Polio
Baroness Merron Excerpts(2 years, 5 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Merron
To ask Her Majesty’s Government what action they have taken in response to the national incident declared due to the polio virus being found in London sewerage systems.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
The established UKHSA public health response mechanism has been stood up in line with national polio guidelines. This national incident means that a national team has been set up to manage and co-ordinate these actions across areas, which is standard procedure for many of the health threats that the UKHSA foresees and manages. Although samples have been detected in London, the UKHSA is working to ensure that other areas are aware and are taking actions necessary to protect populations, including encouraging people to take the vaccine.
Baroness Merron (Lab)
My Lords, while the risk to the public is considered low, the declaration of a national incident will of course give cause for concern, so the Government need to communicate swiftly and clearly about the situation and to ensure that children in particular are vaccinated against polio, especially as there is lower vaccine coverage in London among younger children. What is being done to address this situation and how will the Government roll out their messaging, working with local authorities, schools, the NHS and GPs, who already have added pressure from being contacted in greater numbers by the public who are concerned about vaccinations? Can the Minister reassure your Lordships’ House that he is working closely with the Treasury to ensure a properly funded communications and vaccination campaign?
Lord Kamall (Con)
We should start by being clear about what has been found. As part of routine surveillance, the MHRA analyses sewage from a number of treatment works and looks at what may be identified—it is world-leading in this. We should pay tribute to the UKHSA for its world-leading work and for being ahead of the game in spotting potential health risks early. It is normal for one to three vaccine-like polio viruses to be detected each year in UK sewage samples, but those are usually one-off findings. In this case, a vaccine has been detected; it is probably related to someone having had the polio vaccine and having shed it as part of their faeces. A couple of things will now happen. First, the MHRA will go further down the system to see whether it can isolate where that came from. Secondly, the messaging is quite clear: you must get your vaccine. Most people get their vaccines as part of a routine. They get it twice in preschool and then at school at 14 as their final booster. However, there are some areas of low vaccination, and we are making sure that we are rolling out that message along all the channels mentioned by the noble Baroness.
National Health Service (Integrated Care Boards: Exceptions to Core Responsibility) Regulations 2022
Baroness Merron Excerpts(2 years, 5 months ago)
Grand CommitteeRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Merron (Lab)
My Lords, I start by thanking the Minister for his extremely helpful introduction to these regulations. It is a pleasure to follow the noble Lord, Lord Scriven; I want to pick up some of the points he made. Let me say at the outset that we on these Benches support the regulations, which we accept are consequential and will not change services for people.
The words that have been used are that this is a “tidying-up exercise”. I want to dwell for a moment on the general point that there has been considerable time for this. The Health and Care Bill was introduced in July 2021 and we all know how long it spent in Committee, both in this House and in the other place. We also know how extensive the consideration of it was so it seems strange for us to find ourselves back discussing what are described as “consequentials”. This may be a simple tidying-up exercise—I accept that is what these regulations are—but calling it that ignores how we could have avoided the need to tidy up and, therefore, the amount of bureaucracy, time and effort that has been spent, not least in the department, in having to make these changes. Perhaps the Minister could address the general point that has been made in the course of this debate about why we find ourselves in this situation.
In the debate in the other place, the Minister talked about five more consequential statutory instruments that we should expect as part of this so-called tidying-up exercise. Perhaps the Minister can advise us on those. It is important that everybody, including system managers, knows what is coming down the track. I say that particularly given the record waiting lists and waiting times that the NHS is seeking to manage, yet we are talking about regulations that must be in place for 1 July so that everyone has certainty about what needs to be put in place and to be done. I accept the Minister’s assurance that this does not affect services to patients in a practical sense, but whenever we discuss regulations there is always an air of uncertainty around. Patients need to be assured that they will have a seamless service wherever they live or wherever they are. Therefore, knowing that we will be considering similar consequentials raises questions about certainty.
We hope that the regulations go through and that the Minister will respond to the points of concern that have been raised today. I hope that the regulations will ensure that the NHS can get on with the job that it is here to do.
