Excess Deaths in Private Homes
Baroness Merron Excerpts(1 year, 11 months ago)
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Baroness Merron
To ask His Majesty’s Government what is their assessment of the reasons behind ONS figures showing excess deaths in private homes in England and Wales in the week ending 23 December 2022 were 37.5 per cent higher than the five-year average for the same period.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
My Lords, while the detailed assessment is not yet available, it is likely that a combination of factors has contributed to an increase in the number of deaths at home, including high flu prevalence, the ongoing challenge of Covid-19, and health conditions such as heart disease and diabetes. On 12 January, the Office for Health Improvement and Disparities will update its excess deaths report, providing further insight into causes that have contributed to excess deaths.
Baroness Merron (Lab)
My Lords, while a patient may choose to die at home, the spike in home deaths rings considerable alarm bells. Analysis suggests that record ambulance and emergency delays could be the explanation for a significant number of many more sudden deaths that are occurring at home. Can the Minister point to any government analysis, whether published or ongoing, to explain this unexpected increase in home deaths and a potential link with these delays? If there is no such analysis, how will the Government know how to overcome this shocking state of affairs?
Lord Markham (Con)
I thank the noble Baroness. This is an important question, and I had the opportunity to speak to Sir Chris Whitty on this very subject this morning. The statistics show that, over the course of the year, home deaths have increased by about 22%—a lot of that through personal choice, because it was happening over the summer and earlier in the year. Sir Chris told me that a lot of factors are in play at the moment. Flu is a clear example. There were about 1,000 more deaths in the week mentioned than would normally be expected. The cold snap came early, creating more cardiovascular deaths. However, clearly, the challenges are also a component part, which is why we made yesterday’s announcements about the further measures.
NHS Winter Pressures
Baroness Merron Excerpts(1 year, 11 months ago)
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Baroness Merron (Lab)
My Lords, from this Statement one might conclude that the NHS is facing challenges but that, overall, things are moving in the right direction. This could not be further from the truth and does not reflect how dire the situation has become. It is clear that the Government have failed to grasp what everyone else has managed to: that there is a deeply urgent crisis in health and social care, where irrevocable damage is being done to people’s lives.
While on the one hand the Government are bringing in legislation that will mean that NHS staff can be sacked for exercising their right to strike, on the other they are refusing to conduct meaningful pay negotiations that could end the strikes in the health service. Indeed, they only thought to convene an NHS recovery forum this week, when we are already half way through the winter.
It is increasingly becoming clear that the sporadic pots of money proposed as sticking plasters for various pinch points are not being deployed quickly enough. For instance, the £500 million emergency adult social care discharge fund was announced in September, but some half of it still has not yet reached the front line. The NHS has now said that it is too late to make a difference to the winter crisis. Has the Minister identified what is stopping the funding coming through? What plans are in place to deal with this so that funding can promptly get to where it is needed? It is no good making announcements and then not following through.
Nor is it easy enough to work out whether funding is new or recycled money. I hope the Minister will be able to clarify this now and in the future. The nature of this Government’s approach to funding health and care—half a billion pounds here one week, another few million there—gives the impression of knee-jerk reactions rather than strategic policy-making. In fact, the approach is so last minute that, after making the announcements in yesterday’s Statement, an extra £50 million was suddenly found and a further press release was issued.
Yet we know that prevention is better than cure in every sense. A GP appointment costs the taxpayer much less than a desperate patient turning up at A&E. Is the Minister content with this eternal hole plugging? What plans are there to move towards a more holistic and sensible long-term approach, including plans to fix primary care so that patients can see the GP they want in the manner they choose? What plans are there to recruit the care workers needed to care for patients once they have been discharged from hospitals, and to pay them fairly so that we do not lose them to other employers? As ever, where is the comprehensive and detailed workforce plan to train the doctors, nurses and health professionals that the NHS so desperately needs?
Underlying this has been an abject failure to make the social care system sustainable. Half a million people are waiting for social care assessments. They clearly are at major risk of having to be admitted to hospital as a result. How will the Minister work to prevent this, especially when care workers are leaving in droves to work in retail and other sectors? Is there a government target for when the number of people waiting for assessments, often in pain and discomfort, might finally start to come down?
The Statement cites Covid, flu, strep A, scarlet fever, and even CQC inspections as reasons why the NHS is under such strain. Is this not surely passing the buck, when other countries face similar challenges and yet are not gripped by such chronic crises every single winter?
