Primary Care: Quality and Access Improvements

Debate between Baroness Merron and Baroness Penn

Thursday 21st July 2022 Lords Chamber

[Baroness Merron]

To ask Her Majesty’s Government what assessment they have made of the variations in the quality of primary care across England, including access to GP services; and what plans they have to improve quality and access.

[Baroness Penn (Con)]

My Lords, we are working to expand and diversify the general practice workforce to create an additional 50 million appointments a year, which should improve access for patients across England. NHS England continues to provide support to practices working in the most challenging circumstances in order to provide better access to patients via its accelerated access improvement programme.

[Baroness Merron (Lab)]

My Lords, clearly the Government have no chance of meeting their target of 6,000 additional MPs, or rather, GPs—they might be happy with that at the other end—by 2024, when this month the BMA is reporting that there are over 1,700 fewer GPs. More GPs are seeking to leave, the population is growing and, as we know, health problems are ever more complex. In the light of this, will the Government review the numbers of promised GPs? What urgent and specific action can the Minister offer to those who cannot get an appointment, particularly in the more deprived areas and those places identified for levelling-up support?

[Baroness Penn (Con)]

My Lords, we have 1,400 more full-time equivalent doctors working in general practice compared with March 2019. But the noble Baroness is right that we must do even more to expand the numbers. We have a record 4,000 trainees who have accepted a place on GP training this year. Another element is the wider primary care workforce, where we are on track to meet our commitment of 26,000 additional patient care staff working in primary care. The most deprived areas are being targeted for the accelerated access improvement programme, which is providing tailored support to practices in those areas to improve access.

Ambulance Services and National Heatwave Emergency

Debate between Baroness Merron and Baroness Penn

Wednesday 13th July 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, every ambulance service is on the highest level of alert. Just yesterday, the Association of Ambulance Chief Executives spoke of the intense pressure on the system. This is not new. As the Minister acknowledges, a maelstrom of long-standing factors is causing massive delays, leaving ambulances stuck outside hospitals unable to transfer patients, staff shortages exacerbated by the spike in Covid and, on top of this, a heatwave generating more 999 calls. Can the Minister confirm whether further COBRA meetings are planned? How are the Government prepared for the impact of this heatwave on health and care services? What communications are planned to ensure public safety?

[Baroness Penn (Con)]

My Lords, there are well-established and well-practised co-ordination and escalation procedures in place to manage cross-system and cross-government impacts at all levels. These are activated when appropriate and on the basis of subsidiarity. UKHSA public health advice is being regularly updated and communicated for everyone to stay safe in the heat. As noble Lords will know, today the UKHSA and the Met Office have announced that all nine English regions will be under a level 3 heat alert from Saturday 16 to Tuesday 19 July. The heat alert system runs during the summer. Depending on the level of alert, a response will be triggered to communicate the risk to the NHS, government and public health systems. Advice and information for the public and health and social care professionals, particularly those working with at-risk groups, are provided, including both general preparation for hot weather and more specific advice when a severe heatwave has been forecast.

Health and Care Bill

Debate between Baroness Merron and Baroness Penn

Lords Hansard - Part 2 & Report stage
Monday 7th March 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, we have had a considerable debate on these issues, in Committee and this evening in your Lordships’ House. From these Benches, we absolutely support the provisions to tackle obesity. The reasons have been gone over many times, but I make one point in respect of children—that children with obesity are five times more likely to become adults with obesity, and increase their risk of developing a range of conditions, including type-2 diabetes, cancer and heart and liver disease. It is incumbent on us to take the steps that are necessary.

Given the lateness of the hour—and I know that noble Lords wish to get to the question whether there is to be a Division—I shall focus my comments on the amendments relating to advertising, Amendment 151A, in the name of the noble Lord, Lord Black, and the subsequent amendments, to which I have put my own name. There has been a great clarity of argument as to why those amendments deserve favour, but the one that sticks out for me is about ensuring the effectiveness of the legislation that we are speaking about.

We already know that legislation can have a huge impact. For example, the soft drinks industry levy has led to manufacturers reducing 44 million kilograms of sugar each year from drinks in the UK. We also know of the support for the measure of the watershed for advertising of high-fat sugar and salt products—in other words, to protect children from those influences. We know that the measure is supported by organisations such as the British Heart Foundation, the Food Foundation and many other experts as being able to make the difference, because children are influenced by advertising. We should really be ensuring that children see adverts for healthier food and drinks.

Should the will of the House be tested on these amendments, these Benches will certainly be in support, because we feel that the Government should make sure that the proposed pre-9 pm ban on advertising unhealthier foods on TV, with a total ban online, has to be implemented effectively and appropriately across all media and platforms. If it is not and remains as it stands, it will not do the job that it is intended to do, and we will miss an opportunity, which we hope the Minister will reflect on, as the case has been made so clearly and directly.

[Baroness Penn (Con)]

My Lords, I thank noble Lords for this debate. I will turn first to the amendments in the name of my noble friend Lord Bethell. As noble Lords are aware, the Government introduced an amendment in Committee to enable adjustments to the date of commencement of the HFSS advertising restrictions, should emerging issues require it to be moved.

