Physician and Anaesthetist Associate Roles: Review

Baroness Merron Excerpts

Thursday 5th December 2024 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I congratulate the noble Baroness, Lady Bennett, on securing this debate. This is an important issue, as we have heard today. I thank all noble Lords for their invaluable and varied contributions.

I shall start with the toxicity of the debate. I emphasise this Government’s support of and gratitude to all staff. That absolutely includes physician and anaesthetist associates who work hard to treat and care for patients in the NHS. As the noble Lord, Lord Kamall, said, the debate has been not just toxic but polarised. As the noble Lord, Lord Scriven, acknowledged, we have seen bullying, which is unacceptable; as the noble Lord, Lord Kamall, said, we need to look at the toxic culture as well as the toxic debate. I absolutely associate myself with the comments made by the noble Lords from their respective Front Benches. At times, not just the debate but the activity around the subject has been deeply abusive, not just in words or on social media, and has been aimed at PAs and AAs. There is no excuse for this and it will not be tolerated. They are valued team members, as is everybody who works in the National Health Service, and deserve our respect and support.

Let me assure noble Lords that this review—I am glad that it has been welcomed—will be an independent, end-to-end review. It will cover training, recruitment, day-to-day work, oversight, supervision and professional regulation. It will assess the safety of the PA and AA roles relative to existing professions, the contribution that the roles can make to more productive use of professional time in multidisciplinary teams and whether the roles deliver good-quality and efficient patient care in a range of settings. All these matters, among others that noble Lords have rightly flagged today, will be considered.

The noble Baroness, Lady Bennett, asked about resources, support and co-operation for the review. I can assure her that this review is properly resourced and, importantly, that stakeholders across the health and social care system have already indicated that they will actively support its work. I agree that this is vital to Professor Leng’s work. As the noble Lord, Lord Kamall, identified, Professor Leng is a champion for patient safety who brings a thorough understanding of healthcare in this country. She is one of the UK’s most experienced leaders in it and I am most grateful to her for her work. I will draw key points from this debate to her attention, including the matter that the right reverend Prelate and the noble Lord, Lord Scriven, raised about getting information to the public. I take that point and will draw these aspects of the debate to the attention of my ministerial colleagues and Professor Leng.

As the Secretary of State highlighted when he announced it on 20 November, the review will gather available evidence and data on the PA and AA professions. It will also engage with relevant professions, the public, employers and researchers. In response to a number of questions raised today, I am committed to ensuring that noble Lords are kept informed as the review progresses. As has been identified, it will report in spring 2025 and we will publish our findings and update your Lordships’ House on the next steps.

I will address the concerns of the noble Baroness, Lady Bennett, and other noble Lords on interim action. NHS guidance remains in place on PA and AA deployment while the review is ongoing. Furthermore, NHS England continues to engage with NHS organisations to ensure that this guidance is adhered to. On the pace of the review, we are committed to it moving quickly to provide clarity, while ensuring that it has sufficient time to consider all available evidence.

The right reverend Prelate spoke of the value of a skills mix and the need for it in providing the kind of healthcare that we need into the future. My belief is that it is recognised—the noble Lord, Lord Scriven, also spoke to this—that the mix of professions required to deliver the right kind of care has evolved continually since the birth of the NHS. As the right reverend Prelate said, on previous occasions there have been many other criticisms and concerns; it is the nature of change. However, I want to be clear that the premise behind the use of PAs and AAs as part of the multidisciplinary team is absolutely sound. To give some context, PAs and AAs have been practising in the NHS for over 20 years, as the noble Lord, Lord Scriven, said. It is not a recent development.

The numbers we are speaking about are small. I will give some context to your Lordships’ House. There are 14,000 full-time equivalent doctors in anaesthetics in England and 170 AAs in the whole of the UK. There are 146,000 full-time equivalent doctors in England and 1,600 PAs. There are 38,420 full-time equivalent GPs and 2,105 PAs. I would not want your Lordships’ House to labour under any misunderstandings.

PAs support doctors to diagnose and manage patients —“support” is the operative word. They are not and should never be used to replace doctors. Similarly, AAs are qualified to administer anaesthesia but only under the supervision of a medically qualified anaesthetist. These roles always have to work under the right supervision. Concerns have been raised by medical professionals about blurred lines of responsibility and whether, in some cases, PAs and AAs are being used to replace doctors. So I understand the need for a comprehensive view of how these roles are being deployed and how effectively. I am confident that the review will address this.

I am acutely aware of the rare but deeply tragic incidences where patients have lost their lives following treatment by an associate. I offer sincere condolences—I know other noble Lords will too—to family and friends. They deserve answers and the assurance that we are listening—and indeed we are. My noble friend Lady Keeley spoke so movingly about the cases of Emily Chesterton and Susan Pollitt, which are deeply tragic. As the noble Lord, Lord Scriven, said, it is so important not to lump every PA and AA together, just as it is not right to do that for any other group. The noble Lord, Lord Kamall, rightly observed that tragic death happens when care is provided by other health professionals. Our job is to reduce that as far as we possibly can, which is what we are working to do.

The noble Baroness, Lady Bennett, highlighted a reference to legal action and redundancies, as well as the systematic impact that uncertainty has created for employers, GP practices, NHS services and individuals. That is why this review is so vital. It enables us to take stock of the evidence, establish the facts and provide absolute clarity for patients, professionals and employers.

As the noble Baroness, Lady Bennett, acknowledged, there has been significant debate on the scope of practice, especially for PAs. The review will cover all aspects of PA and AA roles, including their deployment and scope of practice. The issue will therefore be considered as part of the review, and I will not pre-empt its outcome on this or any other aspect. Many questions were rightly asked about what happens in the meantime. NHS England’s guidance on the deployment of PAs and AAs should continue to be followed.

On the important points about patient confusion, the GMC has published interim standards for AAs and PAs in advance of regulation. That will make clear that professionals should always introduce their roles to patients and set out their responsibilities in the team. The Faculty of Physician Associates has produced guidance, which includes an example of what a good initial introduction should look like. The review will also consider the professional regulation of these roles, which, as was set out, the GMC will commence next week.

The noble Lord, Lord Kamall, and the noble Baroness, Lady Bennett, asked about the action that will be taken in advance of the review concluding. It is important to note, as the noble Lord, Lord Scriven, did, that regulation by the GMC will begin in a very short while. As the noble Baroness, Lady Bennett, set out, I am aware that concerns have been raised about the GMC as the regulatory body for the roles. But we can be assured of the benefit of statutory regulation in helping to ensure that all PAs and AAs meet the very high standards expected of—and I emphasise this—every healthcare professional. Where these standards are not met, action can be taken.

This has been a challenging period for the PA and AA workforce, and it is vital that, like all NHS staff, they are treated with respect. It is therefore incumbent on all to do this. I look forward to the review, and I wish Professor Leng well. I thank noble Lords for their valued contributions to this debate. I look forward to PAs and AAs playing their part in providing improved healthcare in this country.

Fracture Liaison Services

Baroness Merron Excerpts

Wednesday 4th December 2024 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I congratulate the noble Lord, Lord Black, on securing this important debate and pay tribute to his very effective campaigning over many years. I am always touched when he refers to his mother; personally, I always feel that his campaigning shows great respect to his mother, and I am sure that the whole House appreciates that. I also enjoyed, as I am sure the noble Lord, Lord Kamall, did, his reminder to me and the now Opposition Front Bench of what we said when we were on the other side, and we are suitably—not chastened exactly—brought to book by his comments.

I thank other noble Lords for their many insightful and accurate contributions. As I am sure noble Lords will be aware, I have much sympathy with many of the points that have been made. I know this is an issue close to many, either because of their own experience or that of those to whom they are close.

As we have heard, including from the right reverend Prelate the Bishop of London, inequalities in access to and the quality of fracture liaison services have a significant impact on so many people across the country. Over half a million people in England alone suffer a fragility fracture every year. More than 40% of those will suffer another fracture within a decade. As the noble Lord, Lord Black, so powerfully illustrated, fracture liaison services can play a vital role in reducing the risk of refracture, improving quality of life and, importantly, increasing the number of years that can be lived in good health.

Many noble Lords referred to the postcode lottery, including my noble friend Lady Quin and the noble Lord, Lord Rennard. Noble Lords spoke of the difference in access coming at a substantial cost. I agree; it is not only a cost for the NHS and social care, but there are also many personal costs of life-changing injury and increased mortality and morbidity. This cannot continue.

Today’s debate refers to the progress towards universal provision by 2030. The noble Lord, Lord Black, and other noble Lords powerfully advanced the case for moving swiftly and the potential consequences of not doing so. It was suggested that there was funding from the previous Government for the expansion of fracture liaison services. All investigations show that no funding was ever confirmed or announced, including as part of the Major Conditions Strategy. I remind your Lordships’ House that the 2030 ambition for the rollout of fracture liaison services was first announced by the previous Government on the day after the election was called. On that point, I am very grateful for the understanding of a number of noble Lords, including the noble Lord, Lord Kamall, and my noble friend Lady Quin, that these are early days for the Government, but I will attempt to be helpful.

This mission-led Government will expand access to fracture liaison services, alongside, importantly, delivering 40,000 more appointments each week and increasing diagnostic capacity to meet the demand for diagnostic services. Why? It is because fracture liaison services play a vital role in the mission to build an NHS for the future, where waiting times are reduced and more care is moved to the community, closer to where people need it. We have to be honest about the scale of the action needed, as noble Lords will know that this Government have been. I will make some points about the background and the challenges ahead. As the Chamber will understand, it will not be solvable overnight.

My right honourable friend the Secretary of State commissioned an independent investigation into the NHS as one of his first actions in government. The findings by the noble Lord, Lord Darzi, laid bare the fact that the NHS currently has the longest waiting lists, the lowest patient satisfaction and a deterioration in the nation’s underlying health, with widespread problems for people accessing services. This includes fracture liaison services.

