Children in Care: CAMHS Waiting Times

Baroness Merron Excerpts

Monday 5th December 2022 Lords Chamber

[Lord Markham (Con)]

I do not know what contribution it is making to waiting lists. However, I do know that the long-awaited workforce plan—which noble Lords opposite have quite rightly asked me about many times, and I am very glad to say we are now producing it—will include these types of people as well, because they are clearly a very important component of the workforce that we need.

[Baroness Merron (Lab)]

My Lords, care-experienced children and young people are disproportionately affected not only by mental ill-health but by barriers to getting support. Bearing in mind that this group of young people often experience multiple placement moves, which are often far away from home, can the Minister say what work is going on to ensure that services are designed around this specific requirement?

[Lord Markham (Con)]

I thank the noble Baroness. As noble Lords are aware, we think that in-patient care should happen only in the most extreme and serious cases. It is much better to have care in the community and local support around that. That is very much where we are coming from. The response to the independent review of children’s social care, which the DfE is leading, will be published in the new year, and I would be happy to update the noble Baroness when we have those findings.

Invasive Group A Streptococcus and Scarlet Fever

Baroness Merron Excerpts

Monday 5th December 2022 Lords Chamber

[Lord Markham (Con)]

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

[Baroness Merron (Lab)]

My Lords, the Minister and noble Lords will know that parents across the country are deeply worried by this situation. To pick up the point that the Minister has just made about the 111 service, perhaps he can respond to the concerns that have been raised by some medical experts that the NHS’s 111 service is not fit for purpose in effectively identifying and triaging critically ill children.

[Lord Markham (Con)]

All I can say on that is that, clearly, that is not acceptable and we need a situation where it can, and that is why we should have inspectors. If we are using 111 as a backbone service, as we are in this case, it is vital that people are getting proper advice. By the way, I see a lot of that, and it is something that I am personally involved in now, as well as using it digitally—a lot of these things can be done through the use of the apps and so on—but, clearly, we need to make sure the advice people get is sound.

Health Promotion Bill [HL]

Baroness Merron Excerpts

2nd reading
Friday 2nd December 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, it is a pleasure to follow the noble Lord, Lord Storey, particularly his closing remark. I also congratulate the noble Lord, Lord Addington, on bringing the Bill before the House today. I believe it seeks what many in the Chamber have said repeatedly—not just today but on many occasions—from a whole range of experiences, and always with the same focus: having a co-ordinated approach to improving our health as individuals, as communities and across the nation.

The noble Lord, Lord Lansley, talked about the need for a cross-cutting priority across government. We have heard about that many times, and it is right to remind us again today that it is what is needed. I know that is what the noble Lord, Lord Addington, is seeking to achieve. Similarly, the noble Lord, Lord Crisp, talked about the need to create good health and environments, and I am sure we are all aligned on that.

I was interested to read in the Library briefing, for which I was most grateful, that when the body we are discussing and referring to in the Bill was initially announced by the Government in March 2021, it was due to be called the office for health promotion. I know that the noble Lord, Lord Addington, is suggesting that we should return to that. I realise that this is before the Minister’s time, but it might be of assistance to your Lordships’ House if he could give us any information today as to why it migrated to a different title.

The noble Earl, Lord Devon, the noble Lord, Lord Hayward, and other noble Lords spoke about the report of the House of Lords National Plan for Sport and Recreation Committee, which was a very welcome contribution. However, it is one thing to make that contribution and another to see action; I think that has been emphasised today. That committee called for the development of a long-term, cross-government national plan for sport, health and well-being, and this debate has been calling for exactly that. The committee also heard evidence that cross-departmental co-ordination is not working, delivery is fragmented and access to funding is complicated and overbureaucratic. Could the Minister indicate what will be taken from the report that has already been done and how progress will be made in all those areas?

There seems to have been a backward move over the past number of years, not least as we see plans being scrapped or pulled back. I refer in particular to targets on obesity, which are not being met; the promotion of less healthy foods, which is now to be allowed to continue for longer than originally anticipated; the Government being seven years behind their target of a smoke-free 2030; and, as we have heard many times, the fact that we still await—I assume it is no longer going to appear—the health disparities White Paper. In all these areas, we need to see more action, but we are seeing a backward trend. Perhaps the Minister could give us some heart in this respect.

