National Insurance Contributions: Healthcare

Debate between Baroness Merron and Lord Scriven

Tuesday 19th November 2024 Lords Chamber

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

I assure the noble Lord that there is no intent to squeeze out any providers, which are much valued and appreciated. We will continue to listen to their concerns and consult them as we make allocations, which is, as he knows, the usual practice for every Government. On the Budget settlement for the Department for Health and Social Care for 2025-26, I assure him that the Chancellor considered the impact of all the changes in the Budget.

[Lord Scriven (LD)]

My Lords, the net cost to the already struggling community pharmacy sector from the national insurance changes is roughly £50 million. One community pharmacist told me last week that this means that they either reduce services to patients by closing for the equivalent of one day a week or make one and a half members of staff redundant. What advice would the Minister give to that community pharmacist and many others in her situation?

[Baroness Merron (Lab)]

What I would say to each sector, including pharmacists, about the services they provide and what is expected in return from any contract is that, as in previous years—I emphasise that it is business as usual in this respect—employer national insurance contributions are dealt with as part of the process. We are very appreciative of the pharmacy sector’s contribution, not least because it will assist with one of the three pillars in moving from hospital to community services. I encourage all pharmacists to work with us to achieve what I believe they and we in government want: a service that is fit for the future.

Human Medicines (Amendments Relating to Naloxone and Transfers of Functions) Regulations 2024

Debate between Baroness Merron and Lord Scriven

Tuesday 22nd October 2024 Grand Committee

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, this draft statutory instrument proposes amendments to the Human Medicines Regulations 2012, which will expand access to naloxone, a life-saving medication that prevents death from opioid overdose. In addition, this draft statutory instrument makes amendments to keep the regulations current by updating references to Public Health England and the Health and Social Care Board, following the dissolution of those bodies.

We know the devastating impact that illicit drugs cause. Drugs destroy lives, tear families apart and make our streets less safe. Drug misuse deaths have doubled in number over the past 10 years, and we know that people who die from drug misuse often do so at a tragically young age, often in their 40s. Almost half of drug misuse deaths in 2022 involved opiates such as heroin. These deaths are avoidable. Dedicated drug treatment services provide the path to recovery and this Government are continuing to ensure that treatment is available and of high quality.

However, we also know that over half of people struggling with opiate addiction are not engaged in treatment. These are incredibly vulnerable people who often have multiple and complex needs; they are at increased risk of accidentally overdosing and dying. Tackling this issue supports the Government’s health mission. It will ensure that people can live longer, happier and healthier lives, and it chimes in with our collective efforts to break down barriers to opportunity and create a fairer society.

Naloxone is a highly effective antidote to opiate overdose. It can already be administered quickly and safely by anyone in an emergency, but current regulations specifically enable only drug and alcohol treatment services to supply it for future use without a prescription. That limits the reach of this life-saving medicine.

The draft instrument that we are debating today proposes two key UK-wide changes to existing regulations: first, to expand the list of services and professionals named in the regulations who can give out naloxone without a prescription. That means that professionals such as registered nurses and probation officers will be able to provide take-home supplies of naloxone where appropriate, should they wish to do so.

Secondly, it proposes to establish national registration services across the whole UK. This will enable other services and professionals who are not able to be named in the legislation but who come into contact with people at risk of overdose, including housing and homelessness services, to register and procure naloxone.

There is a positive background to these changes. The Department of Health and Social Care consulted on them at the beginning of this year and received over 300 responses spanning a range of organisations and professionals from across all four nations of the UK. Of these responses, approximately 95% agreed with the proposals that are set out. This demonstrates the level of interest in this important issue and the breadth of support for the changes we are seeking to achieve.

These changes have also been called for by experts in the sector such as the Advisory Council on the Misuse of Drugs in its review of naloxone in the UK. In addition, Dame Carol Black recommended naloxone provision as an important harm reduction measure in her two-part independent review of drugs.

Allowing more services and professionals to supply naloxone will mean easier access to it for people at risk, which in turn will mean lives saved. With the growing threat posed by synthetic opioids, which are often more potent and more deadly, the importance of this work only continues to increase as time goes on.

I want to provide reassurance that, with these changes, there is no compromise on safety. Naloxone is very safe and effective, even when administered by a layperson with no prior experience. It has an effect only if the person has been taking opioids and it is already widely used across the UK and internationally.

We are taking steps to mitigate against any very limited risks associated with wider access. We will provide updated guidance for services in scope, and we will set out robust requirements for training and safeguarding. I reassure the Committee that the intention of these changes is not to create additional burdens for services, particularly as we are aware that many of those in scope will already be facing pressures. These new powers are enabling, not mandatory. They provide an opportunity for increased provision, based on local need, but they do not make any requirements.

