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.

Polio

Baroness McIntosh of Pickering Excerpts

Thursday 23rd June 2022 Lords Chamber

[Lord Kamall (Con)]

First, I thank the noble Lord for his recognition of one of the challenges of ministerial office, as he will know from his own experience. It is important that we recognise that vaccine-derived polio has the potential to spread, but it is rare and the risk to the public overall is limited. The majority of Londoners are fully protected against polio and will not need to take any more action, but the NHS will begin reaching out to parents of children under five in London who are not up to date. But we are asking for it both ways and for parents to check their records. Let us be clear that the UK is considered to be free from polio, but we recognise a potential risk given our world-leading surveillance of sewage.

On the noble Lord’s specific question, we are quite clear that people must come forward for all vaccines. Sometimes during lockdown people were unable to see a doctor or nurse in person, and the NHS is catching up with that anyway, but the NHS will keep sending the message to try to identify people who have not been vaccinated. At the same time, we are encouraging people to check their records. Let us be clear: we detected this very early in the chain, and it has perhaps come from someone who took an oral vaccine overseas and has excreted it into the system.

[Baroness McIntosh of Pickering (Con)]

I congratulate the UKHSA and the Environment Agency on the investment they have made. When was the polio first detected—there are reports that it was detected as early as February—and when might they be able to narrow down the area in which it has been found?

[Lord Kamall (Con)]

I thank my noble friend for that question. There is routine surveillance that happens anyway. However, in this case they have detected it in more than one surveillance. Quite often, it is seen as a one-off and then not seen again for some time; in this case, it has been detected at each interval of the surveillance. We know it is from the Beckton Sewage Treatment Works—in that part of London. I must be careful about the words I use here: clearly, it is mixed up with a lot of other stuff, and we must now work out how we go along the pipe, as it were, and investigate individual pipes to see whether we can locate the source. In theory, it might be possible to find individual households or streets but it is too early to do so. What we are doing here is really world-beating: it is a first and shows that we are ahead. However, one issue in being ahead is that we detect things that would not have been detected earlier, and people are worried about them.

Covid-19: Restrictions

Baroness McIntosh of Pickering Excerpts

Monday 14th March 2022 Lords Chamber

Asked by

[Baroness McIntosh of Pickering]

To ask Her Majesty’s Government what assessment they made of any available scientific advice when implementing or removing COVID-19 restrictions in England.

[Baroness McIntosh of Pickering (Con)]

My Lords, I beg to ask the Question standing in my name on the Order Paper, and I refer to my work with the Dispensing Doctors’ Association.

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

Throughout the pandemic, the Government’s approach has been informed by a wide range of scientific and medical advice and the latest data, as well as by economic, social and deliverability considerations. Ministers have always had regard to the scientific advice when taking decisions to implement or remove restrictions, but have balanced them against other considerations.

[Baroness McIntosh of Pickering (Con)]

Given that the level of infections is now running at 220,000 new infections per day, and given the fact that the Government are planning to remove free testing from 1 April and have already removed the legal obligation to self-isolate, having already removed the support payments for self-isolation, how do the Government intend to protect the most vulnerable in society and NHS staff, given the Government’s new policy provisions of Living with Covid-19?

[Lord Kamall (Con)]

I thank my noble friend for those questions and will try to answer them as best I can. We are now transitioning to a stage where we are able to live with Covid, and we have just announced our living with Covid strategy. At the same time, we are looking at the best way to help those who are particularly vulnerable medically or economically, who should still be entitled to free tests, for example, and issues such as affordability. We continue to monitor the new variants, the BA2 and the deltacron, and we will also continue to have the ONS surveys.

Health Protection (Coronavirus, Restrictions) (Self-Isolation etc.) (Revocation) (England) Regulations 2022

Baroness McIntosh of Pickering Excerpts

Monday 14th March 2022 Grand Committee

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

My Lords, over the course of this pandemic, we have had to put in place curbs on our liberties. Many of those curbs would at one time have seemed intolerable, but they were part of our national effort to slow the spread of the virus. We have now reached the position that we have been waiting for ever since this national effort began: a time when we can roll back some of the rules that have governed our lives over the past two years.

We are able to take this step because of the incredible progress that we have made; I thank noble Lords for alluding to that in the previous debate. When this virus first arrived, we knew very little about it. People were dying. There was no vaccine. We had to make tough decisions to protect our loved ones, our healthcare staff and the British people while we built up the defences to make us safe.

