Coronavirus: UK Deaths
Baroness Merron Excerpts(4 months, 2 weeks ago)
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Lord Robathan
To ask His Majesty’s Government what initial assessment they have made of the number of deaths in the United Kingdom from coronavirus compared to other countries, and of whether the policy of lockdowns in 2020 was effective.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, estimates of excess mortality from the Office for National Statistics show that, between January 2020 and July 2022, the UK’s cumulative overall mortality rate was 3.1% higher than expected. Using this measure of excess mortality, the UK was ranked 15th highest out of 29 European nations examined by the ONS. Research funded through the National Institute for Health and Care Research estimates that national lockdowns saved more than 470,000 lives in the UK in the first few months of the pandemic.
Lord Robathan (Con)
I welcome the noble Baroness to her position. She may not remember, but I did ask the same question of the last Government. I am sorry that the noble Lord, Lord Vallance, is not answering the question, because he has an encyclopaedic personal knowledge of this—and I would like to welcome him to his position as well. I will pick up the noble Baroness on what she has just said, because it appears that the Swedish model had a lower death rate than the UK model. We know the impact on the economy, on mental health and particularly on children’s education that the lockdowns had, and the important thing, as the noble Baroness will know, is to not make the same mistakes again. So could she please examine this more carefully and come forward with an initial assessment on whether lockdowns, on a cost-benefit analysis, were worth having?
Baroness Merron (Lab)
I thank the noble Lord for his kind welcome and I hear his disappointment that it is not my noble friend Lord Vallance—who will be extremely flattered—answering. On the matter of lockdowns, I start by paying tribute to the British public; it was they who rallied to ensure that lockdowns could save lives. Before Oral Questions, I met with the Chief Medical Officer to discuss the very point that the noble Lord has raised. I say to the House that, when looking at other countries, it is very important to consider the complexity of comparison; it is just not possible to draw direct comparisons. But what I can say is that we are of course waiting for the Covid inquiry, which will shine a light on a number of the matters that the noble Lord has raised.
Lord Patel (CB)
My Lords, on a previous occasion when the noble Lord asked the same Question and cited the Swedish mortality rates, I cited a study carried out in Scandinavia comparing the Swedish model with Scandinavian countries that implemented lockdowns. It clearly showed that the death rates were lower in those Scandinavian countries that implemented lockdowns. To satisfy the noble Lord today, I asked ChatGPT to compile all the evidence. It said:
“In summary, while lockdowns during COVID-19 were effective in reducing death rates from the virus itself, they also had complex and varied impacts on overall public health. The net effect on mortality rates includes both the direct benefits of reduced transmission and the indirect consequences of restricted mobility and access to healthcare”.
Will the Minister agree that there is now some evidence that lockdowns were effective in reducing mortality?
Baroness Merron (Lab)
I thank the noble Lord for his informed observations. It is true to say that every Government were making decisions based on balance and that, with that, as the noble Lord said, not locking down would have meant that more lives would have been lost. It is important to put on record that the clear majority of professional opinion in this country was that lockdowns absolutely had their place. Even though there was a balance in terms of difficulties with mental health, access to services and the impact on the economy, in Opposition we supported the then Government, as we would in any national emergency.
Baroness Neville-Rolfe (Con)
I too welcome the noble Baroness to her role. On a less complex point, lockdown is a very expensive policy and should be used in very limited circumstances. So does the Minister agree in particular that damaging lockdowns in schools—this is about the education of our children—always need to be avoided if at all possible?
Baroness Merron (Lab)
I thank the noble Baroness for her kind welcome. Of course, this was a decision taken by the last Government, supported by the Official Opposition. I would say that these kinds of factors were complex rather than “less complex”. Nobody wants to have to lock down a country, but there are rare occasions when we have to consider that. Of course, circumstances changed under lockdown: the fantastic work of the vaccination programme and the vaccine allowed us to unlock. So it is always a moving feast—but I take note of the noble Baroness’s point about the impact on young people.
Lord Scriven (LD)
My Lords, the last Government decided to stop various methods for testing Covid-19 last year, other than for those in hospital. Other countries, including the USA, still collect data and the World Health Organization publishes it. So could I ask the Minister to help with public health screening and planning? Will the Government potentially look at this kind of testing being done again and the results published?
Baroness Merron (Lab)
I will look into the noble Lord’s point and come back to him in greater detail. But, fortunately, we can observe at least that Covid-19 is now a relatively mild disease for the vast majority of people. That allows us to put in place a more targeted programme aimed at those who are at higher risk of developing serious Covid-19. It is important that we take technical and expert advice about where we put our efforts.
The Earl of Clancarty (CB)
My Lords, following on from the last question, will the Government ensure that the large number of long Covid sufferers do not become victims of the Government’s drive to get the unemployed back to work when what they need primarily is the right medical care and, if necessary, financial support while they get well again? The clue is in the name of the condition; this could be a long process for many, as the Minister will appreciate.
Baroness Merron (Lab)
I certainly do appreciate the point made by the noble Lord and certainly, as of April this year, there were some 90 adult post-Covid services introduced across England, along with an additional 10 for children and young people in the manner of hubs. I hope that will be a great support. Long Covid remains something of a new challenge, but these services are offering integrated assessment, medical treatment, rehabilitation and direct access to diagnostics and I can assure the noble Lord that we will not take our eye off the ball.
Lord Sikka (Lab)
My Lords, a report by the Institution of Health Equity earlier this year stated that, between 2011 and 2019, over 1 million people died prematurely from a combination of Covid, austerity and poverty, which is a shameful record for the last Government. Can the Minister assure the House that this Government will not neglect the poor and will protect and enhance the real value of wages and benefits?
