Health Care Services (Provider Selection Regime) Regulations 2023

Baroness Merron Excerpts

Monday 27th November 2023 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I bring more cheer to the Minister by adding our support for these regulations—I thank him for bringing them before your Lordships’ House today—because the provision of this statutory instrument is to define and give relevant authorities greater flexibility to procure healthcare services. This will, I hope—I know that other noble Lords also hope this—benefit patients and service efficiency by better integrating services. Like the Minister, I am pleased to note that the policy behind these regulations has been informed by both a voluntary impact assessment and an extensive consultation that received 70% support from 420 respondents; this is welcome news.

It is the view of the Opposition that the NHS should be the preferred provider of commissioned healthcare services, not least because it embodies not just a public service ethos but efficiency, resilience and democratic accountability. It is also the case, particularly in the short term, that, in order to treat NHS patients and bring waiting lists down, the independent sector has an important role to play where a service cannot be provided by a public body because the capability or capacity just is not there.

Your Lordships’ House may recall that, when the Health and Social Care Act2012, which my noble friend Lord Hunt described as “wretched” on several occasions, went through its various stages in Parliament, these Benches argued that relevant authorities should have the appropriate flexibility to award contracts, which was something for which the Act did not provide. As my noble friend identified, the competitive tendering requirements of that Act did not serve the NHS, patients or the public at all well. Therefore, where we are today with the provider selection regime, which does allow for this, is as long overdue as it is welcome, as is seeing that good sense, flexibility and efficiency will now apply.

During the passage of the Health and Care Act 2022, these Benches also argued for the legislative provision to be made as outlined in these regulations. Although the Government did not take that on at that time, I am glad that the benefit of hindsight has prevailed and that the Opposition’s view, which was set out during the course of that debate, has now been set out in these regulations.

As the noble Lord, Lord Stevens, illustrated so well, these regulations recognise that it would not be an efficient use of resources in certain circumstances for relevant authorities to use competitive tendering, but that there continues and needs to be a procurement process that relevant authorities can and should use. As the Minister will be aware, concerns have continually been raised about the impact of the current procurement framework, which often places additional burdens on community and mental health providers in particular, where services have been much more likely to be subject to expensive and disruptive competitive tendering processes. I therefore welcome the alignment of the PSR’s aim with the spirit of collaboration within health and care systems, as well as the offer to commissioners and providers of a clear and transparent process by which procurement decisions can be made.

The PSR will offer a consistent model for both NHS and local government bodies to follow with regard to health services, and I hope that this will support local relationships and decision-making, as well as integrated care. However, it is important that national bodies engage with all organisations that will be subject to the new regime in an effort to smooth the transition to a new procurement framework.

I ask the Minister for more detail on how NHS England and the department will review the application of the PSR over the course of the next year to ensure that real-time feedback on the operation of the regime can be collected, as well as evaluated and, importantly, acted on as swiftly as possible. I make this point as it will be crucial to capture feedback on whether any difficulties arise for commissioning bodies in selecting which procurement process is the most appropriate across various different scenarios and circumstances, and whether any challenges arise for providers in the application of their approach.

My noble friend Lord Hunt emphasised the need for support, training and guidance—something that other noble Lords also emphasised. This is a point that the Minister would be well advised, as I am sure he is, to pay absolute attention to, so that we support those who work in NHS procurement and the NHS supply chain, not least because the combination of these regulations, other regulations and other Acts is something of a complex field. We should support and guide those who make the interpretation and the application, and, if necessary, adjust in real time any of that training, support and guidance. More information from the Minister about how this will be done will be extremely welcome.

I am aware that NHS Providers has worked with membership bodies for providers in the independent and voluntary sectors, the department and NHS England to make the case for the new regime to include a challenge function for decisions made by commissioning bodies to be reviewed and scrutinised if appropriate. Although the PSR panel does not have legally binding powers, does the Minister consider it appropriate to give providers some opportunity to challenge the application of the regime and raise legitimate concerns where appropriate?

As I said at the outset, I am glad to provide our support to these regulations. I hope that we can look forward to great improvements because of them in the years ahead.

[Lord Markham (Con)]

I thank noble Lords and welcome the support offered. I appreciate their understanding on my lack of comments on 2012 and all that. I also appreciate having the vast experience of the noble Lord, Lord Stevens, and wonder whether he could be here so that I can phone a friend on some of the questions we have, because I fear he may be far better qualified to answer a lot of them. I will take home the “Think like a patient, act like a taxpayer” mantra.