Since then, our vaccination programme has put more than 140 million doses in arms. That has included a booster programme where we were the first major European nation to boost half our population. It has resulted in more than 70% of adults in England receiving the booster, including 93% of those aged 70 and over. Vaccines have given us greater protection and slowed down the advance of the virus. They have allowed us cautiously to open up the country and attempt some return to normal life. The scientific protection that we have built up, together with our greater understanding of the virus, has shifted the odds.

We must be quite clear that our fight against the virus is not over, but we are now able to take a different approach, moving away from legal curbs towards an approach based on personal responsibility and public health guidance, where we trust people to make the right decision for themselves, for their loved ones and for those around them. I hope that noble Lords will bear with me while I talk through each measure in turn.

First, the legal requirements around self-isolation are being revoked. This includes the duty to self-isolate if you test positive, the duty to provide NHS Test and Trace with details of contacts, the duty to notify an employer that you are self-isolating and the legal duty on employers not knowingly to allow someone who is self-isolating to attend work.

Rather than relying on legal restrictions, we are encouraging people to act responsibly and to follow the guidance that has been set out. If you experience any of the main symptoms of Covid-19, you should take a test. These symptoms are a new continuous cough, a high temperature and a loss of or change in your normal sense of taste or smell. People who test positive should still stay at home and avoid contact with others for at least five full days. They may choose to follow this advice until they have received two negative test results on consecutive days.

Household contacts are also advised to work from home if they can and to avoid contact with individuals who are at greater risk from Covid-19. They should also limit close contact with other people outside their household and wear a well-fitting face covering in enclosed spaces. Following this advice for 10 days after the case’s symptoms started, or the day their test was taken if they did not have symptoms, can help to protect others. Specific guidance for staff, in particular those in vulnerable settings, such as adult social care, healthcare and prisons, is being kept under review and regularly updated.

The other regulations being revoked today are the Health Protection (Coronavirus, Restrictions) (England) (No. 3) Regulations 2020. These gave local authorities powers to issue directions to close, prohibit and restrict premises, events or outdoor places. They also gave the Secretary of State powers to require a local authority to issue a direction for closure. These regulations were vital for a local response to the crisis, allowing us to act with speed in response to local outbreaks, but these powers have not been used since July last year and we are now seeing fewer outbreaks, meaning that they are no longer proportionate or necessary. With these regulations revoked, outbreaks will be managed by local authorities through local planning and pre-existing public health powers, as they would be with other infectious diseases.

Although we are able to take these steps, we must remember that this pandemic is not over. There are simple actions we can all take to limit the spread of Covid-19 to protect those around us: get vaccinated, ventilate shared spaces, wear a face covering in crowded or enclosed spaces, get tested if you have Covid-19 symptoms and stay at home if you are positive. It is important that those who test positive for Covid-19 follow the public health advice to stay at home and avoid contact with others for at least five days.

We are taking additional steps to protect the most vulnerable with targeted vaccines and treatments, including offering spring boosters as we announced and the protection offered by antivirals, of which we have a greater supply per head than any other country in Europe.

In our surveillance to build up our resilience to manage and respond to new variants, we will continue to rely on the world-leading ONS survey, allowing us to track the virus in granular detail. We will make sure that we still have the ability to ramp up testing should we need to and will help countries across the world to develop their own capability for surveillance. These defences will be our first port of call in the future, rather than relying on legal restrictions, while we maintain our vigilance.

The regulations we are debating today restore some freedoms to our nation, but we have to make sure we maintain our vigilance and continue to rely on a scientific evidence approach to keep us safe. I commend these regulations to the Committee.

[Baroness McIntosh of Pickering (Con)]

My Lords, I thank my noble friend, both for his Answer to my Question earlier, which I would like to pursue in more depth here, and for moving the regulations today. I also pay tribute to the work that he, the ministerial team and the department have done. They have worked exceptionally hard in challenging circumstances. I declare my interest as an adviser to the board of the Dispensing Doctors’ Association.

