Integrated Care Boards
Baroness Merron Excerpts(2 years, 3 months ago)
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Baroness Merron
To ask Her Majesty’s Government how they are monitoring and assessing the transition of Clinical Commissioning Groups to Integrated Care Boards; and how the success and impact of the new structure will be evaluated and reported to Parliament.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
Integrated care boards took over the role of commission and secondary care services from clinical commissioning groups on 1 July 2022. NHS England formally oversees these ICBs, and it has a legal duty to assess annually the performance of each ICB and to publish its findings. CQC system assessments will also provide an independent assurance to the public and Parliament. The success and impact of these new arrangements will be measured by a DHSC-commissioned evaluation completed by academics.
Baroness Merron (Lab)
My Lords, there are key factors to providing successful health and social care services that are outside the control of integrated care boards but very much within the control of the Government, including workforce supply and investment in social care capacity. Could the Minister tell the House how the impact of government provision will be measured and, where necessary, what action will be taken to put this right so that ICBs are actually able to deliver quality joined-up services for local people?
Lord Kamall (Con)
As the noble Baroness will be aware, a lot of the work at the local level will be done by the ICBs, in partnership with others, under the ICS system. On the Government’s role on workforce, the department commissioned Health Education England to produce a report to look at the long-term strategic drivers to support long-term workforce planning. This work is nearing its final stages. We have also commissioned NHS England and NHS Improvement to develop a long-term workforce plan for the next 15 years. In addition, as the noble Baroness will know, Section 41 of the Health and Care Act 2022 gives the Secretary of State a duty to publish a report at least every five years.
Cannabis: Medicinal Use
Baroness Merron Excerpts(2 years, 5 months ago)
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Lord Kamall (Con)
In simple terms, I completely agree. There should be a way around this and I will take this back to the department. In fact, I was quite provocative when I was getting advice on this, but I have also been warned that I am conflicted on this issue, so I will try to push it as long as I am not seen as being in conflict. It is very difficult, but I want to do the right thing.
Baroness Merron (Lab)
My Lords, we look forward to the Minister returning on this point, but to build on the points made by other noble Lords, despite the change in the law, many families are experiencing great anguish in getting treatment for young epilepsy sufferers and are left with little option but to pay thousands of pounds each month. What is the Government’s view on implementing all the recommendations of the recent NHS review of the barriers to accessing prescription cannabis products for medicinal use? If they are not planning to implement all the recommendations, which ones are the Government looking at?
General Practitioners: Shortage
Baroness Merron Excerpts(2 years, 5 months ago)
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Lord Kamall (Con)
There are a number of reasons why some GPs and other health professionals prefer to work part-time as opposed to full-time. Many people, especially given the stresses of the pandemic, want a better work/life balance. Some people have suggested in the past that we should focus on full-time equivalents. We should make sure that current staff who want to go from full-time to part-time can do so within the system, so that we can retain them, while tackling all the barriers to retention as well as recruiting more GPs.
Baroness Merron (Lab)
My Lords, the appointments system is not working well for GPs or patients. Healthwatch England reports that complaints about GP services are rising, the main problems being difficulties getting an appointment, exorbitant waits on the phone, about which we all know, and an end to online facilities to book slots. What assessment has been made of the detrimental impact on people struggling to access GP services, particularly those who are more vulnerable, and what is the plan to put this right?
Lord Kamall (Con)
The noble Baroness is absolutely right. We know that, for many people, their first entry into the system—their portal, if you like—is trying to get an appointment with their GP. As the noble Lord, Lord Patel, mentioned earlier, we have to look at how we can modernise this service. In the short term, we have made money available to help improve triage for people who phone up for services; this includes how to manage incoming and outgoing calls. In future, we are looking at more digitisation and extending the functionality of the NHS app so that people can book appointments for all sorts of services; if they are waiting for an appointment or secondary care, they will also be able to see how long they will have to wait and where they are in the queue.
Coronavirus: New Cases
Baroness Merron Excerpts(2 years, 5 months ago)
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Baroness Merron
To ask Her Majesty’s Government what assessment they have made of the recent rise in Covid cases across the UK to 2.7 million infections over the last week.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
We continue to see Covid-19 case rates and hospitalisations rise in all age groups, with the largest increases in hospitalisations and ICU admissions in those aged 75 and older. A large proportion of those hospitalised are admitted for reasons other than Covid. However, Covid is identified due to the increase in case rates in the community and the high rates of testing in hospital, including among those with no respiratory symptoms. Current data does not point to cases becoming more severe.