In response, the Government announced the 10-year plan, which will be published next spring. The plan will be shaped by input from the public, patients and health and care staff through an engagement exercise—on which noble Lords heard me answer a Question from the right reverend Prelate earlier this week, who was good enough to raise it again today. The exercise was launched as:

“The biggest national conversation about the future of the NHS”.


It will include consideration of the three fundamental long-term shifts for health reform, as emphasised by my noble friend Lady Quin and the right reverend Prelate: hospital to community, analogue to digital and changing from sickness to prevention. I agree with noble Lords that fracture liaison services encapsulate all three. This is a long-term challenge and will take time to deliver, so the plan will consider what immediate actions are needed to get the NHS back on its feet and get waiting lists down, as well as long-term changes.

We are continuing our close working relationship with NHS England to tackle issues related to provision of fracture liaison services, which are a crucial prevention service. The noble Lord, Lord Black, my noble friend Lady Donaghy and the noble Baroness, Lady Bull, along with other noble Lords, suggested a number of potential solutions. We are considering a wide range of options as we seek to identify the most effective ways of improving the quality of and access to the fracture liaison service model and the interventions it provides. I look forward to continuing work with noble Lords and being able to bring more information to this House.

My noble friend Lady Ritchie referred to the role of ICBs, and this point was raised several times helpfully in the debate. As noble Lords are well aware, fracture liaison services are commissioned by ICBs and are making decisions according to local need. National expectations of ICBs and trusts for the next financial year will be set out in the 2025-26 NHS planning guidance. I know that the matter of finance has been raised a number of times, including by the right reverend Prelate.

Along with many noble Lords here, we have benefitted from continuing engagement with the Royal Osteoporosis Society and a number of partners. The noble Lord, Lord Brownlow, rightly paid tribute to the role of Her Majesty the Queen. I felt that was an extremely important recognition with which I want to associate myself. In our engagement with our stakeholders, we are looking at the best ways to support the systems that work.

The noble Lord, Lord Shinkwin, raised matters relating to those of working age. It is the case that osteoporosis and the risk of repeated fragility fractures remain significant contributors to economic inactivity. I was pleased to hear the noble Lords, Lord Black and Lord Shinkwin, recognise the significance of musculo- skeletal conditions as drivers of long-term sickness absence. It is absolutely the case that those conditions are the second leading cause of sickness absence and the leading cause of a reduction of years lived in good health and employment.

There is much joint working going on between DWP, DHSC and NHS England under the Getting It Right First Time teams to deliver a programme, working with ICBs to reduce waiting times and improve data and referral pathways. The recent Get Britain Working White Paper included an announcement of £3.5 million in funding for this year to provide a model for musculo- skeletal community services to kick-start economic growth.

The noble Baroness, Lady Bull, and the right reverend Prelate raised women’s health. The noble Lord, Lord Black, was kind enough to draw attention to my previous interest in the issue of fracture liaison services. That now chimes in very well with one of my responsibilities, as I am the Minister for women’s health. I am dismayed at how often women’s health needs are not considered when designing services, and even worse are the additional stark inequalities referred to by the right reverend Prelate. I assure your Lordships’ House that it is a priority for us to ensure that all women receive the high-quality care that they deserve.

I close by restating our commitment to expanding access to these vital fracture liaison services. The work continues, and I look forward to updating noble Lords a number of times as we make progress together.

NHS Plan: Consultation

Baroness Merron Excerpts

Monday 2nd December 2024 Lords Chamber

[The Lord Bishop of London]

To ask His Majesty’s Government what steps they are taking to ensure the consultation for the NHS 10 Year Plan reaches all communities, including those who have least interaction with the health service.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, we want to ensure that the voices and experiences of patients are at the heart of our plans to make the NHS fit for the future, especially those voices that often go unheard. We are working with charities, faith groups, health and care providers, local government and others to ensure that we hear from those that national government often fails to reach. We will monitor this closely and target underrepresented groups before the engagement exercise concludes in spring 2025.

[The Lord Bishop of London]

I thank the Minister for her reply, and I am encouraged by the Government’s consultation on the NHS 10-year plan. However, does she agree with me that, if we are to move from sickness to prevention, any engagement ICBs have with their communities has to be long term and systematic? If so, what are the Government doing to resource ICBs to make sure that their engagement with communities is long term and systematic?

[Baroness Merron (Lab)]

I agree with the right reverend Prelate. Integrated care systems, which are responsible for reflecting the needs of the community and its spending, must follow guidance, and it is important that we identify the seldom-heard groups. We have built into the consultation plans a “workshop in a box”—a toolkit to support discussion in local communities, which ICBs are rolling out. It is a good way of encouraging ICBs to talk directly to local communities.

[Baroness Coussins (CB)]

My Lords, will the consultation be published in languages other than English, with proactive efforts to encourage responses from people whose first language is not English? Secondly, will the department make sure that it consults with public service interpreters working in NHS settings?

[Baroness Merron (Lab)]

I can confirm that both the online portal and the “workshop in a box” to which I just referred will be available in easy read and British Sign Language versions, and in other languages. Attention has been given to those for whom English is not their first language; in-person events can be tailored to their needs—for example, by having smaller groups. The staff to whom the noble Baroness refers are a major group being asked to provide input; indeed, they are taking part in online workshops and can respond online.

[Baroness Pitkeathley (Lab)]

My Lords, does my noble friend the Minister agree that one of the groups that sometimes finds it difficult to interact with health service professionals is unpaid carers? Despite the huge contribution that they make, they often have their needs ignored by those providing services. Does she therefore agree that it is very important that the voice of the unpaid carer is heard in the consultation process?

[Baroness Merron (Lab)]

I agree with my noble friend: we have to hear from unpaid carers, because that will strengthen the exercise. We are constantly monitoring which groups are responding and which are not, and that allows us to tailor our approach to the underrepresented groups who are not coming forward. If that includes unpaid carers, the consultation absolutely will make special, tailored efforts to reach them.

[Lord Scriven (LD)]

My Lords, the life expectancy of people with learning disabilities is, on average, 20 years less than the general population’s. Research has shown that a major contributor to this is a lack of access to appropriate healthcare. What will the Minister do to ensure that this group of people will be not only consulted but listened to, and that the 10-year plan will provide appropriate services tailored to them?

[Baroness Merron (Lab)]

This is indeed one of the groups for whom we need to ensure absolute inclusion. As I mentioned, the work with integrated care systems will be particularly helpful in running the workshop. We train organisations to work with it, and it is designed so that it is easy to use. It can be used in events to reach the seldom-heard voices in communities, including those with learning disabilities. It is vital that we hear from them as we design an NHS fit for everybody for the future.

[Lord Turnberg (Lab)]

My Lords, one of the biggest causes of inequality is where you live in the country. If you live in the north-east or north-west, you live two, three or four years less than if you live in the south-west or south-east. Far fewer resources are available for people in those deprived areas: there are fewer doctors, nurses, physios, dentists and so on. What can the Government do to redress this gross imbalance?

[Baroness Merron (Lab)]

My noble friend allows me to say—and I hope your Lordships’ House will agree with this—that our approach will of course focus on addressing the social determinants of health. The goal will be to halve the gap in healthy life expectancy between the richest and the poorest regions. We are not just going to be moving from sickness to prevention as one of our three pillars, important though that is; we are also seeking, across government, to address the root causes of health inequalities. Again, that is being highlighted as part of the consultation.

[Lord Bailey of Paddington (Con)]

What special efforts will be made to speak to young people, who are often very far away from the health system—those leaving care, those who have just left prison and those from very poor communities? What effort will be made to hear their voices? They are often far away from the NHS because they do not need it yet, but they will in the future.

[Baroness Merron (Lab)]

I thank the noble Lord. Yesterday, I was at an in-person event in Folkestone, and as with all such events up and down the country, it had used systems to find a wide range of people, including young people, who, as he rightly says, are often unlinked with the health service. I emphasise our continued monitoring and our efforts to reach the groups he speaks of. So far, we know that men, those aged under 35, and black Asian and black British people have engaged least with Change NHS. We are now stepping up our efforts.

[Baroness Winterton of Doncaster (Lab)]

My Lords, will my noble friend the Minister look at the role that pharmacists might play in any consultation? While they may not be an obvious source of reaching out, they are embedded in communities and talk to patients and users frequently. If they could be harnessed, it would much improve the consultation.

[Baroness Merron (Lab)]

I am very grateful to all those, including pharmacists, who have used all their networks and contacts to spread the word. That is why we have had over 60,000 responses and more than 1 million visits in what is the largest ever consultation in the history of the NHS. I call on all groups to continue their efforts to ensure that voices across all communities are heard loud and clear.

[Lord Kamall (Con)]

During the vaccine programmes for Covid, the NHS and the last Government put a lot of effort into looking at ways to reach people who are vaccine hesitant—often from some black and Asian communities and other excluded communities. What lessons have been learned by the Government and the NHS to ensure that the consultation on the 10-year plan reaches as many people as possible from these communities, so that their voices are heard?

[Baroness Merron (Lab)]

The lessons that have been learned are that there has to be a whole range of ways of consulting: in person around the country; online, where people can access the website; and through toolkits such as the “workshop in a box”. As I mentioned in an earlier answer, the consultation also needs to be tailored to the needs of those who need to speak up. We are asking the public, staff and organisations what is important, and we want, as the Prime Minister said, their fingerprints all over the 10-year plan.

[Baroness Bull (CB)]

My Lords, people living with homelessness often have chronic and multiple health needs which go untreated, and they are also more vulnerable to substance misuse. Appreciating the difficulty, what are the Government doing to ensure that the needs of people living with homelessness are addressed and heard through this consultation?

[Baroness Merron (Lab)]

We have identified those who are homeless as one of the specific seldom-heard groups, and that is why we are working so closely with integrated care systems: to ensure that we reach them on their territory. The other groups include, for example, sex workers, young people, those with learning disabilities and some ethnic minorities.