I understand, as my noble friend said in response to my Question earlier, that the department and the Government are reaching a balance in living with Covid. The context of these regulations must be set against that background. My concern is that we are still relying on the vaccination programme. I pause and say how welcome the vaccination and booster programme has been. I particularly welcome the fourth jab being rolled out to the most vulnerable. It seems slightly patchy: we heard earlier that some in London have a date for their vaccination, but hearsay and anecdotal evidence are that people are being told that they will have a vaccination but have no date yet.

My main concern is simply this. The Secretary of State has said publicly, and my noble friend has repeated it in the House and in Committee today, that the Government hope to respond and keep the development of the pandemic under review. I welcome that but my concern is very simple: that we are removing all the tools to enable the Government to do so.

--- Later in debate ---

Regarding modelling, the Government have taken account of some of the models. Noble Lords have referred to SAGE and its sub-groups. Recent advice from the Scientific Pandemic Influenza Group on Modelling, or the SPI-M sub-group, included medium-term projections of the trajectory of the pandemic, assuming no future policy or behavioural changes, and estimates of the extent to which all measures and behavioural change are currently reducing transmission. That is one of the issues we looked at when coming up with the living with Covid strategy. We will continue to take a data-led approach to future outbreaks. As I said earlier, there are various ways that we will maintain that and we are very cognisant of potential inequalities.

[Baroness McIntosh of Pickering (Con)]

I am most grateful to my noble friend for repeating the responsibilities of the local authorities. Were they allocated special funds to do this or are they just relying on their existing public health budgets? In other words, are they not getting any new money for this role?

[Lord Kamall (Con)]

I am afraid I do not have a detailed answer, and I do not want to give an inaccurate one. I think I know the answer but I just want to double-check it. I will write to all noble Lords, as more than one Member raised that issue.

We see the importance of continuing to be vigilant, and of surveillance. We continue to monitor the virus and want to make sure that we have informed decisions and that everything is data-led. A number of noble Lords mentioned the ZOE app. Again, I will have to go back to the department to find out more information, if noble Lords will allow me.

In closing the debate, I thank noble Lords for their contributions. I apologise for the questions I have not answered; I will check Hansard and write to noble Lords. We should also thank the scientists, the health and social care workers, the volunteers, the life sciences industry, the postal, courier and transport workers and everyone who has helped us to get to this point. They have helped us to get through what has been a very difficult period in our lives.

We believe that the regulations before the Committee mark an essential step on our journey to living with Covid, away from legal restrictions and towards guidance and personal responsibility. Once again, I am grateful to noble Lords for raising their concerns, some of which I will have to go back to the department and check on, especially concerning the guidance and its communication. I have taken that point on board.

Throughout the pandemic we have sought to strike the right balance between the safety of the public and keeping the country open. We saw restrictions as a vital weapon in the armoury, but now we have the defences of the vaccination programme and the antivirals, along with a better scientific understanding of the virus, and can take a different approach. However, I repeat: we will keep monitoring the data, drawing on the latest scientific advice, and protecting the country through the defences we have built.

It is important that we follow public health advice should we display Covid-19 symptoms or receive a positive test result. We can all help each other in limiting the spread of the virus by getting vaccinated, ventilating shared spaces, wearing a face covering in crowded or enclosed spaces, getting tested if we have Covid-19 symptoms and staying at home if positive. Lifting these restrictions does not mean that we are ignoring the virus; it means managing the virus through the best possible guidance, as we do for other infectious diseases. I urge noble Lords to agree to these historic measures and commend the regulations to the Committee.

Health and Care Bill

Baroness McIntosh of Pickering Excerpts

Lords Hansard - Part 1 & Report stage
Thursday 3rd March 2022 Lords Chamber

[Lord Shinkwin (Con)]

My Lords, I too thank my noble friend the Minister for Amendments 36 and 157. I shall also speak in support of Amendment 59 in the name of the noble Baroness, Lady Hollins. Before I do so, I hope your Lordships’ House will allow me to take this opportunity to thank the healthcare professionals at Guy’s and St Thomas’s, who recently looked after me so well following major surgery. Some noble Lords may have noticed my absence. I have had half my leg rebuilt and am now the proud, if involuntary, owner of a Meccano set inserted by my excellent surgeon, Marcus Bankes, and his registrar, Christian Smith. I apologise in advance if any noble Lord seeks to intervene and I dare not sit down to take their intervention as I am not sure I would be able to get back up again.