Baroness Merron (Lab)
My Lords, with a stark rise in infections, many people—particularly the clinically vulnerable, carers and older people—are feeling anxious, yet the Government have been noticeably silent, perhaps being somewhat distracted. We might be through the worst of Covid but evidently it has not gone away; individuals, organisation and businesses still want guidance. I have two questions for the Minister. Are the Government planning any campaigns, perhaps involving scientists and others, to highlight current risks and to encourage the take up of booster jabs? Are there plans to reintroduce mandatory mask wearing in hospitals, which the chair of the JCVI considers sensible?
Lord Kamall (Con)
I have to strongly disagree with the noble Baroness when she says that the Government are doing nothing. We are reliant on the UKHSA, which monitors rates and gives us advice, along with the JCVI. In my briefing from the UKHSA, it said it is continuing to monitor cases. As many noble Lords will remember, when we announced the living with Covid strategy we said that we are always ready to stand up measures should case rates rise so much that our health system was under pressure. We managed to break the link between infections and hospitalisations and hospitalisations and death; if that gets out of control then of course we will stand up the measures that we had previously.
Health Improvement and Food Production
Baroness Merron Excerpts(2 years, 5 months ago)
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Baroness Merron (Lab)
My Lords, I start by congratulating the noble Baroness, Lady Walmsley, on securing this debate on the relationship between improving the overall health of the nation and food production, because the two things are inextricably linked for all the reasons the noble Baroness set out so clearly for us in the introduction. We are having this debate in the context of two crises in particular, although I am sure we could add others: the cost of living crisis and the obesity crisis. The noble Baroness, Lady Walmsley, rightly made the great claim that, despite our so-called greater affluence, we are nevertheless all the poorer in terms of our health and our access to, and provision of, good food.
From this debate, no one could be in any doubt that the food system is continuing to break. This is affecting childhood obesity, our health, farming and biodiversity, and now there is an inability to get three decent meals a day to some 10 million people in this country. If this does not say to the Government that we require a competent cross-cutting strategy, I do not know what would.
I will refer to the 2020 report by the House of Lords Food, Poverty, Health and Environment Committee, which contended:
“The UK’s food system … is failing”.
In response, the national food strategy very clearly said that
“the damage being done to our health and our planet by the food system demands urgent action.”
It would be very helpful to hear from the Minister how much he agrees with these assessments.
I will focus on the Government’s food strategy, because I am sure that the Minister will make great reference to this in his response. Of course, there were high hopes for the food strategy, following the review by Henry Dimbleby. Very sadly, however, we find that it provoked the kind of united response that we would not have wanted—namely, it was roundly criticised by Mr Dimbleby himself and by farmers, food campaigners and environmentalists. Why? Because it turned out to be vague and unambitious, the mirror opposite of what we hoped for. It would be fair to say that the proposals in the Government’s food strategy do something of a disservice to a very well-researched and well-evidenced report by Henry Dimbleby, who took a completely holistic approach to the journey of our food, the impact on our health and the connections between the two.
The review highlighted the terrible damage that poor farming practices would do to our planet. It also called out the complicity of food manufacturers, whose drive for profits is pushing highly processed junk foods on to the nation, as referred to by the noble Baroness, Lady Jenkin. This is being done in full knowledge of the ill health that we are likely to suffer as a result and the obesity crisis that will overwhelm our health service if urgent action is not taken.
This country is now the third fattest in the G7, with almost three in 10 adults being obese, while many children are going hungry because our school food system fails so many of them in need. Henry Dimbleby’s report was challenging. It said, “Change is never easy”, which is true, and went on to say that
“we cannot build a sustainable, healthy and fair food system by doing business as usual.”
I believe that this debate challenges “doing business as usual”, yet that seems to be the exact approach the Government are taking.
Can the Minister tell your Lordships’ House why the response from the Government barely covered 10% of the Dimbleby review; why it did not respond to the 14 very well-argued recommendations in the report; and why we still do not have a blueprint to tackle the major food issues facing this country?
Where are the policies that would address the situation of 7.3 million people who live in poverty, including 2.6 million children? I ask the Minister: where are the policies to make food banks a thing of the past? That includes food banks which, shockingly, are being set up by hospital trusts to meet the demand from their staff. Where are the policies to tackle the rise in adult obesity, which is putting our health service and individuals under such strain? Why have the Dimbleby plans to improve child nutrition been ignored. Why have the proposals to extend entitlement to free school meals been rejected?
We know that food prices are rocketing and the food system is under strain, but the food strategy fails to address the root causes. Costs are rising dramatically for farmers and food producers, which is putting further pressure on the price of food. As we have heard from noble Lords during this debate, however, crops are rotting in the fields and over 40,000 pigs have already been culled because of labour shortages.