Baroness Merron (Lab)
I can certainly assure my noble friend that we will be working across government to join up our approach because, as I have mentioned in a previous question, the complexity of all this is not to be ignored. Indeed, it is the case that people’s incomes, where they live, the lives that they are managing and how their health is—whether they are, for example, obese or smokers—all impact on health and affect excess deaths. It is our duty to find ways of reducing avoidable deaths and we will do so.
Baroness Bennett of Manor Castle (GP)
I thank noble Lords. Following on from the question from the noble Earl, Lord Clancarty, about long Covid, and of course continuing new cases are arising even from apparently initially mild infections, we also face the threat that I hope the Government are watching closely of H5N1 in terms of other respiratory diseases, and we know it is only a matter of time before another respiratory pandemic faces us. What steps are the Government taking to look at air filtration and ventilation systems to provide a better public health system that is more resistant to future diseases in schools and other public buildings and perhaps to provide ways for people to assess in premises they visit how good the ventilation and filtration is for them to be able to go into those environments?
Baroness Merron (Lab)
The noble Baroness offers some helpful suggestions as to areas that we can be looking at, but this for me all comes under the headline of resilience and certainly we are monitoring potential emergencies, including the one that the noble Baroness refers to. I can assure her also that preparedness will not just focus on respiratory means of passing on disease but will now look at all of the five routes of transmission, and I feel that will make us a much more resilient country.
Black, Asian and Minority-Ethnic Women: Maternal Mortality Rates
Baroness Merron Excerpts(4 months, 2 weeks ago)
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Baroness Gohir (CB)
My Lords, I beg leave to ask the Question standing in my name on the Order Paper, and declare my interests as set out in the register.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, I first pay tribute to the noble Baroness for her work with the Muslim Women’s Network, and for her excellent campaigning to end appalling inequities in women’s experiences across the country. Interventions such as enforced continuity of care for the most deprived and initiatives to tackle racism are key. However, further, urgent action is required. This Government are committed to closing the black and Asian mortality gaps and to ensuring safe and compassionate care for mothers and babies alike.
Baroness Gohir (CB)
I thank the Minister for her comments. A number of maternity reports tell us exactly what is contributing to the poor outcomes for minority-ethnic women and their babies. Will the Government bring the recommendations in those reports together to ensure that hospital trusts and medical professional bodies follow them? Will the Minister consider appointing a maternity commissioner, because it would save lives?
Baroness Merron (Lab)
I certainly agree with the noble Baroness that the maternity landscape is extremely crowded; there have been a number of reports and inquiries, along with investigations. I shall look very closely with officials at the recommendations from those reports as well as those that are forthcoming. With regard to an independent commissioner, I feel that there is general agreement about what the issues are, and the most important priority is to take action. Of course, in reviewing what is going on, as I am now in this post, I will consider all suggestions, and that includes the one from the noble Baroness.
Baroness Uddin (Non-Afl)
My Lords, I also thank my noble friend Lady Gohir for her continuous campaign. I declare an interest having been involved in these matters in Tower Hamlets for some 40 years. I congratulate the Minister on her ministerial role. When she seeks to consolidate these matters and take the best course of action, will she ensure that she looks at the reports that have been on the shelves at the Royal London Hospital trust for the best part of 40 years?
Baroness Merron (Lab)
I thank the noble Baroness for her kind remarks and good wishes. Certainly, all reports will be considered because we will look for what works.
Baroness Benjamin (LD)
My Lords, sickle cell disorder affects mainly people whose heritage is from Africa, the Caribbean and Asia, and the Sickle Cell Society’s report, No One’s Listening, shows that people with sickle cell experience discrimination when they engage with the NHS. We know that black and Asian women are four times more likely to die in childbirth. Can the Minister assure the House that NHS maternity units have the right level of training, staffing and systems to support safe care for expectant mothers living with sickle cell? I declare an interest as a patron of the Sickle Cell Society.
Baroness Merron (Lab)
The noble Baroness is quite right to draw the House’s attention to the important matter of sickle cell. We look to specialist midwives to assist us in this. I have been asked for a particular assurance and it is correct that the noble Baroness seeks that. I shall be pleased to look into it to be able to come back to her in much greater detail.
Baroness Sugg (Con)
My Lords, the previous Government introduced the first ever UK women’s health ambassador, who can help to co-ordinate the complex changes that are needed to reduce the mortality rate for black, Asian and minority-ethnic women and their babies. Can the Minister commit to continuing to support the ambassador’s work?
Baroness Merron (Lab)
I pay tribute to the noble Baroness for her work promoting good health for women and girls, and I look forward to working with her and with other noble Lords across the House. One of the first calls that I made was to the women’s health ambassador and I will certainly look to her to drive forward the change and improvements in patient safety and patient experience that we desperately need.
Baroness Prashar (CB)
My Lords, while I welcome the Minister’s commitment to look at all the recommendations that have been around for a pretty long time, and it is frustrating that action has not been taken, can she give a commitment that once she has considered those recommendations, and if there is a plan of action, she will report to the House on what that plan is likely to be?
Baroness Merron (Lab)
I will indeed be very pleased to report back to your Lordships’ House on this matter. It is something that greatly concerns me, because it cannot be acceptable that women go into childbirth, which should be a happy and safe occasion, and perhaps come away with trauma, and in some cases families experience death as well. We cannot have a situation like that. I have been very moved by the stories I have heard and will commit to working to put improvements in place, and to sharing that with noble Lords.