Finally, addiction is not a choice. It is often fuelled by wider issues, such as trauma and housing instability. This is a complex public health issue and must be tackled as such. We must change the narrative on addiction to one that is about the prevention of drug use, the reduction of harm and enabling recovery. The changes we are discussing here will save lives. On this basis, I beg to move.

[Lord Scriven (LD)]

I thank the Minister for setting out the rationale for this draft statutory instrument so well. I agree that this is a step forward in the ongoing battle against the devastating impacts of opioid overdoses. As she said, opioid overdoses have reached alarming levels, claiming thousands of lives every year. According to the latest statistics, opioid-related deaths have surged alarmingly in most regions. This is not merely a statistic. This is about the loss of lives, families shattered and far too many left to grieve, so it is important to take further action that is effective and wrapped in compassion. The temporary measures taken in Scotland show that the changes outlined in these regulations work and will save lives.

Naloxone, when used in the right place at the right time, is a life-saving medication. This draft statutory instrument will facilitate local supply networks, ensuring a broader distribution system and therefore more effective use of naloxone, empowering, among others, healthcare professionals, the police, prison and probation staff, and people in the youth justice system to facilitate the supply of this life-saving drug.

In response to one of the issues that the noble Baroness raised, a question occurred to me. As this will not be a mandatory provision across the country, how will the Government monitor lives that could be saved but that may not be saved because of a lack of take-up of this in certain towns, cities or regions? It could end up that a life will be saved if one body decides to do this, while a life could be lost in a neighbouring county, city or town if that does not take place.

One of the key provisions in this draft statutory instrument is the move to enable the friends and family of those at risk to administer this drug. Allowing those closest to individuals at risk to carry and administer naloxone creates a lifeline that will, literally, make the difference between life and death.

I listened to what the Minister said about setting up local naloxone providers and supply co-ordinators, and I have read the draft statutory instrument and the explanation—but I am still not clear about what regulatory oversight of these bodies will be in place. Who will be the regulator and what powers will they have to deal with the improvement or, indeed, withdrawal of such a service if it is deemed that the local provider is not carrying out the rules laid down in the draft statutory instrument?

Clearly, the broader implications of these amendments are not merely about the use naloxone but about standing with those who struggle with addiction, and their families. These amendments are an essential evidence-based response to the dramatic increase in opioid use and overdoses. By enabling greater access to naloxone, they will help to save lives.

--- Later in debate ---

[Baroness Merron (Lab)]

My Lords, I am grateful to the noble Lord, Lord Scriven, who I do not believe I have had the opportunity of welcoming formally to his new Front-Bench role. I am delighted to do that today; he is most welcome. I very much look forward to working with him and hope that he enjoys his role. I am also grateful to the noble Lord, Lord Evans, as ever, for his contribution.

I am pleased that both noble Lords, on behalf of their Front Benches, have been so positive in welcoming these regulations. I certainly agree with the closing words of the noble Lord, Lord Scriven: in doing this today, we are standing with those who struggle with drug use and with those around them—the communities, their families and their friends. It is with that motivation in mind that we are doing this.

I will of course write to noble Lords if there are any points that I do not manage to cover adequately. To pick up some of the points, however, the noble Lord, Lord Scriven, asked who will regulate. As part of the legislation, as I said in my introduction, there will be training and data-reporting requirements attached to both routes for new providers. Those new providers could be the emergency services, for example, and they will have to report on levels of prescribing so that effectiveness and safety can be monitored. That will absolutely be required of them.

[Lord Scriven (LD)]

The Minister might not still welcome me to my place now but although I understand that, my point was: what powers do those whom they report to have in ensuring compliance? That is the bit I did not get from reading the regulations.

NHS: Independent Investigation

Debate between Baroness Merron and Lord Scriven

Tuesday 8th October 2024 Lords Chamber

[Lord Scriven (LD)]

My Lords, I thank the Minister for bringing the Statement to the House. You do not have to be a mastermind to realise that the NHS is straining at its seams. It is only down to the great work of the many thousands of people who work in the NHS that millions of people get great care, even though some fall between the cracks.

The Darzi report is a very good medical history and it gives a diagnosis, but we all know that the treatment plan is going to be the important point if we are to deal with a reformed, new and productive NHS. There are some welcome themes in the report that are not new. Those who know the previous Darzi report will see have seen some of them before: prevention; moving resources from hospital care to primary and community care; dealing with the wider determinants of health; improvements in and parity for mental health; and a bigger role for public health.