Perhaps the Minister could tell your Lordships’ House about plans to support British business and ensure that British food is affordable. How do we support our farmers and prevent them being undercut by imports with lower animal welfare and environmental standards? Why was the commitment to tackle low-quality imports taken out of the paper at the last minute? We need a plan to ensure that what we buy, sell and grow is more of our British food, to entrench Britain’s reputation as a beacon for quality food, high standards and the ethical treatment of animals. Does the Minister recognise that we ended up with a food strategy that pleases nobody, lacks ambition and represents a missed opportunity? It would be helpful to hear his response on these points.
I should like to pick up the point about the efforts the Government should be making to encourage the food industry to reformulate its products to reduce high-fat, high-sugar, high-salt foods. Perhaps the Minister can help us with this. Can he confirm, in the context of contrary media reports, whether the Government are committed to removing unhealthier foods from checkouts?
It would be remiss if I did not comment on the backtracking on the restrictions on advertising unhealthy food. There was much debate on this matter in the course of the Health and Care Act. Yet, we saw backtracking not driven by evidence but, sadly, by the Government’s wish to calm what might be called somewhat choppy political waters. They were certainly choppy at the time; nobody knew at that point how much choppier they would get. Now that we find ourselves in a new world, perhaps the Minister could commit to reviewing the introduction of those restrictions, because the evidence says that it makes an impact on childhood obesity and we cannot wait.
The Government also said in the course of the food strategy that they were committed to using public sector food procurement policy to improve the quality of food and catering services in the public sector. This would be very welcome. This becomes especially pertinent when we look at the challenges that inflation poses to school and hospital food. Can the Minister advise the House on how the Government intend to do this and whether the Procurement Bill will be one such means to address this directly?
The national food strategy also has a target of halving childhood obesity by 2030. Perhaps the Minister could comment on where we are in terms of being on track to meet this. If he considers that we are not on track, what measures will be taken to get us back on track?
I refer to the helpful briefing by the Food Foundation, which addresses the consumption and production of fruit and vegetables. Is there an intent to use the food strategy to join up the efforts to increase fruit and vegetable production and consumption and to reform the Government’s buying standards to include portions of veg in every main meal, to increase demand? It would be helpful to hear from the Minister a consideration of the amount of fruit and veg that should be consumed and the messages that are conveyed. The five-a-day message has been widely communicated as the recommended quantity but, as indicated in the Eatwell Guide, the recommendation should be closer to seven a day. On the basis that it is accepted that we should be eating more, can the Minister advise us what might be done on this?
It seems that we have a challenge, as the noble Baronesses, Lady Jenkin and Lady Bennett, mentioned, with the onslaught of ultra-processed foods. We are in danger of increasing the distance between the origin of food and the actual intake. What is the plan to guide us towards healthier foods that we can afford, source, prepare and enjoy? Unless all those aspects are dealt with, we will not find ourselves in the situation of encouraging people into a healthier zone—as the noble Lord, Lord Kirkham, referred to—without further direction.
A number of very important questions are raised by this debate. I look forward to the response of the Minister, who I hope will acknowledge the inextricable link between food production and healthier eating but will also have some answers about how we will get there.
Lord Kamall (Con)
The noble Baroness makes an important point, but we have to recognise the reality: not where we want to get to, but where we are at the moment. People do eat food that will need to be reformulated if we want to make it healthier. Of course, we know that fruit and vegetables are healthy, but not everyone, as we help them transition, will eat fruit and vegetables, or make stuff from the raw products. They will buy products in supermarkets, and therefore if they are buying them, we have to make sure that they are healthier and reformulated. We do not yet live in that ideal world where everyone buys fruit and vegetables, and cooks everything for themselves.
Given that, we also need new regulations on out-of-home calorie labelling. As we know, many people go to restaurants, buy takeaways or have their food delivered. It is important that we have calorie labelling for food sold in large businesses, including restaurants, cafés and takeaways, which came into force on 6 April 2022. As noble Lords are aware, there will be further legislation, on restricting the promotion and advertising of products high in fat, salt and sugar, which will come into effect in the next few years. I know that many noble Lords disagreed with the Government’s views on delaying some of those measures. We will continue to have the end-of-aisle promotion on the target date, but others, such as “buy one, get one free”, are delayed because of the trade-off with the cost of living crisis, but will come. It is delayed, but we have set target dates.
Once again, we have to be open—
Baroness Merron (Lab)
I thank the Minister for referring to the delay, which I accept is a delay, to the restrictions on advertising. Can he explain what that has to do with the cost of living crisis, because I have heard that before?