Lord Kamall (Con)
My Lords, I welcome the Minister to her place. I look forward to working constructively with her as we did when our roles were reversed. Has she read the report by Sands, the baby loss charity? It gave examples of Asian parents being dismissed as either being too anxious or exaggerating their claims, while black parents were stereotyped as feisty or dramatic by some NHS staff. When I was a Minister, a young female civil servant told me about her friend, a young Afro-Caribbean lady whose baby died during birth. When she tried to get the records for what happened that evening, she was told that they had somehow magically disappeared. She was being gaslighted. We know that the majority of NHS staff are highly dedicated but, when we hear stories such as this, what does the Minister believe should be done to tackle the culture of cover-up and gaslighting by that small minority of NHS staff?
Baroness Merron (Lab)
I thank the noble Lord for his kind remarks; I am very pleased to see him again across the Dispatch Box. The duty of candour is extremely important in all this. Racism in this area is not just towards mothers and families; as the noble Lord said, it is also towards staff. Clearly, we need to tackle this for both patients and staff. The patient’s voice is key. Even at this early stage, it is quite clear to me that women, and people of black, Asian and minority-ethnic heritage, are not being listened to. We will bring forward plans to put this right. As part of the report to which I referred earlier, I will be glad to update the House in this regard.
Baroness Blackstone (Lab)
My Lords, I declare my interest as set out in the register. Given the complexity of the causes of these unacceptable mortality rates, what is the Minister’s department doing to ensure that there is a cross-government approach to ending the maternal mortality gap?
Baroness Merron (Lab)
My noble friend is quite right: this is a cross-government matter. There are complex reasons why black, Asian or minority-ethnic people are suffering far worse than those who are white. They include socio-economic factors such as deprivation and health inequalities being felt across the whole range. It is not going to be possible to solve this without cross-government co-operation. I look forward to working with my ministerial colleagues to put it right.
Baroness Hussein-Ece (LD)
My Lords, I too welcome the Minister’s commitment to addressing this very serious issue. As other noble Lords have mentioned, there have been numerous reports over the years from different trusts highlighting the crisis in maternity services. Training will help, but we hear constantly that a shortage of maternity nurses in many trusts is leading to such situations. The noble Baroness also mentioned that women are simply not being listened to. This has come out in many reports. Will she ensure that women’s voices are heard when they are in labour and giving birth, as they are the experts about their own bodies?
Baroness Merron (Lab)
I can say yes to the noble Baroness on the second point, because if we do not listen to patients, we will not get it right. The Government are committed to training more midwives and health visitors and to incentivising continuity of care, as well as to making sure that the National Health Service is focused on tackling inequalities that can be described only as shocking. I absolutely agree about training, but we also need leadership and a determination from the top to put this right, as well as practical plans.
Northern Ireland Dentists: Amalgam Fillings
Baroness Merron Excerpts(4 months, 3 weeks ago)
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Baroness Hoey
To ask His Majesty’s Government what plans they have to ensure that dentists in Northern Ireland will still be able to use amalgam fillings when the EU ban their use from January 2025.
The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)
My Lords, on 19 July, as a result of constructive work between the UK Government and the EU, the EU published a notice that recognises the unique circumstances of Northern Ireland and the representations that have been made by the UK Government. It set specific arrangements in place for Northern Ireland, providing an additional 10 years to still use amalgam fillings, or until an earlier time is agreed by the Minamata convention, to which the UK is party.
Baroness Hoey (Non-Afl)
My Lords, I thank the Minister for that Answer, which will be very much welcomed by dentists in Northern Ireland, but does she understand that there is a fundamental issue here? There are many more health and other regulations that will need that kind of begging of the EU to make a difference, because Northern Ireland is still under the Windsor Framework and the protocol. Will she commit to working to ensure that Northern Ireland’s place in the United Kingdom, as a fully integrated part of the United Kingdom, is restored, and that this Government will do what they can to make that happen as soon as possible?
Baroness Merron (Lab)
As the noble Baroness is more than aware, the Windsor Framework is exactly about safeguarding Northern Ireland’s integral position in the union and the UK internal market. I can assure your Lordships’ House that the Government are committed to implementing the Windsor Framework in good faith. This is a particular set of circumstances and the first opportunity to secure such arrangements, so it is important to see it in this light. I am glad that the noble Baroness welcomes this action by the Government; it is certainly intended to serve the good people of Northern Ireland, and I am glad to be able to present that today.
Baroness Ritchie of Downpatrick (Lab)
My Lords, I refer to my entry in the Register of Lords’ Interests. I welcome the derogation on amalgam fillings, because that issue has been persisting for some time. It proves that a Labour Government are working to find solutions to the outstanding matters relating to the Windsor Framework. In that respect, will the Minister and her colleagues undertake to provide us with details of the resetting of the relationship between the UK and the EU? There are several outstanding matters relating to veterinary medicines and the EU’s carbon floor.
Baroness Merron (Lab)
I am glad that my noble friend welcomes today’s announcement. I am sure the House will appreciate the particular set of circumstances surrounding amalgam, which are extremely complex. This has required considerable collaboration between several departments, as well as the devolved Administrations. I hope it will be regarded as something very positive, but I can assure my noble friend and your Lordships’ House that I will discuss with my ministerial colleagues the points being raised about the Windsor Framework and the relationships that that entails.
Lord Lexden (Con)
Do the Government accept that there is indeed a considerable amount of further work to be done to ensure that the Windsor Framework provides fully for the free movement of all goods within our precious single market?
Baroness Merron (Lab)
Certainly, the Windsor Framework, under which some EU rules apply in Northern Ireland, is intended to help the EU and the UK work together constructively and to ensure the smooth flow of trade within the UK internal market. I am sure that my colleagues in the Northern Ireland Office will continue to keep that under review. I know that the Northern Ireland Secretary has been very involved in the amalgam issue.
Lord Foulkes of Cumnock (Lab Co-op)
My Lords, will the Minister confirm that the noble Baroness, Lady Hoey, is one of the people who got us into this mess in the first place?