In the context of an ageing population where demand on the system will only increase, is the Minister willing to assure your Lordships’ House that a sustainable social care solution will finally be produced before the next winter hits? The NHS Confederation has responded to yesterday’s Statement by referencing the obvious contained in the Government’s words on the need for
“the right wraparound care for those being discharged from hospital”.
The NHS Confederation also says that
“after a decade of austerity neither the social care sector nor the government are in any position to ensure it.”
Does the Minister agree with that analysis: that it is the choices of this Government over the past 12 years that have had a direct and devastating impact on the current delays? It is this fundamental that the Statement has failed to address.
National Health Service (NHS Payment Scheme—Consultation) (No. 2) Regulations 2022
Baroness Merron Excerpts(1 year, 11 months ago)
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Lord Allan of Hallam (LD)
My Lords, I am pleased to be able to take the reins from my noble friend Lady Brinton, starting with this short but important statutory instrument. I echo the happy new year wishes and thank the Minister for his welcome. I understand that a key function that we perform in this House is to ensure that legislation is implemented in the way that Parliament intended as we put flesh on the bones of primary legislation through statutory instruments such as the one we are considering today.
Today’s statutory instrument is a small element of an important part of our modern health service infrastructure: the mechanism for pricing services within the NHS’s internal market. It was a prompt for me to read more pages of tariffs and rules than I ever intended or wished to do, which is mind-boggling and fascinating in equal measure. The subject of our debate today is not the substance of the payment scheme but rather the trigger for when the scheme might be reviewed if there are objections.
As the Minister pointed out, the Government’s intention is to maintain a 66% objection rate for triggering a further consultation period, which is unexceptional as it maintains the previous level. However, like the noble Lord, Lord Patel, I am curious as to why 66% was picked, particularly as I understand that it will not trigger a referral to the Competition and Markets Authority, which would have been a major step, but simply a further consultation period. There may be an argument for why a 51% or 60% threshold would not be appropriate, given that the threshold triggers something less significant than the previous regime.
I am also curious about the experience that we have had over the last decade or so while the other tariff scheme has been in place. Does the Minister have data on the levels of objections received in previous consultations? I suspect that they were much lower than the level we are talking about here but, as we review the scheme, it would be interesting for us to understand whether we were previously getting 10% objection levels, or 50%. I assume that there must be some experience of that within the National Health Service.
Like the noble Lord, Lord Patel, I would like more words about why 66% remains the effective level, and some information about objection levels we have experienced previously. That would be helpful to put our minds at rest, but I think we are all broadly supportive of the instrument as it stands.
Baroness Merron (Lab)
I thank the Minister for introducing this statutory instrument. It is a great pleasure to follow the noble Lord, Lord Allan, for the first time in his new role. I am sure there will be many more times, and we all wish him well. Of course, from these Benches, I echo the happy new year greetings. The new year gift to the Minister is that on no side are we opposing these regulations today. I am sure that will make him absolutely delighted as he starts 2023.
The consultation that we are talking about here is important because, as noble Lords have said, the NHS payments scheme governs how billions of pounds of taxpayers’ money is spent. Of course, quality of care and value for money have always to be at the core of our health service and its decision-making, and we need financial management within the health service to be able to deliver both quality of care and value for money in parallel—they are not an either/or. We saw during the pandemic what happens when the NHS strays from these principles, and we do not want to allow such events to happen again.
The former tariff system which these regulations form part of replacing sought to deliver a more competitive environment to drive up quality and to improve outcomes for patients yet, regrettably, it was often something of a rather rigid system that did not allow for the flexibility that individual commissioners actually needed. Therefore, giving local decision-makers the tools that they need to improve services in their areas is absolutely vital to ensuring that the NHS meets the needs of patients where they are, not where the system thinks they should be. The noble Lord, Lord Patel, raised an important point about meeting the needs of patients where there is variability across the country, and it would be helpful if the Minister could offer us some comment on that. With that in mind, a rigorous and effective consultation on changes is absolutely vital, because we know that, when done properly, payment schemes can deliver a meaningful impact on patient outcomes.
The payment by results incentives that were used by the last Labour Government made a significant impact on the elective waiting lists. We know that this may not be the appropriate way forward in every case and that options have to be carefully considered, but we are now in a situation where elective waiting lists are at record levels. So, given the reports that Ministers are considering bringing back payment by results incentives in some form or another, perhaps the Minister could give some comment on what plans are in place to do that.