I understand that the Minister will answer many questions by saying that we need to wait for the 10-year treatment plan, and probably the Budget, before such specific questions can be answered, but I have a few general questions for the Minister, to get at least a sense of the direction that the Government wish to take.

Is it the Government’s intention to restore the public health grant back its 2014 levels? Are there any general views about looking at changing the structure of public health, nationally or locally? On capital, what is the Government’s thinking about the general theme of allocation to hospital and non-hospital services, and how will this be managed and monitored? On data, what is the Government’s thinking on the workforce plan, particularly when there is a huge imbalance when it comes to digital and data between the private sector and skills within the NHS? That is not to say that there are not some good skills within the NHS, but there is clearly an imbalance.

Welcome as it is that the report talks about moving resources from hospital to non-hospital settings, I was a manager in the health service in the early 1990s and I know that this has been said since at least the 1970s. What are the Government going to do to be able to move resources from sunk costs in the acute sector into other sectors? What mechanisms will be put in place? How will this be monitored? More importantly, who will be held accountable for making sure that it actually happens? How will the new neighbourhood approach affect the existing workforce plan? If a new health service is anticipated, what will the effect be on the workforce plan and the implications for capital allocation?

We all want to see a productive and effective healthcare system that improves peoples’ health and independence, but that cannot be brought about if we do not have a strong, effective, well-funded social care system. I do not understand why social care has been kicked down to the next Parliament, or how we are going to solve the health and well-being of the population without that being done. If the major reforms of social care are in the next Parliament, what steps are the Government going to take in this Parliament to deal with the social care crisis?

I look forward to the Minister’s answers, but, more importantly, to the 10-year treatment plan’s arrival in the next few months.

[The Parliamentary Under-Secretary of State, Department of Health and Social Care (Baroness Merron) (Lab)]

My Lords, I thank the noble Earl, Lord Howe, and the noble Lord, Lord Scriven, for their opening observations. I will seek to deal with as many of them as I can; I am sure a number will be iterated in the course of the Back-Bench contributions.

I start by expressing gratitude to the noble Lord, Lord Darzi—my noble friend, if I can call him that—for what I regard as an open, honest and thorough review. He is known as a man of great service, not just to your Lordships’ House but to the National Health Service. He has served Labour and Conservative Governments with distinction. As noble Lords will be aware, he is an eminent cancer surgeon who has driven innovation and speaks up for staff and patients. It is not surprising to me that the Secretary of State asked him to conduct this review, tasking him to provide what we might refer to as hard truths, warts and all. I realise that when one asks for that it can be uncomfortable, but I hope that we in your Lordships’ House can sit with discomfort in order to find a way forward for the National Health Service.

The noble Earl, Lord Howe, referred to the terminology that the NHS is “broken”. I understand that that is uncomfortable to hear, but when I speak to NHS staff they recognise that terminology. We are at great pains to say that we are not being critical of NHS staff, but unless we start in an honest and open fashion we will not be able to—as the noble Lord, Lord Darzi, referred to—restore the trust that is necessary. As the Secretary of State said in the other place, this Government have resolved to be honest about the problems faced and serious about fixing them. That is why he commissioned this independent investigation. I very much hope that noble Lords can be of assistance in finding the way forward, because we now have a diagnosis on which we can consult and then move on to the necessary prescription to improve the health of our National Health Service.

The noble Lord, Lord Scriven, referred to the 10-year plan. I am glad that he looks forward to it—as do I—but how will we get there? We now have a very clear explanation of where we are. It is evidenced and has widely involved many people and organisations. It should therefore be regarded with great respect, and I think it largely has been. However, the next stage for the 10-year plan will be to have what will be the biggest consultation we have ever had in this country on the National Health Service. It will involve patients, staff, parliamentarians, stakeholders—all those who have a vested and informed interest in it. That will lead us to the 10-year plan. On the question about this being top-down, this is very much a bottom-up exercise, with the Government’s commitment underlying it.

It is important to say that the 10-year plan does not mean that we will wait 10 years for everything. We will identify those areas in which we can make swifter progress and we can then look beyond. The fact is —this came out many times in the report from the noble Lord, Lord Darzi—that this has been a long time in the making and to turn it around will not be quick.

The noble Earl, Lord Howe, acknowledged that there were problems in the NHS. I am grateful for that and for his reference to the need for change. I also listened closely to his reference to what had been done under the previous Government. Facts are facts, but what matters is output. As we are discussing today, whatever the previous investment and previous actions, some of which were very much to be commended, the output has not delivered the results we need. That is why we have the report by the noble Lord, Lord Darzi.