Baroness Merron (Lab)
I thank my noble friend for his opinion; that is noted. The Question from the noble Baroness, Lady Hoey, was extremely welcome.
Lord Caine (Con)
My Lords, I congratulate the noble Baroness on her appointment. Clearly, we strongly support the derogation for Northern Ireland, on which we were working tirelessly prior to the election. While agreement is always to be preferred, the Stormont brake remains a crucial democratic safeguard for Northern Ireland in order to prevent the imposition of new EU laws and regulations that, in this case, could have had a devastating impact on dentistry and public health. In the event of that brake ever being activated, will the new Government commit to standing by all its provisions, including the exercise of a veto where necessary?
Baroness Merron (Lab)
I thank the noble Lord for his kind words of welcome and can assure the House that I will certainly do my best in my new role. On the important issue of what next, which I believe the question raises, this will now be a matter for the Democratic Scrutiny Committee in Stormont. It will look closely at what this new arrangement potentially means and will decide the next step, so I suggest that it is in the right place. Of course, we will continue to work closely with our colleagues in Northern Ireland. I believe there will be next steps after we have had the opportunity to hear what the committee says.
Lord Harris of Haringey (Lab)
My Lords, I refer to my interest, as listed in the register, as chair of the General Dental Council. Can the Minister express a view, on behalf of His Majesty’s Government, on the safety of amalgam fillings?
Baroness Merron (Lab)
Yes, I can confirm that amalgam is safe. The reason for this phase-down of the use of mercury, which is in amalgam fillings, is related to the environment. When mercury is released into the environment—for example, through emissions from crematoria—it can get into the food chain, where it accumulates mainly in fish such as shark and tuna. That can affect those who have a fish-rich diet, in countries such as Greenland, Brazil, Japan and China. However, there is no evidence whatsoever that amalgam is unsafe, and it is with that in mind that we have sought this arrangement for Northern Ireland.
Lord Forsyth of Drumlean (Con)
Further to the noble Lord’s rather ungracious question, can the Minister confirm that if we had not left the EU, it would not have been possible to continue with the use of amalgam?
Baroness Merron (Lab)
I am sure that there are many opinions in your Lordships’ House about what would have happened if we had not left the EU, and I think it is probably appropriate that I leave it there.
Lord Scriven (LD)
Does the Minister agree that it is the policy of the British Dental Association eventually to remove amalgam, so this is about not whether it is removed but the timing of its removal, in a way that helps to ensure continual dental services?
Baroness Merron (Lab)
It is indeed, and I thank the noble Lord for his observation, which is absolutely correct. We are very grateful to the British Dental Association for working closely with us not just on this issue but on how we are going to restore NHS dental services across the country, because that is a real task we are going to have to battle with.
Human Medicines (Amendments relating to Registered Dental Hygienists, Registered Dental Therapists and Registered Pharmacy Technicians) Regulations 2024
Baroness Merron Excerpts(6 months, 3 weeks ago)
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Baroness Merron (Lab)
My Lords, from these Benches, we support the overall terms of these draft regulations, particularly the measures on pharmacy technicians and dental hygienists, who have great value in providing timely and quality care to patients where it is safe and suitable for them to do so.
I know that the dental profession is very supportive of the intention to enable dental hygienists and dental therapists to supply and administer the majority of the medicines listed in the regulations. The Minister described the regulations as “common-sense”, and I certainly share that assessment.
However, I just draw the Minister’s attention to the inclusion of two medicines on the list: minocycline and nystatin. These were not supported by the BDA or the College of General Dentistry—I am sure the Minister is aware of this—for a number of reasons, including antimicrobial resistance. In the case of minocycline efficacy, it is not recommended in any national clinical guidelines and its use in dentistry is no longer accepted practice. Perhaps the Minister can therefore say whether the concerns of the key dental stakeholders were taken into account when the decision was made to retain these two drugs on the list. Can he also assure the House that there has been full and proper consultation with both the British Dental Association and College of General Dentistry on ensuring that the regulations are compliant with both national practice and existing clinical guidelines?
Efforts to increase the skill mix in our NHS dentistry workforce and across pharmacy more generally are welcome, but I am sure that the Minister will forgive me for thinking that we perhaps need to go rather further than technical tweaks if we are to reverse the crisis in which NHS dentistry finds itself. However, as I said at the outset, we support these regulations, and I hope that the Minister will be able to reassure us about the medicines that are included in the list.
As this is the last day that the House is sitting in this Parliament, I, like my colleagues before me and, I am sure, after me, would like to take the opportunity to say to the Minister, the noble Lord, Lord Markham, what a pleasure it has been to work with him while he has been in his role. He has always carried out that role with the greatest courtesy, but also with care and determination to improve things, no matter what obstacles he perhaps found in his way. I thank him for his dedication to his role. As he is standing in for the noble Lord, Lord Evans—who was due to be standing in for the noble Lord, Lord Markham—I also thank the noble Lord, Lord Evans, similarly, for the manner in which he has conducted himself in this House. He too has always been most helpful and a real pleasure to work with and has always tried his best to make progress, as I know we all wish to do.
Lord Markham (Con)
I thank the noble Baroness for her kind words. Likewise, if the right words are “thoroughly enjoyed” then I have thoroughly enjoyed working with both the noble Baronesses on the Front Bench on that side, the noble Lord, Lord Allan—he is not here—and many other colleagues, including the noble Baroness, Lady Hayter. There are a number of common-sense things that we have managed to work through together.
I too take this opportunity to thank all noble Lords. It was a baptism of fire when I started two years ago, but I have come to really respect the function of the House and how well it holds our feet to the fire. We are all, in British society and in the Government, much the better for it.