Bread and Flour Regulations: Folic Acid
Baroness Merron Excerpts(2 years, 5 months ago)
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Lord Kamall (Con)
Perhaps I have not made it clear enough that we are proceeding with this; there is no stopping the process or review. We are clear that the scientific debate should not hold up progress, so we want to launch the consultation in August/early September. The closing date will be 12 weeks after that, and we should have a government response on the final position in Q1 2023. We would then notify the WTO and European Commission, and once that is all cleared, it should result in legislation being ready to be laid in Q4 2023, and the transition period for the industry would be discussed after that. When I spoke to the noble Lord, Lord Rooker—I hope he would acknowledge this—he believed that I was one of the few Ministers who is very intent on progressing this.
Baroness Merron (Lab)
My Lords, as the noble Lord, Lord Patel, has said, the scientific evidence is readily available and evidenced across the world. Can the Minister tell us what, on this new timeline, he thinks the new consultation and process might reveal that we have not seen so far?
Lord Kamall (Con)
The reason we have a consultation is so that we are aware of unforeseen circumstances and that, hopefully, we deal with unintended consequences before they occur. It is all very well saying that the science is settled; we have reached a level of consensus where both sides can agree, and that is what we are progressing from. Once it is implemented, we can start reviewing whether it should be a higher level and whether there are unintended consequences. The history of contestation in science goes back a long way; think of the heliocentrism versus geocentrism debate. People thought that the universe revolved around the earth, but Aristarchus of Samos, al-Battani, Islamic philosophers and others challenged that, and Copernicus proved that heliocentrism was right.
Paramedic Services
Baroness Merron Excerpts(2 years, 5 months ago)
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Lord Kamall (Con)
The right reverend Prelate raises an important issue for those of faith who want to share their last moments of life with someone. I am afraid that I do not have a detailed answer, but I will go back to the department and write to the right reverend Prelate.
Baroness Merron (Lab)
My Lords, as other noble Lords have said, ambulance delays are a symptom of pressures elsewhere in the health and care system. At the end of April, 62% of over 20,000 patients in England who were medically fit to be discharged remained in hospital, largely due to a lack of appropriate social care provision. Can the Minister say how and when there will be a fully costed workforce plan to ensure that the relevant staff are in place to urgently tackle this bottleneck?
Mental Health: Advertising and Body Image
Baroness Merron Excerpts(2 years, 5 months ago)
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Lord Kamall (Con)
If I have been accurately briefed, I will begin by wishing my noble friend a very happy birthday.
This is a really important issue concerning ethnic minorities and people of different colours. First, young people want to see people who look like them on TV and in the media as role models, to show that they are part of everyday society. Also—I am sure my noble friend will be aware of this—sadly, there is the issue of colourism, whereby sometimes there is a preference for people of a lighter colour within certain ethnic minority groups. People who are darker are quite often discriminated against; they are not necessarily abused, but there is this preference for lighter colours. This is all being looked at. What my noble friend says shows what an incredibly complicated area this is. It is really important that we look at all these issues: is it size, is it appearance, is it colour?
Baroness Merron (Lab)
Advanced early intervention is crucial. Treatment for mental health conditions such as eating disorders has consistently unacceptable waiting times. At the end of last year, a record 2,100 children and young people were waiting for treatment, with demand continuing to rise. Can the Minister tell your Lordships’ House when the waiting times will mean timely intervention? What are the Government doing to recruit, retain and train the necessary levels of staff to provide the treatment that is so desperately needed?
Lord Kamall (Con)
I hope the noble Baroness will recognise that before the pandemic, we were meeting the waiting times targets for many younger people. Clearly, as with many things in our health and social care service, the pandemic has had a huge impact—not only delaying the treatment of people who should have been treated before the pandemic, but increasing the number seeking help with mental health issues. As I am sure noble Lords will recognise, for young people those two years were a massive proportion of their lives compared to us. Those are lost years for them, and it has led to many mental health issues. As the noble Baroness will know, we have announced the draft mental health Bill. The NHS long-term plan will have an additional £2.3 billion a year for mental health services by 2023-24, and an extra 2 million people will be able to access support. This will all take time, and we will have to work through that.
Draft Mental Health Bill
Baroness Merron Excerpts(2 years, 5 months ago)
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Baroness Merron (Lab)
My Lords, I start by thanking Professor Simon Wessely for his independent review of the Mental Health Act 1983, an outdated piece of legislation that far too often has facilitated the inexcusable treatment of those with mental health problems.