We will continue to work with regulators and businesses to ensure that guidance is produced promptly to support timely implementation; our intention remains to implement restrictions from 1 January 2023. We think that date balances ambition with the importance of sufficient time for business to prepare. However, limiting this flexibility to a period of only three months, as proposed by my noble friend’s amendment, would be counterproductive, as that timeframe may not allow us to respond adequately to any unforeseen challenges or ensure smooth delivery of this policy.

Turning to the amendments tabled by my noble friend Lord Moylan, I seek to reassure him that our current approach provides an overall assessment of the nutritional content of products, as it accounts for nutrients of concern as well as beneficial nutrients. As such, we consider it to be an effective mechanism for permitting healthier products to be advertised, while still restricting those which are less healthy overall. The detail of the products in scope will be underpinned by secondary legislation, which can provide the necessary detail and be adapted in response to future changes to products on the market. The Government will consult soon on this and other definitions included in the draft regulations, such as the small and medium enterprise exemption.

I turn now to the amendments on platform liability. The Government believe that the online advertising programme remains the best way to address such issues on an industry-wide basis, rather than in a piecemeal fashion. I am pleased to be able to confirm that the DCMS consultation, which should launch in the next fortnight, will examine the harms associated with paid-for advertising online and consider the measures that could apply to platforms and others in the supply chain in order to increase accountability and transparency.

It is our intention to legislate on those conclusions in this Parliament, as we share the view that it is the right time to put in place holistic measures to tackle platform liability. However, it is also right to bring forward powers in this Bill now, so that we can begin to tackle obesity via restrictions to TV, on-demand programme services and online, in line with current enforcement frameworks for advertising that are familiar to industry. Platforms are not able to pre-vet adverts in the same way that broadcasters can. We recognise that there is a need to address that issue, but to do so in the round.

Amending this Bill in relation to online platforms without wider consultation and at a late stage risks unintended consequences. Those could include undermining the clear responsibility of advertisers to adhere to the restrictions that we are debating; interfering with the competitive dynamics that apply across the online advertising supply chain; not addressing accountability and transparency issues that apply elsewhere in that ecosystem; the danger of the restrictions applying to a wide range of internet service providers beyond those intended, including intermediaries and publishers; and not providing regulators with the right tools, funding or structures to regulate effectively. Were this amendment to pass, the Government would need to consider very carefully whether implementation from 1 January 2023 remained possible. The risks posed by creating a more complicated regulatory framework are likely to result in a delay.

Health and Care Bill

Debate between Baroness Merron and Baroness Penn

Lords Hansard - Part 2 & Report stage
Thursday 3rd March 2022 Lords Chamber

[Baroness Merron (Lab)]

My Lords, five years have passed since the ad hoc Select Committee on the Long-term Sustainability of the NHS, under the chairpersonship of the noble Lord, Lord Patel, recommended an office for health and care sustainability. I thank the noble Lord, Lord Warner, for bringing this amendment before your Lordships’ House. This is a clear direction to put sustainability at the heart of planning and is long overdue. So we on these Benches support the amendment, and I hope the Minister will accept this amendment as a way forward.

[Baroness Penn (Con)]

My Lords, I thank noble Lords for bringing this debate before the House today. As mentioned in the debate in Committee, the specific functions described in Amendment 112 are crucial functions that the Government are committed to ensuring are discharged. This commitment is underlined by the fact that there are already bodies and mechanisms in place to fulfil these functions. These are core components of the Government’s commitment to evidence-based health provision. This commitment has been made clear in many of the Bill’s provisions, in our wider programme of public health reform and in the proposals set out in the Government’s plan for health and care.

The amendment makes recommendations on both appraisal and scrutiny of funding and of social and demographic trends. With regard to the monitoring of trends, the department already publishes data relating to disease profiles, which incorporates demographic trends where relevant. This is supported by independent academic modelling from the Care Policy Evaluation Centre, CPEC, to produce projections of the long-term demand on adult social care services. As for funding, noble Lords will also be aware that successive Governments have used the well-established spending review process to set public service budgets. This takes into account the needs of service users, but crucially also considers the fiscal context and how healthcare expenditure balances with the range of priorities across government.

As noble Lords have noted, aligned to those spending decisions, the Office for Budget Responsibility already scrutinises the Government’s fiscal approach and our management of fiscal risks. For example, in October 2021 the OBR provided an independent analysis of the Government’s reform to the funding of adult social care in England and has announced that it will provide more analysis of the long-term implications in its next fiscal sustainability report. There is also, as noble Lords will know, a wide range of highly influential non-governmental bodies dedicated to the kinds of functions proposed for this new body—the King’s Fund, the Health Foundation and the Nuffield Trust to name just three. All of these contribute richly to the public debate on financial sustainability and on the size and composition of the workforce, as well as other related issues, and to the ability of this House to scrutinise government decisions on spending and policy.

The Government therefore do not think that the creation of a further body would add value. At this crucial time for the health and care system, we must proceed with the reforms we have outlined. For these reasons I hope that the noble Lord, Lord Warner, will feel able to withdraw his amendment.