On the issue of dedicated staff, the staff team to whom I pay tribute goes way beyond clinical staff, important as they are, and includes the cleaners, porters and administrators. Noble Lords will recall that, when the workforce plan was published, we said that this was a useful step forward. Our job now, as a new Government, as the noble Lord, Lord Scriven, said, is to adapt the plan to ensure that it brings in one of the three pillars we will be going for: hospital to community. That will absolutely be our focus.

I note that the noble Earl, Lord Howe, does not accept the assessment by the noble Lord, Lord Darzi, of the Health and Social Care Act 2012. I see the noble Lord, Lord Lansley, in his place; I am sure he will have a contribution to make. I have to part company with the noble Earl on that point, as the evidence in the review is that the Act did not work in the direction we were seeking to take.

On capital expenditure, we find ourselves with a massive backlog of capital works, such that the ability of the NHS to deliver is being held back by the buildings and facilities. We have therefore instructed a review of this, which we will then look to.

Finally, the noble Lord, Lord Scriven, was generous enough to say that he does not expect me to respond to the detailed questions about funding. However, I can assure him that all these matters are being considered—in other words, how we can best deliver the output and the improvements in health that the report of the noble Lord, Lord Darzi, seeks to achieve.

Pharmacies: Rural Areas

Debate between Baroness Merron and Lord Scriven

Tuesday 10th September 2024 Lords Chamber

[Baroness Merron (Lab)]

I will be very happy to look at the work that the noble Earl refers to. If he would like to meet me to discuss it, I am sure that would be of great assistance as we look to the future.

[Lord Scriven (LD)]

My Lords, there is a crisis in community pharmacies, as the Minister will know. Two weeks ago, the industry brought out a report that predicted that one in six community pharmacies could close within the next year. What urgent action will the Government take to ensure that that does not happen?

[Baroness Merron (Lab)]

On the point that the noble Lord correctly raises, it is worth reflecting that there has already been a reduction in the number of pharmacies since 2017. There are now some 1,200 fewer pharmacies than we had in 2017 and 600 fewer than there were two years ago. This is a trajectory that we would rather was not the case. Support is available—for example, through the Pharmacy Access Scheme, which provides financial support to pharmacies in areas where there are fewer pharmacies. I can say that we are monitoring access to pharmacies. While it is the case that four in five people live within a 20-minute walk from a community pharmacy, we absolutely recognise that the experiences of patients differ. If we are to see pharmacies as key to future plans for the health services, we will have to address that.

Coronavirus: UK Deaths

Debate between Baroness Merron and Lord Scriven

Monday 29th July 2024 Lords Chamber

[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?

Northern Ireland Dentists: Amalgam Fillings

Debate between Baroness Merron and Lord Scriven

Monday 22nd July 2024 Lords Chamber

[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.

Health Incentives Scheme

Debate between Baroness Merron and Lord Scriven

Thursday 28th October 2021 Lords Chamber

[Baroness Merron (Lab)]

My Lords, I thank the Minister for answering questions on the Statement, which was first made on Friday, before the Government began press releasing new—and some not so new—spending commitments, and eventually published their full Budget yesterday. I must admit to having been somewhat bemused when I read this Statement. It felt like being taken on something of a gentle canter around the issues. To put it mildly, it is more than unusual to see the announcement of an app and wrist-worn devices making the grade for the substance of a parliamentary Statement presented to both Houses.

I make this point because it is important to say that, on any measure, the Government have decimated the budgets necessary to tackle the underlying causes of poor health and the inequalities that arise from and contribute to its incidence and effects. As we know, poor health has many costs—social, economic and personal—and I regret that the Statement is a fig leaf for inaction. Although the Prime Minister and the Secretary of State have acknowledged that stark health disparities exist, the Government repeatedly fail to face the target, let alone hit it.

The pandemic has highlighted just how important it is to have a healthy and resilient nation. Preventing and treating disease is vital for reducing further unnecessary deaths from disease and lessening the burden on the NHS as it contends with the enormous backlog in healthcare caused by the pandemic. However, the Budget presented contradictions, as funding will be mostly focused on a curative rather than preventive approach, which would have prevented obesity and non-communicable diseases happening in the first place. Public health experts and practitioners alike agree that investment in the prevention of disease could make the single biggest difference to the nation’s resilience and health, so can the Minister explain the reason for this omission from the Budget? Does he agree that failure to invest in public health will harm the Government’s levelling-up agenda?

Specifically, we were disappointed not to see any further public health funding in the Budget to allow local authorities to deliver key prevention services, such as smoking cessation and weight management. It is well documented that locally provided public health services are highly effective and cost effective. Can the Minister tell your Lordships’ House why this was ignored?