Lord Kamall (Con)
My Lords, I thank both noble Lords who have spoken in this debate. The noble Lord, Lord Scriven, said this statutory instrument is not controversial, as reflected in the attendance at the debate, but when I saw that the noble Lord, Lord Scriven, was present I thought, “What’s controversial? I’d better look into it.” The noble Lord did not disappoint in that way. He quite rightly holds the Government to account.
Before I conclude I shall try to address some of the points that were made. The department has laid eight instruments so far to support the ICBs for 1 July. They ensure the continuation of the existing policy and provide the supporting legislative framework. The Health and Care Act 2022 (Commencement No. 1) Regulations 2022 were made on 6 May to commence a small number of preparatory sections from 9 May to enable preparatory steps to take place for the establishment of ICBs on 1 July. There are six negative resolution statutory instruments and one affirmative instrument—this regulation. The Health and Care Act 2022 (Commencement No. 2) Regulations 2022 are planned to be made by 30 June. This SI will commence major elements of the Health and Care Act on 1 July, including, but not limited to, ICBs, ICPs—integrated care partnerships—and the merger of NHS England Improvement, TDA and Monitor. We will be laying a further consequential statutory instrument which will amend redundant references to previously existing bodies and update legislation to support the implementation of ICBs.
On the point that the noble Lord, Lord Scriven, made about the federated data platform, I assure him that I have been in conversation with NHS England, particularly the transformation directorate, and it has been quite clear with me that it is an open tender. There is no preferred bidder. It has seen all the speculation in recent press articles and I have asked it directly about it. I will be quite clear: this is a very difficult for me to walk because as a Minister I do not want to interfere too much in those technical solutions and favour one or the other, but at the same time I have to warn about the politics around this. When I was speaking to the officials, they were very clear about that. We have to be clear about this. Whatever you chose, there will be some story out in the press, so we must make sure it is as open as possible.
Nursing: Staffing
Baroness Merron Excerpts(2 years, 6 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Merron (Lab)
My Lords, I start by thanking our nursing workforce and, indeed, the whole health and social care team. I congratulate the noble Baroness, Lady Tyler, on securing this important and very timely debate, and thank her for the way in which she set out the issues. It is important that we are considering them today, given this report. I also thank the Royal College of Nursing for this comprehensive report, which I believe shines a real light on the realities that are being experienced by the nursing team and patients. It produces a very loud red flag for the future, which I am sure the Minister will address. The Nursing and Midwifery Council also helpfully shared its annual registration data, cited in the report. I shall refer to that later.
The key message coming through from this debate, as has come through so many times, is the question of whether the Government have it right on workforce. I am sorry to say that, on this occasion as on previous occasions, the answer is no. This is about having the workforce to do the job. It has been debated numerous times in your Lordships’ House and in the other place. Your Lordships’ House made its view known very clearly that any organisation worth its salt—that certainly includes our National Health Service—would undoubtedly have in place a workforce plan for now and for planning ahead, looking at retention, recruitment and training, and all the many complexities involved. Yet within the Health and Care Act we did not have that commitment.
I will refer to the survey findings, which come in the context of record waiting lists and 50,000 registered nurse vacancies. The report refers to the fact that the UK’s exit from the EU and the Covid-19 pandemic have both highlighted and worsened long-term problems with workforce supply in health and social care. However, the report also says that this is nothing new. For many years, nursing staff have been shouting about the impact of growing staff shortages and the rising demand on their ability to deliver care that is safe and effective. The report argues that the impact of these pressures is now “beyond concerning”, with patient safety, care outcomes, staff retention and staff well-being affected.
On this point, I was glad to hear from the right reverend Prelate, who spoke of her experiences of talking to nurses and rightly reminded us of the positive side: nurses’ passion for improvement and service, and their commitment to delivering for patients. The right reverend Prelate also rightly spoke about the pressure on nurses. I wonder whether the kind of commitment shown to us by nursing teams means that their situation is constantly overlooked. I believe that there is a great tendency for them to be taken for granted because, as the right reverend Prelate said, they will always deliver.
From the report, we know that
“staffing levels are compromising care”
and
“that there are not enough registered nurses on shift”.