I think we all agree that, although this is welcome, it is complex. We are trying to set out an approach, knowing that really we want sensible people to act sensibly around the table and to co-operate with each other. We all know that it is very hard to put a rules-based system around that. As all noble Lords have mentioned, the training of staff in that is vital. I have some personal experience, as I know the noble Lord, Lord Hunt, does, of many of the people in this space, and I have to say that they are very good people. My experience is obviously much more on the national level, but clearly it needs to be taken down to the local level as well.

I believe we are publishing the strategic framework for NHS commercial tomorrow. That tries to set out the importance of commercial capability, and the investment and critical skills required. It will be accompanied by a programme that sets out what upskilling needs to be done and a programme, with support from the Crown Commercial Service, that I hope we can effectively use to upskill in the way that we all believe is necessary.

To answer the point by the noble Baroness, Lady Merron, whenever you are trying to put in place a value-based system, for want of a better word, in terms of culture, you have to have those guard-rails around making sure that there are appeals processes and lessons learned. My understanding of this independent panel is that companies or providers that feel they have been wrongly excluded will have the opportunity to appeal directly. I have challenged them quite strongly on that, given my experience in this space, and asked how much a company will really want to be awkward. Often you know that if you are being awkward and challenging, that might make life more difficult for you in future, so there are some difficulties involved there. A lot of companies often ask whether that challenge is really worth it. Getting that right, with the panel, is vital, so that it is welcoming and open and that, as the noble Baroness, Lady Merron, says, there is that “lessons learned” kind of constant review. At probably the year stage, we will look to understand how it has gone so far and what we can learn from it.

Having been involved in quite a few start-ups, I am also very aware of the point the noble Lord, Lord Hunt, made. Time really is money in these things; a regulatory process that is opaque or cumbersome is not very helpful. I acknowledge some of the issues the MHRA has had. That is what the £10 million investment behind it is trying to address. I know it is very much looking to act on this.

A very good example of that is what the MHRA is doing in the point-of-care space. One Brexit advantage that I have seen is the ability very quickly to set rules around point-of-care medicines, particularly around when you take a biopsy and then provide an individual patient with treatment according to that for a certain cancer. Clearly, if you follow the strict rules, you would have to be regulating that every single time, and that just would not work. The MHRA has introduced a sensible framework that tries to adopt an umbrella-type approach. I know that the MHRA understands the possibilities in this space and really wants to use this as an opportunity to show that we can be fleet of foot and leaders in that space from it all.

On the point raised about trusts sometimes having a conflict and the example provided by Specsavers, that is what the panels are supposed to be there for. It is important—I will check this out—that, in the rules, we are guiding the 42 ICBs on how they should manage some of those conflict situations and when they should put people aside. We have all managed it in our corporate and public lives, and there are rules about it. Just as we put the emphasis on noble Lords to declare interests and so on, clearly we must make sure that there are similar rules for the trust CEOs, but it is a point well made that we need to pick up. I look forward to going into some of these issues much more when we have the value-based procurement meeting shortly.

On how we can make the analysis available, I have seen a tool that the NHS has recently introduced which is very good in terms of being able to drill down straightaway and provide that analysis. That is a good base point. I will find out some more about how that needs to be tweaked, but there is a basic premise about making that information available—that is a sensible move. On the point made by the noble Baroness, Lady Merron, it should be used to arm providers with the ability to challenge the panels.

I welcome the input. Such is the knowledge base around this, I am happy to suggest that, in nine months or one year’s time, we have that round table where I will appreciate some of the skills here. We can ask how it has gone down so far. We can do that through a debate, but it is probably better done through a round table, so I would like to propose that so we can learn the lessons.

In summary, I welcome the points made and that noble Lords believe that this is the right direction, although it needs work along the way to make sure it stays going in the right direction and does what we hope it does. With that, I commend the draft regulations to the House.

Motion agreed.

Mental Health Act 1983

Baroness Merron Excerpts

Tuesday 21st November 2023 Lords Chamber

[Lord Markham (Con)]

Yes. The data, and fundamentally understanding what is beneath it, is key to all this. We have put an executive lead on each trust board to look at exactly these sorts of issues, including the data, so I am happy to take that forward.