Yesterday, the Secretary of State for Health said that the report made “uncomfortable but essential reading”, and indeed it did. When it is at its best, legislation supports the saving and improvement of people’s lives, and I am sure that all sides of your Lordships’ House intend that this Bill will get us to this point.
In supporting this overhaul of the legislation, pre-legislative scrutiny will be crucial, not least because it gives an opportunity to build consensus. Can the Minister provide details of timescales and arrangements for this scrutiny? While the Government have adopted most of the recommendations of the review, can the Minister comment on the ones that have not been accepted and the reasons for doing so?
It is welcome that this Bill contains a number of improvements. It gives people more say over how they are treated. It prevents the use of Section 3 of the Act on those who are autistic or have a learning disability but do not have a mental health condition. There is the new duty on clinicians to consider a person’s wishes and feelings and involve them in decision-making before deciding whether to treat them. There is access to advocacy and statutory care and treatment plans, which will give more transparency and accountability to clinical decision-making and put people’s choices first. All of these and others are welcome.
However, there is a need for the Government to go further. In the debate in the other place, the Secretary of State replied to many of the concerns raised by saying that the new, cross-government Building the Right Support plan would answer a lot of them. Can the Minister confirm when we can expect the plan and what it is likely to cover? When will we see the proposed new 10-year mental health plan and 10-year suicide prevention plan?
Black people are over four times more likely to be detained under the Mental Health Act. Can the Minister confirm whether the Government have any intention to review community treatment orders, which are evidenced as coercive, as not reducing readmissions, and being disproportionately applied to black people? Will the guiding principles suggested by the independent mental health review be included, as these would strengthen people’s rights and help focus decision-makers on eliminating racism? How will the mental health equality framework be advanced so that there are culturally appropriate services and the freedom for local areas to respond to the needs of their specific populations?
On young people, will the Minister look to see the Bill strengthened in making reforms for those young people? Will he address the failure to give under-18s the right to make advance decisions to refuse treatment? Without this, they will be unable to access enhanced treatment safeguards in the same way as adults. Will he also look at the lack of a statutory decision-making test for those who are under 16 which could also render many of these reforms ineffective for the youngest and often most vulnerable people in the system? It is of note that Anne Longfield, the former Children’s Commissioner for England, said that the profit-driven care system was failing vulnerable children. Following reports in today’s media and the MacAlister social care review, what action will the Minister take to put this right?
On the new criteria for detention, will the Minister review this too? Ensuring that fewer people are inappropriately detained is a crucial intention of the reforms, and changes are very much needed to significantly reduce this practice.
Staffing levels are crucial to ensuring quality mental health services. These Benches have been calling for the recruitment of 8,500 mental health staff to treat 1 million additional patients a year, so can the Minister confirm when we will get the Government’s vision for their workforce strategy?
I look forward to the Minister’s response, and if he is unable to answer all my questions today, I would be grateful if he would write to me. Modernising the Mental Health Act will undoubtedly help make mental health services more equitable, compassionate and effective. I am sure that these are aspirations we all agree we must work towards.
The Deputy Speaker (Lord Duncan of Springbank) (Con)
My Lords, the noble Baroness, Lady Brinton, is taking part remotely.
Diabetic Prevention Programme
Baroness Merron Excerpts(2 years, 5 months ago)
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Lord Kamall (Con)
The noble Baroness makes an important point about what we have to learn from these programmes. In many of these programmes we are in a process of discovery. You try things—some will work and some will not. Those which do not work, we want to learn the lessons from. Clearly, the length of the programme, nine months, has put some people off and led to the dropout rate. We are looking at shorter programmes, digital access and self-assessment, and at community-led initiatives rather than top-down government initiatives. To give another example, I met someone at a meeting yesterday who told me that his mosque in Accrington was running healthier-diet programmes for worshippers. We need to see a lot more of those programmes as well.
Baroness Merron (Lab)
My Lords, the national paediatric diabetes audit shows that the impact of type 2 diabetes and the cost-of-living crisis is disproportionately felt by children living in the most deprived areas. What preventive measures specifically geared towards children are in place so that they may avoid type 2 diabetes? What are the Government doing for the almost 4 million children, and their households, who are struggling to access and afford enough fruit, vegetables and other healthy foods to meet official and basic nutrition guidelines?
Lord Kamall (Con)
One of the NHS programmes that will be repeated by integrated care boards when we have them is the eight annual diabetes checks for people of all ages. Certain factors—HbA1c, which is your average blood glucose level, or your glycated haemoglobin; blood pressure; cholesterol; serum creatinine; urine albumin; foot surveillance; BMI; and smoking—are checked for patients of all ages to identify early onset of diabetes.