I will ask a further question to get a sense on this. As we are talking about billions of pounds of public money—of course I believe that this SI and other discussions that we have treat this point with the gravity that it warrants—it would be helpful to hear from the Minister whether he considers that there is enough input through the Secretary of State into this process. I am of course not suggesting that Ministers should be setting payment levels for various treatments, but it would be helpful to have a sense about whether there is enough political input into how we might ensure that the extraordinary purchasing power of the NHS might incentivise innovation, prevention or, for example, buying British.
Furthermore, in previous consultations on the national tariff, such as in 2014, the objection percentage was met, but how have the NHS and the department worked since then and engaged with stakeholders to prevent that from happening again, as far as possible? I was also pleased to read that the department will be monitoring and reviewing the implementation of this legislation. Can the Minister give us some more detail on what form this will take and whether the analysis could be made public? That follows on from the point made by the noble Lord, Lord Allan.
It is important that we get right these changes that we are considering today, and effective consultation is absolutely key. It is in the interests of everyone, because it will ensure better outcomes for patients. I therefore look forward to hearing from the Minister how this will be delivered.
Dentists, Dental Care Professionals, Nurses, Nursing Associates and Midwives (International Registrations) Order 2022
Baroness Merron Excerpts(1 year, 11 months ago)
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Lord Allan of Hallam (LD)
My Lords, I do not have any direct professional interest in the subject at hand, but as somebody who lives in London and needs dental care, and as a parent, I am grateful to those dentists and midwives from all over the world who have provided me with excellent service through the years. We should be grateful to them all.
From these Benches we also broadly welcome the order the Minister is putting forward. It is clear that we should make it possible for all suitably qualified healthcare professionals to practise in the UK and it is, frankly, a waste of an individual’s talent and a detriment to public interest if there are unnecessary delays or barriers to registration. The noble Lord, Lord Hunt of Kings Heath, described dentists coming here from countries such as Ukraine and Afghanistan who can make a significant contribution, and we need to enable them to do so rather than disabling them from doing so.
Of course, there are necessary checks to protect patient safety, but what we are saying with this statutory instrument is that we believe that the professional bodies, such as the General Dental Council and the Nursing and Midwifery Council, are the bodies most competent to determine what those checks should be and to set out the right testing and assessment processes to allow applicants with overseas training and experience to apply their skills here. In this debate I have learned a lot from the detailed experiences of the noble Lords, Lord Hunt of Kings Heath, Lord Harris of Haringey and Lord Patel, about what this means in practice. It seems to me to be the right decision that we should empower those bodies even further and give them the flexibility that they need to be able to adapt over time as circumstances allow, balancing out the need for safety but also the need to get people on to the register as quickly and reasonably as possible. We agree with the Government on the broad thrust of these provisions and that the additional flexibility is important.
I raise one question with the Minister. Do the Government have any criteria in mind for assessing whether this change has been successful? For example, have they looked at the cost and speed of applying to register before and after the additional flexibility is granted and after the new processes are brought in? The noble Lord, Lord Harris, correctly reminds us that this will not be immediately, but certainly over this multiyear process, if we are to make this change, it would make sense to look at the situation before and after. I note that paragraph 14.1 of the Explanatory Memorandum points out that the instrument itself has no monitoring provisions, but with any legislative change it is helpful for that to be the case, and I hope that the Minister will be able to describe some criteria that the Government have internally for deciding whether this has been successful.
Finally, I end on a note of caution about the safety standards. Sadly, something will go wrong; somebody will be registered in future who should not be registered. When that happens, the fact that we are all supportive of this today means that we will all own that decision, and we should not say that this is wrong because of a single bad case. Overall, we are making the correct decision. The correct risk assessment is that we trust bodies such as the General Dental Council and the Nursing and Midwifery Council to make decisions.
As the noble Lord, Lord Hunt, correctly pointed out, this is part of a process; we will be going further, and other professional bodies will be given similar flexibility. That is the right decision now and will be the right decision in future. Even if and when something sadly goes wrong under the new procedures, as I said, we will need to remember that, overall, we took this decision because we wanted to see more of those people—the kinds of people from whom I have certainly benefited—on the registers in the UK providing the professional services that they can.
Baroness Merron (Lab)
My Lords, I thank the Minister for bringing this order before us. On these Benches, as across your Lordships’ House, these changes are welcomed as sensible and as part of a suite of measures that we will continue to consider. Certainly, the increased flexibility that they bring to the work of the General Dental Council and the Nursing and Midwifery Council by amending the registration and examination processes and procedures so that they are as effective and practical as possible is very welcome. This is about harnessing the capacity and meeting the standards that are needed so that we can ensure that we have the right professionals in place. The noble Lord, Lord Patel, raised important points that I hope the Minister will consider on how the practicalities of this need to be done.