On the questions raised, particularly regarding minocycline 2%, there were concerns raised, as the noble Baroness said, including by the British Society of Periodontology. However, when it was looked at, it was felt overall that it was best to keep it on the list because the concerns are quite low. On balance, it was worth keeping it on the list, but keeping it under watch—for want of a better word. Concerns were also raised around nystatin oral suspension but, again, it was felt that there were certain health benefits for certain groups of patients. But there will be training associated with these medicines, to ensure patient safety.
I will happily write in more detail on these—as is my wont; that is my “get out of jail free” card, in many cases—to make sure those questions are properly answered. I welcome the comments from the other Front Bench that these are sensible arrangements. With that, I beg to move.
Integration of Primary and Community Care (Committee Report)
Baroness Merron Excerpts(7 months, 1 week ago)
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Baroness Merron (Lab)
My Lords, I congratulate my noble friend Baroness Pitkeathley on her incisive introduction of what I consider to be a pragmatic and thoughtful report, although I am sure it did not make for pretty reading by the Minister. I thank all members of the committee for their thorough application to the task that was before them: to shine a light on integrating primary and community care to put patients at the centre, which is exactly how it should be. They have done it by offering solutions that are, to quote my noble friend Baroness Pitkeathley, “simple and virtually cost-free”. I am sure that your Lordships’ House would say to any incoming Government, “Watch and learn”.
I am delighted to commend the noble Lord, Lord Jamieson, on his excellent maiden speech, through which he surely honoured the memory of his late mother. As the noble Lord so clearly understands the links between health, housing, environment and other factors, I am sure that we can all look forward to his constructive future contributions.
Day in and day out, primary and community care services provide vital support to millions but, like much of the NHS, they are under considerable strain. Yet, as the noble Baroness, Lady Tyler, said, acute services receive more attention and priority from the Government.
The backdrop to this debate is that backlogs have now reached more than 1 million in community health services. The latest NHS data shows primary care delivering almost 30 million more appointments in March, which is an increase of 25% compared to the same period before the pandemic. Yet, as your Lordships’ House has noted on many occasions, the greatest economic returns from the NHS budget come from investing in primary and community care. This makes good sense.
Some £14 is added to the economy for every £1 invested, and, crucially, it lowers demand in the need for hospital and emergency care. This begs the question being probed in this debate, and which is the headline question to put to the Minister: if these points are accepted—and maybe they are not, in which case I am sure the Minister will say that—then why is there a concentration on acute services, at the expense of prevention and proper integration between primary and community care? There is also a lack of proper integration between the NHS and social care. Why has this situation been allowed not just to develop but to deepen in its severity?
The noble Lord, Lord Altrincham, highlighted that it was repeatedly put to the committee that poorly co-ordinated care undermines the quality of patients’ experiences and can have profound consequences for their long-term health. It should not be that somebody’s health and well-being gets worse because professionals do not contact each other; because patients are made to make inconvenient and unnecessary trips to multiple locations and practitioners; because staffing is inadequate; or because records are not being shared. It is telling that a broad range of witnesses repeatedly spoke of the problematic lack of integration between social care and the National Health Service, even though social care was not within the remit of the report.
For all this, I have heard noble Lords describe the Government’s response to this report as delayed, disappointing and failing to match words with the necessary focus and action. I welcome the principles behind the report’s key recommendations. I trust that the Minister will do likewise and tell your Lordships’ House what more the Government will be doing than is currently the case.
I am sure that many noble Lords will, like me, remember the ambitions articulated during the passage of what is now the Health and Care Act to formalise the integration of primary and community services. However, NHS leaders are telling us that this is not supported by the current commissioning and contracting arrangements. The policy continues, they say, to be developed in silos from the centre, both at NHS England and at the department. I will be interested to hear the Minister’s response to this observation.
For many of us, being treated at home, or as close to home as possible, is best for our health. It is how we want to be cared for. It is also the most efficient and cost-effective for the National Health Service. Nobody wants to be left waiting until hospital treatment is needed; that makes no sense at all. As envisaged in the Health and Care Act, integrated care systems still have the potential to create more joined-up health and care, with primary care being integrated into broader NHS services in the community, through schemes such as Pharmacy First and through the extension of access to services, such as by evening appointments to fit around the needs of local populations.
There is no appetite for further structural reform, but we need to know what is working and what is not. What assessment have the Government made of the effectiveness of ICSs? What are the obstacles to success and how will they be overcome? Is everything in place to ensure that ICSs can make the best possible use of their allocated funds to plan and innovate?
The report highlights the need for a seamlessly integrated patient-centric healthcare sector where patients are given the type of care that they need, when, where and how they need it, whether that be through access to a GP, a pharmacist or a district or mental health nurse. I can tell the House from these Benches that if the next Government are a Labour one, we are committed to making change so that more people get care at home in their community—shifting services out of hospitals and into the community, so that the NHS becomes as much a neighbourhood health service as it is a National Health Service.
The report also says that the Government should focus more on preventive rather than reactive care to tackle the needs of an ageing population, many of whom are coping with complex health issues which require intricate and continuous care. We share that view and are committed to change: we will focus on prevention, shifting the focus to embedding long-term planning, tackling the social inequalities that influence health, ensuring children have the best start possible, empowering people to take responsibility for their health, improving screening programmes and boosting capacity in local public health teams.
I was struck by the observation articulated by the noble Baroness, Lady Finlay, that the committee heard more frustration expressed by witnesses on the inadequacy of digital connectivity than almost anything else. They identified technical issues, cultural attitudes and misunderstandings about GDPR. The noble Baroness, Lady Barker, put it well: that currently, the co-ordination of patients’ data is no one’s responsibility. How do the Government intend to address that point?
