contract from the Government and am at a loss to understand why they did not. Is there any reason that the Cabinet Office failed to reply to them?

[Lord Markham (Con)]

I do not know why they did not reply. What I do know is that there were many companies like the ones mentioned who wanted to do their bit. They stepped up to the mark and provided all sorts of goods and services, sometimes at no cost and for no profit, because they all wanted to be part of the wartime effort. I will find out why they did not get a response.

Food and Feed (Miscellaneous Amendments) Regulations 2022

Baroness McIntosh of Pickering Excerpts

Tuesday 29th November 2022 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

My Lords, I thank my noble friend the Minister for bringing forward the statutory instrument this afternoon. While I am, overall, in support of the regulations contained in the instrument, I have two brief questions.

The Government seem to have a certain resistance to the labelling of food—whether it contains GMO, gene- edited or other ingredients. I note with some interest that the Explanatory Memorandum at paragraph 7.6 says that, until we adopt the regulations before us this afternoon, there has been a requirement to use a “Do not eat” pictograph on the products referred to in that paragraph. I would be interested to know the differences between a pictograph and a label. As we move towards adopting our own regulations—as I understand is the Government’s intention going forward—will the Government look favourably on clearly labelling food- stuffs of interest to the consumer where they contain ingredients made from GMO, gene-editing or any similar method, such as in novel foods, which are also referred to here?

It would be interesting know what purposes are intended for the edible insects—they sound most appetising, or perhaps not—which are referred to throughout the regulations. Are they for human, animal or pet consumption? For what purposes are they used?

My last question is: which authorities will implement the regulations before us this afternoon? Will it be the environmental health officers of local authorities? Does my noble friend share my concern that the way that such regulations are being implemented across England, in particular, is patchy owing to the fact that budgets are, obviously, under extreme pressure at the moment? I would be interested to know which will be the implementing authority.

I said that was the final question; I lied. I would like to ask one more question if I may. What will happen to this regulation—and, presumably, one to come for Northern Ireland should this one not apply to Northern Ireland—under the provisions of the retained EU law Bill?

[Baroness Bakewell of Hardington Mandeville (LD)]

My Lords, I thank the Minister for his introduction to this very interesting statutory instrument, which does, as its title indicates, cover a real bag of miscellaneous items.

The SI provides for the first time for edible insects specific to Great Britain to remain on the market until December 2023. I could not think of an insect specific to Great Britain that I would wish to eat. Having searched the internet, I found that I could buy crunchy crickets and other delicacies, but these did not appear to be indigenous to Great Britain. Can the Minister tell the House to which edible insects this regulation actually relates?

Further on in the Explanatory Memorandum, there is reference to

“regenerated cellulose film intended to come into contact with foodstuffs”.

Having had discussions in the past with the then Minister for Defra, the noble Lord, Lord Goldsmith, about the possibility of recycling this film, I was interested to see it popping up here with conditions for how it was to be used but, sadly, no mention of how it might be recycled.

In Part 3 of the regulations, Regulation 8 covers the use of

“additives for use in animal nutrition”,

which should be fairly straightforward, one would think. A definition of “veterinary medicinal product” used in this context covers

“any substance … having properties for treating or preventing disease in animals”.

However, the definition of “substance” is:

“any matter, irrespective of origin, which may be … human, including human blood and human blood products”,

or “

“animal, including micro-organisms, whole animals, parts of organs, animal secretions, toxins, extracts and blood products”.

Are these really to be used to treat animals that are sick?

Schedule 3 to the regulations lists feed materials that may be included for animals. These include:

“All the fleshy parts of slaughtered warm-blooded land animals … and … all products and derivatives of the processing of the carcase or parts of the carcase of warm-blooded land animals”.


I can see the benefit of this for a safari park or a zoo but, perhaps, not so for farm animals or companion animals. Is the Minister satisfied with the rigorous testing of these products and that no further incident such as occurred with the outbreak of BSE, when sheep brains were fed to cattle, could occur in the future?