We also know that there have been considerable cuts in the public health budget, smoking cessation services having been particularly hit. There are at least two figures circulating about the size of the smoking cessation cut, but none of them is less than one-third. Why have there been cuts in the public health budget and why have they particularly hit smoking cessation services? Can he also confirm his understanding of the amount being cut and what we can look forward to in the future?

A number of noble Lords referred to the World Cup inspiring us at present and bringing us together as a nation. That is true, and we also very much saw that with the Lionesses. While the Minister should take seriously the urgings from noble Lords who have spoken today to give sport the attention it deserves, it is crucial, as many have said, that we broaden this to thinking and talking about recreation and, in particular, physical activity. The noble Baroness, Lady Randerson, made particular reference to women and girls, who may be less inclined to be involved in organised sport but nevertheless need to be supported, encouraged and enabled to take part in physical activity.

I pay tribute to the noble Lord, Lord Addington, for his tireless campaigning and look forward to the Minister’s response.

NHS Dental Contract

Baroness Merron Excerpts

Thursday 1st December 2022 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend. We need a 360-degree approach. It is not just about dentists on the ground, although we agree that we need more in the NHS; it is also about healthy eating, water fluoridation, and oral health workers in the family hubs, for which a £300 million budget has just been announced. I agree that we need to take all those actions.

[Baroness Merron (Lab)]

My Lords, following much pressure, including in your Lordships’ House, the Government have promised for next year independently verified workforce forecasts for the number of doctors, nurses and other professionals. Can the Minister confirm that the space to which he has repeatedly referred in this Question will include dentists? If so, can he commit to an assessment within this of the impact of the NHS dental contract on recruitment and retention?

[Lord Markham (Con)]

My understanding is that the staff plan will include dentists, but I will confirm that in writing. I absolutely accept that the contract changes must attract people into the profession. For the dental deserts, we need to encourage, for example, a dentist who has been in practice for eight years to set up a new practice. They are used to being a dentist, but they are not used to raising the money to set up a new clinic in a new area, which is what they need to do. Clearly, that is the sort of support we need if are to tackle the dental desert issue. I am under no illusions as to what needs to be done, and we are working on it.

Food and Feed (Miscellaneous Amendments) Regulations 2022

Baroness Merron Excerpts

Tuesday 29th November 2022 Lords Chamber

[Baroness Bakewell of Hardington Mandeville (LD)]

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

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

Further on in the Explanatory Memorandum, there is reference to

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

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

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

“additives for use in animal nutrition”,

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

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

However, the definition of “substance” is:

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

or “

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

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

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

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


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

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

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

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

[Baroness Merron (Lab)]

My Lords, I thank the Minister for introducing the regulations and the thinking behind them. I accept the assurances that he has given. We on these Benches welcome the regulations, which are about trying to correct the drafting errors and inconsistencies that have inevitably emerged. I say that with no criticism; this is a complex area, and there is a need to tidy up regulations following exit from the European Union.

It is perhaps timely to take this opportunity to praise the work of the Food Standards Agency, and to note that it is one of the strange things about the changes introduced by the Government that Health Ministers now find themselves talking about animal feed. I am sure the Minister is delighted to do so, and I myself have certainly learned a lot today in preparation.

I turn to the regulations. The instrument generally maintains existing regulations and does not introduce new requirements, exactly as the Minister has said. I note that no concerns were raised by the Joint Committee on Statutory Instruments or the Secondary Legislation Scrutiny Committee, so I am sure that is cause for celebration on the Government Benches.

We in this country have a good food safety system, and this SI, as others may do, simply tries to ensure that that continues. The problem is of course that the world did not stop when it came to the implementation period completion day. As paragraph 7.13 of the Explanatory Memorandum tactfully puts it, “certain difficulties” emerge,

“especially in relation to the approval of new, or amendment of currently authorised, substances.”

Could the Minister help by elaborating on the difficulties that are posed and any potential costs? What happens with regard to trade when we operate to different standards from those of our near neighbours? The SI addresses the administrative challenge but does not seek to solve the problem.