[Baroness Merron (Lab)]

My Lords, the provisions of the Mental Health Act have no clear definition of a safe place in which a sectioned patient may be taken while awaiting medical assessment. That often results in vulnerable people being taken to police stations and forcibly detained by the police. What assessment have the Government made of the frequency of this continuing due to the Government’s failure to reform the Mental Health Act—something that Labour, if we win the next election, will put right? How will the Government ensure that patients are no longer detained in such inappropriate and punitive environments?

[Lord Markham (Con)]

I appreciate the feeling that our response on minimal standards—in our reply, I think, to the report by the noble Baroness, Lady Hollins —did not go far enough to make sure that those patients are in the right quality setting for them, so the noble Baroness, Lady Merron, has made an important point. I was going through with the team what we can do to make sure that that is right. As I mentioned before, the fact that the CQC now has responsibility for those independent reviews will mean that it will look not only at whether it is right that the patients are in those in-patient environments but at whether it is the right environment as an actual place.

King’s Speech

Baroness Merron Excerpts

Thursday 9th November 2023 Lords Chamber

[Baroness Merron (Lab)]

My Lords, it is a great honour to be closing this important debate on behalf of His Majesty’s Opposition. This is a new chapter for our sovereign and our country and, with it, His Majesty brings the optimism and sureness that we need in these times of division and instability—both in people’s lives and across the world.

The Coronation was a visible illustration of the King’s determination to mark his reign as one celebrating the strength of our multifaith nation. For me, it was the greatest honour to make history by being a part of the ceremony, representing the Jewish community, alongside the noble Lords, Lord Patel, Lord Kamall and Lord Singh, who represented other faiths.

In declaring my interests in the register that relate to the Jewish community and in turning to the gracious Speech, I say how warmly I appreciated the acknowledgement of anti-Semitism and the need to remember the horrors of the Holocaust. Recognition of the barbaric acts of terrorism against the people of Israel exactly one month before the gracious Speech, the facilitation of humanitarian support into Gaza and support for the cause of peace and stability in the Middle East all sent a clear and welcome message.

The areas for debate across the days are crying out for the

“competence, optimism, confidence and vision,”—[Official Report, 7/11/23; col. 11.]

underpinned by good governance, of which my noble friend Lady Smith spoke on the day of the gracious Speech. But what did we get? Ambition, not for the country but for this Government to stay in office; little to inspire or give confidence that the Government really understand the seriousness of the challenges that households and our country face; and widespread cause for profound disappointment, as we have heard today and as my noble friend Lady Twycross set out so clearly in opening this debate.

I would like to focus on the health and social care aspects of the gracious Speech. Let me start with something we can receive well. From these Benches, we look forward to the passage of the tobacco and vapes Bill, although at present it seems that the Government still do not know how to tackle vaping. We are sleepwalking into a new generation of young people being hooked on nicotine through vaping, when the Government should have been coming down hard on the industry, starting with banning the branding, advertising and marketing of vapes to children, actions to which Labour has committed. It is worth reminding ourselves that an amendment to the Health and Care Bill in 2021 that proposed getting the ball rolling in this way was voted down.

Professor Sir Chris Whitty has put it very well:

“The key points about vaping … can be easily summarised. If you smoke, vaping is much safer; if you don’t smoke, don’t vape; marketing vapes to children is utterly unacceptable.”


Reports not so long ago suggested that the Government were considering an outright ban, but now they are exploring and consulting on options. I look forward to hearing from the Minister about when we can expect a clear plan from the Government.

I turn to just some of the glaring omissions from the gracious Speech. The NHS workforce plan, on which the gracious Speech leant heavily, has failed to consider social care, even though the two services are inextricably linked. Social care reform needs to be system-wide, long term and joined up around the needs of those being cared for, so that comprehensive and integrated care at home and in the community can be properly provided. But when will we receive a plan to do this? After all, as the noble Lord, Lord Young, remarked, does social care not come into the Government’s category of necessary long-term decisions?

In all this, the role of paid and unpaid carers is crucial, as is that of charities, as highlighted by my noble friend Lord Touhig. So where was the long-term social care workforce plan to overcome the severe staff shortages in the care sector? I venture to suggest that Labour’s new deal for care workers could be an essential first step in tackling the staffing crisis. It will be the first ever fair pay agreement collectively negotiated across the sector.