New paragraph 1A(i) in Regulation 9 refers to the health hazard of parasites in fishing grounds but makes no mention of whether the discharge of sewage into fishing grounds could be a hazard. I will not ask the Minister to comment on that.

Lastly, Regulation 19 deals with the authorisation of genetically modified materials and appears to extend that to 30 December 2025. Why could that extension not have been included in the precision engineering Bill, which is currently making its passage through the Lords? Are such products to be labelled as genetically modified? The noble Baroness, Lady McIntosh, has already referred to labelling.

As I have said, this SI covers a large number of issues, too numerous to mention today, and contains some corrections of previous errors. While I find some of the SI extraordinary, I do not oppose its passage.

[Lord Markham (Con)]

My Lords, it is my duty to close this important debate. Your Lordships perform an essential role in scrutinising the measures we have put forward today, and I thank all noble Lords for their contributions. Let me turn, as best I can, to answering some of the points raised. Where I do not quite succeed, I will gladly follow up in writing.

First, my noble friend Lady McIntosh of Pickering asked for an explanation about the pictograph. My understanding is that it is a picture which does not depend on a specific language to understand it. On what happens regarding the IP rights behind it, my understanding—again, I will confirm this—is that a number of questions were asked as to the ownership of those rights. The IP ownership was unclear, so the process for even trying to license it was not clear. That was the issue at hand, but I will come back with further detail on it.

Turning to the other questions, my noble friend Lady McIntosh asked how the SI will affect the retained EU law Bill. The Food Standards Agency is carefully considering the scope of the powers in the retained EU law Bill and whether they can be used to deliver a better, bespoke British system of food safety. Those will all be part of what we go through in the coming weeks and months.

On the labelling of GM and other foods, there are regulations requiring mandatory measures in the traceability and labelling of GM products. This is seen as necessary to inform a consumer about their choice whether to buy and eat GM food, so that will take place in all these cases. The noble Baroness, Lady Merron, asked about the level. My understanding is that it is a minor trace level, consistent with what exists today, but, again, I will follow up on the detail of that. We have been working with the FSA in these areas, which feels that it is in a position to answer and regulate in this area.

Perhaps my favourite question related to edible insects; I only wish I had known about this before “I’m a Celebrity… Get Me Out of Here!” They are apparently for human consumption. I can write on this if noble Lords let me know whether they would like the Latin or the English version, but they are apparently: the lesser mealworm, the house cricket, the yellow mealworm, the banded or decorated cricket, the bird grasshopper or desert locust, the migratory locust, and the black soldier fly. I will not try to read the Latin out for each of those, but I will happily put them down in writing.

I was asked why this could not be included in the precision breeding Bill. The wider question of the future of precision breeding and gene editing is not considered by this SI and would be a matter for the Secretary of State for Environment, Food and Rural Affairs. For now, the commercial cultivation of gene-edited plants and any food products derived from them will still need to be authorised in accordance with existing GMO rules.

On the question of the noble Baroness, Lady Bakewell of Hardington Mandeville, on safety going forward, as I said, our approach to food safety is and always will be underpinned by three principles: that UK food remains safe and what it says it is; that the high standard of food safety and consumer protection that we enjoy in this country is maintained; and that, following our exit from the EU, a robust and effective regulatory regime is in place, which means that business can continue as normal.

I hope that I have answered the detailed questions. Like the noble Baroness, Lady Merron, I did not expect to need to understand this as part of my brief, but it is part of the rich variety of my job. I thank noble Lords for their questions and their support, generally, for our proposals. To reiterate: these regulations are critical to ensure that the UK consumer continues to enjoy the high standards of safety and quality provided by UK food and feed regulations. This instrument makes no changes to policy or to how food and feed businesses are regulated, and it is limited to necessary amendments to ensure that.

[Baroness McIntosh of Pickering (Con)]

I press my noble friend on what the implementing authority will be.

[Lord Markham (Con)]

I apologise; I will definitely need to come back in writing on this, but my understanding is that, at a local level, it will be local authorities. I am grateful for noble Lords’ contributions and the sincerity of their views.