I am grateful to my noble friend Lord Harris, who laid out what the order does but also what it does not do—in our deliberations it is important that we understand that. I noted his comment that there was no ministerial claim that this will solve a workforce crisis, but, as my noble friend Lord Hunt said, we have a challenge in getting a workforce in place to provide the services that we need. In that regard, it is important that we consider the changes today in the current context of the health system in the United Kingdom.
It is important to say that, sadly, in 2021 alone, 2,000 dentists and over 7,000 nurses quit the NHS. There are more than 46,000 empty nursing posts across hospitals, mental health, community care and other services, which means that one in 10 nursing roles is unfilled across the service overall. As we have spoken about many times in your Lordships’ House, the number of NHS dental practices fell by more than 1,200 in the five years before the pandemic, and there are 800 fewer midwives than just three years ago. That is the context in which we are discussing this.
I turn specifically to the order. If, as expected, the GDC begins recouping costs incurred around international registration, including charging applicants more to take the overseas registration exam, could the Minister give an indication of what effect this might have on the number of dentists operating in the UK? I am sure he understands that, given the number of dental deserts that we already face, we cannot afford to lose the capacity of any further dental professionals.
As well as the overseas registration exam, non-EEA dentists also have to go through the performers list validation by experience process to practise here. The Minister will be aware that stakeholders expressed concern about dentists’ PLVEs being disrupted—for example, by being endlessly rearranged or cancelled—and that that is acting as something of a deterrent to working here. Can the Minister confirm whether there is recognition of that difficulty, and whether the department is looking at what needs to be done to make the process as coherent and smoothly run as possible?
In the other place, the Minister of State committed to write further on the breakdown of positive and negative responses to the consultation that was carried out. Can the Minister of State’s response be made available to Members of your Lordships’ House so that we might also better know what stakeholders were thinking when they responded to the consultation on these changes?
The Government’s Explanatory Memorandum states that policy changes that the regulations make following this order
“may potentially impact international applicants and existing registrants with different protected characteristics, particularly with regards to age, sex and race”
but does not provide detail on what that impact might be. Can the Minister offer any insight into this, if the department has correctly forecast what the regulators are planning?
As we have discussed today, the intent of the order is that there will be changes to application processes and so on. Can the Minister indicate what plans there are to review and audit changes to ensure that there is consistency of decision-making, fair treatment of all applicants and the achievement of the right standards?
In conclusion, while we all support the substance of the order, I hope the Minister can give an assurance that its impact and implementation will not be beset with logistical hitches and unforeseen consequences, because we are keen to ensure that changes are made to deliver the right result to get the workforce more into place than it has been hitherto. I look forward to hearing what the Minister has to say about how the order may assist that, if not entirely cure it.
Lord Markham (Con)
I thank noble Lords for their contributions to the debate. I shall attempt to answer the questions set. As ever, I will happily follow up in detail afterwards.
I accept the premise that no one believes that this is a silver bullet that answers all the issues around recruitment and workforce needs. At the same time, I think there is a belief that this is one of many things that can, hopefully, help increase access at the end of the day. I reiterate our commitment to independence, in answer to the question from the noble Lord, Lord Hunt. That is fundamental to this issue and, hopefully, something that the noble Lord, Lord Harris, has recognised through this process.
Probably the point I would like to devote most time to is the one about the DCP register. I must admit that it is something I brought up specifically and wanted to go around the houses on. I absolutely understand the issue: are we cutting off our nose to spite our face? On the equivalence argument—our dentists cannot apply overseas—part of that, as it was described to me, was also the feeling that even in the UK our dentists cannot use the DCP route, so to speak, in that they might be a qualified dentist but want to use some other qualifications, rather than be a dentist. So it was felt that there was no consistency there either.
Hospital Beds: Social Care
Baroness Merron Excerpts(1 year, 11 months ago)
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Lord Markham (Con)
I thank the noble Baroness. She is absolutely right that the target of 7,000 beds is a key part of this. All Ministers have been talking about it with every ICB over the last few days to see exactly where they are on the target for both real beds and virtual beds. I will happily provide exact information on the target, but I know that we are making good progress.
Baroness Merron (Lab)
My Lords, an estimated one in four hospital beds is occupied by people living with dementia. Many of the admissions would have been avoidable if they had had better community support. Of course, their stay in hospital is typically twice as long as those of other people who are over the age of 65. Does the Minister acknowledge that those dementia patients need to be discharged to a place of their own, or their carer’s, choosing, after a holistic assessment? What steps are the Government taking to ensure that this happens, so that people with dementia do not experience discharges that are inappropriate and unsafe?