Drug-related Deaths in England and Wales

Baroness Merron Excerpts

Tuesday 26th November 2024 Lords Chamber

[The Lord Bishop of Newcastle]

To ask His Majesty’s Government what assessment they have made of data published by the Office for National Statistics on 23 October indicating that the number of drug-related deaths in England and Wales was higher in 2023 than in any other year since records began in 1993, and what steps they are taking to reduce the number of such deaths.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, drug-related deaths are tragically at record highs, especially in deprived areas. We are committed to tackling this problem, including by correcting the years of disinvestment in treatment services as highlighted by Dame Carol Black in her independent review. I was glad to lay legislation that widens access to naloxone, a life-saving opioid reversal medication, and this Government will continue to work across health, policing and the wider public services to prevent drug use and address the causes of inequality, including in Newcastle.

[The Lord Bishop of Newcastle]

I thank the Minister for her Answer. The ONS data revealed that the north-east has been the English region with the highest proportion of drug-related deaths for the 11th consecutive year—three times higher than the lowest rate, in London. Can the Minister say a little more about what targeted steps His Majesty’s Government are taking to reduce drug-related deaths, particularly in the north-east?

[Baroness Merron (Lab)]

The right reverend Prelate is absolutely right to highlight the situation in the north- east. I can assure her that funding is allocated on the basis of need, and that includes the rates of drug-related deaths. I hope it was helpful that senior officials from the department recently met with the drug and alcohol service commissioners, the police and crime commissioners and the directors of public health from across the north-east to discuss synthetic drug threats. We will certainly continue to work with local areas, including the north-east, to tackle this very real issue.

[Lord Bird (CB)]

Can we accept the fact that a lot of the people who are dying are homeless, and a lot of them are the people who are on our streets? We know that drug addiction and bad health on the streets are a cocktail of death. Can we see some effort by the Government to put in place the rehab, detox and therapeutic communities that are necessary to get the demons out of the lives of people who are on the streets and in homelessness?

[Baroness Merron (Lab)]

I understand the point that the noble Lord is making. We are funding the rough sleeping drug and alcohol treatment grant, which gives targeted treatment and wraparound support services to those who sleep rough, or who are at risk of doing so, in 83 local authorities. That includes a whole range of things. In addition, we are funding the housing support grant and working across government, including with the Deputy Prime Minister, who has brought together a dedicated interministerial group to tackle the very real problem that the noble Lord describes.

[Lord Mendoza (Con)]

My Lords, the Minister mentioned synthetic opioids. We all know the terrible scourge that they have wrought in America, with something like 75,000 deaths a year from synthetic drugs such as fentanyl and nitazenes. Can the Minister assure us that we are monitoring the supply of these drugs into this country so that we are spared the terrible scourge and loss of life among young people that has been experienced in America?

[Baroness Merron (Lab)]

I understand what the noble Lord is saying. Synthetic opioids, as he will know, are certainly more potent, and indeed can be more deadly, than other forms of drugs. We are working with other government departments to enhance the surveillance to which he refers and to improve early warning in response to the threat of synthetic opioids, and we will continue that work.

[Baroness Pinnock (LD)]

My Lords, many charities that support those with drug addiction are raising concerns about the increased costs that they will have to fund as a result of the increases in national insurance charges. What assessment have the Government made of the impact on those critical services being able to support those with drug addictions?

[Baroness Merron (Lab)]

The noble Baroness will have heard me say before that we had to take some tough decisions at the Budget to fix the foundations in the public finances, and that enabled a settlement for the Department of Health and Social Care of some £22.6 billion. As she knows, the employer national insurance rise will be implemented in April 2025, and in due course the department will set out further details of the allocation of the funding I referred to for next year.

[Lord Kamall (Con)]

My Lords, I know this Government take drug-related deaths seriously, as did the previous Conservative Government when we awarded 12 projects a share of a £5 million fund to reduce rates of fatal drug overdoses, adopting a similar approach to that of the Vaccine Taskforce to tackle health challenges. Has there been any evaluation of how successful those projects were? What plans are there to continue or expand them?

[Baroness Merron (Lab)]

Our continuing work in this area is part of the Office for Life Sciences programme. This Government continue to fund research into wearable technology, virtual reality and artificial intelligence, all in a bid to support people with drug addictions. Since coming into office, we have awarded £12 million to projects across the UK that are showing innovation in respect of technology, because we want to support people with addictions.

[Baroness Meacher (CB)]

My Lords, what steps are the Government taking to support vulnerable children in schools who, without support, are likely to become addicted to drugs, in order to ensure that they reduce the numbers of drug deaths?

[Baroness Merron (Lab)]

I assure the noble Baroness that education on drug use is an essential part of harm reduction and prevention. It is a statutory component of relationship, sex and health education.

[Baroness Blackwood of North Oxford (Con)]

My Lords, the two-year review of the LGA’s 10-year drugs plan has made a number of recommendations to improve the response. On the question of synthetic drugs, it recommended the implementation of early-warning systems so that changes at street level can be responded to in real time and samples of new substances can be tested as soon as possible. Can the Minister please look into those recommendations and see what support can be provided by the Government?

[Baroness Merron (Lab)]

I will indeed be doing that, not least because our work with other departments continues to take account of the early warning to which the noble Baroness refers. That is in respect of the threat of synthetic opioids, which we know is extremely real and pressing.

[Lord Foulkes of Cumnock (Lab Co-op)]

The right reverend Prelate the Bishop of Newcastle is absolutely right: there is a direct relationship between poverty and drugs deaths, which is why it is vital that we increase our resources for fighting poverty and why we need to raise taxes on wealthy landowners such as James Dyson and Jeremy Clarkson.

[Baroness Merron (Lab)]

As always, I pay close attention to the contributions of my noble friend, who makes helpful observations. We do indeed need to continue our work in this area. It is quite important to look back at the history that Dame Carol Black reported on. She talked about one of the difficulties being that funding for community drug and alcohol services was subsumed into the public health grant in 2013, which meant that by 2019-20 funding for those services had been reduced by over a third. That is a £212 million disinvestment. The result of all this is that drug use has increased, with all the major indicators of its harm. This is something we need to turn around.

[Lord Patel of Bradford (Non-Afl)]

My Lords, I echo what the Minister has just said. The last Labour Administration set up the National Treatment Agency for Substance Misuse and ring-fenced £800 million to provide treatment when drug users needed it. It reduced drug-related crime, drug use plateaued, and drug-related deaths were at an all-time low. Sadly, this funding was pulled suddenly, which resulted in the highest level of drug-related deaths ever, with drug use on the increase and drug-related crime going up. Can we go back to some of the sensible ideas we had about providing treatment for drug users?

[Baroness Merron (Lab)]

My ministerial colleague Andrew Gwynne will be looking at how we improve drug and alcohol addiction services. In the light of recent Office for National Statistics data, the Office for Health Improvement and Disparities has an action plan to reduce drug and alcohol-related deaths. Because of this recent data showing major increases, it will review the plan to make sure it is properly grounded and effective.

Mental Health Bill [HL]

Baroness Merron Excerpts

2nd reading
Monday 25th November 2024 Lords Chamber

Moved by

[Baroness Merron]

That the Bill be now read a second time.

Relevant document: Report of the Joint Committee on the Draft Mental Health Bill, Session 2022-23. Welsh legislative consent sought.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, it is an honour to move the Second Reading of the Mental Health Bill—a Bill which Members of both Houses have been waiting for and working on for some considerable time.

There is much consensus that our mental health laws are not fit for the 21st century. Many elements of the Mental Health Act 1983 are outdated. Its operation is associated with racial disparities and poor care for people with a learning disability and autistic people, and it fails to give patients an adequate voice. Modernising the Mental Health Act is a vital manifesto commitment for this Government, so I am proud to introduce reforms that will ensure that care is appropriate, compassionate and effective; give patients more say over their care; improve support to help patients understand and exercise their rights; and protect the safety of the public, staff and patients.

The wait has been too long. I know that a number of noble Lords were involved when the Act was last amended substantially in 2007, but, although attitudes to mental health have, thankfully, changed since then, the law has not kept up. The Bill is the product of the combined effort over some years by Members of both Houses and many outside Parliament, and all parties have rightly come together to support it. Sincere thanks are due to many, but I will highlight just a few, starting with Members of your Lordships’ House who served on the pre-legislative scrutiny committee in 2022: the noble Baroness, Lady Buscombe, as chair, as well as the noble Baronesses, Lady Barker, Lady Berridge, Lady Hollins and Lady McIntosh of Hudnall, and the noble Lord, Lord Bradley. All have given a huge amount of time, expertise and energy, which has informed and motivated this Government to strengthen the Bill. I confirm that we have improved the previous draft Bill by heeding the committee’s recommendations to include guiding principles and advance choice documents in this revised Bill.

I pay tribute to the former Prime Minister, the noble Baroness, Lady May, whom I had the pleasure of meeting earlier today with the Secretary of State. The noble Baroness, Lady May, identified the need for modernisation and set up the independent review of the Act in 2017. Without this, we would not be here today. I thank the independent review chair, Sir Simon Wessely, and his vice-chairs, including the noble Baroness, Lady Neuberger, who made the case for change and provided the blueprint to follow. I know they will continue to be champions for reform. I also thank the many stakeholders and parliamentarians who have engaged with us ahead of Second Reading and over the years, and those with lived experience, who have bravely told their stories.

The Bill will complement other major reforms that this Government have announced. The Budget announced £26 million to be invested in new mental health crisis centres to reduce pressure on accident and emergency departments. To cut mental health waiting lists, we will go further still, recruiting an additional 8,500 staff. As part of our mission to reduce the number of lives lost to suicide, these NHS workers will be specially trained to support people at risk. We will improve support for young people, with walk-in hubs in every community, making support workers more accessible to children, and a specialist mental health professional based in every school. The NHS has asked every provider of mental health services to review its offer for serious mental illness. By focusing on early intervention—prevention is the key—we seek to prevent people reaching crisis and to reduce the need for detentions in the first place.