The gracious Speech could have addressed retention and the issues that contribute to high attrition rates across the NHS workforce, but it did not. I am concerned that this is at a time when a recent NHS survey reports that nearly one-third of staff often think about leaving their job, while the workforce plan also fails to address the maintenance and building backlogs that bedevil the ability to have enough physical capacity with which to deliver services. I note that my noble friends Lady Blower and Lady Wilcox made similar comments about inadequate retention and recruitment plans for teachers, another significant staffing group who are crucial to success.

The Government have promised to deliver their plan to cut waiting lists. But where is the actual plan? We on these Benches stand ready with a commitment to provide 2 million more appointments by paying staff extra to work evenings and weekends, which will be paid for by abolishing the non-dom tax status. Is that something the Government would consider doing? If so, we would be pleased to have provided the inspiration.

Instead, what we have is regressive legislation in the form of the Strikes (Minimum Services Levels) Act. It seems that the Government’s answer to the shortage of doctors and nurses is to sack NHS staff. They say they want minimum service levels on strike days, but what is their plan to provide minimum service levels on non-strike days? Had Ministers not spent months refusing to negotiate with NHS staff, there might not have been more than 1 million operations and appointments cancelled due to strike action this year, and NHS England would not be asking for £1 billion extra from the Treasury. We all want minimum standards of service and staffing, but it is this Government who consistently fail to provide them.

It is significant that so many noble Lords, including the noble Baroness, Lady Hollins, have criticised the absence of a Bill to provide the desperately needed reform of the outdated, untrusted and discriminatory 1983 Mental Health Act. As the noble Baroness, Lady Watkins, so aptly observed, this Bill has been on a wating list for 40 years. Since the Government published, in 2018, the findings of their own commissioned review, more than 200,000 people have been detained under the Act—many inappropriately, including those with autism and learning difficulties—and more than 20,000 people have been subjected to a community treatment order.

A White Paper responding to the review was published in 2021. Last year a draft Bill was published, and pre-legislative scrutiny got under way. A huge amount of valuable and informed cross-party work has been undertaken, with wide consultation among stakeholders. The failure to bring forward those long overdue reforms, including changes to the criteria for detaining patients, is letting down our most vulnerable. This cannot continue.

Health and social care is not the only area of omission. In the gracious Speech there is no legislation to build the homes we need or the education system that people of all ages need, or to tackle the increasing level of persistent absenteeism in schools—which was noted by the noble Baronesses, Lady Gohir and Lady Bull, and many other noble Lords.

There were two general themes underlying the debate today, about which many noble Lords have spoken, and on which I shall conclude my remarks. First, inequalities run ever deeper across our society, whether we look at maternity care, life expectancy, the quality of health throughout life, or detention on mental health grounds. As the noble Lord, Lord Best, said, there are also inequalities in housing availability, affordability and quality. We are seeing an increasing divide on the basis of social determinants, of which the right reverend Prelate the Bishop of London spoke, whether they be because of race or colour, or where people live, their income, their education and/or their start in life.

Secondly, as my noble friend Lady Jay said, one Bill a strategy does not make. The gracious Speech provides a disconnected programme, with no strategy to address the deep-rooted fractures in people’s lives to which my noble friend Lord Howarth referred.

I listened closely to the right reverend Prelate the Bishop of Gloucester, who spoke of the very real impact of disjointed government on victims, families and communities. What a missed opportunity this gracious Speech has been. I can only hope that the next gracious Speech will be different and will grasp every opportunity for change.

Ultra-processed Food

Baroness Merron Excerpts

Thursday 26th October 2023 Lords Chamber

[Lord Markham (Con)]

That is absolutely right. We should always base this on the science. I thank my noble friend for that comment.

[Baroness Merron (Lab)]

My Lords, nearly half of baby snacks and up to three-quarters of baby biscuits and rusks are categorised as ultra-processed. Many of them are high in fat, sugar and salt and if overconsumed, reports suggest, can lead to weight gain, unhealthy eating habits and a wider negative impact on development. Have the Government made any consideration of measures to help parents to be more informed of these risks? What discussions have taken place with industry to address information and formulation?

[Lord Markham (Con)]

To take the second question first, the industry has worked with a lot of comments on reformulation across the board—for younger children and older ones. Noble Lords will remember me saying that foods such as Mars, Galaxy, Bounty and Snickers bars have all been reformulated, as have Mr Kipling’s “exceedingly good” cakes. Clearly, we need to look across the board at it all. I know that the industry is working in the area of young people. I am happy to follow that up in writing with the precise details.