Similarly, where the review process is described in paragraph 7.15, it would be helpful if the Minister could clarify the circumstances in which the Food Standards Agency will be required to review the operation and effect of the regulations. If, for example, a new extraction solvent is approved in the EU, does that automatically trigger a review? Will the Food Standards Agency be required to undertake additional processes to deliver on that? If so, has an assessment been done of whether the FSA has the capacity to undertake such duties, or can the Minister advise whether the FSA will be getting additional resources?

There is the issue of the “Do Not Eat” pictograph, which is referenced in paragraph 7.22. This states that we cannot use it because of “uncertainty” over the intellectual property rights applying to the ownership of the picture, which seems a bit strange because there must be similar cases of artwork where such provenance is uncertain. Was it asked whether we could use it, and was any uncertainty flagged up at the time? How much would a licence have cost? It is probably right to say that it seems a strange way to proceed if we cannot agree on joint use of an existing symbol to promote food safety. That suggests some problems on which the Minister may wish to comment.

I want also to reference the need to reinstate powers to extend the transitional period for the trace presence of withdrawn genetically modified organisms. There is considerable interest in genetic modification, as we know, and some concern that rules on imported products are inconsistent with rules governing domestic production. Can the Minister say a little about the scale of the issue? For example, just how much oilseed rape is there with traces of the withdrawn GM products referenced in this case?

If the Minister is not able to answer the detail of the points that I have raised, I will be pleased to hear from him in writing. We from these Benches certainly welcome the statutory instrument, and thank him and his team for their efforts.

[Lord Markham (Con)]

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

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

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

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

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

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

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

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

Tobacco Control Plan

Baroness Merron Excerpts

Wednesday 23rd November 2022 Lords Chamber

[Lord Markham (Con)]

I am not aware of those figures, but the general feeling is that the savings to the health system would far outweigh them. I would always err in favour of doing everything we can to reduce smoking, whatever the impact on the tax we raise, because the savings on the health side are far, far greater.

[Baroness Merron (Lab)]

My Lords, despite the Government pledging to explore additional measures to clamp down on the sale of e-cigarettes to under-18s, no plan has yet materialised, while vaping among 11 to 18 year-olds has more than doubled. What assessment have the Government made of this alarming trend, and what action is being considered to keep children and young people away from this gateway to a smoking habit?

[Lord Markham (Con)]

This is a difficult area. On the one hand, I think we all agree that vaping is much better than smoking, so we are trying to get the message out to people to stop smoking and use vaping if need be. At the same time, we do not want vaping to be a gateway, as she says. Giving those mixed messages is never an easy thing to do, which is why we must consider as part of the Khan review the best way to get that message out. The recent Cochrane review shows that vaping is as safe as all other methods of stopping smoking, such as patches, so it should be our key way of stopping smoking.

NHS Waiting Times

Baroness Merron Excerpts

Tuesday 22nd November 2022 Lords Chamber

[The Lord Speaker (Lord McFall of Alcluith)]

For the second time in a week or so, I do not notice the noble Lord in his place but I believe that the noble Baroness, Lady Merron, will kindly step in again.

[Baroness Merron (Lab)]

With the permission of my noble friend Lord Hunt of Kings Heath, and on his behalf, I beg leave to ask the Question standing in his name on the Order Paper.

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

In February 2022, we published the elective recovery plan, setting ambitious targets to recover services, backed by more than £8 billion in funding from 2022-23 to 2024-25 and supported by a £5.9 billion investment in new beds, equipment and technology. We are providing an additional £3.3 billion in 2023-24 and 2024-25 to ensure that the NHS can take rapid action to improve performance, including urgent and emergency care and getting elective performance back towards pre-pandemic levels.

[Baroness Merron (Lab)]

My Lords, last week’s report from the National Audit Office laid waste to the idea that all of the NHS’s current woes are down to the pandemic. By 2019, NHS England had not met the elective waiting time performance standard for four years, nor its full set of eight operational standards for cancer services for six years. Following the Government’s announcement last week of a review into NHS efficiency, can the Minister confirm whether the Government are still committed to their 18-week target between GP referral and consultant-led treatment, as well as their other targets around A&E waiting times, ambulance responses and cancer treatment?