I turn to what the Bill seeks to achieve. The Mental Health Act is there to protect people. Its core purpose is, and will remain, to be able to intervene, detain and treat when someone is so unwell that they present a risk to themselves or others. The overall aims of these reforms are to improve the care and treatment of people with severe mental illnesses when detained under the Act, to improve patient outcomes and recovery, and to protect the public, patients and staff. The existing Act confers certain rights on people who are detained, including the right to appeal their detention at a tribunal and a right to an advocate as well as to a medical second opinion in certain circumstances. The Bill seeks to strengthen and expand these rights. It will require the inclusion in the statutory code of practice of the new and revised guiding principles recommended by the independent review, which in turn informs professional practice around the Act. By doing this, we aim to improve things for patients and support a change in culture.

We are strengthening and clarifying the detention criteria to make clear that people will be detained only if they pose a risk of serious harm to themselves and/or others, and if there is a reasonable prospect that they will benefit from the proposed treatment. We are reforming the use of community treatment orders—CTOs—to reflect the revised criteria, to increase oversight and scrutiny of decision-making, and to improve the transfer of patients under a CTO from hospital to community services. We are also introducing statutory care and treatment plans for patients detained under the Act, except when under very short-term sections, to provide a clear plan for a patient’s recovery and a path to discharge.

Where the patient’s voice has previously been unheard, the Bill will place them at the centre of their care and treatment. We are introducing a new clinical checklist requiring clinicians to, as far as possible, involve patients in decisions about their care and to take their feelings and wishes into account.

We are making sure that patients know they can create an advance choice document and that appropriate support is available to help them do so, allowing those at risk of detention under the Act to outline their wishes and decisions while they are well. This document helps them retain control over decisions about their admission, care and treatment if they later become too unwell to communicate these preferences. Last week I saw and heard about the differences that these can make on my visit to the South London and Maudsley, where the words of welcome from service users about these measures highlighted the contribution that advance choice documents can make, particularly to tackle racial inequalities.

We are allowing patients to choose a nominated person to look out for them and their interests when detained and will be increasing their powers. The independent mental health advocacy service was a notable success of the 2007 reforms to the Act. It is a thriving sector, with advocates and volunteers working for excellent organisations such as VoiceAbility, making sure that people are involved with decisions about their care.

We are now looking to expand these services in two ways. First, we are making sure that patients who come into hospital voluntarily can access an advocate to help them understand their rights and be involved in decisions about their care. Secondly, for detained patients, access to advocacy will be on an opt-out basis, ensuring that patients are proactively offered this support when detained to improve advocacy uptake among detained patients.

I know only too well that noble Lords are acutely aware that for some people with a learning disability and autistic people, detention is both non-therapeutic and unnecessarily long. In order to better meet people’s needs in the community, we will limit detention so that people with a learning disability and autistic people can no longer be detained beyond 28 days, unless they have a co-occurring mental health condition that requires hospital treatment. This will affect only civil patients. Hospital will remain an option for those in contact with the criminal justice system, where the only alternative to detention in hospital is prison.

For people with a learning disability and autistic people, the right measures and support are very much needed alongside this change. That is why the Act will require that when people are detained, there is a care (education) and treatment review to be given due weight in decision-making. We are also creating new duties on commissioners to hold registers to help manage the risk of people going into crisis and being detained, and to better meet the needs of people through appropriate community services.

I am grateful for the work of the Ministry of Justice Minister, my noble friend Lord Timpson, and his department, to improve access to mental health care and treatment for people in the criminal justice system. The Bill will end the use of both prison and police cells as places of safety. It will end the use of remand for own protection under the Bail Act where the court’s sole concern is the defendant’s mental health.

We will introduce a statutory 28-day time limit for transfers from prison and other places of detention to hospital when a person requires treatment for their mental health under the Act. We will also introduce a subset of conditional discharge, called supervised discharge, to support the small number of restricted patients who are no longer benefiting from being in hospital.

We are aware that there have been concerns about public safety and are therefore ensuring that our reforms do not weaken the ability to detain people who could pose a risk of serious harm to themselves or others. I assure your Lordships’ House that these reforms do not change the core function of the Mental Health Act. Clinicians will remain able to intervene, to detain, and to treat whenever someone with severe mental illness presents a risk to themselves or others.

We are confident that this is the right package of reforms. However, the Bill further strengthens the measures in respect of public protection. The Bill improves on the previous draft Bill by: first, accepting the Joint Committee’s recommendation to remove “how soon” from the new detention criteria, making sure the Act cannot be misinterpreted to mean that a harm must be imminent to justify detention and early intervention; secondly, introducing a new requirement for the responsible clinician to consult another person when they are making a decision about whether to discharge a patient; and thirdly, strengthening the code of practice’s guidance on discharging patients and promoting the need for discharge planning tailored to the individual needs of patients and their circumstances. We will consult on changes to the code.

I am very grateful to noble Lords across the House for their ongoing support for and interest in the Bill. It has been a long time coming, and I know that we all want to get this on the statute book, which is why it is a priority piece of legislation for this Government. There has been a failure to reform, but today we begin to change that. I look forward to what I know will be a collegiate and constructive debate, which many will follow—inside both Houses and outside. I beg to move.

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, I put on record my gratitude to all Members of your Lordships’ House for contributing to what was widely agreed, I am sure, to have been an excellent debate—excellent not just because of the level of engagement but because of the detail. I really feel that spirit of wanting to improve the legislation and the support for the Bill thus far. I will endeavour to respond to as many themes as possible; I am very grateful to the noble Lord, Lord Kamall, for his sympathy, which I accept, but I regard that as a good thing. I regard it as admirable that I will not be able to answer all the questions, because that is the purpose of being here. It sets us up for Committee. It is obviously going to be a very rich Committee, and I very much look forward to it.

I hope noble Lords will understand that I look forward to following up on the many points that I will not get a chance to address in the time I have and doing a proper review of the debate today, picking up points as needed. I pay tribute to the dedication and the detailed attention to the Bill that noble Lords have already given. I am very glad to see my right honourable friend the Secretary of State gazing on. The reason I say that now is that the Secretary of State knows only too well—and not just from me—the contribution that your Lordships’ House makes and will continue to make. I for one certainly appreciate it, as I know he does.

I also thank the noble Baroness, Lady Parminter, for her bravery in sharing her and her family’s experience and anguish of eating disorder. I say the same to my noble friend who shared her experience about her sibling. It is not always easy to do that, but it really brings a lived experience of those around the person we are often thinking about, and it is so important that we do that. This debate has confirmed to me what I knew already—but it is always worth doing it again. It is the product of persistence and of a number of investigations and recommendations. It is also inspired and underwritten by the tireless campaigning that many have undertaken to improve the rights and experiences of people with mental health conditions and learning disabilities and autistic people.

It also reflects the input of those with lived experience, which was first raised as necessary in the debate by the noble Baroness, Lady May. It is about striking the right balance between getting the details of a framework of legislation right, along with the urgent need for reform, and the point that noble Lords have raised about how that is going to be done.

Attitudes and knowledge, as many noble Lords have acknowledged, have changed radically. Mental health is increasingly out of the shadows, and through the Bill we can make sure that legislation does a much better job of keeping up with a shift in societal attitudes and expectations and the development of treatment.

Regarding the role of your Lordships’ House, like the noble Baronesses, Lady May and Lady Barker, I recognise the relevance of this House. I too welcome that the Bill has started its passage through Parliament here because I believe your Lordships’ House will do the job that it is here to do, which is to improve legislation, and this debate today has certainly confirmed that.

In looking at what we are trying to achieve, I am reminded of the words of Professor Sir Simon Wessely in his foreword to the independent review’s final report, where he said that

“we want the Mental Health Act to work better for patients, the public and professionals. We hope that the result will be to reduce the use of coercion across the system, whilst giving service users more choice, more control and better care, even in the event that detention is still required. And we particularly hope that the end result will be to reduce the inequalities and discrimination that still remain”.

Almost six years after the former Prime Minister, the noble Baroness, Lady May, commissioned that independent review, the draft legislation before us speaks to those aspirations as well as delivering our manifesto commitment to modernise the 1983 Act.

On the reduction of detentions, I certainly agree with the noble Baroness, Lady Murphy, and other noble Lords that reducing detentions cannot be achieved by legislation alone. It will depend on having the right services in the community.

New models of care in the NHS are already giving over 400,000 adults greater choice and control over their care. We are also trialling new models of care through six early implementers, bringing together community crisis and in-patient functions into one neighbourhood team that will be available 24 hours a day, seven days a week, to increase access and improve continuity of care in the community. I know from the debate today that many noble Lords are looking for that sort of development and good practice.

As we know, the Bill makes a number of improvements in respect of patient experiences and care, and of the increase of choice and autonomy. It seeks to tackle racial discrimination and provide safety for public, staff and patients, and to provide better support for those with autism and learning disabilities.

I turn to some of the main themes that have been raised. I say to the noble Baroness, Lady Tyler, that we continue to be committed to engaging with those with lived experience. Part of the point of the Bill is that, where those with lived experience have not had their voices heard, I believe our continued engagement will allow that.

On racial inequalities, many have spoken passionately about this matter, including the noble Baronesses, Lady Watkins and Lady Buscombe, and the noble Lord, Lord Adebowale. The racial disparities associated with the operation of the current Act were one of the many drivers of reform, and rightly so. The changes in this Bill will give patients greater say in their treatment and encourage more collaboration and less coercion in care and treatment planning, which are all crucial to reducing inequalities. This will include increasing oversight and scrutiny of community treatment orders, where racial inequalities are at their most acute. It will also be about encouraging the uptake of advance choice documents, where those with lived experience, as I said in my opening remarks, have been very generous in their reference to their use in reducing inequalities. Legislating so that people can choose their own nominated person will also protect rights.