Ambulance Delays

Baroness McIntosh of Pickering Excerpts

Wednesday 9th November 2022 Lords Chamber

[Lord Markham (Con)]

Many noble Lords have talked today about what is a whole-system problem, which the noble Lord has mentioned in terms of care homes. It is all about treating people in the right place, with the right equipment, so I absolutely agree with this approach. It is the approach that we are taking to make sure that people are treated in the right place, so I will take the noble Lord’s suggestion back to the department.

[Baroness McIntosh of Pickering (Con)]

My Lords, I remind the House of my interest in the Dispensing Doctors’ Association. My noble friend has rightly identified the problem of underfunding in primary care. What is he going to do at this time to address the chronic underfunding in the delivery of primary care in rural areas?

[Lord Markham (Con)]

The government pledge of 50 million additional appointments is across the country. It is the job of the ICBs to make sure that each area is well catered for; the idea is that this is felt in every area, including rural areas. I am glad to say that we are making good progress on our target to increase appointments by 50 million and, rest assured, I am working with the integrated care boards and their systems to ensure that they touch every part of England, including rural areas.

NHS: Winter Challenges

Baroness McIntosh of Pickering Excerpts

Monday 10th October 2022 Lords Chamber

[Lord Markham (Con)]

As I am sure the noble Baroness is aware, we are investing an unprecedented amount of money into the NHS and have recruited more doctors and nurses. We are setting up 7,000 new beds to cope with it all. At the same time, I accept that we are in a period of unprecedented challenge from not just the cost of living crisis but the effects of Covid and the likely impact of flu this year. That is why I very much see our role as making sure that that record level of investment is used to the best effect and that we drive performance across the NHS. I am sure we all have lots of examples of brilliant services and examples of where more needs to be done, candidly. My role in this, as someone with a background of business experience, is to try to take those areas of best practice that I have seen in some of the hospitals I have already visited and make sure they are allocated across the whole NHS.

[Baroness McIntosh of Pickering (Con)]

My Lords, I congratulate my noble friend and welcome him to this place. I remind the House of my interests with the Dispensing Doctors’ Association. I commend the Government’s vaccination programme for this winter, but in rural areas there is a very difficult and dangerous situation where vaccines for the over-65s are not currently available in many rural practices but they cannot vaccinate the under-65s until they have vaccinated the over-65s. Will my noble friend personally take an interest in this matter and ensure that vaccines for the over-65s are rolled out to rural practices as soon as practically possible?

[Lord Markham (Con)]

I think we are all aware of the importance of the vaccine programme, and I know that, to date, we are following the medical advice as to who the priority groups should be. If I may, I will follow up with a written response so I can give my noble friend the detail required on her question.

Primary and Community Care: Improving Patient Outcomes

Baroness McIntosh of Pickering Excerpts

Thursday 8th September 2022 Lords Chamber

[Baroness McIntosh of Pickering (Con)]

I add my congratulations to the noble Lord, Lord Patel, for calling such a timely debate. It is rather curious to hold a debate without any general practitioners being present to contribute. I understand that in your Lordships’ House there are no general practitioners. I declare my interest as advising the board of the Dispensing Doctors’ Association, which represents over 4,000 general practitioners in over 1,000 dispensing practices, accounting for 15% of all practitioners.

What lies at the heart of this debate and what I would like to focus on is how health services are delivered in rural areas. There are twin challenges which lie at the heart of this debate; there is a rural and urban aspect to health policies, which is often overlooked. We often have a metropolitan elite running the Civil Service at the highest possible level. There is also the challenge of the conflict between primary and secondary healthcare. It is a flawed approach to seek reform to primary care without looking at the bigger picture. I entirely endorse what the noble Lord, Lord Kakkar, said about needing a cohesive and holistic approach to any possible reform.