What is the Minister’s view as to whether legislation and guidance need to be reviewed to ensure that the tension, whether real or unjustified, between data privacy and effective healthcare planning and provision is overcome? As the noble Lord, Lord Allan, raised, does the Minister consider that appropriate training has been and is being given?
Turning to the workforce, dealing with the problems of its recruitment, retention, numbers, training, morale and well-being will support the integration of services, as spoken to by the noble Baroness, Lady Redfern. What plans are there to include integration in training, and how will NHS and local government staff be made aware of other services and how to work closely with them? Does the Minister consider that the social care workforce should be a component of the NHS long-term workforce plan?
Putting patients at the centre is, as my noble friend Lady Armstrong wisely observed, far from outlandish. Wrapping the NHS around the patient, instead of the patient having to wrap themselves around the NHS, is how it should be. I hope that this report will contribute to that outcome.
Immunisation: Children
Baroness Merron Excerpts(7 months, 1 week ago)
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Lord Markham (Con)
The noble Baroness is quite right. I had two young sons at around that time, and it was a concern. Of course, we did go ahead, but it was a consideration. It is an excellent question. I have not seen the study of those various cohort groups but I will go back, because it is something we need to bring out.
Baroness Merron (Lab)
My Lords, it is concerning that measles cases continue to rise, with a particular spike in London, where certain areas have low vaccination rates. With the advent of microarray patch technology, can the Minister confirm that this is being looked at? Does he agree that the chance to dispense with using needles and special storage, and the opportunity to use less of professionals’ time, could present an opportunity to drive up vaccination rates?
Lord Markham (Con)
It has to make sense to take more measures that are easy for people, including maybe less skilled people, to operate. Funnily enough, I was talking just today to the head of Moderna about how it is packing syringes, or has planned to for vaccinations going forward, rather than vials, to take that step out of the process. The easier we can make it, the better.
International Health Regulations: Amendments
Baroness Merron Excerpts(7 months, 1 week ago)
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Lord Markham (Con)
I do agree: I do not think that it would help to postpone it. I had this exact conversation with the American Health Secretary, who is very aware that we are getting nearer and nearer to an American election and, for all the countries to be able to co-operate fully, the timing is right to reach a solution now. However, we will not reach an agreement at any cost or anything which might impact our sovereignty.
Baroness Merron (Lab)
My Lords, the Brownstone Institute, to which the noble Lord’s Question refers, was set up to work against Covid restrictions and lists articles which argue that Covid-19 vaccines do not work, that children should not be vaccinated and that vaccine mandates compare with the crimes of the Soviet gulag. On this basis, perhaps the Minister would like to comment on what note he should be taking of the Brownstone Institute, if any. What assessment has been made of the impact of dangerous propaganda like this on the low take-up rates of vaccinations that we see among minority ethnic groups and where there are regional and social disparities?
Lord Markham (Con)
I thank the noble Baroness. All Members of the House, when we had a good Question on the take-up of Covid vaccines, agreed that information supporting the take-up is a vital health message to get across. To any detractors, I say very firmly that it is not the view of the Government, and I know that it is not the view of nearly all noble Lords.
Covid-19 Vaccination: Coronary Disease
Baroness Merron Excerpts(7 months, 3 weeks ago)
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Lord Markham (Con)
Absolutely. We are all very aware of the damage done by all the myths around the MMR vaccine 20 to 30 years ago and the impact that has had on people. The more we can get the message out, the better. As the noble Baroness, Lady Merron, asked me yesterday, we have learned that it is about making sure that we communicate to all groups so that we can make sure that ethnic minorities and other minority groups get that information.
Baroness Merron (Lab)
My Lords, after many years of stalled progress, the rate of premature deaths from cardiovascular disease continues to increase, for reasons that the British Heart Foundation describes as “multiple and complex”. The warning signs of this have been present for over a decade. As this phenomenon did not start with Covid, what assessment has been made of the contributory factors of government policy pre Covid and what steps are being taken to turn this around?
Lord Markham (Con)
Deaths from heart disease among those under 75 are down by about 20% compared with 2010, which is a clear trend. Notwithstanding that, we are very aware—Sir Chris Whitty is concerned about this—that Covid meant that a lot of people did not get basic heart and blood pressure checks. That is why we have introduced the Midlife MoT, which is designed to give people a 10-year risk analysis; have put blood pressure devices in pharmacies and all sorts of other places to get 2 million checks; and have a workplace heart disease strategy check. All this is designed to get that prevention in place so that people are aware of and understand the risks.
NHS: Long-term Sustainability
Baroness Merron Excerpts(8 months ago)
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Baroness Merron (Lab)
My Lords, I congratulate the noble Lord, Lord Patel, on securing this debate and for introducing it with his characteristic authority, insight and care, with which we are so familiar in your Lordships’ House.
I am delighted that my noble friend Baroness Ramsey of Wall Heath chose this debate in which to make her excellent maiden speech. How proud her mother and father would have been today, and what a difference she made to the life of her late sister, and, indeed, to the National Health Service; and what a difference I know she will make to your Lordships’ House.
To give some context to the need for long-term sustainability, over the last 14 years, as we have heard, the health service has acquired the undesirable distinction of having the longest waiting lists, the lowest patient satisfaction and the worst strikes in its history. The noble Lords, Lord Patel and Lord Kakkar, not only described the harsh realities and inequalities of the current systems but asked what all parties would do about correcting it. I am flattered to be invited to give some flavour of how an incoming Labour Government—if there is to be such a thing—would approach the challenges ahead.