Inequalities in outcomes are not just a result of how the Act has been applied but also due to wider social and economic factors. We will therefore be working across government to ensure that the Bill’s provisions are effectively implemented, aiming to reduce those racial disparities in decision-making under the Act, starting with using the code of practice to make clear which actions can be taken in the application of the Act. We are also taking forward non-legislative reforms recommended by the independent review, including the Patient and Carer Race Equality Framework and also piloting culturally appropriate advocacy models to support those from minority ethnic backgrounds to understand their rights under the Mental Health Act and to give voice to their individual needs.

On the mental health commissioner, I have heard many comments, including those expressed by the noble Baronesses, Lady Murphy, Lady Barker, Lady Buscombe and Lady Berridge, and the noble Lord, Lord Bradley, and others. That is quite a group to address, but I will have a go. It is true that we have not taken forward the pre-legislative scrutiny committee’s recommendation to establish a statutory mental health commissioner. We recognise that improvements need to be made to the quality of care and the patient safety landscape. However, the concerns are that the proposed mental health commissioner’s function would be potentially largely duplicative of existing bodies and functions, and nobody wants to risk diluting accountability or causing confusion. As noble Lords will know, Dr Penny Dash has been asked by the Secretary of State to assess if the current range and combination of organisations within the healthcare regulation landscape is effective and to make recommendations of what might be needed, and I think it is important that we await her recommendations.

Learning disability and autism were raised by a number of noble Lords, in particular by the noble Baronesses, Lady Hollins, Lady Buscombe and Lady Browning, my noble friends Lady Keeley, Lady Ramsey and Lord Touhig, and the noble Lords, Lord Scriven and Lord Adebowale. This is a very important point and I recognise that we want to improve care and support for the over 2,000 people who are currently detained, as well as anybody who may need support in the future. We know from the NHS’s safe and wellbeing reviews that four in 10 people who are detained in this group have needs which could have been met in the community with appropriate support. That is why we are going to be focusing on developing community services and improving the quality of care, which will happen alongside the Bill’s reforms.

Through the Bill, we will be taking forward a package of measures for those with a learning disability and autistic people, so there will be a significant programme of work, alongside investment. I will be pleased to engage with expert stakeholders and those with lived experience, including parliamentarians, and to update your Lordships’ House as we progress.

With regard to the recommendations of the pre-legislative scrutiny committee, there is no doubt in my mind that the Bill has benefited greatly from undergoing scrutiny in 2022. It is a better Bill for that and we have tried to incorporate more of the Joint Committee’s recommendations within it. Many of those recommendations relate to the statutory code of practice and we will consider how we take these forward following Royal Assent.

On the important point of implementation, raised by many noble Lords, including the noble Lords, Lord Adebowale and Lord Bradley, the truth is that we estimate that the full implementation of these reforms will take around 10 years. The speed at which we can implement will be limited by the time that we need to expand and train the workforce. This goes to the point raised by the noble Lord, Lord Kamall, and I am grateful for his honesty in the way that he described previous work on the workforce. I thank him and his ministerial colleagues—predecessors of mine—who have worked on this.

The reality is that while some reforms can commence much sooner than others, we will need to commence powers under the new Bill in phases. Implementation will depend on what happens during the passage of the Bill and the reality of future funding settlements—to the point raised by the noble Lord, Lord Stevens—as well as other developments, such as the 10-year plan, but I can briefly give an indicative timeline.

A small number of reforms relating to the criminal justice elements of the Bill will commence within two months of Royal Assent. In the first year after Royal Assent, there will be a focus on updating the code of practice and creating the necessary secondary legislation to enable implementation. We will need a further year to train existing staff on the reforms and ensure that processes are in place. We would therefore hope to commence the first phase of significant reform in 2027, and to commence further reforms as and when there is sufficient resource in place to do so. In the spirit of honesty, the truth is that for what I would call the most burdensome reforms—for example, the increased frequency of mental health tribunals—those would not be likely to commence before 2031-32.

Alongside the passage of the Bill itself, we are looking closely at implementation in relation to learning disability and autism. Again, the exact timing of implementation of the reforms will depend on future funding. I know that noble Lords will understand that I am limited in what I can say on that, but we have already demonstrated our direction of travel by: treating and resourcing mental health seriously, including having a mental health professional in every school; introducing open-access Youth Futures hubs; recruiting 8,500 mental health workers; and having £26 million in capital investment. Indeed, there is the priority that many noble Lords, including the noble Lord, Lord Crisp, have acknowledged of bringing this Bill forward as a matter of urgency.

The noble Lord, Lord Meston, and the noble Baroness, Lady Berridge, raised the disparity of treatment between children and adults. It is true that there are a small number of reforms which do not apply to children and young people, as was also raised by the noble Baroness, Lady Watkins. It is the case that there is a difference; nevertheless, we are committed to improving children and young people’s autonomy over their care and treatment. We still believe that these reforms will go some way to achieving this. Like adults, under-18s should be supported to share their wishes and feelings by the clinician when it comes to care and treatment decisions.

On the issue of prison transfers, which was raised by the noble Baroness, Lady Watkins, and the noble Lords, Lord Scriven, Lord Bradley and Lord Adebowale, we recognise that operational improvements are needed to ensure the safe and effective implementation of the statutory 28-day limit. NHS England is indeed taking steps to address some of the barriers to timely transfer of patients. The wording in the Bill, which refers to the need to “seek to ensure” a transfer within 28 days, should be sufficiently robust to provide accountability for a breach of that time limit, while recognising that there are multiple agencies involved.

As we know, while this legislation—

[Baroness Berridge (Con)]

I hate to interrupt, given the lateness of the day and the lateness of the hour, but the point that a number of noble Lords were making in relation to children is that this Bill potentially does not sit with the principles under the Children Act. If the Government intend impliedly to repeal parts of the Children Act, then it would be good to have that clarification from the Dispatch Box.

[Baroness Merron (Lab)]

I look forward to coming to that point in Committee. The marrying up of legislation will be important, as is making progress on the Bill. That applies to the point of the noble Lord, Lord Alderdice, and others about fusion. We do not want to hold up this Bill while we make progress, but we will be mindful of the interface with other legislation.

In this Bill we are starting with the most overdue reforms to make the law fit for the 21st century. I very much look forward to working through the Bill in much greater detail in Committee. I am most grateful to all noble Lords who have not just spoken this evening but worked to get us to this point.

Bill read a second time.

--- Later in debate ---

Moved by

[Baroness Merron]

That the Bill be committed to a Committee of the Whole House, and that it be an instruction to the Committee that they consider the Bill in the following order: Clauses 1 to 3, Schedule 1, Clauses 4 to 23, Schedule 2, Clauses 24 to 38, Schedule 3, Clause 39 to 54, Title.

Motion agreed.

NHS: Dentistry Provision

Baroness Merron Excerpts

Monday 25th November 2024 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, 28% of the population of England needs but cannot access NHS dentistry. We want to ensure that everyone who needs a dentist can get one, including by providing 700,000 more urgent dental appointments and recruiting dentists to areas that need them. Government approval is not required to establish new dental schools; we encourage prospective providers to approach the General Dental Council, and we will work with partners to assess the best distribution of training places.

[Lord Fuller (Con)]

My Lords, I live in Norfolk which, alongside its neighbouring counties, is the only part of our nation not to have a school of dentistry. Even the Secretary of State says that our county is the “Sahara of dental deserts”. It is important: poor oral health is the principal cause of admission to hospital for children of primary school age, and incidences of mouth cancer are being missed locally. The last Government announced plans to recruit 1,000 more dentists a year and to build completely new schools of dentistry in which to train them alongside hygienists. Will these plans be taken forward by the new Government? Does the Minister agree with me that, where entirely new schools of dentistry are to be established, it makes much more sense to put them where we do not have very many dentists, rather than to have even more schools where we do have them? I hope she will say that the Government look favourably upon the proposals from the University of East Anglia to establish a brand-new school of dentistry and oral hygiene in Norwich.

[Baroness Merron (Lab)]

I commend the noble Lord for raising his long experience of facing and dealing with these problems locally in Norfolk. I note the report in September that the Norfolk and Waveney area has the worst ratio of NHS dentists to patients in England, with 1,000-plus people having to attend Norfolk’s casualty department last year due to serious dental issues, so this is a serious point. We are aware of the University of East Anglia’s interest in this area, and my colleague Stephen Kinnock, the Minister responsible for this area, recently met with east of England MPs to discuss this matter. However, as I have said, it is not the Government who make these decisions, although we encourage those new dental schools to be in areas of particular need. I encourage the University of East Anglia to take its proposals to the General Dental Council.

[Lord Scriven (LD)]

My Lords, has any extra allocation been made in-year—this year—from the Budget’s NHS allocation for the extra appointments the Government wish to see in dentistry, or is this expected to be bought from existing ring-fenced dentistry budgets?

[Baroness Merron (Lab)]

My Lords, the Government are investing around £3 billion in dentistry each year. As the noble Lord will be aware, I cannot yet confirm 2025-26 dentistry budgets, but they will be confirmed in planning guidance published by NHS England in due course. I know that the noble Lord will be aware that, despite the tough fiscal circumstances the Government have inherited, the Budget set out a big increase in day-to-day spending for health and social care. Regarding the process, and our planning, it is entirely normal that we set out matters in planning guidance. We are, of course, keen to reform the dental contract with a shift to focusing on prevention and the retention of NHS dentists. That work is immediately under way.

[Lord Fowler (CB)]

My Lords, no one fought harder for the elimination of dental deserts than Lord Colwyn, who died recently and whom most of us in this House remember. Would not the best memorial to Lord Colwyn be to place a new priority on dental services particularly for children? As well as making that a priority, and to show that it is, should we not allocate it a budget?