I put on record that there were 365 million GP consultations in 2021, which equate to about 6.5 consultations per patient. Excluding Covid vaccinations, that equates to over 311.5 million consultations—the same number delivered in 2019. There were 179 million face-to-face appointments in 2020-21, according to NHS Digital. It is also important to state that GP pay peaked in 2005-6 and has fallen every year to 2013-14. It is still not back to the pay between 2004-8, without taking inflation into account. The source for that, again, is NHS Digital.

My concern is the lack of joined-up government in delivering healthcare across the piece. Neither the Department of Health and Social Care nor NHS England rural-proof policy. That flouts the detailed proposals set out by the noble Lord, Lord Cameron of Dillington, in 2015, when our current Prime Minister was the Defra Secretary. Whenever rural-proofing is raised with officials, we are told it is a Defra issue. I hope that it is something my noble friend the Health Minister will take a personal interest in. Perhaps this could be addressed by a House of Lords committee, such as the one sought by the noble Lord, Lord Patel.

The expression “delivering at scale” fills me with alarm and anxiety. Policy which delivers at scale must recognise the challenges of delivering health policy in all its settings, particularly rural ones. For example, do officials understand the lead times to run a vaccination campaign and how this affects a GP workload? GP practices need to order vaccines in November and by January by the latest to run an autumn schedule. There has been much vacillation and incoherent messaging to contractors about the flu and Covid booster campaigns this year. I think that has added to uncertainty in GP practices and to their lack of preparation time.

The preference for large vaccination centres run directly by the NHS does not work in rural areas. Indeed, the National Audit Office reported:

“In terms of delivery costs, dedicated vaccination centres have been the most expensive method at £34 per dose compared with £24 for GPs and community pharmacies. GPs and community pharmacies were the most popular delivery model for all priority groups”.


There has clearly been wastage of valuable medicines in the big centres, which I see as an example of delivering at scale. I argue that it simply does not work in rural settings, where it is extremely difficult for patients living in a rural area to access such a big out- of-town urban centre.

Dispensing in rural areas is often the best choice for those with chronic conditions, and often rural practices dispense because there is no viable pharmacy. This dates back to Lloyd George and national insurance when it was first set up. Dispensing practices receive a disproportionate number of outstanding inspections from CQC, for some bizarre reason. They are often the last public service left in many communities and are highly valued by their patients.

I applaud the work done by successive Ministers for Health, not least my noble friend Lord Bethell, succeeded by my noble friend Lord Kamall, but the digitalisation of the health service in a health rural setting has not been a huge success. There are huge problems of rural connectivity. Poor broadband and mobile signals hamper delivery of the service and make remote consultations almost impossible. There is no electronic prescription service available for dispensing patients. Recruitment of GPs is difficult but, where they train in rural practices, they tend to stay and become partners.

I argue that the system of drug reimbursement needs to be overhauled to remove perverse incentives so that what is good for patients is also good for the NHS and contractors. I add that the closure of community hospitals in rural areas has put increasing pressure on acute hospitals and, indeed, community nurses. That has exacerbated the situation, as others have set out in this debate.

We need to assess the impact of Covid and the delays in diagnosis and treatment. We need to consider the impact on the morale of front-line medical and nursing staff. I applaud the fact that the Government are looking at the pension cap, which has been addressed by others today. We need to look at models such as that agreed by senior judges, which I think would be acceptable to all parties; that seems a good model to use.

In the briefing preparing for today, I noticed that one concern is that the need for regulatory reform has been extended at the moment only to regulating physicians and anaesthetists. When will that be extended and in what timeframe to, for example, general practitioners and all doctors generally? That goes to the heart of having a positive, cohesive approach.

I have a question for the Minister. Bearing in mind that some 15% of the population live in an area served by dispensing doctors—in rural, isolated, sparsely populated areas—how do the Government intend to deliver healthcare in those settings on the same basis as in urban settings?

I conclude with parity of esteem. My father was appointed as one of the first ever general practitioners in 1948. His brother eventually became a general consultant. He referred to my father rather affectionately as a panel doctor. Until then we end this contest and conflict between hospital consultants and senior GPs, I do not believe we will achieve the parity of esteem that best serves patients and the health service.