Lord Markham (Con)
I thank the noble Baroness. We are all seeing different shapes and forms of describing how we need a local care system set up by the integrated care boards that can have an overview of all the needs in their area. That is exactly what we are doing, and exactly what the Patricia Hewitt review is reviewing. It will give advice on how best to do that by looking at the best needs of mental health care patients, or any other kind of patient, to make sure that the proper institutions and places are set up to give them the up-front support so that, as the noble Baroness said, they never need to go to hospital in the first place.
Plastics: Health Research
Baroness Merron Excerpts(1 year, 11 months ago)
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Lord Markham (Con)
We have set up a research fund; as I say, £100 million has been spent around plastic waste in the last few years. Again, I have spoken to the chief scientific officers on exactly this, and if there are good research proposals in this space, they are ready to look, assess and commission them if they will be valuable here.
Baroness Merron (Lab)
My Lords, air pollution is the largest environmental risk to public health. Can the Minister say what assessment has been made of the contribution to that risk by the burning of plastic in landfill?
Lord Markham (Con)
Again, my understanding from the science is that that is not a concern here. The presence of nanoparticles in the bloodstream has not caused concern to date. However, again, if there are good research proposals in this space, that is exactly what the research council was set up to look at.
Streptococcus A: Antibiotics
Baroness Merron Excerpts(2 years ago)
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Lord Markham (Con)
I thank my noble friend and will take this opportunity to offer that public health advice. A rash, which is often the first sign of a bacterial infection in this case, or a child being floppy, drowsy or dehydrated are all key signs that they should urgently seek medical help. People can call 111 or 999 and be guided through the triaging process to make sure that they get help quickly. At the same time, medics have been told to lower the barrier for prescribing, so to speak, so that they can make sure that people get it early. Although every death is a tragedy, we are clearly now seeing some reduction in the death rate, which is welcome.
Baroness Merron (Lab)
My Lords, while many pharmacies are being forced to sell the antibiotics they can get their hands on at a considerable loss, as wholesale prices soar, the Government have been saying that no company should be using this as an opportunity to exploit the NHS. Can the Minister assure the House that the Government have learned from previous mistakes with procurement and are taking measures to ensure that no company profits unduly from the increased demand for medication?
Lord Markham (Con)
As I mentioned, no one wants to see profiteering in these sorts of situations. The absolute focus right now is on expanding supply, because that is clearly the first thing you need to do. But you then absolutely need to learn lessons and see that appropriate action is taken against companies doing that.
NHS and Social Care Workers
Baroness Merron Excerpts(2 years ago)
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Baroness Merron (Lab)
My Lords, it is a pleasure, as always, to follow the noble Lord, Lord Bird, who speaks as he finds. I congratulate the noble Lord, Lord Allan, on bringing this important debate to your Lordships’ House at such a crucial time. Just this week, the Institute for Fiscal Studies published a report that found that, even though the NHS has more staff on the payroll today than it did in 2019—something I am sure the Minister will want to remind us about—it is, however, treating fewer patients and backlogs are at a record high. I hope the Minister will offer some explanations as to why this is so when he comes to speak.
We know there is a recruitment and retention crisis across the NHS and social care sector, and on the day, as noble Lords have referred to, that nurses are taking unprecedented industrial action, it is worth reflecting on Health Foundation estimates that have found that, at the current rate of exodus from the workforce, by 2030-31 there will be a shortfall of 140,600 full-time nurses. On the point of nurses’ pay, which has been raised today by noble Lords including my noble friend Lord Davies, I raise with the Minister his reply TO a question I put yesterday, when he said:
“we have always followed the recommendations of the independent pay review body, as Governments of all colours have done since 1984.”—[Official Report, 14/12/22; col. 664.]
Will he review this assertion and come back to the House? To raise just one example, Chancellor George Osborne took the decision to override the public review body’s recommendation and put a freeze on all public sector pay. I look forward to hearing from the Minister on this point.
More broadly, with health and care staff well-being at an all-time low, and bearing in mind that the NHS lost more than 500,000 days to poor mental health in August alone, and the comments of the noble Lord, Lord Bird, about the importance of the prevention of ill health—something I very much agree with—how will the Government seek to tackle the root causes of absence due to poor mental health in our NHS and social care sector?