Although the pain was excruciating and the morphine, which I am weaning myself off, very welcome, it saddens me to say that that pain was compounded by the way in which I received no support from your Lordships’ House. I might as well have been dead. It reminded me that this wonderful institution remains a place whose rules and modus operandi were designed by and for rich, non-disabled men. I will say no more on the matter now, but it is clear to me that this needs to change if we are to become a stronger, more diverse, more representative House. If we do not want to be consigned to the past, we must stop living in the past. The appalling way we treat Members whose disability enforces temporary absence from your Lordships’ House is indefensible and cannot continue.

Returning to the substance of the amendments under discussion, I am hugely grateful that the Government have listened to concerns I raised at Second Reading and others raised, in my absence, in Committee. All credit goes to noble Lords for the strength and the passion with which they did this, and to the Minister for so obviously listening and taking their concerns on board. Taken together, Amendments 36 and 157 should make a real difference to the lives of all babies, children and young people in this country, particularly those with speech, language and communication needs. I should declare at this point my interest as a vice-president of the Royal College of Speech and Language Therapists. I know the Minister and his colleagues across government, not just in the Department of Health and Social Care but also in the Department for Education and the Ministry of Justice, share my ambition and the ambition of other noble Lords in wanting children and young people with communication needs and their families to have the best possible level of support so they can realise their potential.

To help deliver that ambition, I ask my noble friend to reflect on four things. First, I would be so grateful if he would look kindly on Amendment 59, so ably spoken to by the noble Baroness, Lady Hollins. This would help to close any potential accountability gap and considerably strengthen the provisions of Amendment 36.

Secondly, will the Minister pledge to ensure that all the guidance to the Bill specifically references children’s speech, language and communication needs? The statutory guidance and accountability lead for SEND is a very positive development, but it is not sufficient. The vast majority of children with communication needs do not have an education, health and care plan. This includes children with developmental language disorder—over 7% of all children—those who stammer, and those with speech-sound disorders. The guidance must, therefore, ensure that the needs of those children are supported. A model that the Government have already established for this is the statutory guidance to the Domestic Abuse Act, where speech, language and communication are listed as a specific intersectionality.

Thirdly, will the Minister agree to meet the chief executive of the Royal College of Speech and Language Therapists to discuss how the guidance on the Bill can best capture those issues? Fourthly, on Amendment 157, can the Minister reassure the House that the report will include commitments to act to improve information-sharing? Finally, may I reiterate my huge thanks to my noble friend the Minister, and say how pleased I am to be able to do so in person, in your Lordships’ House? It is good to be back.

[Baroness McIntosh of Pickering (Con)]

My Lords, I welcome my noble friend back and commend him for his bravery. We came into the House at the same time, and he is a source of constant inspiration to us all; I have endless admiration for him. I apologise to the House for having omitted to declare my interests when I spoke for the first time on Report on Tuesday. I refer to my entry in the register of interests, and in particular to the fact that I work with the board of the Dispensing Doctors’ Association. I am also a patron of the National Association of Child Contact Centres and a co-chair of the All-Party Group on Child Contact Centres and Services.

I again commend my noble friend the Minister for summing up and assessing the mood of the House and tabling the amendments today; I am grateful to him for that. I also support the noble Baroness, Lady Hollins, and her Amendment 59, which is very appropriate. I hope my noble friend will look favourably on it, and I pay tribute to the work of the noble Baroness. One of her remarks earlier on Report which struck a chord with me was about the shortage of psychiatrists and other mental health professionals, particularly for those in the age group affected by these amendments.

I endorse and support the amendments in the name of my noble friend Lord Farmer. He refers in particular to the family hubs, and I make a plea to the Minister to recognise, as part of a family hub, a child contact centre. Centres are usually manned by volunteers, and they do fantastic work—not necessarily in keeping families together, because, unfortunately, their role largely comes into play when families have broken, but they play a fantastic role in maintaining contact with the absent parent.

Obviously, in these constrained times, the budgets of all organisations come under increasing scrutiny and pressure, so I urge the Minister to use his good offices to speak to those in the Ministry of Justice and the Department for Education to ensure that the budget for child contact centres will be renewed not only for two years but for three years—the period promised earlier. Those centres do fantastic work, under great constraint, and I am proud to be associated with them. I wanted to use this opportunity to support the amendments and to urge my noble friend the Minister to use his good offices in this regard.