There is also a greater intensity of nursing care required by patients. This highlights that we have a worsening situation, not one that is static. This once again makes the case for proper workforce planning that can move with the times. I anticipate that the Minister will refer to the pandemic as being one of the greatest pressures. While that it is true, the report also said:
“Going into the … pandemic … 73% of nursing staff surveyed … said that staffing levels on their last shift were not sufficient to meet all the needs of the patients safely and effectively. In 2022, this has risen to 83%.”
This is not a new problem; it has been exacerbated but it would not be right to refer solely to the impact of the pandemic.
We have heard a number of the key findings, but the one that really strikes me is this:
“Only 25% of shifts had the full number of planned registered nurses on shift.”
Linked to that, 81% of those surveyed
“felt that patient care being compromised was due to not having enough registered nurses on the shift”,
and yet one in five said
“they felt unable to raise their concerns.”
This is a very dangerous cocktail to which I hope the Minister will have a response.
The report makes a number of recommendations, and we have had a number of proposals in the debate today. I am interested to hear the Minister’s response to the recommendations of the report and the points raised within this debate.
As we know, the Government have announced an increase in the number of nurses, and that can be tracked back to a 2019 manifesto pledge. In addition to providing us with an update on this situation, it is worth reiterating the point made by the noble Baroness, Lady Tyler, on the comments of the Chief Nursing Officer for England, Ruth May, who said that while she welcomed the pledge, it fell short of what was actually needed. This will be the case because recruitment on its own is not the point; it is also about the vacancy numbers, the shortfall and the numbers of nurses that are leaving.
On that point, I refer to the information from the Nursing and Midwifery Council. When asked why people had left, they said the main reasons were too much pressure, poor workplace culture, struggles with increased workloads and a lack of staff. Could the Minister give us more information on when he will be able to share the 15-year plan for the workforce? When will it materialise, and how will it take all of these matters into account?
The report calls for a “credible, costed long-term” health and care workforce strategy. A nursing team is at the heart of this. I hope that the Minister will hear the points made in today’s debate, but also the previous calls for a proper workforce plan, which will be the only way we can meet the demands upon us.
Vaccinations
Baroness Merron Excerpts(2 years, 6 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Kamall (Con)
I am afraid I am not aware of the details to which my noble friend refers, but I would be happy if he wrote to me. I will then take that back to my department.
Baroness Merron (Lab)
My Lords, more than one in 10 children are not fully protected against measles by the time they start school, and research shows that many parents are unaware that it can lead to serious complications, such as pneumonia and brain inflammation —or, indeed, that it can be fatal. With the major focus on Covid vaccinations over recent years, what assessment has been made of the effect on the uptake of routine vaccinations, including MMR? What steps are being taken to restore any affected vaccination levels?
Lord Kamall (Con)
The noble Baroness raises a very important point. We have to recognise that the UK has one of the most comprehensive childhood and adolescent immunisation programmes in the world. We have seven national childhood immunisation programmes, three adolescent programmes and two elderly programmes. Vaccine uptake in the UK remains high overall, but there has been some decline in routine childhood vaccines—so we have been looking at school-based immunisation programmes, some of which were clearly interrupted due to Covid. At the same time, from October to December 2021, the coverage of childhood vaccination programmes actually increased.
Defibrillators
Baroness Merron Excerpts(2 years, 6 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Kamall (Con)
All I can say is that I hope so. I will try to find out and commit to write to my noble friend.
Baroness Merron (Lab)
My Lords, with Travelodge, Tesco and Royal Mail all announcing that they will participate in the British Heart Foundation use training pilot, will the Minister undertake to look at the potential impact of this training on saving lives and work with his ministerial colleagues across government to encourage such training on defibrillator use by other companies, the public sector and other organisations?
Lord Kamall (Con)
If noble Lords will excuse the pun, one of the heartening things in answering this is that, when I received briefing on this, it is really important and interesting how we are working across government. It is not only in the Department of Health; we are working with the Department for Transport on transport locations, DCMS on sports grounds, the Department for Education on education settings and other departments. This is really a cross-government initiative.