Children’s Health: Ultra-processed Foods

Baroness Merron Excerpts

Wednesday 25th October 2023 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I start by congratulating the noble Baroness, Lady Jenkin, on securing a debate on what is clearly an extremely live issue, as we have heard in the many contributions from noble Lords today. There is one point of agreement, at least in the Chamber, and that is that rising obesity is damaging our children’s health and their chances in life. In 2021-22, more than one in 10 four to five year- olds were obese, while a further 12.1% were overweight. Nearly one in four 10 to 11 year-olds was obese, with a further 14.3% being overweight. Those from deprived areas are more than twice as likely to be living with obesity compared with the more affluent, and this is not an acceptable state of affairs.

We know that balance is essential to a healthy diet and that, for most people, cutting out ultra-processed foods entirely is not realistic. As we have heard, people need to be supported to make informed, healthier choices, and wider social determinants—most notably poverty, as the noble Lord, Lord Bird, said—need to be addressed, particularly in the current economic crisis, but the Government have missed some tricks here. They have delayed the ban on junk food advertisements targeted at children and scrapped the health disparities White Paper.

Can the Minister explain how the Government’s decisions will contribute to tackling childhood obesity and improving the health of the nation? In delaying these key measures, have the Government instead got any plans for further policies to address this issue?

In July, the Scientific Advisory Committee on Nutrition published the findings of a review into the potential impact of ultra-processed foods on children’s health. It cited limitations in available evidence and recommended that further research should be undertaken in several areas, including in assessing and developing a classification system that can be applied reliably to estimate processed food consumption. As the noble Baroness, Lady Jenkin, said, the First Steps Nutrition Trust found a strong inverse correlation between the consumption of ultra-processed foods and the nutritional quality of diets. It said also that those who eat a diet rich in UPFs were consuming more calories, mainly due to larger portion sizes, which resulted in weight and body-fat gain. These are important points and I ask the Minister for the Government’s response to these findings, and when can we expect it?

The Health Minister Neil O’Brien MP said that the Government would not hesitate to take action if the evidence suggested that it was needed. In July, the Minister told your Lordships’ House that it was unclear whether UPFs were inherently unhealthy or whether the issue was instead that such foods were typically high in calories, saturated fat, salt and sugar. As the Minister clearly considers that there is uncertainty, what steps will the Government take in order to take action, rather than relying on inaction?

Domestic Violence and Brain Injury

Baroness Merron Excerpts

Monday 23rd October 2023 Lords Chamber

[Lord Markham (Con)]

The hope from this research is understanding all the different causes and some of the protocols. I know it is controversial sometimes, because, speaking as a centre half myself, heading the ball is a key part of the game. However, making sure that children under a certain age are not heading the ball a lot is one of the things that we should be looking at as prevention.

[Baroness Merron (Lab)]

My Lords, as not all brain injury from domestic violence is immediately apparent, will the Minister raise with his colleagues in the relevant departments the consideration of a reappraisal in policing and the criminal justice system? Will the Government also work with those supporting victims of intimate partner violence to actually give a name to the brain trauma that victims may be suffering? If victims know that traumatic brain injury is part of their trauma, it can give a source of strength and guidance to those who are suffering, enabling them to seek the right medical support.

[Lord Markham (Con)]

The noble Baroness makes a very good point; it is often the hidden side of domestic violence. The problem is that there is not much information on this, but a US study shows that as many as between 30% and 74% of women who suffered domestic violence had suffered from traumatic brain injury. It is about making people aware that this is not an edge case; this is something that unfortunately is all too familiar. As the noble Baroness mentions, every strand of society needs to be aware of this and to act on it.

Reinforced Autoclaved Aerated Concrete: Hospitals

Baroness Merron Excerpts

Wednesday 13th September 2023 Lords Chamber

[Lord Markham (Con)]

In every hospital—and Watford was one of the first ones I visited—there is a programme on which the draw-down of the funding depends; there is already a new car park there, for instance. I can assure the noble Baroness that the plans are in place to make sure that the draw-down is in time. I have also said on all the hospitals I have visited over the summer—I have seen about 20 or so—that I have a quarterback role where I have to project manage across them all and, where there are issues, they can approach me directly. I will raise today’s question with the Treasury and make sure that Watford is well in order.