Health and Care Bill

Baroness McIntosh of Pickering Excerpts

Lords Hansard - Part 1 & Report stage
Tuesday 1st March 2022 Lords Chamber

[Lord Kamall (Con)]

My Lords, in moving Amendments 4, I shall also speak to Amendments 23, 58 and 79 in my name. Before I start, I really should acknowledge the contribution and engagement of a few noble Lords, in particular the noble Lords, Lord Sharkey and Lord Patel, and my noble friends Lady McIntosh and Lady Blackwood for their constructive engagement with me and my officials.

We have seen the power of research as we have made our way through the pandemic, and research will continue to be essential. I agree that research needs to be embedded in the very DNA of the NHS. Earlier this week, I chaired a round table with a number of research charities and other stakeholders, and we all talked about the importance of embedding research into the NHS. A bit like the challenge I had when I was in academia, when you wanted more time for research but at the same time were told to get on with your day job of teaching students, likewise many clinicians are under the same pressures in terms of the day-to-day delivery of healthcare while wanting time for research.

We know that informed research helps to improve healthcare and health outcomes. It brings benefits to patients, staff, the NHS and the wider economy. We believe that integrated care boards will play a leading role facilitating and enabling research and fostering a culture and environment for research to flourish. To this end, the Bill currently places a duty on each ICB that it

“must, in the exercise of its functions, promote … research on matters relevant to the health service, and … the use in the health service of evidence obtained from research.”

I have, however, heard clearly from noble Lords that they want to see a step change in research. That is a request, or a plea, that I agree with, so rather than directly funding or conducting research, ICBs will primarily facilitate and enable it. However, ICBs will also have the power to conduct, commission or assist the conduct of research. This could include hosting or being a collaborating partner in research infrastructure.

I also heard from noble Lords, particularly the noble Lord, Lord Sharkey, that it is not clear what a duty to promote research should involve. To that end, I have tabled Amendments 4, 23 and 79 to clarify that the meaning of “promote” includes “facilitate”. I once again thank the noble Lord, Lord Sharkey, for his engagement. This highlights that facilitation is a subset of the range of activities meant by promoting research while retaining the breadth of a duty to promote research.

The duty is broad and could be met in a number of ways. For example, when exercising its commissioning functions, an ICB may select providers which have a proven track record of being research-active or can demonstrate the intention and capability to participate in research. The provision is also flexible so that bodies can develop the processes and structures that work most effectively, but we anticipate that ICBs would have dedicated research offices or teams to support their role in research and to encourage the conduct of research.

To ensure that research is fully embedded in local systems, we expect ICBs to consider research when preparing, with the responsible local authority, a joint strategic needs assessment articulating local research needs where they identify them. We would also expect ICBs to ensure that the joint local health and well-being strategy sets out how research needs can be met by the ICB. We have tabled Amendment 35, which is to be debated in the next group, to ensure that the research duty, along with other duties, is given particular consideration during ICBs’ planning of their strategies. We have also tabled a package of amendments to provide increased transparency, accountability and oversight of the research duties.

During the debate in Committee, my noble friend Lady Harding remarked that

“what gets measured gets done”.—[Official Report, 24/1/22; col. 47.]

We agree. Amendment 4 requires NHS England’s business plan to explain how it proposes to discharge its research duty and requires its annual report to contain an assessment of how effectively it discharged this duty. We have tabled similar amendments for ICBs. Amendment 55, also to be debated in the next group, would require that ICB annual reports must explain how the ICB has discharged its research duty. Amendment 58 would require that the NHS England’s performance assessment of each ICB includes an assessment of how well it discharged its research duty. I beg to move.

[Baroness McIntosh of Pickering (Con)]

My Lords, I take this opportunity to thank my noble friend for listening and acting in the terms set out in the amendments in this group, which I support on research as far as they go. I have to express my disappointment that my noble friend has not seen fit to extend his bonhomie to NICE. I have therefore tabled Amendment 29, and I am delighted to have the support of the noble Lords, Lord Hunt of Kings Heath and Lord Patel. As set out by the noble Lord, Lord Kakkar, our thoughts are with the noble Lord, Lord Patel, who is unable to be with us today, and we wish him the speediest possible recovery. It is a great shame that he cannot be here today because we would all wish to pay tribute to his work historically as the forerunner of NICE. We are grateful to him for it. It is a great disappointment to me that he is not able to be here in person.