On that point, I am glad that my noble friends Lord Hunt and Lord Reid and the noble Lord, Lord Crisp, recognised the positive impact on the health of the nation of the last Labour Government, in which I had the honour of serving as a Public Health Minister. That allows me to say to noble Lords, including the noble Lords, Lord Bethell and Lord St John, and the noble Baronesses, Lady Boycott and Lady Finlay, that, when it comes to prevention and a focus on the broader improvement of health, I am totally signed up.
My noble friends Lord Hacking and Lord Parekh have brought a welcome analysis to today’s debate. I agree with my noble friends Lord Hunt and Lord Turnberg and the noble Baroness, Lady Hollins, that bullying, burnout and pressure on the workforce is no way to retain or get the best out of people—we need only talk to people in other sectors to remind us of that.
This change will require a change in culture on so many levels. The noble Lord, Lord Crisp, spoke of the fundamental need for shared vision, hope and energy. It struck me that they are exactly what is missing at present in health and social care. As we have heard today and so many times before, social care is inextricably linked to the health service. I remind any incoming Government, including a Labour one, that there are a number of first-rate and considered Lords reports, including on social care, primary and community care, and long-term sustainability. Therefore, any Government would be extremely well advised to delve into them. Wes Streeting, shadow Secretary of State, has been very clear about the measures that need to be taken on social care, emphasising the need for long-term planning, thinking and funding.
The right reverend Prelate, the noble Baroness, Lady Cavendish, and my noble friends Lord Turnberg, Lady Pitkeathley and Lady Warwick were absolutely right to speak about the invisibility of unpaid carers and the poor treatment of employed care staff. That is not sustainable—and neither are the record levels of sickness and long-term conditions that affect the workforce, which my noble friend Lord Davies and the noble Lord, Lord Londesborough, spoke about so clearly.
I do not consider myself a technological expert, but rather a technological convert, which I am sure the noble Lord, Lord Allan, will be very pleased to hear. So I have looked to countries such as Israel, which I believe to be at the cutting edge, which is where the UK needs to be. At the emergency department of the Sourasky Medical Center, people register digitally, identify themselves through facial recognition and measure their own blood pressure, temperature and heart rate in self-triage booths. Patients are given a barcode and a number is sent to their phone, which they can track on a screen. The most serious cases are seen within minutes, and virtually no one waits more than an hour. Last month, this Tel Aviv hospital became the first in the world to integrate an AI chatbot into its triage process.
What is the driving force behind that? This Israeli hospital is designing healthcare around the needs of the patient, which my noble friend Lord Carter and many other noble Lords called for. Sadly, that is very much in contrast with Britain, where our NHS reels from crisis to crisis, while the political debate circles around funding, staffing and pay. The way that we bank, shop, travel and work has been digitised in the past decade, yet the NHS remains largely outdated. There are multiple IT systems in the NHS and no requirement for them to be interoperable.
That means that systems cannot talk to each other, sometimes even within the same hospital, let alone between institutions or between primary and secondary care. There are at least 21 different types of electronic patient records in hospitals and 34 apps to book an appointment. No company would be able to survive with productivity like this, as the noble Baroness, Lady Tyler, said. Let me ask the Minister: how has the Government allowed the NHS to develop like this?
NHS England’s digital lead, Joe Harrison, estimates that every pound spent on technology generates between £3.50 and £4 in savings. Such an approach makes sound financial sense, as well as good health sense. While the case for reform is overwhelming, too often the innovators are thwarted by a fragmented system or vested interests. What is being done to overcome this?
We know that an estimated 13.5 million hours of doctors’ time is wasted every year due to inefficient IT. Fixing that would be the equivalent of 8,000 new doctors joining the NHS. That is the difference between the huge staff shortages that we see and filling almost every vacancy for a doctor. With our country’s population ageing, the health of the public worsening and chronic disease rising, the sustainability of the NHS is crying out for change.
I recently went to the National Theatre’s production of “Nye”, as I know many other noble Lords have done. When he created the NHS in the 1940s, Nye Bevan had absolutely no idea of the scientific revolution ahead. Regrettably, if we dropped Nye Bevan into the NHS today, he would see the modern-day pressures of an NHS that is overly hospital-based and gets to patients too late, at greater cost and with worse outcomes.
If Labour does get into government, we will arm the NHS with the modern technology it needs, doubling the number of scanners, and putting AI into every NHS hospital, so that patients are diagnosed earlier. We will get rid of the unnecessary bureaucracy whereby innovators have to tout their technology to each individual NHS trust; we would stop the need to sign separate agreements with each of them. We will streamline the route in for innovators and put the entire NHS in partnership with the technology and life sciences sector.
Following the pandemic, more than 32 million of us carry the NHS app in our pockets. That provides the potential to transform how the NHS interacts with patients, promotes good health and increases people’s control over their own healthcare. We would make the NHS app not just something to assist the NHS in healthcare but a key component in delivering care—both preventive and curative—and empowering patients.
Finally, what do the health and care leaders want? They know that investing in primary and community care results in a lower demand in hospital emergency care. For every pound invested in the NHS, £4 comes back to the economy. The greatest economic returns come from investing in primary and community care, where we see a £14 economic return for every pound invested. If Labour is to be in government, this is the step change that we will make.
Cass Review
Baroness Merron Excerpts(8 months ago)
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Baroness Merron (Lab)
My Lords, Dr Cass and her team are to be thanked for their rigour and their care with this report, in which they have navigated many complex and sensitive issues. This review into the NHS’s gender identity services concludes that children and young people have been let down by inadequate research and evidence on medical interventions, and they have been failed by inadequate services amidst a debate which has, sadly, been marked by extreme toxicity.
At the same time, at the heart of the complexity around gender identity services are two aspects that are simultaneously true. There are trans adults who have followed a medical pathway and say that, for all the pain and difficulty involved, it was not just life-affirming; it was life-saving. There are also people who followed a medical pathway and say that it has ruined their lives irreversibly and ask how anyone could let that happen. For those children, young people, and now adults, but particularly those who are being referred into gender identity services today, there is a duty to get this right.