[Baroness Merron (Lab)]

I would like to associate these Benches with the comments made by the noble Lord about the late Lord Colwyn, whose contribution was indeed considerable. I agree that that would be a very appropriate legacy to his memory. The fact is that we are in the position that the previous Government’s dentistry recovery plan did not go far enough and, as we all know, there are too many people struggling to find an NHS appointment. As part of our 10-year plan we are working to assess the need for more dental trainees in areas including the east of England, which the previous noble Lord referred to, because many people continue to struggle. This cannot go on, not least because prevention is absolutely crucial as we move towards making an NHS fit for the future.

[Lord Harris of Haringey (Lab)]

My Lords, I refer to my interests in the register as chair of the General Dental Council. I am grateful to my noble friend the Minister for twice referring to the General Dental Council, but she has, perhaps inadvertently, given the impression that all that is required for a new dental school is that somebody rocks up to the General Dental Council and says they would like to open one. What consideration has she given to where the resources will come from for the training of extra dentists through a new dental school? Can she say what is being done to look at the best use of the number of dental professionals that exist around the country in order to make the best use of the skills mix between dentists and dental care professionals?

[Baroness Merron (Lab)]

My noble friend makes, as ever, very important points, and I am grateful for the opportunity to clarify that it is not a matter of just rocking up to the General Dental Council. However, we may find—I am sure that we will—that, in order to deliver our workforce ambitions, we need to work with partners such as NHS England and the GDC to explore the creation of new dental schools in currently underserved areas of the country. We have already had one such example. Provided that a prospective dental school meets the requirements of the GDC and the Office for Students, it will be considered for future government-funded training places. I absolutely agree with my noble friend that there are a number of layers to this, and I also agree that we need to look at the whole dental team, including dentists. There are a number of people involved in care, and it is crucial that the workforce plan can deliver on that.

[Lord Kamall (Con)]

My Lords, the Minister said that it was not only about rocking up to the General Dental Council, as the noble Lord, Lord Harris, said, but about having conversations. Can the Minister confirm what specific conversations the Government have had with the NHS, with the General Dental Council and with other dental bodies to encourage the opening of schools of dentistry in so-called dental deserts, especially in areas such as Norfolk, which my noble friend Lord Fuller described as the Sahara of dental deserts?

[Baroness Merron (Lab)]

As the noble Lord will know, we are very keen to see that the areas that are most underserved—as I know from my own experience in Lincolnshire—are targeted. One of the reasons is the problem of recruiting and retaining dentists, as there is not a dental school to call upon. That point is well understood. We are keen to target the areas that need the most, as well as providing additional urgent dental appointments. Early conversations have also taken place with the Minister for Care, Stephen Kinnock, about reforming the dental contract, which is absolutely key, and that work will continue at pace.

[The Lord Bishop of Newcastle]

My Lords, the Child of the North report, published in September, on the crisis in oral health in children, reported that 20% of children in the north-east have tooth decay in their permanent teeth. What plans do the Government have to implement one of the report’s recommendations—namely, to have a national strategy for children’s oral health, of which the establishment of new dental schools could be a part?

[Baroness Merron (Lab)]

The right reverend Prelate makes a very good point. The fact is that the overall state of our children’s oral health is very poor, including in the north-east, as she rightly identifies. One of the shocking facts is the impact on children’s ability to sleep, eat, play, socialise and even learn. It is also shocking that tooth decay is still the most common reason for hospital admission in children aged five to nine years. We will indeed look at the report, but we do have a strategy, including the introduction of supervised toothbrushing for young children in disadvantaged areas.

NHS: Treatment of Children from Other Countries

Baroness Merron Excerpts

Thursday 21st November 2024 Lords Chamber

[Lord Hogan-Howe]

To ask His Majesty’s Government what policy they have in relation to the treatment of children from other countries who have life-threatening and rare diseases for which high-quality treatment is available on the NHS.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, no specific government policy exists for treating children from other countries with life-threatening or rare diseases and it is generally preferable to treat patients close to home, subject to capacity and expertise. Some UK international healthcare agreements, mostly with Europe, the British Crown dependencies and overseas territories, permit doctors to refer patients to the UK. Referrals are usually reimbursed and happen when wait times are excessive or the treatments are not available in the child’s home country.

[Lord Hogan-Howe (CB)]

I thank the Minister for the reply. This really is a Question about trying to inspire the NHS at a time when it probably most needs it. Professor Owase Jeelani is a consultant paediatric neurosurgeon based at Great Ormond Street. His worldwide speciality is the separation of conjoined twins who are unfortunately joined at the head. He has now carried out nine of these operations, obviously affecting 18 children, and, because of the frequency, his success rate and the outcomes have improved over time. More recently, four of the nine operations were carried out abroad. If they are carried out at home, £1 million has to be raised every time to pay for them, which the professor ends up having to do. Alternatively, he and his team have to travel abroad, which means that he spends less time operating at Great Ormond Street in other specialities on children who need his support. Is the Minister prepared to meet the professor to see whether there is any better way of dealing with these problems, which are rare? It is of course an international problem and the babies affected have no hope unless someone does this.

[Baroness Merron (Lab)]

The noble Lord shines a light on the rarity of this condition as well as its importance. I would of course be happy to meet the professor. The noble Lord will know from our own discussions that this is an extremely complex area across the NHS and there is, as I said in my Answer, no overarching UK approach. Rightly, this is a trust-led approach because trusts have to make decisions about the balance between specialist work and other work, including the reduction of waiting lists.

[Baroness Manzoor (Con)]

I support the premise of the Question. Can we look at the NHS supporting these cases? From my perspective it is vital for three reasons. First, it is inspirational on the world stage for the NHS. Secondly, it retains expertise in the NHS. Thirdly, it offers the soft diplomacy powers that we need internationally. I urge the Minister to look at this again to see if the Government can find a way round it.

[Baroness Merron (Lab)]

I will be glad to take back to the department the comments of the noble Baroness and the noble Lord, but I reiterate that it is individual expert centres that are responsible for liaising with referring clinicians. By definition this has to be done on a case-by-case basis because we are talking about highly specialised treatments for rare diseases. Again, there is no set nationwide policy for local implementation because of the very nature of the challenge and the specialism to which the noble Baroness refers.

[Lord Scriven (LD)]

My Lords, maybe a good place to start would be to be bolder and more ambitious with the rare diseases framework that already supports international collaboration as part of the Government’s policy. As part of this framework, will the Minister investigate setting up an international centre of excellence in the UK that could be funded by both the UK and international partners for procedures and R&D to be carried out here, which would deal with some of the problems that both noble Lords have mentioned?

[Baroness Merron (Lab)]

The noble Lord is right to make reference to the UK rare diseases framework. The intention of that is to improve the lives of those with rare diseases—for example, by helping to get a faster diagnosis, increasing awareness of rare diseases, better co-ordination and care, and improving access to care, treatment and drugs for those in this country. I will add his suggestion to the list of matters to raise with the department.

[Lord Kamall (Con)]

My Lords, we can all be proud that the UK is home to some of the world’s best medical experts on rare conditions. As the noble Lord, Lord Hogan-Howe, said, there are patients in other countries—often poorer countries—who seek the help of a UK expert. The Minister knows that in the UK the NHS charges, understandably, and that is welcome, but there are other challenges if that expert goes abroad. She spoke about some international agreements in an earlier answer, so can she say a bit more about how NHS England works with other systems in other countries, especially with reference to some of those agreements?

[Baroness Merron (Lab)]

The agreements that the UK has in place which contain referral arrangements whereby the funding is discussed and agreed as part of the process of the referral are with the member states of the EU, Switzerland, the EFTA-EEA bloc of countries, the British Crown dependencies and some overseas territories. As the noble Lord rightly acknowledges, it is only fair that those using the NHS are those contributing to it, and we therefore have to ensure that we stick to those agreements. If trusts seek to undertake work outside of that area, that will be a matter for individual trusts, which will have to make decisions about their funding and their requirements to serve the NHS.

[Lord Beamish (Lab)]

Will my noble friend the Minister join me in congratulating the heart transplant unit at the Freeman Hospital in Newcastle, particularly the unit which conducts children’s heart transplants, providing a great service not just for this country but for children from across the world? One of the issues, though, is trying to encourage donors to come forward. What more can be done to encourage donors, specifically children, to come forward?

[Baroness Merron (Lab)]

I am very happy to add my congratulations to the hospital, which my noble friend knows very well. There are several approaches that we take on donors. One is the increased use of technology to ensure that organs donated can be used when and where needed. We tend to lose a lot of organs because that is not possible to do, depending on the technology. Another approach is to ensure that organ donation is a route that people are assured they can take, feel confident in, and are willing to participate in, including where somebody has died and we must deal very delicately, of course, with their loved ones.

[Baroness Watkins of Tavistock (CB)]

My Lords, I declare my interest as a member of the board of NHS England. Clearly we need to meet the needs of our own population at the moment but also need to retain staff, and there could be a real opportunity for working with the overseas development aid budget to enable exchange sabbaticals between Commonwealth countries and staff here in relation to these special services, so that children from Commonwealth countries who otherwise would not have access to these rare treatments could do so both here and abroad. Could the Minister talk with the ODA department to see whether such an initiative could be developed?

[Baroness Merron (Lab)]

I will certainly ensure that officials take up the suggestion of the noble Baroness to explore possibilities.

[Lord Lansley (Con)]

My Lords, one of the reasons why people are envious of the NHS is because we are able to do things through the NHS which are not necessarily able to be supported in other countries by private medical insurance, and we have the benefit here of some of the finest clinicians in the world. That is something I am sure the Minister will want to focus on when she meets Professor Jeelani. There will doubtless be very specific ways in which he and his team might be helped, but could she bear in mind the fundamental principle that only about one in three million babies is in this condition and they have no hope other than to be treated by his excellent team? That is a responsibility, regardless of residence and those definitions, that we probably take on board through the NHS.