General Practitioners: Shortage

Baroness McIntosh of Pickering Excerpts

Tuesday 12th July 2022 Lords Chamber

Asked by

[Baroness McIntosh of Pickering]

To ask Her Majesty’s Government what assessment they have made of the reported shortage of GPs in England; and what steps they will take in response.

[Baroness McIntosh of Pickering (Con)]

I beg leave to ask the Question standing in my name on the Order Paper and declare my interest with the Dispensing Doctors’ Association.

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

The Government recognise that growing the GP workforce is challenging, particularly in light of pressures from the pandemic. There are over 1,400 more full-time equivalent doctors in general practice in March this year compared with March 2019, showing that there is some movement in the right direction. However, we need to go further, and we are working with NHS England and NHS Improvement, Health Education England and the profession to boost recruitment, address the reasons why doctors leave and encourage them to stay or return to practice.

[Baroness McIntosh of Pickering (Con)]

I am grateful for that Answer, but my noble friend will be aware that by 2030, we will be facing an acute shortage of GPs as more doctors leave the profession than join. There are 9 million people living in remote rural, coastal and island communities, which is more than live in London. Will my noble friend ensure that all health policy is rural-proofed, and that those living in rural areas have equal access to healthcare to those living in urban areas?

[Lord Kamall (Con)]

My noble friend makes a very important point, and she referred continually throughout the passage of the Health and Care Act to practices in rural areas. We have looked at the challenges and have asked GPs about this in surveys, and we know that there are problems about the reduction of working hours, administrative burdens, some stress and burnout, and some issues about equitable distribution. One thing we do have is the Targeted Enhanced Recruitment Scheme launched in 2016, which has attracted hundreds of doctors to train in hard-to-recruit areas by providing a one-off financial incentive.

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

Baroness McIntosh of Pickering Excerpts

Tuesday 28th June 2022 Lords Chamber

My main message to the Minister is this: surely there is now a case for Ministers setting out a long-term vision for community pharmacies, placing them at the heart of primary care and ensuring that there is funding and workforce support to enable this to happen. Given the tremendous pressure on the health service, we have a huge untapped resource which we must fully encourage to do all it can to support patients at a very difficult time. I beg to move.

[Baroness McIntosh of Pickering (Con)]

My Lords, I congratulate my noble friend on bringing forward the order before us today. I am interested to understand the background to why we are moving from ministerial discretion to regulated control. I think my noble friend will assure the House this afternoon that the concerns raised by the Secondary Legislation Scrutiny Committee have been addressed and that any changes will be brought forward by statutory instrument, in which case the committee and the House will have the opportunity to look at them.

I join the noble Lord, Lord Hunt, and my noble friend, in paying tribute to community pharmacies for the work that they have done throughout the years, and particularly during the Covid pandemic.

What will the position of dispensing doctors be, who fulfil a role where community pharmacies do not reach? Quite a large network of rural areas is served by dispensing doctors. As the daughter and the sister of dispensing doctors, and as someone doing outside work with dispensing doctors, I think it is appropriate that we look at how they are potentially being asked, for example, to deliver a booster jab this autumn at the same time as the flu jab. That will pose enormous logistical challenges for community pharmacies, dispensing doctors and others. How do my noble friend and his department expect to address those challenges so that the rollout will go as smoothly in the autumn—particularly if it is combined with a flu jab—as it did in the previous three or four rounds?

[Lord Grade of Yarmouth (Con)]

My Lords, the health or otherwise of independent community pharmacies can be judged by the rate of closures, which has been increasing over the last few years for a number of reasons, not least the overall deal with the NHS. That deal requires, for example, an individually owned community pharmacy to be deemed to have received the same discount on the purchase of drugs that Boots and the other big chains get on volume discounts. There is a serious crisis in this sector. Can my noble friend the Minister give us some idea of the rate of closure? If he does not have the statistics today, perhaps he could place them in the Library. Closure is an upward trend.