As the noble Lord, Lord Allan, and other noble Lords have said, for the past two years Ministers have promised us that a workforce strategy is coming. When will that actually be before us? As my noble friend Lord Davies reminded us, the Minister’s predecessor, the noble Lord, Lord Kamall, repeatedly promised, when we were discussing the Health and Care Act, that work was under way, it was all in hand and we did not need legislation to make it happen. Indeed, the Minister himself has repeatedly promised that the workforce plan will be coming soon, so perhaps we can hear some more facts. When will we know the timetable for publication and implementation? Will there be a formal consultation process? I know the Minister will understand that commissioners need to plan, and staff and patients need reassurance. So, when will this House and stakeholders see the timelines? How comprehensive will the plan be and, most importantly of all, will it be costed and fully funded? It really is time that we had some answers and some concrete dates for publication.
The two pillars of health and social care are inextricably linked. Social care is not just an add-on to NHS workforce needs, as we see from these alarming figures: there are 13,500 people who are in hospital as we speak and medically fit to leave but cannot be discharged, because of the lack of home and community support, particularly in domiciliary and care homes. We know that we have a problem before us. The backlog of social care assessments, estimated by ADASS at 500,000, means delayed assessments for people in need and their carers, and not enough funding or staffing to carry out these assessments or to ensure that the right support is available and can be provided and delivered. This means that people are taking up bed spaces and are in the wrong place, when they should be in their homes and in the community.
Worryingly, the latest NHS figures show that over 145,000 people in England have died while waiting for social care over the past five years. This is a very bad state of affairs, so can the Minister say why the £500 million promised some time ago to help support hospital discharge is being paid out only this month and next? As I and other noble Lords have repeatedly raised in this Chamber, why has there been delay when there is such an imperative for immediate action?
We know that care workers are paid poverty wages and leaving in droves; there are currently 165,000 vacancies in the social care sector. How will the Minister be encouraging people to join the sector? Will there be encouragement for existing care workers to stay when they face a lack of decent standards, fair pay and proper training?
On the matter of social care, I take this opportunity to commend the excellent report from your Lordships’ special Adult Social Care Committee, so ably chaired by my noble friend Lady Andrews. I hope the Minister will read the report carefully, if he has not done so already, as we will be pressing strongly for a full debate in your Lordships’ House as urgently as possible in the new year. When will the Government’s response be ready and published?
The report warns that the continued invisibility of the adult social care sector is damaging both to people who need social care and to the unpaid carers who provide care at a time of increasing need, rising costs and a shrinking workforce. There is also the failure of improved carer support and payment for vital care workers. If only all these absences could be put right, they could be the key to getting the extra staffing in place that is so desperately needed.
I want to ask the Minister about another authoritative report, which was actually commissioned by the Government. It is an academic research paper from the independent think tank the King’s Fund on tackling the NHS’s 7 million—the number who are waiting for care. This is a devasting report, warning that a “decade of neglect” by successive Conservative Administrations has weakened the NHS to the point that it will not be able to tackle the backlog. The King’s Fund reports that years of denying funding to the health service and the failure to address its growing workforce crisis has left it with too few staff, too little equipment and too many outdated and poorly maintained buildings to perform the amount of work that is needed. How do the Government respond to the findings of the very report that they commissioned?
Finally, just yesterday, 33 months after the World Health Organization declared Covid-19 to be a pandemic, the Guardian newspaper spent 33 hours inside the NHS, reporting from inside a hospital, an ambulance service, a pharmacy and a GP surgery. When responding to what turned out to be yet another exposé of how bad 33 hours on the front line of the NHS can be, the Royal College of Emergency Medicine’s president said that the single biggest issue exposed
“was the struggle to discharge medically fit patients”.
When we hear this from the lead emergency medicine doctor in the country—a cry for urgent action to bring reinforcements to the creaking health and care workforce—how will the Minister respond to that call?
NHS Industrial Action: Government Preparations
Baroness Merron Excerpts(2 years ago)
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Baroness Merron (Lab)
My Lords, the Royal College of Nursing and UNISON have said that they are prepared to call off strikes if the Government will negotiate with them seriously regarding pay. So the key question to the Minister is whether his Government will confirm whether they are prepared to do this in order to avoid disruption to patients in the NHS. As today’s devastating King’s Fund report on the state of the NHS, which was commissioned by the Government, so clearly shows, these strikes are not just about pay. Can the Minister give his view on the wider factors that have led to the strikes and give some commentary as to why the Government have not taken preventive action?
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Markham) (Con)
I thank the noble Baroness. On the other actions, so to speak, we have already met a couple of times with the union and are very happy to meet to talk about other things we can do on terms and conditions. As regards the main element around pay, we are following the results of the independent pay review body, which, as the House will be aware, has been in existence since 1984. Parties from each side have taken its expert advice and followed it, and that is what the Government have done in this situation.