We on these Benches have campaigned for many years against this Government’s short-sighted cuts to public health funding. A reduction in spending of a quarter in this area has led to growing obesity in our population, loss of smoking cessation services, a ticking time bomb of poor sexual health, and overburdened drugs and alcohol services. Of course, any savings made by those cuts has been hoovered up by the impact on the rest of the health service.

Obesity is at a crisis level in this country. Two-thirds of adults are above a healthy weight; half are obese. A new IPPR report says that multiple disadvantages were “conspiring” to drive down health outcomes and prevent life expectancy from growing across parts of England. Hundreds of thousands of children in England are growing up overweight or obese because of widening health disparities across the country. Their excess weight means that they will face a higher risk of serious conditions, such as type 2 diabetes, heart disease or cancer, later in life. The IPPR analysis found that as many as one in 12 cases could be avoided if health outcomes in the worst parts of England were improved to match the best. This does not make pretty reading.

We are of course not going to argue against measures that attempt to help the public improve their health, but like the obesity strategy that precedes it, the latest pilot announced in the Statement is tinkering around the edges. We need to acknowledge that tackling obesity is about tackling poverty. People in the poorest communities are twice as likely to be obese as those in the best off. This scheme is about encouraging people to make healthy choices, but the cost of living crisis will make that even harder for too many people. How is someone supposed to make healthy choices if they simply cannot afford to?

According to a report by Broken Plate, the poorest fifth of UK households would need to spend 40% of their disposable income on food to meet Eatwell Guide costs, as opposed to just 7% for the richest fifth. Therefore, if poverty limits someone’s food choices, their exercise choices and their time, can the Minister tell the House why this does not feature in the heart of the Government’s plan to tackle this scourge?

Whatever this pilot achieves, and whatever their obesity strategy achieves, it will be completely undermined by the £20 a week cut to universal credit, which, despite yesterday’s announcement, will push millions on to cheaper, less healthy alternatives. Can the Minister tell the House what will happen to the health of adults and our children? Will those who are invited to join this pilot come from the communities that will benefit most? They are the people who have suffered most from the cuts to public health. Will the Minister commit that this scheme and the obesity strategy will be followed by the restoration of moneys cut from the public health grant?

[Lord Scriven (LD)]

My Lords, from these Benches I thank the Minister for coming to answer questions on the Statement. These Benches welcome anything, including innovation, that targets the poor health and loss of life years that obesity brings. However, this is really the emperor’s new clothes, because it has to be set in the wider context of the detriment of poor health, public health budgets and poverty. Public health budgets have been decimated, so that many issues connected to the determinants of health cannot be dealt with. Low pay has become the norm for so many in our country. School budgets for extra activities, such as physical activity, and timetabling have caused problems, and food and drinks industry standards also have to be addressed. Tackling obesity is about tackling the lack of opportunity and tackling poverty. Innovation with a wristband is like asking somebody to learn the Green Cross Code they have a motorway to get across. It is not going to be successful.

As a country, we have to start early: we have the second-largest child obesity problem in the whole of Europe. So what are the Government doing to ensure that daily sport as an activity is available in every state school, so that every child has some daily activity? What is the Government’s response to the report by the Association for Physical Education with regard to children’s health and, in particular, with regard to swimming?

Diet at home and in school is important. The Jamie Oliver Foundation Bite Back report basically found that healthy options in schools were more expensive. What are the Government doing to ensure that fresh, healthy food is available at an affordable price in every school in the country? How are the pilots being chosen? The correct areas are the areas of deprivation, because that is where the highest incidences of obesity are. What are the criteria? How are they being selected? How are areas being offered the chance to become part of the pilot? This must be seen as a healthy eating and exercise approach, and not a weight-loss problem. There are far too many citizens in our country who suffer with eating disorder issues. So what are the Government doing to ensure that it is this framework of healthy eating and healthy lifestyles, rather than being seen purely as weight loss?

With regard to the wristband and the data, who will have access to the data? Where will it be stored? What precisely will the data be used for? Will any private sector organisation have access to the data and its interpretation, and, if so, what conditions are in place to ensure that we do not have the problem that we had with DeepMind, where it was used for purposes over and above what was anticipated?

Finally, talking of the private sector, HeadUp Systems is noted in the Statement. This is a company that has a £30,000 turnover and made an £11,000 loss last year. So how, and on what criteria, was HeadUp Systems chosen? What role will it have? Which other private sector organisations were asked to provide the support that HeadUp Systems is doing? What Ministers or officials did members of HeadUp Systems approach or have access to? If there is a contract, what is its value and on what basis was it given to HeadUp Systems?