[Baroness Merron (Lab)]

My Lords, as the Minister said in answer to an earlier question, the Government will replace only seven of the 27 NHS sites confirmed to have RAAC in their construction, while the other 20 are set to be monitored and mitigated until it can be removed. How long will it take to complete the removal on these 20 sites? What assessment has been made of the risk to patients?

[Lord Markham (Con)]

Three of those have already had the RAAC eliminated from them. The remaining ones are part of the programme and the commitment to have their RAAC eradicated by 2035, but in the meantime the remedial measures are there and that is what the £698 million is all about. I visited them first hand to see the work, and all credit to the team—they have become real experts on the subject. At every hospital I visited, you could see that the team were right on their game and understood very well what work they needed to do there, always using expert advice from the Institution of Structural Engineers and others.

Children’s Health: Sugar

Baroness Merron Excerpts

Tuesday 12th September 2023 Lords Chamber

[Lord Markham (Con)]

Yes, as I mentioned previously, our modelling shows that roughly 95% of the calorific reduction that we are expecting will come from the movement of the product positioning. The evidence, almost at the end of the first year, is that this is working. Effectively, the category of non-high HFSS products has gone up by about 16% while products high in fat, sugar and salt have gone down. We know that supermarkets are taking the lead in doing this voluntarily, in terms of the so-called BOGOF, or “buy one get one free”, promotions. Tesco and Sainsbury’s have already stopped that on a voluntary basis and, as I mentioned earlier, the companies are also reformulating their foods. There is a lot of progress in a lot of areas.

[Baroness Merron (Lab)]

My Lords, children from the most deprived areas are four times more likely to be obese and three times more likely to have dental decay than those in the least deprived, with sugar as a key contributor to poor health and future prospects. Does the Minister agree that targeting excessive sugar intake at earlier stages will have more impact on the more deprived communities and, if so, how do the Government propose to do this?

[Lord Markham (Con)]

Yes, the noble Baroness is absolutely correct, and that is why in the major conditions survey we have an ambition to reduce sugar intake by 20%, working right across the board and especially with baby food manufacturers. As I set out earlier, there are a range of things that we have already done: the sugar tax reduced intake by 46%, and the movement of the so-called “pester power” has made a big impact. We are seeing companies reformulate food. But it is something we will keep under review, and we will do more if we need to.

NHS: Staff Numbers

Baroness Merron Excerpts

Tuesday 12th September 2023 Lords Chamber

[Baroness Merron (Lab)]

My Lords, the Government’s workforce plan is silent on having enough properly maintained treatment facilities, buildings and equipment, all of which have become increasingly inadequate. Could the Minister confirm what assessment has been made of the physical capacity requirements to deliver the NHS workforce plan? How will he ensure that staff have what they need to do their job?

[Lord Markham (Con)]

The noble Baroness is absolutely correct: a workforce plan needs to be backed up with the physical real estate to deliver it. As noble Lords are aware, I am responsible for the new hospitals programme, which is part of that. In primary care, much of the long-term workforce plan is all about getting upstream of the problem in terms of prevention, and clearly we need to make sure that the physical real estate is there to support that. So the next steps will be to make sure that the capital meets the long-term workforce plan.

Countess of Chester Hospital Inquiry

Baroness Merron Excerpts

Tuesday 5th September 2023 Lords Chamber

[Baroness Merron (Lab)]

My Lords, the Statement that we consider today reminds us of acts that were so cruel that it is hard to make sense of them. Our thoughts must be with the families who have suffered the worst of ordeals and with the children who were so brutally taken from them. It can only be hoped that the conviction and the sentencing have helped bring some closure, even though the murderer dared not face up to them in person in court. More than this, the extent of the crimes committed by Lucy Letby may not yet be fully known, as Cheshire police have widened the investigation to now cover her entire clinical career.

There are heroes in this story—the doctors who fought to sound the alarm in the face of a hard-headed and stubborn refusal to even consider the evidence that was brought forward. I am sure that the whole House would wish to join me in recognising the courage of Dr Stephen Brearey and Dr Ravi Jayaram.

This killer should and could have been stopped months before. If it had not been for the persistent bravery of the staff who finally forced the hospital to call in the Cheshire police, the lives of even more babies would have been put at risk. The refusal to listen, the failure to approach the unexplained deaths of infants with an open mind, and the failure to properly investigate when the evidence appeared to be so clear, are absolutely unforgivable. There was then the insult of ordering concerned medics to write a letter of apology to a serial killer. It is clear that the allegations that were made and the evidence produced were not met with any respect or regard.