Food (Promotion and Placement) (England) (Amendment) Regulations 2022
Baroness Merron Excerpts(2 years ago)
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Baroness Merron
That this House regrets that the Food (Promotion and Placement) (England) (Amendment) Regulations 2022 (SI 2022/1007) do not justify the delay in banning the promotion of high fat, sugar and salt (HFSS) products; and notes the evidence from the His Majesty’s Government’s own Impact Assessment that the ban would have substantial monetised benefits.
Relevant document: 15th Report of the Secondary Legislation Scrutiny Committee (special attention drawn to the instrument)
Baroness Merron (Lab)
My Lords, the regret Motion standing in my name, and also that standing in the name of the noble Baroness, Lady Walmsley, are critical of the Government’s handling of the Food (Promotion and Placement) (England) (Amendment) Regulations 2022. These regulations introduce measures designed to limit the ability of retailers to promote the purchase of products classified as high in fat, salt and sugar; the intention of the regulations was to help address the high prevalence of obesity in this country.
It is worth reflecting that on 29 September 2022, just a day before the regulations were due to come into effect, the Government of the then Prime Minister Liz Truss introduced these regulations to facilitate a delay to the “multi-buy” components of the regulations—multi-buy promotions are the “buy one, get one free” on products high in fat, salt or sugar. This was passed via a negative procedure without debate, whilst the location-based restrictions came into effect as planned on 1 October this year. That brought into play restrictions on the placement of unhealthier food products near to supermarket checkouts at aisle ends and store entrances.
The motivation, if I can put it that way, for this regret Motion is that the House of Lords Secondary Legislation Scrutiny Committee strongly criticised the Government’s handling of this issue, particularly with regard to the Government’s justification for the delay, and the lack of parliamentary scrutiny for the amendment. It is the report of the committee that has formed the basis for these regret Motions, and I certainly do agree with the observations that the committee made.
Let me summarise for the purposes of your Lordships’ House the concerns encapsulated in this regret Motion. First, the Government have not brought forward sufficient evidence to justify their decision. Their stated rationale for the delay was the “global economic situation”. I suggest to the Minister that this is a somewhat cursory comment; one sentence is not enough. It is quite unclear what the Government feel the “unprecedented global economic situation” is. Are we referring to the post-pandemic situation, the war in Ukraine, high gas prices or something else? In other words, this is hardly a full description that one might expect. The Secondary Legislation Scrutiny Committee concluded that there was insufficient
“justification for delaying the start of a measure intended, over time, to accumulate public health benefits including significant savings to the NHS.”
The Government’s decision to take this still further goes directly against their own impact assessment for these policies, which states:
“Although price promotions appear to be mechanisms to help consumers save money, data shows that they increase consumer spending by encouraging people to buy more than they intended to buy in the first place.”
The impact assessment further states that
“the monetised benefits greatly outweigh the costs on a ratio of around 14:1”.
The Secondary Legislation Scrutiny Committee then outlined a number of procedural criticisms of the Government, the most significant of which include that appropriate parliamentary time was not given for scrutiny of the legislation. After all, as I have already mentioned, the statutory instrument was introduced just one day before the regulations were due to come into effect, without the standard 21-day period normally expected to allow for scrutiny by Parliament through the negative secondary legislative procedure. Of course, the statutory instrument was also laid without a full analysis of the public consultation being published, making it impossible to assess the views of the sectors affected by this decision.
There are a few questions arising from this that I invite the Minister to address when he replies. Why were the Government not able to bring forward sufficient evidence to justify their decision? Why do their claims about the impact of this policy on the cost of living contradict their own evidence presented in the impact assessment? Could the Minister say whether the consultation responses will be published, even at this stage?
I also seek reassurance from the Minister that similar procedural issues will not arise with future legislation. I make this point in particular reference to the fact that the Government will be bringing forward secondary legislation to delay the upcoming restrictions on the advertising of products high in fat, sugar and salt on TV and online, before they are due to come into effect on 1 January. I hope that we will not see a repeat of the failure to provide the requisite amount of time to allow for parliamentary scrutiny of legislation when we come to that statutory instrument. There should not be an attempt to bypass Parliament by not giving it the opportunity to discuss and examine the regulations.