[Baroness Merron (Lab)]

I understand the point that the noble Lord makes and am sympathetic to it. He will also understand the need to ensure not only that we have the expertise here and use it correctly, but that the payment is in place so that the areas of excellence can also meet the requirements of other demands on them, including the reduction of waiting lists. He knows that it is a very delicate balance and that is why it is right that this is a trust-based approach, but I will certainly bear that in mind when I meet the professor.

Carers and Poverty: Carers UK Report

Baroness Merron Excerpts

Thursday 21st November 2024 Lords Chamber

[Baroness Pitkeathley (Lab)]

I beg leave to ask the Question in my name on the Order Paper and remind your Lordships that today is Carers Rights Day.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, from these Benches I pay tribute to the memory of our dear and noble friend Lord Prescott.

I thank Carers UK for its report, which, importantly, as my noble friend said, is raised on Carers Rights Day. We will take the findings into account as we continue to support unpaid carers, whose major contribution I pay tribute to. We have announced an increase to the carer’s allowance earnings limit. Carers can earn around an additional £2,000 per year. This is the biggest uplift since the allowance was introduced in 1976. Furthermore, we will review the implementation of carers’ leave.

[Baroness Pitkeathley (Lab)]

My Lords, I readily acknowledge the welcome concessions by the Chancellor in the Budget and thank my noble friend for her response. There is never any difficulty in getting recognition for our moral obligation to carers, but figures published this morning by Carers UK remind us of their contribution to the economy. They show that the value of their support is worth £184 billion per year in the UK—directly comparable to the spending on the NHS in the four nations, which is £189 billion. I hope my noble friend understands that it is against this background of their huge economic contribution that we ask for entitlements for carers and for recognition of their rights to lead an ordinary life, to combine paid work with caring, and to not to be condemned to a life of poverty because of their caring responsibilities.

--- Later in debate ---

[Baroness Merron (Lab)]

I very much appreciate the point my noble friend makes, and the point made in this very important report. As well as the increase to the carer’s allowance earning limit, which I mentioned in my initial Answer, there will be an update to the Accelerating Reform Fund, which provides funding to local authorities, including for support for unpaid carers. In addition, the National Institute for Health and Care Research has commissioned an evaluation of unpaid carers’ support funded through the better care fund.

[Baroness Verma (Con)]

My Lords, I declare my interests as set out in the register. Will the Minister look at respite relief for not just unpaid carers but paid carers? There is just not enough respite relief for people who are doing this 365 days a year, and they need to have that. Will the Minister also look at families taking unpaid care work and the winter fuel allowance? This will impact a lot of families, and unpaid carers are usually well over 60.

[Baroness Merron (Lab)]

I understand the point the noble Baroness is making. I was pleased that my ministerial colleagues Stephen Kinnock, the Minister for Care, and DWP Minister Stephen Timms recently attended a Carers UK-hosted round table to discuss all these points, including poverty and finances. I hope your Lordships’ House will acknowledge and welcome the steps we have already taken and be assured that we know there is much more to do. We will continue to work cross-government on this.

[Baroness Tyler of Enfield (LD)]

My Lords, I welcome the recent announcement about the earnings limit on the carer’s allowance, but that helps only carers who are able to combine paid work with unpaid care. It is estimated that over 1.5 million carers are now providing over 50 hours of care per week, making it impossible for them to do paid work. What are the Government doing to support those carers? Will they look at increasing the carer’s allowance, which is currently £81.90 a week—the lowest benefit of its kind, I believe—and expanding the care-related premium to universal credit and pension credit?

[Baroness Merron (Lab)]

There is to be an increase in the carer’s allowance from April of next year. The change we have made in the earnings limit will, over the next four to six years, bring in an additional 60,000 people who were previously not eligible. The DWP is very conscious of a number of the pressures on unpaid and other carers and will continue to look at that. Further developments will be reported.

[Baroness Watkins of Tavistock (CB)]

My Lords, has further consideration been given to reducing or having an amnesty on repayments by carers who were overpaid due to the complex algorithm involved in being able to work for a certain amount of money? Having acknowledged that they should be able to earn at least another £2,000 without such a disadvantage, could we not cancel the situation for many, particularly over this winter, before the new carer’s allowance comes in?

--- Later in debate ---

[Baroness Merron (Lab)]

I and my ministerial colleagues are extremely aware of the anxiety the overpayments have created, and they are being independently reviewed to establish exactly why they happened. While I cannot commit to the amnesty the noble Baroness asks for, I can assure her and your Lordships’ House that we and the DWP are working to be as sympathetic to people as possible. I urge anyone in receipt of carer’s allowance to inform DWP of a change in their circumstances, so that overpayments can be avoided in future.

[Lord Kamall (Con)]

My Lords, we on these Benches also add to the tribute to the noble Lord, Lord Prescott, who has passed away.

My noble friend Lady Verma referred to the stress unpaid carers are under. We know that unpaid carers who look after family members may themselves have mental health issues, or may be looking after people with such issues. What support do the Government currently provide for the mental health of unpaid carers and those they care for, and what extra measures do they plan to introduce?

[Baroness Merron (Lab)]

One of the key things in all this is the identification of carers. As has been discussed in your Lordships’ House on a number of occasions, a lot of people do not identify as carers. Therefore, we are encouraging GPs and, in the case of young carers, schools, to identify carers, so that they can get the support they deserve. The noble Lord, Lord Darzi, identified that making sure that unpaid carers receive recognition and support is key, and it will be in the 10-year plan as we go forward.

[Baroness Keeley (Lab)]

My Lords, I want to raise the issue of the 21-hour study rule whereby an unpaid carer is not allowed to claim carer’s allowance and be in full-time education of more than 21 hours a week. I cannot see a good reason for that rule. It would be very welcome if the Labour Government changed the rule to allow unpaid carers to study without losing their carer’s allowance.

[Baroness Merron (Lab)]

I thank my noble friend for that and can assure her that I will be discussing that very point with ministerial colleagues and am happy to return to her on it.

[Baroness Altmann (Non-Afl)]

My Lords, particularly today, will the Minister join me in paying tribute to all carers and care workers, paid or unpaid? Does she agree that, with an ageing population, it is long past time to stop treating care as some kind of second-rate service and to give it parity with the NHS? It saves the NHS significant amounts of money, and carer’s allowance is extremely low. Following the recent Budget, care charities will still have to fund the extra national insurance costs, even though NHS workers are exempt.

[Baroness Merron (Lab)]

I, of course, join all noble Lords in paying tribute to care workers, whether paid or unpaid. On paid care workers, that is one of the reasons why, as we move towards a national care service, we have for the first time laid legislation to ensure that there will be a fair pay agreement. On national insurance contributions, I can assure the noble Baroness that the Chancellor considered all the implications of the measures that were announced in the Budget when settlements were made. Further details of those will be announced in due course.

National Insurance Contributions: Healthcare

Baroness Merron Excerpts

Tuesday 19th November 2024 Lords Chamber

[Lord Kamall (Con)]

My Lords, unintended consequences have plagued policymakers and Governments for many years. I am interested in whether the impact on primary care providers, hospices and care homes was a deliberate or unintended consequence of the recent rise in employers’ national insurance. Did the Government conduct an impact analysis of the cost to primary care providers, hospices and care homes before the Budget? If not, have they conducted one since or do they intend to do so? Can the Minister assure non-state providers of primary care, hospices and care homes that this was not a deliberate measure to squeeze them out of the health and care space and that the Government will consider appropriate measures to ensure that they can continue to be financially viable and invest in facilities, staff and front-line services?

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

I assure the noble Lord that there is no intent to squeeze out any providers, which are much valued and appreciated. We will continue to listen to their concerns and consult them as we make allocations, which is, as he knows, the usual practice for every Government. On the Budget settlement for the Department for Health and Social Care for 2025-26, I assure him that the Chancellor considered the impact of all the changes in the Budget.

[Lord Scriven (LD)]

My Lords, the net cost to the already struggling community pharmacy sector from the national insurance changes is roughly £50 million. One community pharmacist told me last week that this means that they either reduce services to patients by closing for the equivalent of one day a week or make one and a half members of staff redundant. What advice would the Minister give to that community pharmacist and many others in her situation?

[Baroness Merron (Lab)]

What I would say to each sector, including pharmacists, about the services they provide and what is expected in return from any contract is that, as in previous years—I emphasise that it is business as usual in this respect—employer national insurance contributions are dealt with as part of the process. We are very appreciative of the pharmacy sector’s contribution, not least because it will assist with one of the three pillars in moving from hospital to community services. I encourage all pharmacists to work with us to achieve what I believe they and we in government want: a service that is fit for the future.

[The Lord Bishop of St Albans]

Can the noble Baroness help us understand the huge impact this is having on the hospice movement, which is an extraordinary sector? We get an incredible service from it but, ironically, while we are having a national debate on assisted dying—some of us prefer to call it assisted suicide—this will make it even more difficult to provide this much-valued service. Is there not a case to be made for special support for those independent hospices which have to raise massive amounts of money from charitable sources, so that we are not penalising them?

[Baroness Merron (Lab)]

As the right reverend Prelate is very aware, most hospices are indeed charitable. They are independent organisations that receive some statutory funding for providing NHS services. As we discussed in a recent debate in your Lordships’ House, the amount of funding that charitable hospices receive varies by integrated care board area, and that will depend in part on population need and the breadth and range of palliative care and end-of-life care provision within the ICB footprint. With NHS funding being provided on a tariff basis, as is usual every year, there is NHS planning guidance, a local government finance settlement and consultations with independent providers. That will happen this year as it has every single year under every previous Government.

[Baroness McIntosh of Pickering (Con)]

My Lords, the Minister is aware of my interest with the Dispensing Doctors’ Association. The idea that allocations will be made in due course simply will not wash. GP practices, care homes and pharmacies will close their doors if the Government do not act urgently.