Personal Protective Equipment: Waste
Baroness Merron Excerpts(2 years, 6 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Merron
To ask Her Majesty’s Government what assessment they have made of the expenditure on unusable and excess Personal Protective Equipment (PPE), and the reasons for the waste.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Lord Kamall) (Con)
We have delivered over 19.8 billion items of PPE to keep front-line staff safe. Facing a dangerous virus, and against the background of no vaccine, as well as rising demand, market disruption and panic buying, we procured as much PPE as possible rather than too little. Only around 3% of PPE that the department purchased is unusable, and we are working with waste providers to dispose of unusable stock in the most environmentally friendly and energy-effective way.
Baroness Merron (Lab)
My Lords, £9 billion was wasted on PPE due to obscenely inflated prices, irregular payments to intermediaries and faulty kit which is now poised to go up in smoke, along with nearly one in four of the contracts in dispute around products which are not fit for purpose or where allegations of slavery have been made. We know that the Government were responding to an unfolding crisis, but how was this shameful episode allowed to go unchecked and why has the department been allowed to establish a track record for not following public spending rules?
Lord Kamall (Con)
We have to go back and remind ourselves of the situation in 2019 and 2020. We have to remember that, at the time, there was no vaccine and the whole market suddenly panicked—people were competing with each other to buy equipment. We heard stories of government officials sitting in factories with suitcases of cash, trying to make sure that they could buy material at the best possible prices, and at the same time we saw containers being redirected at sea and people being gazumped. We therefore made the decision at the time, without being accurately able to predict how much PPE equipment we needed—no one could have done so—to procure as much as possible.
Health and Social Care Leadership Review
Baroness Merron Excerpts(2 years, 6 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Baroness Merron (Lab)
My Lords, I thank everyone who works in the NHS for their continued dedication and skill. We owe them our gratitude. I also put on record my thanks to General Sir Gordon Messenger and Dame Linda Pollard for leading this very important review.
We know that we are at the foothills of a huge programme of NHS reform and reorganisation, which your Lordships’ House carefully scrutinised during the passage of the Health and Care Act. It came through loud and clear that the healthcare system requires proper leadership and a workforce that has enough staff to do the job, something that we know is not the case at present nor is suitably in the pipeline.
I confirm that these Benches support the review’s seven recommendations and welcome that the Secretary of State has already agreed to implement them. However, the critical thing will be to see whether, when and how the proposals are implemented and we will keep a close eye on this. Regrettably, we have too often seen the commissioning of a review by Ministers only to see those same Ministers drag their feet on implementing the recommendations or shelve them completely. Will the Minister give us today a firm date for when he intends to publish the plan to implement the seven recommendations?
The social care survey from the Association of Directors of Adult Social Services shows that more than 500,000 people are waiting for a social care assessment in England, and we need swift action to alleviate this. Will the Minister explain why the review has not covered leadership in social care or primary care in sufficient detail? Is not this a missed opportunity?
Of course, this review is just one part of dealing with the crisis that the NHS faces. New staff getting an induction when they first join the NHS is sensible, but that is just a basic requirement of any organisation worth its salt. We all know that there are bigger, real mountains to climb. Waiting lists are at a record high: 6.4 million in the queue for treatment—nearly one in 10 people—patient satisfaction is at its lowest since 1997, and there have been longer waiting times for cancer treatment in every year since 2010. So it goes on.
There are currently 106,000 vacancies in the NHS, and staff are leaving in droves. In many specialities, they are leaving faster than they can be recruited to those vacancies. It remains to be seen how a shake-up for management will help our health outcomes and alleviate pain and suffering when there are not enough front-line staff. This has to be the Government’s focus.
Yesterday, the Secretary of State talked about the 15-year workforce strategy that he has commissioned. When can we expect it? It would be much appreciated if the Minister could put more flesh on the bones of this brief reference yesterday. Who will be leading this and what will be its terms of reference?
It would be negligent not to mention the role that managers played in the North East Ambulance Service cover-up. The Government are still considering whether to launch a review. Will the Minister provide an update? Surely, if management is to be improved, there is a need to learn from the times when it fails. The incidents at the North East Ambulance Service are a clear case in point.
Finally, it is regrettable that NHS senior leadership still does not represent the diversity of the population that it serves. How will the Government drastically improve equality, diversity and inclusion? And how will the best leaders—whether or not they have a so-called good network—be encouraged, prepared and brought into the most challenging roles where we need to see them?