This debate would not have been needed had the Government explained everything clearly in their Explanatory Memorandum, and had they allowed Parliament the opportunity to scrutinise, as is normally required. I say to the Minister that the Explanatory Memorandum is important. It is not just about how parliamentarians understand regulations; it is also about the public, industry and third-sector stakeholders. We all look to understand regulations by these means. I hope the Minister will take that point away and emphasise to the department the importance of providing the right supporting materials for often complex—and sometimes highly challenging—government policies. With that, I beg to move.
Baroness Walmsley (LD)
My Lords, my regret Motion regrets these delay regulations because they damage public health and are against the Government’s previously stated policy. When the legislation for the ban, which these regulations delay, went through your Lordships’ House in the Health and Care Act 2022, it was supported enthusiastically from these Benches. We are keen on measures to prevent ill health, save patients distress and save the NHS money, and the evidence provided by the Government in the impact statement at the time was compelling.
However, during Report, the Government introduced an amendment to allow them to delay the implementation of this measure and others in the Bill. I distinctly recall being extremely sceptical and rather suspicious about this, because of the robust opposition to these and other measures from some Members on the Government’s own Back Benches and certain lobby groups. I felt that the Government were trying to keep their troops happy and ditch the measures by stealth.
In response to my concerns, I clearly remember the noble Baroness, Lady Penn, who was leading on this amendment for the Government, assuring me that the delay power was needed only in case of a very short delay being necessary as a result of consultations on implementation. I was not convinced then and I am not convinced now. I believe that the delay power was put into the Act at the behest of lobbyists who have their own interests at heart, rather than the health of the nation, in order to allow the measures to be kicked down the road indefinitely and quietly buried.
Last week, the Government announced £20 million of funding for research to develop new medicines and digital tools to help people shed 20% of their weight. Although this will be welcome to those living with obesity, it is closing the door after the horse has bolted. In addition to spending all this money on helping people lose weight, why not promptly implement some of the measures already in legislation to help prevent obesity in the first place? By its own figures, obesity costs the NHS £6 billion annually, and this is set to rise to over £9.7 billion each year by 2050 unless effective preventive measures are taken.
As the noble Baroness, Lady Merron, said, in its 15th report, the Secondary Legislation Scrutiny Committee criticised the Government robustly on this regulation. It reminded the House that, in the impact assessment to the original instrument setting up the ban, the Government said that
“the monetised benefits greatly outweigh the costs on a ratio of around 14:1”.
That is pretty good value. Of course, the costs would have been borne by the manufacturers, retailers and advertisers of these unhealthy foods, and the benefits would have been felt by patients and the NHS, but clearly that did not suit those who lobbied the Government to introduce this delay.
What is the Government’s justification for it? The unprecedented global economic situation. What I would like to ask the Minister to explain to the House is this: whose pocket do they think they are saving by delaying the ban on this kind of price promotion? Is it that of the shoppers who are trying their hardest to put food on the table after they have paid the vast increases in their energy bills and mortgages thanks to the Government’s economic mismanagement? Or is it that of the large, profitable organisations that make, sell and advertise these foods? I am not convinced that the global economic situation is going to cause these companies to go bust, but I am convinced that continuing to allow this kind of promotion will do harm to the average shopper. Why do I say that? For the very simple reason that the Government themselves, in their own impact statement, said:
“Although price promotions appear to be mechanisms to help consumers save money, data shows that they increase consumer spending by encouraging people to buy more than they intended to buy”.
So now we know: the big manufacturers, retailers and advertisers of unhealthy foods have won, and the patients and shoppers have lost.
Baroness Merron (Lab)
My Lords, I thank the Minister for his response. I particularly appreciate his acknowledgement of the criticism that the Secondary Legislation Scrutiny Committee made about process. I am sure that all of us in your Lordships’ House will very much welcome his assurance—I do not wish to put words into his mouth—that we will not see a repeat of that on his watch. That is very reassuring.
However, it is interesting that the Minister referred to this as just delay to take some time to adjust. I am not sure who we are referring to on taking the time to adjust, particularly in view of the fact that the Minister has informed your Lordships’ House that some supermarkets have already come forward to implement these measures. They clearly did not need time to adjust. I remain somewhat mystified by the logic put forward today, particularly as the points made by noble Lords very much echoed those raised in the passage of the Health and Care Act and have been repeated many times in this Chamber—we have great concerns about the failure to take action that we know will make a change because the Government’s own documentation says that it will.
I welcome the Minister’s concern that the processes were not followed. I very much hope that we will not have to repeat such a regret Motion. However, I have to part company on what I felt was a response that said that it is all in hand and this is merely a delay for a time to adjust—although we do not even know for whom. It is regrettable that we are in this position. However, on the basis that we are there, I beg leave to withdraw.