The Cass review refers to many scandals, which exposes both the inordinate amount of time that children and young people are waiting for care while their wellbeing deteriorates, and medical interventions that have been made on what could be called shaky evidence. Can the Minister say how it came to be that NHS providers refused to co-operate with this review? How was it allowed that adult gender services would not share data on the long-term experience of patients? What accountability does the Minister feel that there should now be?
The Minister will know that the discussion around the substance of the review has been highly toxic. People have felt silenced, and it has required investigative journalism to prompt this review to take place. Tribute should be paid to journalists, including Hannah Barnes, and to the whistleblowers, who together helped shine a light on the Tavistock clinic. It is concerning to note that Dr Cass said that the
“toxic, ideological and polarised public debate has made the work of the review significantly harder”,
and that will
“hamper the research that is essential to finding”
a way forward. This particularly vulnerable group of children and young people is at the wrong end of the statistics when it comes to mental ill health, suicide and self-harm. They have been badly let down, so we owe it to them to approach this discussion with the sensitivity it demands.
Parts of this report today will sound very familiar: services unable to cope with demand; significant staff shortages; a lack of workforce planning; and unacceptably long waits for the mental health support and assessments that children and young people need, such that in some cases children become adults before they even get a first appointment with the gender identity services. To this point, the Cass review recommends a follow-through of services up to the age of 25, to ensure continuity of care. Will the Minister indicate how long it will take to establish these services, and could the Minister set out what plans there are to cut waiting times for assessments for mental health and neuro- developmental conditions?
Last month’s decision by NHS England to stop the routine prescription of puberty blockers to under-18s is welcome. However, the loophole that exists for private providers risks illegal trading. In the other place, the Secretary of State said that she expected private clinics to follow the report’s recommendations to follow the evidence. I underline our support for these expectations on compliance. Does the Minister consider that further regulation might be needed to enforce the recommendations? Could he say something more about the timescales involved in making progress, both for the CQC to incorporate the recommendations into its safe care and treatment standards and for NHS England’s urgent review on clinical policy for cross-sex hormones?
Children’s healthcare should always be led by the evidence and be in the best interests of their welfare. Dr Cass’s report has provided the basis on which to go forward. This report must also provide a watershed moment for the way in which society and politics discuss this issue. There are children, young people and adults, including trans children, young people and adults, who are desperately worried and frightened by the toxicity of the debate. There are healthcare professionals who are scared to do their job and make their views known. I hope that we can now put children’s health and well-being above all else.
Baroness Burt of Solihull (LD)
My Lords, I believe that the Cass review is an extremely thorough summary of where we are now and of the pathways available to young people that we need to explore. Most importantly, this report gives a way forward for young people and their clinicians who feel anxious and frightened because they find themselves at the centre of a political maelstrom.
Interestingly, the most balanced response I have seen to the report came from Stonewall, which was consulted by Cass, and I have used some of its points here. Cass says that these youngsters have been sorely neglected by the NHS, which sidelined them away from mainstream care to services that have fallen short. She points to how we can start the process of making it up to them, by giving them the holistic care that they need and deserve.
Despite the way in which the report was received by certain gender-critical individuals, it does not question trans identities or recommend rolling back healthcare access. It does not say that puberty blockers are unsafe or dangerous. It does say that there is insufficient and inconsistent evidence about some of the effects of puberty suppression. In addition, it notes that cross-sex hormones are well established and have transformed the lives of trans people, and supports their use from the age of 16. Importantly, it does not, at any stage, suggest a ban on social transition for any age of child or young person, but recommends that this be done with the support of parents and clinicians.
Cass says that gender incongruence is a result of a complex play between many biological, psychological and social factors, of which sexual orientation can be one. There are many factors, and no simple answer. For example, saying that such young people are simply confused gay people, unhappy teenagers, or that it is all the fault of social media, is all too simplistic. Regrettably, this has not stopped the Government spinning their own version of who is to blame.
For example, this week’s Statement by Secretary of State Victoria Atkins said that Tavistock clinicians “almost always” put children on an irreversible path of blocking puberty, then prescribed cross-sex hormones and on to surgery as an adult. This is not my understanding of the situation. In 2019-20, only 161 under-19s were referred by gender identity development services for puberty blockers. It was estimated that only around one in six GIDS patients ended up being prescribed puberty blockers. Is not the picture bad enough, without painting something even worse?
There are currently more than 5,000 children on the waiting list for treatment. The NHS has confirmed that everyone currently on puberty blockers via the NHS—fewer than 100 children—will be able to continue on them. These children, and any new recommendations for puberty blockers, will not be prescribed unless they agree to take part in a clinical trial to test the effectiveness of puberty blockers properly. How long does the Minister estimate that it will take for this clinical trial to be set up? Speaking of waiting lists, I understand that it currently takes three years for a child on the list even to be seen. How will the trial ever be set up, except for the few now on puberty blockers, while the rest languish for years on waiting years while their puberty seeps away? Does the Minister not agree that it is time to make up this shocking treatment which has, or rather has not, been given to children by the NHS and put them immediately on a par in priority with other NHS services?
These are our children. They, and the clinicians who want to treat them, have been intimidated by the toxic environment that we have all helped to create. I have heard the Cass report described as a rock that we can now all cling to. We will never all agree about some quite fundamental issues regarding trans and the nature of trans, but we must never make our children suffer for it; we must never make them pawns in a zero-sum game. We must rise above it and argue well, with more light than heat, to protect our children, who, after all, must be at the centre of all we seek to do.