--- Later in debate ---

[Baroness Merron (Lab)]

Under previous Governments, including her own, this was exactly what happened, and it will continue to happen. There are established processes on NHS guidance and the national tariff system, and there will be consultations on primary care contracts, which will play out in the normal—and what I regard as a fair and open—way. I make that point in respect of all Governments, not just this one.

[Lord Clarke of Nottingham (Con)]

My Lords, the root of this problem is that, in an election that the Labour Party was bound to win, it made a promise that it would not raise income tax, national insurance or corporation tax. The taxes it promised not to raise provide 70% of the Government’s income and are the basic toolbox of any Chancellor in any Budget. They sometimes go up or down according to the economic needs of the nation, and they are the broadest-based and fairest taxes. Now that the Government have imposed these rather damaging taxes to raise revenue in this last Budget and have gone for the choices they have, can I have the Minister’s assurance that this promise is not good for the next five years? It will confine the Government’s ability to raise revenue when they need to, so they will go into more areas and will do unintended damage to employment or particular sectors of the economy.

[Baroness Merron (Lab)]

I appreciate hearing the view of the noble Lord, with his considerable experience, but this is a place where I know the current Chancellor would beg to differ. I gently point out that I believe the root cause is something rather different: this Government inherited a £22 billion black hole.

[Noble Lords]

Oh!

[Baroness Merron (Lab)]

Noble Lords may wish to groan and comment, but it is a fact. The deficit that the previous Government ran up in my department alone would mean 20,000 fewer appointments per week. That compares very unfavourably with the 40,000 more appointments that this Government are promising.

[Lord Foulkes of Cumnock (Lab Co-op)]

Does my noble friend agree that we are all getting a bit fed up with the groans from those on the other side when we take the time to remind them of the appalling debt we inherited? It is a truth that has been independently verified that we inherited this £22 billion. They are unwilling to admit the truth. Does she also agree with the noble Baroness, Lady Taylor of Stevenage, that we are putting forward proposals that they, understandably, constantly attack, but that they will not put up alternative proposals for dealing with the debt we have inherited?

[Baroness Merron (Lab)]

I certainly agree with the comments of my noble friend Lady Taylor, who set out the government response very clearly in the last Question. I also share the view of my noble friend Lord Foulkes that it is important to be honest; I believe we have taken that on board as a new Government. That is why, for example, we commissioned the independent review by the noble Lord, Lord Darzi, to find out the state of the NHS in order that we could move forward. What the noble Lord found did not make for pretty reading, and it is our job to put this mess into a rather better shape than it is now.

[Baroness Fox of Buckley (Non-Afl)]

My Lords, what has been described as “groans” might, in another language, be described as holding a Government to account. The Government are in charge now and have to answer the charges as put.

If the Minister is correct that the Treasury evaluated what the changes to employers’ national insurance contributions would be, the Government will have known that this was going to affect not just big nasty bosses but a wide range of employers—hospices, care homes and all sorts of charities. The hairdressing sector is being decimated as we speak. I just went and stood in the rain for two hours at the farmers’ demonstration, where tenant farmers pointed out that these national insurance changes will mean they will have to sack farm workers. This is having a wide decimating impact. If the Government are going to be honest, I hope they will talk to each and every one of the sectors and tell them that this is going to be resolved one way or another.

[Baroness Merron (Lab)]

This Government are very committed and are indeed talking to all sectors, including in my own department. As to the point the noble Baroness rightly raises about holding Governments to account, I welcome that. It gives me and my noble friends an opportunity to set out the plans, responsibilities and concerns of this Government. We will take them seriously and continue to work to get consensus wherever we can.

Cancer: Older People

Baroness Merron Excerpts

Tuesday 19th November 2024 Lords Chamber

[Baroness Ritchie of Downpatrick]

To ask His Majesty’s Government what steps they are taking to ensure a UK-wide approach to improving outcomes for older people with cancer.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, sadly, the risk of developing cancer increases as a person gets older. Health is a devolved matter, as your Lordships’ House will know, and the department is working with the NHS in England to improve outcomes for people of all ages with cancer. On my noble friend’s specific point, we are working to bring England in line with other nations by delivering a new national cancer strategy next year following the publication of the 10-year health plan.

[Baroness Ritchie of Downpatrick (Lab)]

I thank my noble friend for her Answer. I am sure she is aware that the UK’s cancer burden is projected to rise by around one-third by 2040, and 60% of those cancer diagnoses are expected to be among those aged 70 and above. Yet there is evidence that older people’s cancer care is not always provided to the level that it should be. Therefore, what assurances can she give me of actions the Government will take as part of the forthcoming cancer plan and the 10-year NHS plan to address these health inequalities in cancer care and treatment throughout the UK?

[Baroness Merron (Lab)]

My noble friend is quite right that the incidence of cancer is expected to rise across the UK, especially in older people. I agree that older people can face specific barriers when accessing care. Following on from the independent review by the noble Lord, Lord Darzi, I assure my noble friend that the 10-year health plan and the subsequent cancer strategy for England, both to be published next year, will help us do more to prevent cancer, identify it early and treat people quickly. They will have regard to older people.

[Lord Patel (CB)]

My Lords, I am delighted to hear that we will have a new cancer strategy. I have tried to get a debate in this House on that for two or three years now. Maybe the Minister will use her influence with the powers that be so that we can have a government-led debate on the cancer strategy. However, one of the reasons why our outcomes are poor is late diagnosis of cancer. Only 54% of cancers are diagnosed at stages 1 and 2. What plans do the Government have to improve early diagnosis of cancer?

[Baroness Merron (Lab)]

I am sure the powers that be heard what the noble Lord said about a debate. On the point he raised, I absolutely agree that diagnosing cancer earlier, at stages 1 or 2, improves outcomes and survival. I refer again to the report by the noble Lord, Lord Darzi: we need to do more to diagnose people at an early stage. Work is already being undertaken to improve cancer screening uptake. We will continue to roll out targeted interventions such as the lung cancer screening programme, which has a particular effect and impact on the most disadvantaged areas. Members of your Lordships’ House will know that the Budget also committed to £1.5 billion of capital funding for new surgical hubs and diagnostic scanners, which will increase capacity.

[Lord Kamall (Con)]

My Lords, I will carry on the thread of questioning that the noble Lord, Lord Patel, started about early diagnosis. As the Minister said, it is very important that we look at early diagnosis. Noble Lords who are interested in diagnosis were looking forward to a follow-up report to the 2020 community diagnostic centre review by Sir Mike Richards. That was due to be published before the Budget, yet the Health Service Journal has reported that it has been shelved. Is this true? If so, can she explain why?

[Baroness Merron (Lab)]

It is important that we concentrate on the biggest ever NHS consultation, because that will lead us to the 10-year plan, and all that we are doing will sit within that. As the noble Lord will know, we are committed to getting the NHS to diagnose cancer earlier, treat it faster and improve waiting times. One of the announcements in the recent Budget, which also shifts the dial, is that we will deliver an extra 40,000 scan appointments and operations every week. The 10-year health plan will set out our approach for shifting healthcare from sickness to prevention, including reducing the incidence of cancer.

[Baroness Burt of Solihull (LD)]

My Lords, my mother-in-law died riddled with cancer that was not diagnosed until the very end of her life. We know that older people often suffer from several conditions and that frailty may minimise the treatment options available. The comprehensive geriatric assessment is the gold standard for the assessment of older patients and can make a real difference in outcome and cost, but cancer is not embedded in that assessment. Will the Minister find out from clinicians whether that might be possible?

[Baroness Merron (Lab)]

I give my sincere condolences to the noble Baroness and her family. Yes, I will raise that. It is a good point to look at, and I thank her.

[Baroness McIntosh of Hudnall (Lab)]

My Lords, what plans do the Government have, if any, to include older people in routine screening programmes, particularly given all the statistics that we have heard in the course of this Question and others? I have asked this question before. I have never heard an answer that I found entirely convincing. I am confident my noble friend will be able to help on this occasion.

[Baroness Merron (Lab)]

I thank my noble friend for her confidence, and I will do my best. Decisions on screening, including the age ranges at which they operate, are made by the UK National Screening Committee. They have an upper and a lower age limit, which are based on evidence and kept under review. Current evidence does not support making changes to these ages. For breast screening, for example, self-referral is available for those over the age of 71 and for bowel screening it is available for those over 75. I confirm to her that this is all evidence-based, and we always keep an eye on the continuing evidence.

[Lord Lansley (Con)]

My Lords, I declare an interest in that I am a happy statistic of having survived more than five years after cancer treatment. But I know that I am not alone and that many others of the near 2 million cancer survivors have chronic conditions resulting either from cancer or from its treatment. Will the cancer strategy recognise and offer support to the many cancer survivors who have continuing chronic conditions resulting from their cancer?

[Baroness Merron (Lab)]

I am glad that the noble Lord is, as he describes himself, a happy statistic. We are all grateful for that. I certainly share the view that there are a number of ongoing chronic conditions and impacts on other aspects, such as people’s mental health. The cancer strategy needs to look at this in its development, and I am grateful to him for highlighting it.

[Baroness Pitkeathley (Lab)]

My Lords, as another happy statistic, I ask whether my noble friend thinks that older people are perhaps more reluctant than our younger friends to mention symptoms and are more inclined to say, “Oh, it’s nothing; I’ll get over it”. Would more public education programmes be useful in this regard?

[Baroness Merron (Lab)]

I am glad that my noble friend is also a happy statistic—although I see all noble Lords as more than just statistics. She makes a very good point but it is not just about those who are older; many people are reluctant to consider taking action when they have symptoms. My request to them is that they do not wait and that they act. That is how we get things diagnosed earlier, to provide the right support and care. There is a lot of embarrassment about certain symptoms and I make the plea that people should not be embarrassed. Certainly, as she suggests, the new cancer strategy will take account of how we educate people as well as diagnose and treat them.