These Benches welcome the review and its recommendations, but there are many outstanding questions while the NHS is in dire need of support and a workforce able to meet the demands and serve the people who need it.
The Deputy Speaker (Baroness Fookes) (Con)
My Lords, the noble Baroness, Lady Brinton, is taking part remotely and I now invite her to speak.
Children: Cancer
Baroness Merron Excerpts(2 years, 6 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Kamall (Con)
I completely apologise to all noble Lords. It is important that we look at this issue; I am afraid I will have to write to the noble and gallant Lord with more detail.
Baroness Merron (Lab)
Following on from the question of the noble and gallant Lord about the matter of significant improvements being made in the lives of children with cancer by detecting cancer early and avoiding delays in care, there are of course three components to early diagnosis, with the first being awareness of symptoms by families and primary caregivers. Can the Minister tell your Lordships’ House what assessment has been made of the level of awareness and what is being done to promote that awareness among families and primary caregivers?
Lord Kamall (Con)
The noble Baroness raises an important point about how we raise awareness, and that goes right across not only the population but patients themselves. NHS England and NHS Improvement are developing plans for future phases of their Help Us Help You campaign to raise awareness of key cancer symptoms. To date, the campaign has contributed to the record high levels of urgent cancer referrals that the NHS has seen since March 2021.
Perhaps I may take the opportunity to address the question from the noble and gallant Lord. Covid clearly affected the backlog. One of the things about the waiting list is that now 80% of people on it are waiting for diagnosis. One of the issues we are looking at is how you push out more community diagnosis centres around the country, not only in hospitals but in shopping centres and sports arenas, so that effectively we go to the patient and detect as early as possible. We hope that all that, in conjunction with things such as blood testing and genomic sequencing, will lead to earlier diagnosis.
Sugar Reduction Programme: Bread
Baroness Merron Excerpts(2 years, 6 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Kamall (Con)
Right. I begin by thanking my noble friend for that very comprehensive question. As I said earlier, some sugar is needed in the process, but he makes an important point about how we reduce the unneeded additional sugar that is added. I have already given the reasons why there is some sugar, and no doubt the chemical processes will be improved over time: as mankind’s innovation and ingenuity increase, we will see more substitutes for sugar. I was also interested in the point made by the noble Lord about chapatis; next time I go to a restaurant I will ask about their sugar content.
Baroness Merron (Lab)
My Lords, with the UK attending the 75th World Health Assembly in Geneva as we speak, it is concerning that the Government have delayed their planned measures to encourage a move away from foods that are high in fat, sugar and salt. To compensate for this, particularly for those who are experiencing higher levels of deprivation, can the Minister tell your Lordships’ House in what specific ways the Government intend to show the leadership that is so urgently needed?
Lord Kamall (Con)
I thank the noble Baroness for raising that point. Part of my role is in international health diplomacy, where other countries come to the UK wanting to learn from us. It is very interesting that a number of other countries are asking to learn from our sugar and salt reduction programmes, our alcohol and anti-tobacco programmes and our campaigns for healthy eating—not just telling people they should not do things but encouraging them to have a healthier lifestyle
NHS Dental Services
Baroness Merron Excerpts(2 years, 6 months ago)
Lords ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lord Kamall (Con)
On the face of it, that sounds a reasonable suggestion, so I shall take it back to the department and see if the people there agree.
Baroness Merron (Lab)
My Lords, reports of children who can no longer chew food normally and who have never seen a dentist are damning indictments of the lack of NHS dental services. With sugary drinks and snacks contributing to poor dental health, why have the Government decided to delay the introduction of restrictions on advertising unhealthy products? What assessment has been made of how this delay will affect children’s teeth and create additional pressure on the NHS?
Lord Kamall (Con)
I know the noble Baroness has been trying to get that question on the agenda as a Private Notice Question, so I congratulate her on asking it now. Clearly, it is right that we address this issue. The recent delay was only because of certain promotions, because we wanted to see this holistically with the cost of living crisis. Restrictions or a ban on, for example, where products can be placed will still go ahead in premier areas. Overall, it is right that we get balance to this, as any Government must. There are clearly concerns about affordability, which is why we have delayed those measures, but let us be quite clear that this is a delay; we are not kicking this into the long grass.