[Lord Markham (Con)]

I thank the noble Baroness. With reference to past performance, that is what the spending increases were all about. They were an acceptance that we need to do more in this space, and we are doing more. The pandemic clearly brought unprecedented circumstances and that is why we have announced more funding to get on top of that in the next few years, tackling all the areas that the noble Baroness mentioned in terms of A&E wait times, GPs and all the rest.

NHS: Waiting Lists and Increased Spending

Baroness Merron Excerpts

Tuesday 22nd November 2022 Lords Chamber

[Lord Markham (Con)]

I thank my noble friend. To be honest with him, I am hoping we can act quicker than that—that is absolutely the plan. I can tell him that we know the areas where they are performing and they are on the elective recovery plan, and we know those that are not. I do not need a royal commission to tell me that. To my mind, it is about understanding what those hospitals are doing well and putting in place focused action and support to help those that are behind the plan.

[Baroness Merron (Lab)]

My Lords, on an earlier Question, I and other noble Lords asked the Minister if the Government were still committed to their target of 18-weeks between GP referral and consultant-led treatment, and their other targets for A&E waiting times, ambulance responses and cancer treatment. I offer the Minister another opportunity to say to your Lordships’ House whether this is the case.

[Lord Markham (Con)]

I thank the noble Baroness. As I am sure the House is aware from the statements of the Chancellor and the Health Secretary, in a lot of areas we are trying to make sure that we place fewer targets on the health professions and GPs and allow them to manage. At the same time, we make sure that if they are not performing, action is taken, but generally we trust them to manage. The beauty of Google is that I have been able to check the 18-week target, and it is a statutory commitment, so I can give that assurance. However, on the others, we are making sure that we look at the performance measures that really matter.

Health: Pancreatic Cancer

Baroness Merron Excerpts

Monday 21st November 2022 Lords Chamber

[Lord Markham (Con)]

This is where we see the diagnostic centres being a key area in this. We have set up 91 community diagnostic centres. In addition, in 2020 we had only 12 non-specific symptoms pathways; we are now rolling those out to 96, so that 75% of the population will be covered by March 2023, with a target of 100% by March 2024.

[Baroness Merron (Lab)]

My Lords, the UK is lagging behind comparative European nations on cancer survival rates. In the landmark How Good is the NHS? report, the UK came last on pancreatic cancer survival rates. Could the Minister give a view as to why the UK compares so unfavourably to elsewhere? How will the recent comments of the Health Secretary about changes to national targets affect waiting times and survival rates for patients with pancreatic cancer?

[Lord Markham (Con)]

We are very clear on the need for speed in cancer treatment; that is one target that will not change, because we know its importance in all this. With pancreatic cancer, we are where we were with prostate cancer about 10 or 15 years ago, and I am glad to see that we have made great strides on that with initiatives such as the Movember campaign and the action on that. Candidly, we are not where we need to be on pancreatic cancer, and we need to adopt those sorts of awareness campaigns, as well as fast action on screening, to improve our performance.

GPs: Anti-depressants and Alcohol

Baroness Merron Excerpts

Wednesday 16th November 2022 Lords Chamber

[Lord Markham (Con)]

We all agree that GPs are best placed to do this. I think the House is aware of our commitment to increase the number of GP appointments by 50 million, and we are well on course to meet that target. At the same time, we have the independent review of drugs by Dame Carol Black, which looks at mental health, drugs and drink and how they are closely related, to make sure we have the best advice. First and foremost, I totally agree that the best-placed person is a GP talking to their patient.

[Baroness Merron (Lab)]

My Lords, the Joseph Rowntree Foundation reports that the number of anti-depressant prescriptions is twice as high in the most-deprived areas compared to the least-deprived, with the differential even more marked when it comes to severe conditions. With the long-promised health inequalities White Paper now seemingly sunk without trace, where is the Government’s strategy to change the conditions that affect mental well-being in the most deprived areas?

[Lord Markham (Con)]

My Lords, as set out in the draft mental health Bill, mental health activities are very focused on where help can be given in areas of inequalities. As to the position in the White Paper, I am afraid that the answer is the same as in the previous case: I do not have any information at the moment on any date.