I also support Amendments 171 and 178 in the name of the noble Lord, Lord Hunt, but I shall leave the noble Lord to set them out.

My noble friend has set out that the government amendments set a responsibility on integrated care boards to respond annually and to measure the research work that they have done. Quite frankly, I am a little concerned and gobsmacked as to why my noble friend is not insisting that integrated care boards do the same as regards NICE. The key provision of my Amendment 29 is:

“Within 28 days of any medicine or device receiving market authorisation from NICE, an integrated care board must update its formulary to include that medicine or device.”


I have set out other provisions, but the other one to which I draw attention is in proposed new subsection (3), which says that every year an individual ICB must report

“in a publicly accessible format”—

to me that would mean it being accessible on its website—

“all medicines and devices that have been added and removed from their formulary over the previous year and maintain an active list of all medicines and devices available on their formulary.”

Vaccination: Condition of Deployment

Baroness McIntosh of Pickering Excerpts

Thursday 3rd February 2022 Lords Chamber

[Lord Kamall (Con)]

I thank the noble Baroness for raising that point. It is really important to note that, when engaging in debates such as this, it is sometimes easy to forget patients, and we should not do that. The health service should be all about patients; it should be patient-centred. I understand the concerns. One of the reasons that we originally introduced VCOD, particularly for care homes and then more widely, was that patients were very concerned and relatives of patients were concerned about their loved ones—they were terrified, given the early outbreaks that we saw in care homes. On the particular consultation, I am afraid that I do not have the information with me, but I will commit to write to the noble Baroness.

[Baroness McIntosh of Pickering (Con)]

I thank my noble friend for answering questions on the Statement here this afternoon. One thing that struck me when I read through it was that

“Incredibly, over a third of the UK’s total number of covid-19 cases have happened in just the last eight weeks.”—[Official Report, Commons, 31/1/22; col. 71.]


Taken together with the point raised by one of the noble Baronesses on the Front Benches—that the Government are planning to stop publishing the level of Covid infections and deaths, and to stop testing from the end of March—what reassurance can he give us this afternoon that the Government will know where the infection is and what the level of infection is? Against that background, how does my noble friend expect to protect the NHS and care homes at that time?

[Lord Kamall (Con)]

I thank my noble friend for her question. I will be frank with her: I was not aware that the Government intend to stop publication, so I will have to go back to the department and double-check whether that is indeed true or whether it is a qualified statement. I commit to write to all noble Lords, given that it seems to be what we have heard. Clearly, as we are told, we follow the evidence, and the scientists continue to follow the evidence, so I would expect that data to continue to be collected. The best answer I can give at this stage is that I will go back to the department and investigate, and will write to noble Lords.

Personal Protective Equipment: Accounting

Baroness McIntosh of Pickering Excerpts

Wednesday 2nd February 2022 Lords Chamber

[Lord Kamall (Con)]

The noble Lord asks a detailed question, so I hope noble Lords will forgive me if I try to respond in some detail. If you look at the breakdown of the writedown, you will see that, first, about £4.6 billion was attributable to changes in global prices following the point of purchase in a highly inflated market—noble Lords will remember that even toilet rolls went up at one time. As the noble Lord rightly says, the £673 million was for stuff that had failed the quality testing or technical insurance. The £2.6 billion was for stock that will not be used for its intended purposes but can be repurposed. We are also looking at stock in excess of the current forecast requirements, which can be stockpiled, and we are also introducing a tender for testing to see whether the life of some of that stock can be extended.

[Baroness McIntosh of Pickering (Con)]

My Lords, can I press my noble friend a little more closely on one issue? I speak as president of the UK Warehousing Association. I am grateful to my noble friend for his explanation. What timetable do the Government have to remove this redundant PPE equipment from the warehouses in which it is currently situated to enable stock to be stored in those warehouses which really needs to be at this time?

[Lord Kamall (Con)]

There are different ways; some of it is about stockpiling stuff that is still useful and which we would use in future anyway. We are looking at research into testing whether the life of some of our stock can be extended—we are working with some of the best scientists on that. We are also looking at where we can give stock away or sell it on, as all the stock we are passing on meets WHO standards. To give noble Lords one example, we bought lots of latex gloves; usually we do not buy latex gloves in this country because of allergies and, now that we no longer need them, we can give them to a country such as Syria.