This is a tragic and true story, where events came together and flags were raised and ignored. It is to this point that I would like to take the Minister. I start by saying that we very much welcome that the inquiry has been put on a statutory footing, and it is welcome that the full force of the law will be behind it. However, can the Minister tell your Lordships’ House why it took so long to get to that correct decision? It is right that families have now been listened to, but why were they not consulted before the initial announcement? Will they be consulted ahead of any future decisions?

This is not the first time that whistleblowers in the National Health Service have been ignored. On all the occasions such as these where they have not been listened to, there has been a missed opportunity to save lives. The reality is that nobody thinks that the system of accountability, professional standards and regulation of NHS managers and leaders is good enough. Why were senior leaders at the hospital still employed after the conviction? Regarding the absence of serious regulation, which enables a revolving door of those with records of poor performance or misconduct, does the Minister agree that this is unacceptable, particularly when lives are at stake?

I refer the Minister to the duty of candour. It is 10 years since Sir Robert Francis’s report was published in which he put forward the duty of candour, and yet the duty of candour of a number of consultants was ignored and overridden in this case. As a result of that, will the Minister ensure that there is an independent external route through which concerns can be raised in future? Will he look at the accountability, scrutiny and supervision of clinicians throughout the National Health Service, because the pressures on the service at the moment mean that, sometimes, these vital double-checks can be missed? What review has been conducted into the effectiveness of the duty of candour? What is the conclusion of any review that has taken place about what has gone wrong over the past 10 years?

The terrible events at the Countess of Chester Hospital shine a clear light on a lack of consistent standards. Therefore, it is welcome that the Government are considering a register of NHS executives and the power to disbar, which was recommended by 2019 Kark review. However, the Government should go further. Will they begin the process of bringing in a regulatory system for managers, and standards and quality training, as was recommended by the 2022 Messenger review? Can the Minister indicate how and when there will be progress on bringing together a single set of unified core leadership and management standards for managers, and training and development to meet these standards? What is being done to promote excellence in leadership and to ensure patient support when things go wrong?

I am sure we can all agree—I know that the Minister will join with this—that we owe it to the children who lost their lives and to the families who grieve their loss to do what we can to prevent anything like this ever happening again.

[Lord Allan of Hallam (LD)]

My Lords, we have all been appalled at what happened at the Countess of Chester Hospital, and we would also like to extend our sympathy to all those affected, especially those parents of children who were taken from them. Those were losses that we now know that could, and should, have been prevented. I echo the comments of the noble Baroness, Lady Merron, in praise of those doctors who did raise concerns and fought to have them taken seriously. The accounts that we have seen of legitimate concerns either being ignored, or in some cases being actively suppressed, are truly shocking and represent a call to action that we must heed.

The inquiry is welcome, and will cover a lot of important ground, and I will not try to pre-empt their work today. Instead, I want to focus on one aspect where the department could act now without cutting across the work of the inquiry, and that is the role of NHS trust non-executive directors. This is something which the patient safety commissioner also highlighted in her statement on the Letby case. She said of NHS non-executive directors that

“it is vital that they are able to ask the right questions and escalate concerns where needed.”

The relationship between non-executive directors on a board and senior management teams in any organisation involves the delicate balance of responsibilities. Would the Minister agree that NHS trust non-executive directors should see patient safety as a priority responsibility—perhaps the single most important among their broad set of duties? Would he also agree that it is a healthy and positive situation if trust managers feel that they are under scrutiny from their non-executive directors on safety issues and believe that they will be pulled up if they are not fully open with them? We saw in this case claims of management not presenting the full sets of facts to their boards. They must be entirely candid with their non-executive directors and must expect to be challenged; that is the culture we want to see on trust boards, not one of cover-up and misleading.

In this context, could the Minister confirm whether the department will take steps now to reinforce with trust boards the importance of non-executive directors being able to raise safety issues? Importantly, will they be providing non-executive directors with training on how to perform this function effectively, so that they understand the best ways in which to challenge executives where necessary?

As I said at the outset, we welcome the inquiry from these benches, but I hope that the Government will not wait until the inquiry has completed its work to start making changes, and that they will be equally committed to making changes now where these would improve governance, and that the Minister can confirm that they are looking at strengthening the role of non-executive directors on NHS trust boards.